waking up from bipolar disorder

O soft embalmer of the still midnight,
Shutting, with careful fingers and benign,
Our gloom-pleas’d eyes, embower’d from the light,
Enshaded in forgetfulness divine:
O soothest Sleep! if so it please thee, close
In midst of this thine hymn my willing eyes,
Or wait the “Amen,” ere thy poppy throws
Around my bed its lulling charities.
Then save me, or the passed day will shine
Upon my pillow, breeding many woes,—
Save me from curious Conscience, that still lords
Its strength for darkness, burrowing like a mole;
Turn the key deftly in the oiled wards,
And seal the hushed Casket of my Soul.

– To Sleep by John Keats

My bipolar disorder first truly manifested itself at the age of 19. Like most people with this disorder, it is punctuated with alternating moods of extreme depression or extreme mania (energy, euphoria, elation). At 19 I experienced a full blown manic psychotic episode, highlighted by total mental incoherence and borderline insanity. In the 13 intervening years it has been a struggle to manage this illness. One of the hallmarks of my descent into madness is a total inability to sleep. Typically, after abusing substances and not sleeping for a few days, I would begin a severe manic cycle. As I have painfully learned to treat this disorder, I have learned about the importance of sleep for my brain. Lack of sleep is my number one trigger for problems. I have always had some form of insomnia, from a young age, but as I got older it became worse. Once I finally got to the point of understanding the consequences of not sleeping and abusing alcohol in particular, I have been able to ward off any further disastrous episodes and resultant consequences. It has been five years since my last hospitalization as a result of this illness. I have been hospitalized four times, arrested twice, and should have been hospitalized on at least two other occasions. This is why, at 2 in the morning when I can’t sleep, my desire to shut off my brain verges on total desperation. A hallmark of bipolar disorder is racing thoughts, and when I close my eyes and lie down, sometimes my mind fails to shut up and drift off. I call it “the clown car going in a circle in my brain.” The internal monologue intensifies. No matter how tired I may have been during the day, when I close my eyes for some reason I feel wired and wide awake.

This mental state, late at night, is one of the most frustrating experiences in my attempt to sleep. It seems like closing my eyes makes me feel more awake. My thoughts race, in a circle, endlessly. I think of something stupid I did when I was 8 years old, randomly, and start to feel bad about it, feeling more awake as a result. To deal with this, in the past, I resorted to drugs and alcohol to tranquilize myself. I would simply abuse marijuana or alcohol, or other drugs, to the point where I would pass out. I would do this even while taking prescribed psych meds. I was self-medicating. I wanted to change my mood, which was often depressed and shitty or too sped up and manic, and substances helped me to do that. But even more than that, I wanted to completely shut my brain off so I could stop thinking and pass out. I didn’t ever find a good med combo during that time to help me do that, and really I still haven’t. There was a cost, for this, however. Eventually the drugs stopped working. A long enough pattern of drug abuse would convince me that I didn’t need my meds and I could just use drugs to get the same results, and that would lead to long term instability which would end with a big blow-up, a self-made crisis that would require medical and sometimes legal intervention.

I’m clean today, mainly because the drugs were serving to make me suicidally depressed and were blocking the medication from being effective much at all. Drug abuse was costing me stability, and the depression and lack of chemical balance in my brain was causing insomnia yet again. I was on the verge of another crisis and I had a sort of mental wake up call that forced me to re-evaluate what I was doing with my life and how I was failing to take care of myself. The temptation of drugs is that I could turn off my emotions at will and knock myself out into that blissful sleep state that I so desperately desired. By the end, however, I just felt miserable, and the drugs no longer made the highs and especially the lows of my emotions something I could handle anymore. The insomnia was getting worse. I had to get honest with myself about what I was doing and why.

It’s been seven and a half months since I’ve been clean. Sleep is still a struggle. At least a few times a week I don’t fall asleep easily, sometimes I’m up very late and have a difficult day at work as a result. I’ve found a good combo of meds to manage the highs and lows of my mood, and luckily for me it still works. Sometimes someone with bipolar disorder has to change their medications, because after a while they stop working. The combo I’ve been on has worked for several years and my mood is better than it’s been in a long time now, since the medications are allowed to work and I’m not interfering with them by introducing other chemicals into my brain.

For me the biggest factor for dealing with bipolar disorder is accepting the seriousness of my condition and pushing past the denial and rationalizations for behavior harmful to my brain. I’m not normal and I never can be. I can’t safely abuse drugs and alcohol without risking total mental breakdown. I have to remind myself of this almost daily. With my history, I’m extremely lucky to be stable, housed, and employed. I could be living on the street or in an institution. If I didn’t have insurance to pay for my medications I’m not sure what I’d do or where I’d be. When something is wrong with my brain I have to take action to address it because ignoring it or blame shifting only serves to make it worse.