Recovering From Conversations With My Mother

One of the hardest things I do regularly is talk to my mother. She is very critical. I don't make enough money, my hair doesn't look right, my lipstick is the wrong color, I need to lose weight, I need to be more social, I need to go to the gym more--the list goes on and on. There are always a quite a few things I am not doing right that I need to improve. If it is not one thing, it is another. Things are constantly being added to this list of complaints. Some of them are minor, but the negative energy and disapproval wears on me nonetheless.

These conversations full of unsolicited advice are very demotivating. They make we want to quit everything and give up. My hopeless and suicidal thoughts ramp up the more I talk to my mother. I have told her that I try very hard to stay positive and that these conversations bring me down. I tell her that I need support, not criticism. Yet these unpleasant topics come up again and again. The negative emotions that come up affect me for hours and days.

My parents are getting old. I feel like I should spend some time with them, but it is very hard. Lately, I have been limiting the time I spend with them. I do not enjoy the time I spend with my parents. I see it as a duty. Most of the time it is depressing, lonely, and painful.

I have taken to giving myself pep talks after I talk to my mother. I tell myself that I don't really want to give up everything and die. That is just a reaction I have when I am repeatedly criticized and insulted. I think of all that I have to live for. I think of how far I have come. I tell myself that I have a very good job. I do not make a lot of money, but I have good benefits and I have been getting raises.

It makes sense to keep my job even though it is not good enough for my mother. My job is flexible and I need a lot of time off to go to various health-related appointments. That is a benefit that is hard for people to understand if they do not have to live with a chronic illness. My primary illness is Bipolar I, but side effects and other health conditions have come up over the years, and other medications and treatments have been added. Taking care of my health has become a juggling act that not every employer would support.

When dealing with my parents, there is no joy, but I think of the importance of compassion. My upbringing was far from happy and stable, but without my parents, I would not be alive. You do not get to choose your family, and this is the family I got. Maybe the purpose was to make me stronger.

Sleep Study

I've been having trouble sleeping for years. I'm 42 now and my insomnia started when I was about 14. The diagnosis of bipolar disorder at 19 explained my sleeplessness at the time. About 10 years ago, I started having sleep problems again. I had gained a lot of weight because of bipolar medications, and my psychiatrist suspected that I had sleep apnea. He referred me to a sleep specialist and I had a sleep study. It was determined that I had mild sleep apnea (too mild to treat) and I was told that I would get better sleep if I slept on my side, so that is what I did.

This past summer, I started to suspect that my sleep apnea had gotten worse. I was waking up about 6 or 7 times each night, that I remembered, and I didn't feel rested. Part of the problem was that I was taking lithium, and it was causing extreme thirst, which was compelling me to drink huge amounts of water, and I was in the bathroom all day and all night. I was so thirsty that I would drink more water each time I woke up at night. Whether because of my extreme thirst, or suspected sleep apnea, I wasn't getting good sleep, so I asked my general practitioner to refer me to a sleep specialist, and I let my psychiatrist know about it. My psychiatrist was very interested in learning the results of my sleep study.

My sleep study in October was disastrous. I got out of bed 7 times to go to the bathroom and drank 6 cups of water throughout the night. I only slept for 1 hour, although it seemed like I didn't sleep at all. During that hour, I stopped breathing 16 times because of sleep apnea. That qualifies as moderate sleep apnea and is considered serious enough to treat. I went back for another sleep study in November, and this time I wore a CPAP, a device that blows a gentle stream of air into the nose during sleep to keep the airway open so that you can breathe properly. I slept 7.5 hours and was getting at least 90% oxygen all night, which is in the healthy range of oxygen. It was determined that I would get my own CPAP, and I did.

In December, I met with a respiratory therapist and was fitted with a mask and learned how to use and care for the CPAP. At first, I was given a full face mask. After three weeks of sleeping with it, I decided that it was too uncomfortable, so I went back for another mask. This time I got nasal pillows and they are proving to be much more comfortable.

I was not really excited about using the CPAP at first, but now, at the end of January, I feel so much healthier and more energetic since I've been using it, that I believe it is worth the expense and awkwardness. Also, it is thought that if you have sleep apnea and bipolar disorder, using a CPAP can lessen your experiences of both mania and depression. As an added bonus, I even look better. My eyes look much more rested and my skin looks radiant. Now, in addition to considering it necessary for good mental and physical health, I consider it to be a beauty treatment, and that makes me feel more excited about wearing it.

