Please give us some hope about inpatient rehab
October 8, 2018 6:00 AM Subscribe
Since her traumatic very early childhood, my wife has struggled to sleep. None of the proscribed or prescribed solutions have worked for her. Now her health problems are coming to a head and we are working very hard at getting her help. In the latest development, she has been told to go to inpatient alcohol rehab before her sleep therapist will see her again. Okay. Now what?
In her younger days, she would sometimes go a couple days without sleeping; she has always struggled to go to sleep before, say, 2-3 am. Obviously, this has been an issue. In her forties now, she is still sleeping like a teenager; up late, watching tv and playing games, sleeping until the late morning if she can. She's really frustrated by this; she knows all the sleep hygiene tips about not using electronics, setting regular sleep hours, trying melatonin, etc. She just can't get herself to do it; she doesn't trust sleep, and never has. The only solution she has found that works for her without getting groggy in the morning (like she does with Ambien or Lunesta) is self-medication with alcohol. She didn't have a drop of alcohol before 25, but she finds it really hard to sleep without it.
She knows, and we know, alcohol is bad. And of course, the longer she drinks, the more she has to drink to feel the effect. Her liver panels are still fine, but her holistic health is poor; she was recently diagnosed with fibromyalgia, though she's experienced the symptoms for years. She started taking gabapentin and cymbalta, and hooray! The pain went done to 'tolerable' for the first time in ages. But the sleep got way worse.
Whereas before, she often would sleep 4-6 hours a night and get up (grumpily) in the morning to go to work, the medication is making it super hard to get up. Given the opportunity, she'll sleep for 13 or more hours at a stretch. She doesn't wake up herself; she needs an external alarm or me to help. And while she's still working, she's called in sick to sleep more; she's missed meetings, and has taken naps at work and when working from home. She is scared and frustrated about this; she's feeling like work is getting frustrated with her, and she's worried about her job.
While this has all been going on, we've been prepping for a spinal surgery for her. She needs to lose weight and work on her sleep to have a successful recovery. We have a huge and growing team of doctors, including a sleep specialist, who referred her to a sleep psychologist, who she saw this past week. The psychologist focused entirely on her drinking, and told her that there was nothing she could do for her until she went in for at least three weeks of inpatient alcohol rehab to 'dry out'.
My wife is fine with the idea of quitting drinking. It's not social or fun for her. But she is worried that this latest solution will make no more improvement than sleeping pills, a CPAP, meditation, or other solutions did. So I have a few questions for the hivemind:
1) Has anyone dealt with trauma-induced sleep issues? Did you, and how did you, overcome them?
2) Does anyone have recommendations for inpatient rehab, especially around the Seattle area? Does insurance cover it? What do we need to know as we pursue this?
3) Does anyone have advice on how my wife can deal with her frustration at continually starting over as her health problems mount? How do we keep running this seemingly perpetual marathon?
4) If you or a loved one have been in similar straits, can you tell me how to best help as a husband? I have a major personal project (finishing school) that I am having difficulty focusing on right now, and I have mounting struggles at my own work. But I want to use my support time as efficiently as possible; how can I make her feel the most loved and supported, without making her feel infantilized or high-maintenance?
Thank you all so much for listening. We know we'll come out the other side of this; we're just struggling to see the light at the end of the tunnel right now.
In her younger days, she would sometimes go a couple days without sleeping; she has always struggled to go to sleep before, say, 2-3 am. Obviously, this has been an issue. In her forties now, she is still sleeping like a teenager; up late, watching tv and playing games, sleeping until the late morning if she can. She's really frustrated by this; she knows all the sleep hygiene tips about not using electronics, setting regular sleep hours, trying melatonin, etc. She just can't get herself to do it; she doesn't trust sleep, and never has. The only solution she has found that works for her without getting groggy in the morning (like she does with Ambien or Lunesta) is self-medication with alcohol. She didn't have a drop of alcohol before 25, but she finds it really hard to sleep without it.
