The kitchen is very, very clean...

It's three am.  I've watched a movie, listened to two entire Grateful Dead concerts, and cleaned the kitchen until it shines.  I feel GREAT!  Unfortunately, for folks with bipolar disorder great is a mixed blessing.  Any departure from a baseline mood is likely to create waves for days to come.  Will my mood, as it did two weeks ago, suddenly turn into mania or will I crash into a mild to moderate depression? 

I'm sad about leaving my farm in Idaho.  There is so much I had hoped to do there.  Maybe start a CSA,   continue to sell artisan cheeses at the Farmers Market, or work on selling more hogs.  All those dreams are on hold right now.  Farming has turned from a budding enterprise into a hobby.  A therapeutic hobby to be sure, but that's not really how I envisioned things going.  I'm discouraged.

On the other hand, I'm not discouraged about how many of the other areas of my life are going.  I feel like my recovery and bipolar control are going extremely well.  I rarely think about drinking.  My bipolar symptoms are largely under control despite tonight's hypomania.  My family life is wonderful.  I'm making new friends here in Oregon.  I am so grateful for all that I do have.  I feel truly blessed.  When I'm in a better frame of mind, I get the feeling that we are right where we are supposed to be at this particular moment in time.

When I think about what's really important, I guess I don't have much to complain about.  Now I just have to try to get a little sleep.

Manic Episode

I hadn't been writing much on the blog.  After all, there hadn't been much to write about.  I'd been going along doing quite well.  Sleeping right.  Eating right.  My mood had been stable.  More stable than it had been in a long time in fact.  Then Bam!

I don't know what all of the "triggers" for the episode were, but letting my program of self-care go a little bit was one of the triggers for sure.

My wife left town for a couple of days.  Friday night I fell asleep on the couch and forgot to take my evening meds.  In the morning, I somehow rationalized that this would be a good opportunity to drink a whole bunch of caffeine.  So I started hitting the iced tea and triple iced espressos.  By the time evening rolled around I was feeling so good, so hypomanic, that I didn't want to take my evening meds again.  I guess I was figuring they would bring down the ecstatic mood I was in.  Then it turned on a dime and morphed into a full blown mania.  Complete with agitation, feelings of impending doom, panic, paranoia, and yes even mild delusions.  I was watching the two older boys, but by this time they were asleep.  I was feeling like I was incapable of being a responisible parent should there be some emergency although was probably not the case in reality.  I was wondering if I should call a friend to come over to be with me.  I was feeling like perhaps I should take a ride in to the hospital to come down.  I was feeling as if the episode would never end although I know that they always end.  Knowing that I was out of control I began reaching out and connect with anyone who would listen on Facebook chat.  Why I didn't call someone on the phone I don't know.  By this time I was jumping at every little noise in the night.  Finally a friend of mine convinced me to take my meds.  He suggested drinking a bunch of water and lying down.  I finally slept for a little bit and the meds knocked the whole episode down a notch.  Sunday came and I was still pretty wrecked.  I managed to go to an NA meeting which helped.  All though Sunday I continued with a moderate mixed state mania.  Another night of two hours of sleep.  By this time I had only slept 4 hours in the last 48.  Finally on Monday morning I got a hold of my psychiatrist.  She suggested that I immediately stop drinking caffeine and dramatically increase my lithium dose.  This I did and within a couple of hours the episode was over.

This was the worst manic episode I had had in years.  I was shocked.  Only a couple of days of shoddy self-care and I was out of control.  What a wake up call.

In the aftermath the increased lithium was making me feel like a zombie, but anything was better than the mania.  Later in the week, working with my doctor, we managed to lower the dosage to where I was neither manic or a zombie.  I'm feeling pretty good, although sleeping was a little harder.

On the bright side the episode helped me recognize and reaffirm how important self care is.  I need to take care of myself especially when my wife is out of town.  I realize now how "addictive" my behavior was.  What I fine line I was walking.  In a scary way it could have easily been alcohol I was drinking instead of caffeine.

I made a nice little checklist of the 10 or so things I need to do for my bipolar and recovery self-care.