Unfortunately, many people with bipolar disorder gain weight from the medications, and that causes other health problems, like sleep apnea. There is a possibility that if I lose weight, I will be able to sleep well without the CPAP. Getting to my ideal weight is my next quest. When you get good sleep, you have fewer stress hormones in your body, so it is easier to lose weight.

Since I've been using the CPAP, I've lost 23 pounds. This is probably also the result of a medication change. When my psychiatrist learned, from the sleep study, that I was waking up and drinking water all night, she substituted Trileptal for lithium. I've been asking psychiatrists to take me off of lithium for years, but this was the straw that finally broke the camel's back. I'm also taking Lamictal and Saphris to control my bipolar disorder and I'm doing very well. I'm stable and alert and feeling much more optimistic about the future than I've felt in years.

Stress

Tonight, while attending my biweekly support group, one of two support groups I attend, everyone spoke of stress more than usual. We all experience relationship stress, work stress, and the stress of having bipolar disorder itself. It's stressful to think about whether or not to disclose the illness to friends, families, and coworkers, and the mania and sleeplessness that occur at times with the illness, along with the with the seemingly endless depressions, are stressful states to be in.

At many times in my life, stress has sent me over the edge into mania and depression, and has caused me to be hospitalized more times than I can remember. As people with bipolar disorder, it is essential that we try to get a handle on our stress levels. For me, medication, diet, exercise, meditation, lifestyle changes, and therapy, have helped me to manage my stress. When stress seems to be getting out of control, I know I need to do something about it. If I can't handle the stress on my own, it's definitely time to call both my psychiatrist and my therapist. Spending time in a serious state of stress often leads to unpleasant outcomes for me: mania and depression. Hospitalization always seems like a huge setback, plus it's time consuming, often at the worst times, and expensive.

The biggest lifestyle change I've made is going on disability. At the time I went on disability, I was mired in a serious depression that I spiraled into after becoming so inert that I couldn't continue to teach. I had chosen to become a special education teacher because I thought that, as a person who had experienced many years of stability, I was ready to handle the stress, and my diagnosis of bipolar disorder would give me the insight and compassion to help students who were struggling with learning and behavior disorders. I did a good job for almost five years. In fact, I earned several awards and a lot of positive feedback from students, parents, and my principal. But the stress eventually got to me and I became almost immobile and was no longer able to gather the energy to teach. In fact, waking up was hard, as was attending to daily tasks such cooking and cleaning, and even getting dressed. I got to the point where I was barely able to care for myself, and I applied for, and was granted disability.

The period before I went on disability was the lowest part of my life. After I received disability, a lot of the stress I had felt was removed. Ironically, I saw disability as a time to focus on my health. I gradually regained my mental and physical strength. For anyone who has experienced long periods of depression, it's obvious that it's physically unhealthy. Too much time spent in bed or sitting causes muscular weakness, and many people who are depressed don't eat enough, or eat the wrong foods, and the poor nutrition causes a deterioration in health.

After a year on disability, I was able to begin working at a part time job, and now I've been working part time for slightly over three years. I'm feeling much better about myself, and people are beginning to wonder why I'm still on disability. The answer is stress. It has been a breaking point for me in the past and I need enough experience with my stable self to prevent stress from harming me again. I feel that I need a longer period of stability behind me before I go off of disability. My therapist and psychiatrist have shared their opinions that I am not ready to go off of disability yet, if at all.

Although I've been on disability for several years, and have reduced my stress, I've still become manic and have had to be hospitalized twice in the past three years. And I've experienced one serious depression where I was unable to work as many hours as usual for a couple of months. I'm hoping that my medication changes and lifestyle changes will continue to work, and I'll improve in my ability to handle stress to the point where I'll be able to handle the stress of working full time. I want nothing more than to deal with my bipolar disorder in a healthy way and to live the most productive life that I possibly can.

Temazepam

Since my 10-day hospitalization for mania, which ended in April, my psychiatrist has made adjustments to my combination of medications. I am now taking 1350 mg. lithium carbonate ER at night, 5 mg. of Saphris in the morning and 5 mg. of Saphris at night, 200 mg. of Lamictal in the morning, and 15 to 30 mg. of temazepam at bedtime, as needed, for sleep.

