Spiraling downward through medication changes, insomnia, and nausea
November 15, 2015 5:14 AM Subscribe
I am a 40-something woman who was diagnosed with Bipolar II and ADHD about a decade ago. I have also suffered from chronic insomnia throughout my life, more so as I get older.
Up until recently, I was able to find an acceptable sort of holding pattern through both talk therapy and medications, but a recent change of meds has sent me into a horrible, months-long insomnia, followed by a nervous collapse, followed by days of nausea and painful indigestion. I saw a doctor last week and I am going to see him again in the next few days, but I wanted see if anyone can tell me A) why I my body is acting this way, B) what I might be able to do to mitigate my situation, and C) how I might explain to my work why I am so indisposed from a confluence of individually benign ailments.
I teach at a community college, and I have been able to function on a combination of Lamictal to keep my mania in check, Adderall for the ADHD, and Ambien for sleep. Since I follow a regular pattern each semester - an increasingly intense workload, followed by a month(s) long break to recuperate - I am always hesitant to change meds in the middle of the semester, as I've learned from experience that they're sort of an evil Jenga that can set off a chain-reaction if disturbed.
I live in a city with a dearth of mental health professionals and have been unable to find another psychiatrist who is on my insurance, taking new patients, or convinced that I just need more Jesus in my life (my city is also famously Christian). So I've been seeing a nurse midwife who is nice but who ventures into woo territory a little too often. For instance, she's annoyed that I won't shell out 200 dollars to get my saliva tested for neurotransmitters so I can take supplements that will magically fix me. But as long as she keeps writing the prescriptions for my current scripts, this is the best I can do.
However, she did not want me taking Ambien anymore, since it's for short-term use, and I guess 12-years is not exactly short-term. At the time, I was ready to try something news, forgetting my "no med experimentation during the semester" rule. I have never been able to fall asleep, and although Ambien changed that wonderfully for a bit, its effectiveness had decreased so that I have been lucky to get 5 hours of sleep a night for the past few years.*
She reduced my dose to half. When I asked for a small amount of a xanax-type drug to take some of the edge off of sleep anxiety - a workaround I used previously when I tried to go off the drug - she said she didn't want to give me anything addicting and that I should just smoke pot instead (it's legal in my state, and I do partake, but I had been trying to cut down previously).
For about a month, I was able to get to sleep but would wake up after 3 hours. After a month of 2-3 hour nights, my energy and concentration were shot, so she prescribed me another ADD drug to get me through the day, took me off the Ambien completely, and put me on a new sleep drug that might as well be Skittles, for all its efficacy. I went for about a week with 1 hour of sleep a night, but Wednesday, I completely broke down. I was having trouble remembering words, I couldn't focus on lectures that I have given for years, I did not feel safe driving, and my depression was worse than its ever been, in part because I was unable to do a job that I am proud of, and I could not muster the energy to do anything with my friends and family.
After I couldn't stop crying for several hours, my husband drove me to our GP, who prescribed me the full dose of Ambien and a few Atavan to calm me down. He also gave me a stern lecture on mixing pot with wonky brain chemicals, and I'm not arguing with him. I was able to sleep for about 7 hours that night. But when I woke up, I found I couldn't keep food down, and even when my stomach was empty, I was bloated and (embarrassingly) burping almost constantly. I thought it was a poorly-timed stomach bug, but it's been four days now, I'm back to not sleeping because of the discomfort, and I am no closer to being able to focus on a growing mountain of student work that needed grading yesterday. I don't think the stomach problems are all anxiety based; these feel more constant and painful. I don't think my physical or mental health can recover until I sleep, but this stupid med change has just brought everything crashing down. But when I tried to write an email to my dean tonight, I couldn't find a way to translate "I can't sleep and am burping a lot" into a situation that sounded as dire as it seems to me. I do have an ADA accommodation addressing the bipolar challenges, but I'm worried I just look lazy and wimpy - like I should just drink some warm milx and take some Tums and do my damn job. Any insights or advice would be helpful because I'm having a hard time thinking my way out of this situation that keeps getting worse.
*I have tried almost everything to fall asleep, both chemical and behavioral, so I'm not looking for sleep remedies.
I teach at a community college, and I have been able to function on a combination of Lamictal to keep my mania in check, Adderall for the ADHD, and Ambien for sleep. Since I follow a regular pattern each semester - an increasingly intense workload, followed by a month(s) long break to recuperate - I am always hesitant to change meds in the middle of the semester, as I've learned from experience that they're sort of an evil Jenga that can set off a chain-reaction if disturbed.