No Booze

No Drugs

No Caffeine

Moderate Nicotine

Daily exercise

Sleep hygiene

Prayer

Meditation

Meetings

Eat Right

I have another chance to cope better this weekend.  My wife is going out of town again.  I'm going to try to stick to my regimen as closely as possible.

Wish me luck!

cyclothymia

While there is no doubt that I fall fully on the bipolar spectrum, I am currently experiencing a form of cyclothymia.  Cyclothymia is a form of mild or subthreshold bipolar disorder.  Instead of cycling from full blown manic to major depressive episodes, in cyclothymia the fluctuation is from hypomania to mild depression.  I have been on a mild mood cycle all week.  I feel good in the morning, hypomanic in the afternoon, and mildly depressed in the evening.

While cycling of this sort still allows me to be fairly functional, it is exhausting after a week of it.  By evening I am overwhelmed by life and having a feeling of impending doom.  Well, not doom exactly, more like...nothing's ever going to work out so why bother trying any more.  And from that feeling it is easy to move on to, "since nothing's ever going to work out, why not get drunk."  Obviously, getting drunk is not the answer, but it is hard to see what the answer might be.

At this juncture it is important to step up the basics.  Take the positive actions that are fairly obvious.

1.  Step up meeting attendance
2.  Eat right
3.  Exercise
4.  Talk to somebody
5.  Do the dishes

You can stay sober and reasonably sane for a long time by simply focusing on small victories.  Victories like going to bed with a clean kitchen.  Showering and shaving, complete with aftershave, is another tried and true for me.  If you don't have bipolar disorder or you're not an addict, doing the dishes may seem like a trivial task.  On some days doing the dishes can be a lifesaver for me.

The other basics I mentioned, meetings, eating, exercising, and sharing, all seem about as straightforward as the dishes...right?   Well, they are straightforward in a way, but when you are feeling depressed and that your world is spiraling downward, the telephone can seem to weigh a hundred pounds.  Or getting in the car and driving to a meeting can seem like an impossible journey.

And really that's what this whole bipolar recovering addict thing is.  An incredible journey.  Just like the Disney movie, only way weirder.  

Hypocritical?

It’s kind of funny, or at least it would be if I weren’t  so tired and frustrated.  It is easy for me to write about techniques for staying healthy.  It’s easy to write about how great everything is.  But  fact is, I’m having some fairly significant symptoms concerning my bipolar disorder.  Or maybe it would be more accurate to say that some of my behaviors are off the mark. 

I haven’t been sleeping, and I have been using caffeine.  It’s been like this  all week. I’ve been averaging about three to four hours of sleep a night. Today I had to make a two hundred mile drive and I got sleepy behind the wheel.  So, of course, I drank a 20 ounce truck stop  coffee.  It didn’t keep me awake behind the wheel.  I still ended up pulling off the road and taking a nap.  But boy is it keeping me awake now.  It’s now 2:30 am and I’m wide awake. 

I know what to do to address the situation.  I just don’t seem to be able to do it.  As tough as insomnia can be, the treatment is, at least, fairly straightforward.  Establishing good sleep hygiene can be incredibly hard to do.  My day has almost been the opposite of the list provided in the “sleep hygiene” link. 

Caffeine and nicotine-yup.

Naps-yup

Spicy food-oops guess I shouldn’t have just eaten that jalepeno omelet.

Exercise-nope, not today.  Spent  all day in the car.

Regular, relaxing bedtime routine-actually my routine has been to crank up the rock-and-roll and dance around the kitchen doing dishes.  Not exactly a relaxing bedtime routine, but at least the dishes are getting done.

Tough part about addressing my sleep hygiene and getting to bed is that I enjoy staying up.  Some nights I enjoy staying up clear through. The problem lies in the consequences of not sleeping.  There is always a reckoning.  When the reckoning comes it is not just me who pays the price but my family as well.  When I finally do crash, I am not able to participate in family life.  Not able to be a good parent or partner.  Ultimately poor decision making in the sleep department can lead to significantly for serious bipolar symptoms later.

All this said, it is important to remember one of the most important positive behaviors for treating the bipolar is not to beat myself up. I need to remember that bipolar is an illness and that my symptoms are just that.  Symptoms.  Getting angry at myself doesn’t help anything.  I am responsible for my choices and behavior, but it is important to remember that poor decision making is part of the disorder.