I just took my first dose of temazepam for sleep last night and I feel good today. I slept well, I did not have a medication hangover when I woke up, and I have been calm and productive all day. I'm thankful that my psychiatrist prescribed it, and I'm hoping that this will complete the perfect combination of medications for me. If it works, it will be the combination I have been hoping for for the past 23 years - one that lets me feel and act like my best self.

My former psychiatrist switched me from temazepam to Ambien about 7 years ago because, he said, Ambien was less likely to be habit forming. That didn't make sense to me, as I hadn't formed a habit, but he insisted that I needed to make the change, so I did, and I haven't experienced as much stability since then as I did before he made the switch.

I told my current psychiatrist what happened when I was switched from temazepam to Ambien, and she wrote a prescription for temazepam right away. Anyone who has bipolar disorder knows how important sleep is to managing the health condition. Some doctors avoid prescribing sleep medications, because they may be habit forming, and instead use other medications, like the antipsychotic Seroquel, for example. I tried to use Seroquel for sleep, but I felt very much impaired and overly sedated during the day. I made many more mistakes than usual, and always felt like I was ready for a nap. I'm happy that my current psychiatrist sees me as a unique individual and prescribes the medications that work best for me.

Many mental health bloggers shy away from writing about the medications that they take, but I don't. I've always been told, and I've learned through life experience, that medication is necessary for managing bipolar disorder, especially Bipolar Disorder I, the most severe form, and the one that I happen to have. Since I'm sharing everything else I do to maintain balance, and since medication is so important for that, I'm describing the medication that I take, and how my psychiatrist decides to prescribe it. She only likes to change one medication at a time, so she can evaluate how each one works in combination with my other medications. This can be a laborious process, but I feel that it is helping me to experience more wellness.

Every person who takes medication is a different person with a different lifestyle. There is no one size fits all in psychiatry - at least there shouldn't be. I'm not suggesting my exact cocktail of medications to anyone else, I'm just writing that it is what's currently working for me. Reading stories of recovery, including stories of people finding medications that work, has always given me hope. More than anything else, in writing this blog, I want to encourage anyone with a mental illness, as well as their friends and relatives, to hang on to hope.

Recovery

From 2002 through 2007, I experienced the longest stretch of recovery that I have experienced since I was diagnosed with bipolar disorder in 1989. I believe that  this recovery came about as a result of the medications I was taking and the ways I was trying to improve my life, but I wasn't focused on it, it just happened.

In 2002 I went through an upsetting breakup. Afterward, I decided  to put my energy into my work, my education, and my friendships. I wasn't thinking in terms of preventing a relapse of bipolar disorder at all, but I ended up concentrating my efforts into some areas of my life that contributed to my wellness.

Although I had been compliant with my treatment for bipolar disorder for many years, I still had not fully accepted my diagnosis. I secretly hoped that I would grow out of it, or it would just disappear. By 2005, I had earned a Master of Arts in Teaching and had been teaching for almost two years. At that point, it seemed like I had my life under control, so I asked my psychiatrist to make some changes to my medication because of some side effects I was bothered by. In hindsight, I realize that this wasn't the best idea, because the changes increased the likelihood that I would become unstable. That is how psychiatry works though. Everything is done through trial and error, because the brain and its disorders are still poorly understood.

Teaching was my life and my life was becoming more and more unbalanced. I was putting all of my energy into work. The hours I worked,  as well as the sedation caused by my medication, made it very difficult for me to exercise, something that has always contributed to my wellness. When I got home at the end of the day, I was exhausted and rarely ate anything more nutritious than a microwave dinner. I spent most nights preparing for my next day at school and then reading until I fell asleep. I spent less and less time with my friends. My students and coworkers brought me joy, and that sustained me for a while, although my life away from school was taking a steady downturn.

In 2006 I found out that I had developed workplace-related asthma because toxic black mold was growing in my classroom. My allergist advised me to transfer to another school because he felt that it was unlikely that my school would clean up the problem anytime soon. I took his advice and transferred to a new school in 2007. My health habits had been slipping while I worked at my old school, but when I entered my new environment, where I didn't know anyone, and was also an unknown, I quickly fell into a deep depression. My classroom was immaculate, and my asthma disappeared, but I was overwhelmed, became unable to work, went through shock therapy, and qualified for Social Security Disability. Everything I had worked for seemed to slip away so quickly. It was the biggest wake-up call I have ever experienced.

