Wednesday, June 6, 2012

Insomniac: Gayle Greene

In the Winter of 2010, in my desperation to end my recent chronic insomnia, no doubt amplified by OCD "act now" compulsions, I frantically had my CPAP/OSA gear checked out to make sure it was still calibrated correctly. I felt like I just couldn't get enough air to breathe and sleep. Since I was comfortable wearing the CPAP mask after using it successfully for eight years, I was stumped, other than suspecting that the air pressure might need an adjustment. However I was assured by the sleep specialists that the machine was set correctly. I was by this time taking citalopram, a SSRI, for depression/anxiety/OCD, and unfortunately this med can contribute to insomnia as a side-effect, but I actually had suffered the insomnia before I started taking it. SSRIs can also take up to eight weeks before their theraputic effect is experienced.

I was prescribed the hypnotics Lunesta and Ambien to help, but they proved to be of limited use. I would only sleep, fitfully, for two to six hours, only to stumble out of bed after eight hours, already drained. I then tried the antidepressant trazodone (a serotonin modulator), that is often used "off-label" for insomnia, but it seemed to make my nose slam shut, which was no good for the CPAP machine. I couldn't focus enough to go to work, or do much of anything at all, and I suspect the Ambien then deepened my depression. In any case, I was suffering many very dark thoughts, and finally had to be admitted to Presbyterian Hospital in Dallas. Every night, I would try out a new "drug cocktail," and it took at least ten days to find the right mix. I would never have survived, if I hadn't been fortunate enough to have been admitted to the hospital. I was blessed that I had very supportive friends to reach out to. I had reached a crisis state of pure hopelessness. The winning cocktail turned out to be a combination of doxepine (a tricyclic antidepressant), lorazepam (a benzodiazepine), and olanzapine (an atypical anti-psychotic). Don't try this mix at home -- these are heavy-duty meds, but they were neccessary. I'm happy to say I've since weaned off the lorazepam and olanzapine, but not before socking on extra weight. That was the lesser of two evils.

Naturally, before my meltdown I read obsessively about insomnia, in the hopes of ending it as soon as possible. Gayle Greene's memoir/history/overview, Insomniac, was the best of the bunch. She is doing much to raise awareness about this terrible disorder.

Insomniac by Gayle Greene

"I can't work, I can't think, I can't connect with anyone anymore. . . . I mope through a day's work and haven't had a promotion in years. . . . It's like I'm being sucked dry, eaten away, swallowed up, coming unglued. . . . These are voices of a few of the tens of millions who suffer from chronic insomnia. In this revelatory book, Gayle Greene offers a uniquely comprehensive account of this devastating and little-understood condition. She has traveled the world in a quest for answers, interviewing neurologists, sleep researchers, doctors, psychotherapists, and insomniacs of all sorts. What comes of her extraordinary journey is an up-to-date account of what is known about insomnia, providing the information every insomniac needs to know to make intelligent choices among medications and therapies. Insomniac is at once a field guide through the hidden terrain inhabited by insomniacs and a book of consolations for anyone who has struggled with this affliction that has long been trivialized and neglected."

Editorial review from Publishers Weekly

"No one can describe a journey better than someone who's made the trip, and insomniac Greene's exploration of the disorder is both fascinating and disturbing. Many people, including doctors and insomniacs themselves, believe that sleeplessness is the patient's fault: too much caffeine and stress, irregular bedtimes, lack of exercise. In fact, no one knows what causes it, but the effects of insomnia are clear: as Greene, a professor of literature and women's studies at Scripps College, shows, sleep deprivation kills creativity, reduces levels of the hormones needed to repair cells and is directly linked to weight gain and memory loss, high blood pressure and diabetes. Insomniacs are usually referred to mental health practitioners or the growing number of sleep labs offering behavior modification or drugs (which, for Greene, have always buil[t] tolerance, and rapidly, necessitating ever-larger doses). This is a somewhat cranky book, Greene admits, and rightly so. You can't live with this problem as long as I have, you can't be blown off and written off as many times as I have, and not get cross. Supplementing her own experience with that of other chronic insomniacs and a look at the science of sleep, Greene offers an enjoyable and informative account that will provoke even readers who get their full eight hours a night."

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