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This last trip was a rough one. I had the worst sleep hangover one day, to the point where it was probably dangerous for me to be driving. I had fewer than four hours of sleep that night, and if I'd closed my eyes for a second during my two hour commute to an early appointment, I would have fallen asleep. I was also severely nauseated, couldn't eat or even drink coffee (!), and couldn't think straight for my first few awake hours. Changing time zones - although absolutely necessary for my work - does not agree with me. I have to find a solution.
When I can, I try to schedule a "catch up" day when I get home. That's what I'm doing today. Despite total exhaustion, I fell asleep at about 1:30am last night and woke up at 8:45am today. That's pretty normal, and even an earlier wake-up time than I expected. However, by 1:00pm I couldn't keep my eyes open again and I fell asleep on my couch for two more hours. It's almost 4:30 and I'm just starting to feel normal and focused and like maybe I can accomplish something today, although I'm not going to try anything more taxing than a blog post or some reading.
I'm curious to see what time I'll get tired tonight. I stopped taking the melatonin after my super-horrible sleep hangover day on the road because I'm afraid that it caused that awful morning. Getting fewer than four hours of sleep is one thing, feeling like I drank two bottles of tequila the night before is another. The only explanation I have is that it was the melatonin.
I'm debating whether or not to try it again, now that I'm home and have a relatively stable schedule for at least the next 10 days. I'm throwing some ideas around in my head...all I know is that something has to change. It just has to. I can't live like this or I will end up totally useless. I wonder how many homeless people have DSPS???
Thursday, February 12, 2009
I Missed My Calling
I'm standing in the emergency room of a hospital surrounded by frantic people. There's a guy on a gurney in front of me, and he's a mess. Bloody, broken, unconscious. I realize that everyone is looking at me and finally a nurse standing to my right says, "Tell us what to do." I look down and I realize that I'm wearing a white coat. Panic rises in my gut and all I can think is, "Why do I have this coat on??? I'm not a doctor!" I'm frozen. The nurse looks up at me, pleading and yet incredibly calm and centered. "If you don't do something, he's going to die." Still, all I can think is, "I've been studying sociology for years! I don't know what to do!!! None of that education and experience is helping me here at all!!!"
Then suddenly, I snap into action. I start doing things and telling other people to do things. I don't know how I know what to do, but somehow it's just there and I do all the right things. As someone wheels the patient away, the nurse puts her hand on my right shoulder. She says, "He's going to be fine. You did it. I'll go tell his family that he's okay and that you'll be right out to talk to them."
My eyes snap open, my heart is pounding, and in a panic my first thought is, "I should have gone to medical school!!"
This is my longest-running Burgermare, recurring regularly for the past 8 or 9 years. It's always the same. If I met the nurse on the street, I would recognize her. She has short brown hair, is in her late 40s or early 50s, and is a little bit shorter than I am. Sometimes she's wearing glasses, sometimes not. Sometimes her scrubs are light green, other times they're light blue. But her words to me are always exactly the same. "Tell us what to do." "He's going to be fine. You did it."
Growing up, my adult role models were not physicians. They were police officers, mechanics, and stay-at-home moms. College wasn't even on my radar until I took a few classes at a community college more for fun than anything else. When the counselor saw my grades and SAT scores, he asked me why I was there instead of at a top university? I had no answer. I hadn't known that was an option for me.
So I went. Later, my professors guided me toward advanced degrees in sociology. I did well in the sciences, but my interest there leaned toward marine biology. I also considered marine bio for graduate school, but ultimately the bulk of my social support was in the field of sociology and so I ended up here.
A few years into grad school, I started working with a professor who specialized in doctor/patient communication. As a research assistant working on his studies, I spent a lot of time in doctors' offices - days, weeks, sometimes months collecting data in the same office. I began to think that I would have made a really good doctor. The more I saw the mundane reality of their working world, the more I was sure that it would have been an excellent choice for me. When I began to learn about eastern medicine, I knew that an integrated practice was my calling.