She knows, and we know, alcohol is bad. And of course, the longer she drinks, the more she has to drink to feel the effect. Her liver panels are still fine, but her holistic health is poor; she was recently diagnosed with fibromyalgia, though she's experienced the symptoms for years. She started taking gabapentin and cymbalta, and hooray! The pain went done to 'tolerable' for the first time in ages. But the sleep got way worse.
Whereas before, she often would sleep 4-6 hours a night and get up (grumpily) in the morning to go to work, the medication is making it super hard to get up. Given the opportunity, she'll sleep for 13 or more hours at a stretch. She doesn't wake up herself; she needs an external alarm or me to help. And while she's still working, she's called in sick to sleep more; she's missed meetings, and has taken naps at work and when working from home. She is scared and frustrated about this; she's feeling like work is getting frustrated with her, and she's worried about her job.
While this has all been going on, we've been prepping for a spinal surgery for her. She needs to lose weight and work on her sleep to have a successful recovery. We have a huge and growing team of doctors, including a sleep specialist, who referred her to a sleep psychologist, who she saw this past week. The psychologist focused entirely on her drinking, and told her that there was nothing she could do for her until she went in for at least three weeks of inpatient alcohol rehab to 'dry out'.
My wife is fine with the idea of quitting drinking. It's not social or fun for her. But she is worried that this latest solution will make no more improvement than sleeping pills, a CPAP, meditation, or other solutions did. So I have a few questions for the hivemind:
1) Has anyone dealt with trauma-induced sleep issues? Did you, and how did you, overcome them?
2) Does anyone have recommendations for inpatient rehab, especially around the Seattle area? Does insurance cover it? What do we need to know as we pursue this?
3) Does anyone have advice on how my wife can deal with her frustration at continually starting over as her health problems mount? How do we keep running this seemingly perpetual marathon?
4) If you or a loved one have been in similar straits, can you tell me how to best help as a husband? I have a major personal project (finishing school) that I am having difficulty focusing on right now, and I have mounting struggles at my own work. But I want to use my support time as efficiently as possible; how can I make her feel the most loved and supported, without making her feel infantilized or high-maintenance?
Thank you all so much for listening. We know we'll come out the other side of this; we're just struggling to see the light at the end of the tunnel right now.
1. Yes. And I used alcohol. The problem with alcohol is that the sleep it produces is very poor and only lasts a couple of hours. Then you wake up and it's impossible to fall back asleep again.
Also alcohol and Cymbalta is a VERY bad combination.
posted by elsietheeel at 7:01 AM on October 8, 2018 [5 favorites]
Also alcohol and Cymbalta is a VERY bad combination.
posted by elsietheeel at 7:01 AM on October 8, 2018 [5 favorites]
That sounds like hypervigilance from trauma. I second the dog - since I had my dog and a door that I could lock where only I had the key, I sleep much much better. Someone with PTSD in my life had a shock recently and couldn't sleep for a while to the point where they had to fly to another country to stay with relatives to get sleep in a known "safe" place, just everywhere else felt too dangerous. Crashed and slept for several days and was able to reset. Another PTSD person I know has been on meds and alcohol to treat sleep issues for 6+ years now. EMDR has been highly recommended for dealing with the root causes, but they refuse therapy. In the meantime, what seems to help is indeed having a guard dog pet, locks and exercise.
Having a torch under my pillow helped at one point, a heavyish torch that felt a little like a weapon and also meant it was a light in the dark.
It isn't a smooth line of recovery. It's a tangled squiggle mostly forward. I'd say I'm 80% better than a decade ago, but I did a couple of all nighters from anxiety recently that set me back a while. The people in my life who have it, the ones getting better are the ones who did therapy and pets, and do small steps.