I live in a city with a dearth of mental health professionals and have been unable to find another psychiatrist who is on my insurance, taking new patients, or convinced that I just need more Jesus in my life (my city is also famously Christian). So I've been seeing a nurse midwife who is nice but who ventures into woo territory a little too often. For instance, she's annoyed that I won't shell out 200 dollars to get my saliva tested for neurotransmitters so I can take supplements that will magically fix me. But as long as she keeps writing the prescriptions for my current scripts, this is the best I can do.
However, she did not want me taking Ambien anymore, since it's for short-term use, and I guess 12-years is not exactly short-term. At the time, I was ready to try something news, forgetting my "no med experimentation during the semester" rule. I have never been able to fall asleep, and although Ambien changed that wonderfully for a bit, its effectiveness had decreased so that I have been lucky to get 5 hours of sleep a night for the past few years.*
She reduced my dose to half. When I asked for a small amount of a xanax-type drug to take some of the edge off of sleep anxiety - a workaround I used previously when I tried to go off the drug - she said she didn't want to give me anything addicting and that I should just smoke pot instead (it's legal in my state, and I do partake, but I had been trying to cut down previously).
For about a month, I was able to get to sleep but would wake up after 3 hours. After a month of 2-3 hour nights, my energy and concentration were shot, so she prescribed me another ADD drug to get me through the day, took me off the Ambien completely, and put me on a new sleep drug that might as well be Skittles, for all its efficacy. I went for about a week with 1 hour of sleep a night, but Wednesday, I completely broke down. I was having trouble remembering words, I couldn't focus on lectures that I have given for years, I did not feel safe driving, and my depression was worse than its ever been, in part because I was unable to do a job that I am proud of, and I could not muster the energy to do anything with my friends and family.
After I couldn't stop crying for several hours, my husband drove me to our GP, who prescribed me the full dose of Ambien and a few Atavan to calm me down. He also gave me a stern lecture on mixing pot with wonky brain chemicals, and I'm not arguing with him. I was able to sleep for about 7 hours that night. But when I woke up, I found I couldn't keep food down, and even when my stomach was empty, I was bloated and (embarrassingly) burping almost constantly. I thought it was a poorly-timed stomach bug, but it's been four days now, I'm back to not sleeping because of the discomfort, and I am no closer to being able to focus on a growing mountain of student work that needed grading yesterday. I don't think the stomach problems are all anxiety based; these feel more constant and painful. I don't think my physical or mental health can recover until I sleep, but this stupid med change has just brought everything crashing down. But when I tried to write an email to my dean tonight, I couldn't find a way to translate "I can't sleep and am burping a lot" into a situation that sounded as dire as it seems to me. I do have an ADA accommodation addressing the bipolar challenges, but I'm worried I just look lazy and wimpy - like I should just drink some warm milx and take some Tums and do my damn job. Any insights or advice would be helpful because I'm having a hard time thinking my way out of this situation that keeps getting worse.
*I have tried almost everything to fall asleep, both chemical and behavioral, so I'm not looking for sleep remedies.
I'm concerned about this nurse midwife situation. I think you need a better, more effective doctor, even if that means finding someone elsewhere in your region. (You might also see if psychiatrists on staff at your local hospital have private practices.) If you'd like to MeMail me, I'll see if I can't help you find someone via assiduous Googling. (I have some experience with this stuff d/t caring for family members.)
posted by listen, lady at 5:34 AM on November 15, 2015 [3 favorites]
posted by listen, lady at 5:34 AM on November 15, 2015 [3 favorites]
From an HR standpoint: all you need to communicate is that you're experiencing a "flare-up" of your symptoms and require accommodations in the form of ________. No need to get into specific symptom description unless asked, which they probably won't. What they want to know is what you want from them - medical leave for X weeks, someone to help you with grading, a TA to hang out in the back of the room and take over if you have to leave suddenly, whatever.
posted by SMPA at 5:36 AM on November 15, 2015 [3 favorites]
posted by SMPA at 5:36 AM on November 15, 2015 [3 favorites]
I'm going to suggest something else. Insomnia is a pretty known indicator of the onset of peri-menopause and, for many women, it gets worse as menopause evolves. Maybe it's worth thinking about that explanation and exploring whether hormones or some other intervention might be appropropriate. Here's the National Sleep Foundation on the matter: link. Lack of rest then makes everything else worse.
posted by carmicha at 5:43 AM on November 15, 2015 [2 favorites]
posted by carmicha at 5:43 AM on November 15, 2015 [2 favorites]
I'm going to suggest something else. Insomnia is a pretty known indicator of the onset of peri-menopause and, for many women, it gets worse as menopause evolves.