Well, blessings and good night. 

Prosaic

I thought about my last post and realized that it was prozaic in tone.  That is to say that it was, "lacking in poetic beauty."  This, not suprisingly, comes from years of expository writing with very little narrative writing.  There is no real problem with expository writing except that it fails to accurately convey the emotions and thoughts present during a manic or depressive episode.  Bipolar disorder is, by definition, a mood disorder and not a cognitive disorder.  Therefore I will attempt to intersperse some narrative style into my writing.  This will be a stretch for me but probably a good experience.

The other night, when I forgot my medications, became hypomanic, and stayed awake all night I felt awful.  My mood was rapidly cycling between euphoric and dysphoric.  Because of the forgotten dose of Paxil I was having a physical as well as emotional reaction.  My arms were tingling and I was having periodic, panicky sensations.  I like to call them "fear fantasies."  I was feeling that I might be having a heart attack.  Fantizing about the collapse on the floor, the ambulance ride to town, and the frantic dying phone calls to family members as I was preparing to be airlifted to the nearest city with a cardiac unit.  Needless to say, I was not actually having a heart attack except in my mind.

During sections of my hypomanic episode I was feeling as if I could do anything.  Stay up all night, make a batch of cheese, write a fabulous blog post, clean the kitchen, read a novel, and or write a new song on the guitar.  In reality, I accomplished very little.  My mind was racing and wouldn't slow down.  The euphoric feeling that I could do anything and the world was at my fingertips alternated with the dysphoric feeling that I was dying, losing my mind, may never sleep again, and may have to be locked up permently in a psychiatric unit.  Of course, none of these things actually happened.  The weird thing about symptoms of bipolar disorder is that they feel they are going to last forever.  Or, more accurately that life has always been and will always be crazy.  That applies to both depressive and manic episodes.  The idea that, "tomorrow is a new day" or that "this too shall pass," makes no sense to someone who is experiencing symptoms of mental illness. 

I was trying to find words, either my own or someone elses, that encapsulated the feelings I was having.  I thought of the Yeats poem, "Second Coming", and the line that the "centre could not hold."  The stanza goes like this,

Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;

William Butler Yeats

This is exactly how it feels to be having a mixed state manic episode.  My brain is whirling in ever tightning circles, going in a faster and faster inward spiral until in ultimately implodes.  By the same token, the real world also seems to be imploding as well.  Spiraling out of control, falling apart, and eventually self destructing.

How did I snap out of this episode?  Well, getting back on my medications most certainly helped.  Eating and sleeping didn't hurt either, getting into some meaningful work, and trying to be of service to "God and my fellow man."  This last meaningful work part involved a trip up into the mountains to cut firewood for next winter.  It was a long, sweaty day of splitting rounds of wood and loading them on to the truck.  By the end of the day, I was physically exhausted and my mental state had ironed itself out.

With that, blessings and good night.

Lack of structure and routine...

Had a rather hectic day yesterday.  I forgot to take any of my medications until about 8:00 pm.  Not only that, I drank two cups coffee at a 7:00 pm Narcotics Anonymous meeting.

I had a pretty good day despite the forgotten medication.  Kind of pumped up and jazzy (hypomania?), but I  didn't think anything of it. As is always the case with hypomania, it always ends badly.  I did end up taking my medication after the meeting, but by that time it was too late to have a peaceful, relaxing evening and a good night's sleep.

:Instead I feel agitated, sick to my stomach, and wide awake.  Agitation and irritability can all be symptoms of the downside of hypomania.  Trouble with insomnia is a chronic problem for me.  It is made even more problematic because insomnia is both a cause and effect of further bipolar symptoms.

Caffeine is another problem for me.  I had been abstinent from caffeine for 3-4 months and found that living caffeine free resulted in an improvement in some of my bipolar symptoms.  About a week ago, I started drinking a little coffee and tea.  Now, in the grand scheme of things, a few cups of coffee is not the end of the world, but I do notice a difference.

So, as much as I would like to spend my time writing about my successes, there are always setbacks as well.  Tomorrow is a new day.  Hopefully one which involves a more stable routine, attention to detail, and less caffeine.