Oh and make your home or bedroom at least subconsciously safe. Whatever that means to your wife. Like Dr Ford's second front door. I like to sleep in a cupboard-style bed, hidden away. I like the dog between me and the door. I cannot sleep deeply in an open-style apartment at all, but explaining why means going into really gross memories and irrational fears (based on childhood memories, so seemingly rational to the terrified child) which y'know, just let me put the dog bed there.
posted by dorothyisunderwood at 7:07 AM on October 8, 2018 [5 favorites]
Having a torch under my pillow helped at one point, a heavyish torch that felt a little like a weapon and also meant it was a light in the dark.
It isn't a smooth line of recovery. It's a tangled squiggle mostly forward. I'd say I'm 80% better than a decade ago, but I did a couple of all nighters from anxiety recently that set me back a while. The people in my life who have it, the ones getting better are the ones who did therapy and pets, and do small steps.
Oh and make your home or bedroom at least subconsciously safe. Whatever that means to your wife. Like Dr Ford's second front door. I like to sleep in a cupboard-style bed, hidden away. I like the dog between me and the door. I cannot sleep deeply in an open-style apartment at all, but explaining why means going into really gross memories and irrational fears (based on childhood memories, so seemingly rational to the terrified child) which y'know, just let me put the dog bed there.
posted by dorothyisunderwood at 7:07 AM on October 8, 2018 [5 favorites]
Has she tried and failed to quit drinking before? If not, inpatient treatment seems like overkill, and like it could further damage her sleep. (I say this as someone with chronic insomnia; sleeping somewhere different, possibly with a roommate, would destroy me. It would be three weeks of catnaps, and I'd be so sleep deprived when I got home that I'd do anything for some sleep, including drinking if that helped me.)
While yes, she should stop drinking, the sleep psychologist was wrong to focus solely on that. If you have the option to see another one please do, even if you wait until she's stopped drinking.
posted by metasarah at 8:15 AM on October 8, 2018 [6 favorites]
While yes, she should stop drinking, the sleep psychologist was wrong to focus solely on that. If you have the option to see another one please do, even if you wait until she's stopped drinking.
posted by metasarah at 8:15 AM on October 8, 2018 [6 favorites]
If the psychologist is recommending inpatient treatment, there may be actual addiction at this point (the wife may need to be in a controlled environment to undergo withdrawal).
posted by kingdead at 8:20 AM on October 8, 2018 [2 favorites]
posted by kingdead at 8:20 AM on October 8, 2018 [2 favorites]
I love Cymbalta and will stay on it as long as I am able (knock on wood it keeps working). I also have fibro-type pain issues, plus depression, anxiety, and OCD. Cymbalta has been a life saver in those regards. Cymbalta also 100% made my sleep issues and alcohol issues worse. She might talk to the doctor who prescribed it to see if they have suggestions.
posted by I'm Not Even Supposed To Be Here Today! at 8:28 AM on October 8, 2018 [1 favorite]
posted by I'm Not Even Supposed To Be Here Today! at 8:28 AM on October 8, 2018 [1 favorite]
But she is worried that this latest solution will make no more improvement
Well...quitting drinking is a critical step to being able to do all the other next steps she needs, but no it's not likely going to fix her insomnia or PTSD or health problems, and she's being set up for failure if that's what she's being told. It's a necessary prerequisite to successful pain management, surgery, and insomnia treatment. It will remove one variable that's probably not helping (drunk sleep isn't really restorative, and it's probably altering the normal functionality of some/all of her medications), and it will likely pave the way to future relief, but it's not going to fix anything obvious instantly.
But, psychologists do not have medical training, and not all psychologists have good PTSD training. I would absolutely discuss this demand with her medical team and her actual treating psychologist/therapist because there are other ways to do medically-supported cessation programs that might be less disruptive to someone who's basically clinically non-functional from insomnia, chronic pain, and PTSD. It is likely the sleep psych is solely basing this on not wanting to work with non-compliant patients, which I understand is frustrating and bad for metrics but is also going to be part of the job. If you don't have any indication that this requirement is being set IN CONTEXT of the rest of her health issues I would want the rest of her care team to weigh in.