This is sort of a "if you hear hooves, don't think zebras" situation—taking a sleep aid for 12 years and then stopping it definitely causes insomnia.
posted by listen, lady at 5:49 AM on November 15, 2015 [7 favorites]
This is sort of a "if you hear hooves, don't think zebras" situation—taking a sleep aid for 12 years and then stopping it definitely causes insomnia.
posted by listen, lady at 5:49 AM on November 15, 2015 [7 favorites]
Use the accommodation you have. This is a health crisis and deserves to be treated as such. It isn't a moral failing, or any kind of failing.
Your health crisis is making it difficult to do your job, so you need accommodation.
(If it were me, I'd probably do whatever was most efficacious for getting *some* sleep in the moment, and in the off-season, do the rounds with a sleep clinic [if you have access to that] with a view to finding a different long-term solution. I don't know what that might be (maybe chronobiotics & a rigid light/dark schedule, slow ramp-up? I also struggle with sleep issues, trying to figure something out myself, I know it's hard), but if the Ambien was only getting you five hours of questionable sleep for years, it's worth making figuring it out a mission [when you have the time], and you weren't wrong to want to try something different. Don't punish yourself for that, on top of everything else.)
posted by cotton dress sock at 9:03 AM on November 15, 2015 [1 favorite]
Your health crisis is making it difficult to do your job, so you need accommodation.
(If it were me, I'd probably do whatever was most efficacious for getting *some* sleep in the moment, and in the off-season, do the rounds with a sleep clinic [if you have access to that] with a view to finding a different long-term solution. I don't know what that might be (maybe chronobiotics & a rigid light/dark schedule, slow ramp-up? I also struggle with sleep issues, trying to figure something out myself, I know it's hard), but if the Ambien was only getting you five hours of questionable sleep for years, it's worth making figuring it out a mission [when you have the time], and you weren't wrong to want to try something different. Don't punish yourself for that, on top of everything else.)
posted by cotton dress sock at 9:03 AM on November 15, 2015 [1 favorite]
(unless you can take enough time off to figure it out now.)
posted by cotton dress sock at 9:08 AM on November 15, 2015
posted by cotton dress sock at 9:08 AM on November 15, 2015
I'm going to also side with carmicha in that not all of your symptoms are necessarily related to your bipolar disorder, or your med changes, so take care in lumping everything together.
I understand the need to not appear "lazy and whiny" but seriously, write your letter and take some time off. I've had bipolar for decades and I know that people are not very understanding of mentally interesting disorders. However, I also know that this is your sanity you're talking about. Take some you time and don't worry about what others think. You have the ADA time. Use it.
But you might could have the stomach flu. These things last way longer than four days. Weeks even. The last one I had lasted two weeks. Yours might be exasperated by the fact that you're anxious and have gone through recent medicinal changes. Or you could have eaten some bad fish. But, I'm not a doctor. You should really go see a doctor and see what's up with your stomach which might have nothing to do with your bipolar, your anxiety, or your recent medicinal changes.
posted by patheral at 9:43 AM on November 15, 2015
I understand the need to not appear "lazy and whiny" but seriously, write your letter and take some time off. I've had bipolar for decades and I know that people are not very understanding of mentally interesting disorders. However, I also know that this is your sanity you're talking about. Take some you time and don't worry about what others think. You have the ADA time. Use it.
But you might could have the stomach flu. These things last way longer than four days. Weeks even. The last one I had lasted two weeks. Yours might be exasperated by the fact that you're anxious and have gone through recent medicinal changes. Or you could have eaten some bad fish. But, I'm not a doctor. You should really go see a doctor and see what's up with your stomach which might have nothing to do with your bipolar, your anxiety, or your recent medicinal changes.
posted by patheral at 9:43 AM on November 15, 2015
I'm also concerned about this nurse midwife. You clearly need an MD and possibly a psychiatrist. Once you're back on keel, that should be a priority.
Your burping might be benign, just take some Tums, in an average patient, but you are not average. It's part of a much worse set of problems in you, and you should give it credit as such. Beyond the insomnia, which sounds very acute, you must be stressed about the larger picture, that these meds are necessary for you to keep on top of the bipolar and ADHD.
