Depression and Sleeplessness
Depression and Sleeplessness

As I indicated in my previous post about “Misunderstanding My Pain,” in hindsight there were many symptoms, diagnoses, etc. that probably seemed to indicate I had RLS and PLMD as early as my high school years. However, they were missed because they presented themselves as chronic tendinitis of both my patellas or other things easily associated with being a teenager, playing sports, etc.

Another one of those that in hindsight I think was hiding the truth: depression. I have probably been treated for depression a few times, but only remember officially being told and being prescribed medication for depression once. I was in my mid-20’s and struggling. I had up to three part-time jobs that still didn’t always take care of the bills, my career seemed to be stuck in neutral no matter how much I was sacrificing, and I was living alone (which was probably for the better) while most of my friends lives and careers were moving forward nicely. But the biggest problem was I couldn’t sleep. I could go days seemingly catching catnaps or not sleeping at all (I was sleeping, but 15-30 restless minutes at a time and never getting into any deep sleep).

I vividly remember one morning calling my parents (my dad is a doctor) around 6:30 or 7 in the morning because I knew they would be up. It felt like I hadn’t slept at all that night. I remember my mom jokingly saying, “what are you doing up this early?” And my weary response, “I haven’t fallen asleep.” She promptly handed the phone to my dad and our conversation lead to him making some other phone calls. Later that day, he told me to call a doctor at Johns Hopkins – I was most likely going to be treated for depression.

I will not ever say that treating me for depression was the wrong tactical move. If you can’t sleep and are struggling to function, you would be depressed as well. Like the knee problems, the depression was most likely real, but it wouldn’t necessarily answer the questions or solve the problems. It was more likely a symptom of the bigger problem.

AmbienI was put on medications like Ambien which certainly helped me get to sleep for a time. I met with the doctor usually once a week or once every other week. But as the treatment continued and my body got more and more used to the medications, I was starting to notice that while I was in better spirits, my sleep wasn’t necessarily improving. I could get to sleep sooner (thanks to the medication – especially the drowsy side effect), but my pain and discomfort and my restlessness wasn’t going away.

Eventually, I lost interest in being treated for depression. I stopped taking my medication (it was getting to the point of not working anyway). And I moved on. Things were improving career wise and I seemed to have a direction. But again… everything in hindsight seemed to be masking what was really going on.

When I look back on the last 25 years, I can’t tell you about any time where my sleep felt good. I can’t tell you any time where I could wake up and be ready to go. I never felt like I was 100%. That can wear on a person. That can make a person depressed.

But the kicker was that despite being treated for depression – I still wasn’t coming out of the fog. And that lead to what I later discovered was anxiety.

Now anyone who knows me will tell you: I am not an anxious person. I take things in stride, I adjust accordingly, I don’t let defeatist ideas take over my mind. Even if I do have some apprehension or am scared of something, I will do my best to put on a brave face and push through (though, there are limits). However, when it came to my bed, bedroom, and sleep… I clearly became anxious.

Sleep and Anxiety

This is why I have previously said one of my doctors diagnosed me with insomnia induced anxiety or anxiety induced insomnia – the chicken or the egg. It really is just that. I worry I won’t sleep and my inability to sleep causes me to worry. My bed has never been that sanctuary people talk about at the end of the day. I will lie around on a couch, floor, wherever and will come to bed when I absolutely have to. My room(s) has always been a mess, because I don’t want to spend time in that room.

But there is another side of that coin… the longer it takes me to go to sleep the more anxious I become that I won’t sleep and thus the more worried I get that I won’t get up when I need to.

My sleep issues have had a major affect on getting up when I need to the next day. I missed classes because I would sleep through alarms. I would be late for work or meetings because I hit the snooze button or in reality turned the alarm off. I would miss something because I was so tired I couldn’t even wake up.

Imagine you and I both go to bed at 11pm and have to be up at 7am. You go right to sleep and thus waking at 7am is no problem. However, I lie in bed for an hour, maybe two, or three before I might fall asleep (for varying reasons) so now my sleep window has been cut to five hours. Now add in the fact I haven’t been getting enough sleep in the first place along with a side of anxiety I won’t wake and we have a recipe for disaster. The alarm sounds at 7am and you are fully rested. I have barely slept (we haven’t talked about the fact I probably tossed and turned all night as well) and can barely function let alone realize I need to get up.

Two things happen in these occasions: I don’t sleep (or barely) in the first place making me very tired the next day or I sleep right through my alarm(s) and may be late or miss whatever I was supposed to get to in the first place.

You would be depressed, too, when all of this is adding up to challenging your career, social life, and well being.

I have found some techniques to solve parts of the sleep equation. I set multiple alarms and I set them far earlier than I need to get up (even though I end up getting up late anyway). I leave myself more of a buffer in the mornings and thanks to my medication to battle my RLS/PLMD and insomnia/anxiety, I have had less problems over time.

However, if I am in a new environment (i.e. hotel or place I am not familiar) or am roomed with someone other than my wife… it can be problematic. That’s why years ago my doctor basically wrote me a prescription that when I am on business trips, I am to sleep alone.

Being comfortable with sleep has always been a challenge and probably will not be one that goes away completely. And it all stems, I believe, in the fact that RLS and PLMD were silently keeping me up and causing all kinds of other problems.