You need to be working with one of her medical doctors to find an inpatient program, if indeed that ends up being the entire team's recommendation. They will help with insurance because that's not a yes/no question, and hopefully they will be able to guide you/make the required insurance justification for a multi-diagnosis program meant for people with health issues and/or trauma.
posted by Lyn Never at 8:51 AM on October 8, 2018 [11 favorites]
Well...quitting drinking is a critical step to being able to do all the other next steps she needs, but no it's not likely going to fix her insomnia or PTSD or health problems, and she's being set up for failure if that's what she's being told. It's a necessary prerequisite to successful pain management, surgery, and insomnia treatment. It will remove one variable that's probably not helping (drunk sleep isn't really restorative, and it's probably altering the normal functionality of some/all of her medications), and it will likely pave the way to future relief, but it's not going to fix anything obvious instantly.
But, psychologists do not have medical training, and not all psychologists have good PTSD training. I would absolutely discuss this demand with her medical team and her actual treating psychologist/therapist because there are other ways to do medically-supported cessation programs that might be less disruptive to someone who's basically clinically non-functional from insomnia, chronic pain, and PTSD. It is likely the sleep psych is solely basing this on not wanting to work with non-compliant patients, which I understand is frustrating and bad for metrics but is also going to be part of the job. If you don't have any indication that this requirement is being set IN CONTEXT of the rest of her health issues I would want the rest of her care team to weigh in.
You need to be working with one of her medical doctors to find an inpatient program, if indeed that ends up being the entire team's recommendation. They will help with insurance because that's not a yes/no question, and hopefully they will be able to guide you/make the required insurance justification for a multi-diagnosis program meant for people with health issues and/or trauma.
posted by Lyn Never at 8:51 AM on October 8, 2018 [11 favorites]
It sounds like the psychologist is concerned that your wife is an alcoholic and does not feel that treatment for the other issues will resolve without inpatient rehab for alcoholism. This is a pretty antiquated approach to both therapy and alcoholism. MANY alcoholics are in therapy concurrently with their drinking, and find it helpful. Furthermore, rehab for three weeks is not a magic cure for alcoholism.
Inpatient rehab will definitely make you abstinent (if the security is good) but my guess is that there is a concern that quitting drinking cold turkey will cause your wife to have bad physical side effects that would be better managed in an inpatient setting. It is important to probe further in this to find out whether her care team actually thinks she has an alcohol abuse problem (e.g. can't stop/won't stop), or whether they just think she'll need inpatient care when she stops drinking of her own free will.
She has insomnia, fibromyalgia, obesity, needs back surgery, and self-medicates with alcohol. The one on the ground floor here is the alcohol use, which is why doctors are focused on that - it's the one thing she may be able to get under control and has a good statistical chance of resulting in easier and more effective treatment of all the other problems. I urge you to support her in empowering herself to start small, by listening to her doctor about their blunt assessment of her alcohol use and why they are suggesting inpatient, and listening with an open mind. Alcoholism is covered by the ADA, and she can't lose her job for going to rehab.
posted by juniperesque at 9:51 AM on October 8, 2018 [5 favorites]
Inpatient rehab will definitely make you abstinent (if the security is good) but my guess is that there is a concern that quitting drinking cold turkey will cause your wife to have bad physical side effects that would be better managed in an inpatient setting. It is important to probe further in this to find out whether her care team actually thinks she has an alcohol abuse problem (e.g. can't stop/won't stop), or whether they just think she'll need inpatient care when she stops drinking of her own free will.
