azurelunatic: A pajama-clad small child uses a rainbow-striped cruciform parachute. From illustration of "Go the Fuck to Sleep". (insomnia)
Azure Jane Lunatic (Azz) 🌺 ([personal profile] azurelunatic) wrote2017-02-14 12:45 am

Sleep class!

So because not only do I have insomnia, I also suffer from it, the most-recent in the chain of moderately alarmed sleep-adjacent professionals (the neurologist at Deer Creek) referred me to the Improve Your Sleep! class, which has been eating my Monday evenings over the last month.

The main feature of this class, in the eyes of the neurologist and my counselor, has been the CBT aspect of it. Apparently the number one thing that cures insomnia is CBT. So everyone was hopeful. (I had specified to the neurologist that I would in fact be running anything suggested in the CBT past my Supervisor and my therapist. Which was a good call to have made.)

It turns out that when Guide Dog Aunt loaned me a book on sleep a few years ago, the one that pointed out that there was not in fact any moral value to any specific sleep schedule, and that instead of saying stuff like "I'm lazy because I sleep until noon", one should look at it in terms of "My most productive hours are in the evening, and I schedule my life in a way that suits my sleep schedule" -- that general tool of re-framing the guilt and fear around sleep is in fact the very CBT that this class relies on. So, unfortunately, the CBT that I had hoped would be new information was not, in fact, new information at all. The book specifically addressed Negative Sleep Thoughts. The class then expanded the concepts of re-framing runaway negative thought chains in a better light, which is also a Fishmum trick that I've been teaching my little fishies and my partner...

The other main leg of this class is meditation and the relaxation response. I believe that I can trace my habit of meditative breathing in particular to the summer when I read ... some Heinlein book or other ... and thought that taking up meditation would be a grand idea. The latest that could have been was 1996. Then I formally took up meditation (and learned all of the techniques discussed in the meditation unit of this class) in 2001-ish, when I went to DeVry to get a degree in Holistic Massage join a coven. So depending how you slice it, I've been familiar with, and practicing, meditation for anywhere from fifteen to twenty years.

The main new information I got out of the class, in fact, was that sleep-maintenance insomnia was recently discovered to be associated with a sleep-time body temperature that has not dropped as it ought to for that part of the night. And I do, in fact, routinely overheat while attempting to sleep. Which means that if I'm in bed and even slightly think that I might not get to sleep soonish, I should immediately go and get the ice pack, and not try to be a hero.

Also, low doses of sedating antidepressants are also used as sleep medications. The instructor was down on this practice, because antidepressants are only good for people with depression. FUNNY THING, THAT.

Pretty much all the rest of the class was review, and (due to my internets research) I was often in possession of more detailed information than the instructor. I came to feel that I could probably have taught the class myself, given the curriculum.

The first class was pleasant enough. I think there were about ten of us. One woman came in late, and borrowed a pen from me. We had a pleasant chat while she was waiting for her husband to pick her up. She's sleep-deprived to the point that she can't safely drive, and caretaking for her autistic son has done a number on her sleep schedule and ability to stay asleep.

I reviewed the materials in the packets for the four weeks. The second week, the cognitive re-framing, was going to be hard, since the materials blithely suggested that "most people" could get away with abbreviated amounts of sleep with nothing more terrible than a loss of creativity and a bad mood. Pro tip: when your patient reports suicidal ideation and impulses tied to as little as one night of abbreviated sleep while under stressful circumstances (and the current Republican administration is nothing if not stressful circumstances) telling the patient that everything is probably going to be okay if they blow sunshine up their own ass is life-threateningly bad advice. So I realized that I had better sit next to the door in case I had to step out of the room.

During the second class, the instructor was trying to impress upon us the way that a poorly timed nap can fuck up your sleep schedule pretty badly. My friend said that this was going to be a problem for her: you put her in the car (as a passenger) and she passes out pretty much instantly.

"It should be easy to stay awake in the car!" said the instructor.

"It's hard."

"Well, life is hard."

At this juncture, I decided that the most constructive action I could take was going to be going and sitting in the hall for a bit (and angrily texting my partner). I came back in after about five minutes.

Later in the evening, the instructor planned to lead us through more meditation/relaxation, to include the rest of the class period. I abruptly realized that I did not actually feel that making myself vulnerable to and in front of this instructor was a good idea, and grabbed my stuff and left the building.

In the third class, I sat by the door. (My friend did not show up for this class, or the following week.) When the meditation/relaxation section arrived, I popped both headphones in and proceeded to listen to podcasts, and only emerged when that bit was done. At the end of class, I asked the instructor about the bits in the next one, saying without explanation that I would not be taking part in the relaxation exercise, and would likely leave the room. He said when the long one would be, and there would be another short one later.

In the fourth class (tonight), I sat by the door, and took a chair with me when I popped out for the duration of the exercise. The instructor came and fetched me when it was done. And I did other things for the short one.

I did ask, this time, what he recommended to keep you awake when the sleep pressure is high but it's a bad time for a nap. And if there were resources on being a millennial and not having a whole house to work with in terms of keeping stress out of your bedroom. (Do something loud. And, probably, somewhere.) I asked about next steps. He recommended the meditation class, or the anxiety class. "That really doesn't seem to be a recommendation geared for someone who has been practicing meditation for fifteen years," I said, smiling aggressively.

He recommended tai chi.

"That's really rather along the same lines," I said, still smiling.

There was a class evaluation form, which asked about how much we learned from the class, and how helpful it was. It was ... not.

So I'll be asking my GP, my counselor, and my psychiatrist about next steps, then. Now that I've taken this miserable class so they'll take me seriously.
jesse_the_k: Pill Headed Stick Person (pill head)

[personal profile] jesse_the_k 2017-02-17 05:58 pm (UTC)(link)
I've been taking low-dose tricyclic antidepressants to help me sleep for years. Every three - four years I rotate to a new one.

Amtriptyline is super effective--I hated it the first time around because it creates dry mouth. But having taken both lithium and Wellbutrin, my default hydration is so high that I'm loving the Amtriptyline this time around. 30mg at dinner.

Sleepy at bedtime.