SMPA's verbiage is good. Your dean doesn't need to know your symptoms, he just needs to know that you need some kind of accommodation.
I hope your doc is putting you right back on what worked a month ago. Get back on keel, get through the semester (the end is in sight!), then consider whether you really need to switch meds.
Zolpidem has been shown to be safe over long term. There is some (unexplained) correlation with increased injury risk, and an odd correlation with cancer, but for solving sleep it appears to be fine long-term. If it works -for you- (I'm sure you've heard all the stories of bad effects in a small % of patients, but by now you know whether you are one of them), stopping it for generalized reasons isn't justified, especially in your context.
Hope you get some sleep, and back on keel soon.
posted by Dashy at 9:57 AM on November 15, 2015
Your burping might be benign, just take some Tums, in an average patient, but you are not average. It's part of a much worse set of problems in you, and you should give it credit as such. Beyond the insomnia, which sounds very acute, you must be stressed about the larger picture, that these meds are necessary for you to keep on top of the bipolar and ADHD.
SMPA's verbiage is good. Your dean doesn't need to know your symptoms, he just needs to know that you need some kind of accommodation.
I hope your doc is putting you right back on what worked a month ago. Get back on keel, get through the semester (the end is in sight!), then consider whether you really need to switch meds.
Zolpidem has been shown to be safe over long term. There is some (unexplained) correlation with increased injury risk, and an odd correlation with cancer, but for solving sleep it appears to be fine long-term. If it works -for you- (I'm sure you've heard all the stories of bad effects in a small % of patients, but by now you know whether you are one of them), stopping it for generalized reasons isn't justified, especially in your context.
Hope you get some sleep, and back on keel soon.
posted by Dashy at 9:57 AM on November 15, 2015
He also gave me a stern lecture on mixing pot with wonky brain chemicals, and I'm not arguing with him. I was able to sleep for about 7 hours that night. But when I woke up, I found I couldn't keep food down, and even when my stomach was empty, I was bloated and (embarrassingly) burping almost constantly. I thought it was a poorly-timed stomach bug, but it's been four days now, I'm back to not sleeping because of the discomfort ...
I'd guess your stomach issues are due to stopping the pot, because
You might, with the permission of your doctor, resume the pot and diminish your dose of it by smaller steps to allow your system to adapt more gradually.
posted by jamjam at 11:41 AM on November 15, 2015
I'd guess your stomach issues are due to stopping the pot, because
The nervous system of the bowel of several species, including the mouse, rat, guinea pig and humans, contains cannabinoid CB1 receptors that depress motility of stomach and intestine. (...)and your system was likely responding to the inhibition imposed by the exogenous cannabinoids by ramping up the signals for acid secretion and stomach/intestinal contractions, but when the external inhibition was withdrawn, those ramped up signals resulted in too much stomach acid and an overactive stomach and intestines.
Gastric acid secretion is also inhibited in response to CB1 receptor activation, although the detailed underlying mechanism has yet to be elucidated. Cannabinoid receptor agonists delay gastric emptying in humans as well as in rodents and probably also inhibit human gastric acid secretion. ...
You might, with the permission of your doctor, resume the pot and diminish your dose of it by smaller steps to allow your system to adapt more gradually.
posted by jamjam at 11:41 AM on November 15, 2015
There are other options for insomnia as well - trazodone, seroquel spring to mind. You need a psychiatrist. Your Adderall should be considered as well. Keep pushing to find a proper doctor.
posted by crazycanuck at 3:57 PM on November 15, 2015
posted by crazycanuck at 3:57 PM on November 15, 2015
Sleep deprivation is a medical issue, and digestive problems can come hand-in-hand with it. This really is on par with an emergency and good for you taking care of yourself. You are being professional by taking the time to address the root issue (sleep) so you can come back fully functional.
It sounds so hard in your area to find the right help, and that is awful. I really don't think a woo-heavy nurse-midwife is likely to be the best resource for you though. I have never used it but the Sleep Foundation does have a directory.
posted by warriorqueen at 4:32 PM on November 15, 2015
It sounds so hard in your area to find the right help, and that is awful. I really don't think a woo-heavy nurse-midwife is likely to be the best resource for you though. I have never used it but the Sleep Foundation does have a directory.
posted by warriorqueen at 4:32 PM on November 15, 2015
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posted by desjardins at 5:22 AM on November 15, 2015 [4 favorites]