She has insomnia, fibromyalgia, obesity, needs back surgery, and self-medicates with alcohol. The one on the ground floor here is the alcohol use, which is why doctors are focused on that - it's the one thing she may be able to get under control and has a good statistical chance of resulting in easier and more effective treatment of all the other problems. I urge you to support her in empowering herself to start small, by listening to her doctor about their blunt assessment of her alcohol use and why they are suggesting inpatient, and listening with an open mind. Alcoholism is covered by the ADA, and she can't lose her job for going to rehab.
posted by juniperesque at 9:51 AM on October 8, 2018 [5 favorites]
1. Yes. Therapy for the trauma, creation of a safe place to sleep, and also exercise to the point of good exertion before 5 pm, and a super consistent waking hour. Given your wife’s issues, I think exercise is going to be hard to achieve but for me it is *the* killer app to reset adrenaline spikes.
2. I did the self-medicating with alcohol after losing my daughter and it is not a sleep solution, or wasn’t for me. It was a mask to a sleep problem and it didn’t keep the PTSD from wearing me down. So it may be about understanding that it’s not giving up a cure. It’s giving up a crutch.
posted by warriorqueen at 10:50 AM on October 8, 2018
2. I did the self-medicating with alcohol after losing my daughter and it is not a sleep solution, or wasn’t for me. It was a mask to a sleep problem and it didn’t keep the PTSD from wearing me down. So it may be about understanding that it’s not giving up a cure. It’s giving up a crutch.
posted by warriorqueen at 10:50 AM on October 8, 2018
Since you're in Seattle, has she tried cannabis? For some people, it helps with insomnia, PTSD, chronic pain, and alcohol avoidance. Washington state has both medical and recreational marijuana, so there are commercially available products that don't require smoking, if that's a concern, as well as products that contain super-low amounts of THC so they aren't psychoactive. PTSD is one of the conditions eligible for Washington's medical marijuana program. The benefit of the medical card is that the purchases aren't subject to sales tax (still subject to the excise tax though). Her doctors might not be certified under the program to get her signed up for a card, but they can likely advise whether there would be any interaction with her current medications.
posted by melissasaurus at 11:45 AM on October 8, 2018 [1 favorite]
posted by melissasaurus at 11:45 AM on October 8, 2018 [1 favorite]
There's some good advice above.
she is still sleeping like a teenager
I don't know where this is coming from, but I don't think it's a helpful characterization. Some people are just like this! (See delayed sleep phase syndrome.) It doesn't mean that they're immature or choosing to do it because they're irresponsible and don't understand consequences. Even--or rather, especially!--if her issues derive from trauma rather than biological DSPS, it still wouldn't be a useful approach in my opinion. This kind of language would emphatically not make me feel loved or supported, and would, in fact make me feel infantilized and judged.
posted by wintersweet at 12:25 PM on October 8, 2018 [5 favorites]
she is still sleeping like a teenager
I don't know where this is coming from, but I don't think it's a helpful characterization. Some people are just like this! (See delayed sleep phase syndrome.) It doesn't mean that they're immature or choosing to do it because they're irresponsible and don't understand consequences. Even--or rather, especially!--if her issues derive from trauma rather than biological DSPS, it still wouldn't be a useful approach in my opinion. This kind of language would emphatically not make me feel loved or supported, and would, in fact make me feel infantilized and judged.
posted by wintersweet at 12:25 PM on October 8, 2018 [5 favorites]
My trauma sleep issues were very bad... I also had a phobia of beds where in didn't sleep in a normal bed for YEARS (bunk beds top bunk only, waterbeds and/or the floor were better than the guaranteed panic of a regular bed, but definatey didn't fix my sleep issues) Depending on my living situation I did different things.
I suggest a program with a trauma specialty whereever you go .
Ay first, my panic was so bad I was given a hefty dose of antipsychotics, but it got me into a bed and I slept in it. As I worked through trauma issues this dose was too much and changed , I've been on tons of different sleep meds at this point.
I also was triggered by the time of day. When I moved to working nights, suddenly my sleep became perfect. I went off all my sleep meds for the first time in 10 plus years. It may be unrelated because I spent massive amounts of time and money on therapy in those ten years. When my shift changes now I'll sleep at night just fine.