Ironically, becoming disabled has enabled me to focus on my wellness. I think my problem with recovery in the past is that I just tried to forge ahead, without properly acknowledging and respecting my disorder. I have bipolar disorder and I can never forget that. I have given up the hope that it will ever disappear and have become vigilant about staying well. So few people, without the condition, understand the discipline it takes to live well with bipolar disorder. Things that are no big deal for many people, like staying up all night, or getting drunk, can lead to rapid mood changes, serious depression or mania, and the need for immediate psychiatric intervention, including hospitalization, for people with bipolar disorder.

Twenty three years after my diagnosis, I finally understand all that it takes for me to stay well. I have gone through a great deal of trial and error with medication, therapy, support groups, relationships, work, exercise, diet, and more. I have seen attitudes toward mental illness change in the years since I was diagnosed, and I think if there were as much acceptance when I was diagnosed as there is now, it wouldn't have taken me as long to reach my current level of recovery. My hope for myself is that I will be able to stay on the path of recovery, and my hope for others is that attitudes toward those with mental illness will continue to improve so that it will be easier for those who need help to get it. I also hope that more research will lead to a better understanding of all mental illnesses and also to better treatments, with fewer side effects, for those who are affected.

In the Holiday Spirit

This time last year, I was struggling with a deep depression that started in November and lasted until March. I felt awful, which is really hard at one of the most festive times of the year. I went to the bare minimum of social functions that I felt I could get away with. I only made it to my work party, my boyfriend's work party, and small gatherings with family and my closest friends.

When people are depressed, they are encouraged not to isolate themselves, but it is really hard not to. Most people are confused by drastic mood changes. They don't understand why someone who is normally animated and talkative would sit silently in a corner watching everyone else have fun. When I am depressed, I only feel comfortable with those who know me well and understand that, at-times, I can't fully participate in social events, even if I want to. Big parties, which are usually fun, and great opportunities to meet interesting people, become strangely intimidating if I am depressed. At those times, it is extremely awkward to try to have a conversation with someone new, because I can barely focus on what they are saying and I can't think of anything to say myself. So, I avoid those types of encounters by turning down invitations to events that would be difficult to handle.

Fortunately, this year, I'm feeling happy and healthy, and I've been stepping up my social life ever since Thanksgiving. I'm looking forward to the abundance of merriment to be had throughout the holiday season. Last night, I met seven friends at an Indian restaurant and had a pleasant dinner in a charming part of town where a holiday festival was being held. After dinner, we walked through a shopping center which was hosting a  beer tasting as a fundraiser for a private school for children with autism. We didn't participate, but it was good to see such a big crowd having fun and supporting a worthy cause. Next, we walked to one of my friend's houses for an impromptu get-together. There was a lot of talking and laughing, and a lot of silliness and fun. I'm so thankful that I'm able to enjoy the simple pleasures in life this year, and I hope to keep it up. I feel like I've finally figured out how to maintain my mental and physical health, and I hope to savor the good times for many years to come.

Maintaining Balance

I came out of my last depression in March, and for the past seven months, I have been working to organize my life in such a way so that I will be less likely to become depressed this fall and winter. So far I have done everything  I can think of. I am exercising regularly, eating well, sleeping well, doing light therapy, taking my medication and supplements (multivitamin, fish oil, and fiber powder), keeping regular appointments with my psychiatrist and therapist, going to my support group, enjoying spending time with friends and family, and keeping my house clean and organized. I have also gotten out all of my fall and winter clothes and have even gone shopping for a few new items to spice up my wardrobe. And last night the time changed. I was determined to get my life in order by then. It seems to be a good seasonal deadline for me.

Now, the trick is to maintain this balance through the early spring when everything tends to become easier for me again. Last week, in an effort to keep everything balanced, I skipped two spinning classes so that I could do some work around the house, including cleaning and organizing my desk and going through some paperwork that I had let pile up. I also put off writing a blog post. I was disappointed that I wasn't sticking to my schedule, but at this point, I'm caught up with everything and am sitting here writing this post before going to my spinning class at the YMCA. It is a peaceful Sunday morning. Reflecting on my choices of how to use my time this week, I think I made good ones. For me, balance is important, but sometimes it requires flexibility. At this point in my life, each day is not always perfectly balanced, but when I look at my life one week at a time, I see a good amount of balance, and while there is always room for improvement, I am satisfied with what I am accomplishing.