But I got sidetracked. By that time, I was so deep into a PhD program and so deep in student loan debt that making that leap was impossible. And there was another thing.
Sleep.
Medical school is notoriously a trial of sleep deprivation. I was terrifed that I wouldn't be able to do it. I didn't even know that DSPS as such existed yet, but I knew that I'd been trying to wake up early for my entire life - and I'd failed. Miserably. I'd struggled through the few required 8am classes in grad school, but we were on the quarter system and I always knew that it was only for 10 weeks, and only two days a week. I struggled through my own dissertation research, which involved meeting parole agents before dawn. I struggled through the work that I was doing to support myself, begging for afternoon meetings and shifts.
Could I have struggled through medical school? I don't know. I was afraid to try. The risk seemed too great, since I would be dealing with human lives.
Looking back, I think I could have done it. If I'd changed course the minute that I realized it was a better path for me, I could have made it work somehow. I still do a lot of medical sociology as part of my job, and I've seen doctors who wake up at the crack of dawn and work until 7 or 8pm. However, I've also seen doctors who start at noon, see patients in the evening, and work until after midnight. I'd like to think I could have been one of them. I'd like to think that if I had known them earlier in my life, I would have been able to make it through the Sleep Deprivation Marathon of medical school, knowing that it wouldn't last forever.
This week, a cardiologist told me that sleep deprivation is one of the risk factors he thinks other physicians miss. He believes that regardless of whether it's caused by apnea, insomnia, or a circadian rhythm disorder, it has serious consequences for our health that we don't take seriously enough. I yearned to be on his end of things, helping patients understand that sleep disorders are, in fact, to be taken seriously. From the end that I am on, I was surprised and thrilled that there are doctors out there who do take it very seriously, and who want to help change societal perceptions around sleep.
People still tell me that it's not too late to go to medical school. But it is. Unless I win the lottery, it's too late. I couldn't even really afford graduate school, so I definitely can't afford a second round, even if I could somehow struggle through the early mornings.
What I'm doing now isn't a bad career path either. It works for me, and I continue to learn a lot about the practice of medicine from a sociological standpoint. I'm coming to terms with the fact that DSPS is one of the major factors that shapes my path in life - and that despite my best efforts, it will continue to do so. It's a tough pill to swallow.
Then suddenly, I snap into action. I start doing things and telling other people to do things. I don't know how I know what to do, but somehow it's just there and I do all the right things. As someone wheels the patient away, the nurse puts her hand on my right shoulder. She says, "He's going to be fine. You did it. I'll go tell his family that he's okay and that you'll be right out to talk to them."
My eyes snap open, my heart is pounding, and in a panic my first thought is, "I should have gone to medical school!!"
This is my longest-running Burgermare, recurring regularly for the past 8 or 9 years. It's always the same. If I met the nurse on the street, I would recognize her. She has short brown hair, is in her late 40s or early 50s, and is a little bit shorter than I am. Sometimes she's wearing glasses, sometimes not. Sometimes her scrubs are light green, other times they're light blue. But her words to me are always exactly the same. "Tell us what to do." "He's going to be fine. You did it."
Growing up, my adult role models were not physicians. They were police officers, mechanics, and stay-at-home moms. College wasn't even on my radar until I took a few classes at a community college more for fun than anything else. When the counselor saw my grades and SAT scores, he asked me why I was there instead of at a top university? I had no answer. I hadn't known that was an option for me.
So I went. Later, my professors guided me toward advanced degrees in sociology. I did well in the sciences, but my interest there leaned toward marine biology. I also considered marine bio for graduate school, but ultimately the bulk of my social support was in the field of sociology and so I ended up here.
A few years into grad school, I started working with a professor who specialized in doctor/patient communication. As a research assistant working on his studies, I spent a lot of time in doctors' offices - days, weeks, sometimes months collecting data in the same office. I began to think that I would have made a really good doctor. The more I saw the mundane reality of their working world, the more I was sure that it would have been an excellent choice for me. When I began to learn about eastern medicine, I knew that an integrated practice was my calling.