It is possible to get through this .
posted by AlexiaSky at 12:35 PM on October 8, 2018 [3 favorites]
I suggest a program with a trauma specialty whereever you go .
Ay first, my panic was so bad I was given a hefty dose of antipsychotics, but it got me into a bed and I slept in it. As I worked through trauma issues this dose was too much and changed , I've been on tons of different sleep meds at this point.
I also was triggered by the time of day. When I moved to working nights, suddenly my sleep became perfect. I went off all my sleep meds for the first time in 10 plus years. It may be unrelated because I spent massive amounts of time and money on therapy in those ten years. When my shift changes now I'll sleep at night just fine.
It is possible to get through this .
posted by AlexiaSky at 12:35 PM on October 8, 2018 [3 favorites]
Ay first, my panic was so bad I was given a hefty dose of antipsychotics, but it got me into a bed and I slept in it.
Oh yes, this too. Seroquel a couple hours before bedtime helped me sleep through the whole night (and maybe I'd go to bed an hour or two early sometimes, but I'd rather go to bed early than have a rough time getting up).
posted by elsietheeel at 5:05 PM on October 8, 2018 [1 favorite]
Oh yes, this too. Seroquel a couple hours before bedtime helped me sleep through the whole night (and maybe I'd go to bed an hour or two early sometimes, but I'd rather go to bed early than have a rough time getting up).
posted by elsietheeel at 5:05 PM on October 8, 2018 [1 favorite]
I speak from experience working with outpatient psychiatrists for clients with severe mental illness (including PTSD) and often chronic medical issues and definitely sleep issues: From a completely pragmatic standpoint, I would highly recommend against adding cannabis or any other medication not expressly prescribed/recommended by her treatment team right now, while she is apparently being diagnosed with a substance-use disorder. I am not making any claims about whether she actually has a substance-use disorder, but her psychologist seems to be making that diagnosis, and her psychologist likely (given the referral) has the ear of her sleep specialist, and it can get really hard for people diagnosed with active substance-use disorders to get help other than advice to "get treatment for your substance-use disorder." Adding a second side-eyed substance right now may confirm her treatment team's diagnosis that she has substance issues, rather than just sleep issues.
Again, I say all that in a completely nonjudgmental way about your wife's current state as well as about the efficacy of cannabis. But from a "managing up" perspective on doctors, if she's planning on continuing to seek medical care right now, adding another stigmatized substance will likely complicate things.
posted by lazuli at 6:55 PM on October 8, 2018 [1 favorite]
Again, I say all that in a completely nonjudgmental way about your wife's current state as well as about the efficacy of cannabis. But from a "managing up" perspective on doctors, if she's planning on continuing to seek medical care right now, adding another stigmatized substance will likely complicate things.
posted by lazuli at 6:55 PM on October 8, 2018 [1 favorite]
I know I'm a bit late on this, but every time a doctor has prescribed gabapentin to anyone I know, they always advise them to take it before going to sleep, as it makes many people very drowsy when they first start taking it. Maybe she is reacting to the gabapentin?
posted by kuanes at 7:48 AM on October 9, 2018
posted by kuanes at 7:48 AM on October 9, 2018
I've taken both gabapentin and cymbalta, separately and in combination. I'm not a great sleeper, but nothing like your wife's experience, so take this for what it's worth. I've found that taking the medication at night and having a very fast morning routine helps a LOT. Less than 25 minutes pass from my alarm going off to being in my car on my way to work, and that includes brushing teeth, shower, getting dressed, and a caffeinated breakfast shake; it works so much better than pretty much anything else I've tried. I still have rough days, but more days than not my energy stays up through the day.
posted by mchorn at 6:04 PM on October 15, 2018
posted by mchorn at 6:04 PM on October 15, 2018
This thread is closed to new comments.
The sleep psychologist is right that she needs to dry out before addressing the underlying issues, but there are things you can do to address the sleep problem while that is going on.
posted by corb at 6:43 AM on October 8, 2018 [1 favorite]