But I got sidetracked. By that time, I was so deep into a PhD program and so deep in student loan debt that making that leap was impossible. And there was another thing.
Sleep.
Medical school is notoriously a trial of sleep deprivation. I was terrifed that I wouldn't be able to do it. I didn't even know that DSPS as such existed yet, but I knew that I'd been trying to wake up early for my entire life - and I'd failed. Miserably. I'd struggled through the few required 8am classes in grad school, but we were on the quarter system and I always knew that it was only for 10 weeks, and only two days a week. I struggled through my own dissertation research, which involved meeting parole agents before dawn. I struggled through the work that I was doing to support myself, begging for afternoon meetings and shifts.
Could I have struggled through medical school? I don't know. I was afraid to try. The risk seemed too great, since I would be dealing with human lives.
Looking back, I think I could have done it. If I'd changed course the minute that I realized it was a better path for me, I could have made it work somehow. I still do a lot of medical sociology as part of my job, and I've seen doctors who wake up at the crack of dawn and work until 7 or 8pm. However, I've also seen doctors who start at noon, see patients in the evening, and work until after midnight. I'd like to think I could have been one of them. I'd like to think that if I had known them earlier in my life, I would have been able to make it through the Sleep Deprivation Marathon of medical school, knowing that it wouldn't last forever.
This week, a cardiologist told me that sleep deprivation is one of the risk factors he thinks other physicians miss. He believes that regardless of whether it's caused by apnea, insomnia, or a circadian rhythm disorder, it has serious consequences for our health that we don't take seriously enough. I yearned to be on his end of things, helping patients understand that sleep disorders are, in fact, to be taken seriously. From the end that I am on, I was surprised and thrilled that there are doctors out there who do take it very seriously, and who want to help change societal perceptions around sleep.
People still tell me that it's not too late to go to medical school. But it is. Unless I win the lottery, it's too late. I couldn't even really afford graduate school, so I definitely can't afford a second round, even if I could somehow struggle through the early mornings.
What I'm doing now isn't a bad career path either. It works for me, and I continue to learn a lot about the practice of medicine from a sociological standpoint. I'm coming to terms with the fact that DSPS is one of the major factors that shapes my path in life - and that despite my best efforts, it will continue to do so. It's a tough pill to swallow.
Saturday, February 7, 2009
What's the Definition of Insanity?
Doing the same thing over and over again and expecting a different result?
I'm insane. I had such high hopes that a different dosage/timing of melatonin would finally work. I am so disappointed.
Yesterday, my hopes were sky high! I took the .3mg dose at 5:30pm and could barely keep my eyes open by 8:30pm. Now, I wasn't entirely thrilled with this development. I was a little annoyed. I had things to do and I was so tired that I couldn't do them. However, I was also more than a bit excited. I'm leaving for Chicago tomorrow and NYC in a couple of weeks, and I thought maybe this was a chance to get on a more easterly schedule to make those trips easier.
So I sucked it up and went to bed. I was fast asleep by 9:00pm. The last time that happened was when I was climbing mountains all day. So far, so good.
In the morning, I opened my eyes. It was light, and I could hear my neighbors starting their day. The woman behind me was setting her kettle on the stove and Superman was bouncing a ball above my head. But it's Saturday...these are the noises that I usually hear around 9:00am on a Saturday. It should be much earlier than that!
I turn my head toward the clock - it's 8:50am. Instead of advancing my sleep cycle, I simply slept for 12 hours. I'm so frustrated that I just want to cry.
I give up. I'm at a loss. I don't know what else to do. I really don't.
I'm insane. I had such high hopes that a different dosage/timing of melatonin would finally work. I am so disappointed.
Yesterday, my hopes were sky high! I took the .3mg dose at 5:30pm and could barely keep my eyes open by 8:30pm. Now, I wasn't entirely thrilled with this development. I was a little annoyed. I had things to do and I was so tired that I couldn't do them. However, I was also more than a bit excited. I'm leaving for Chicago tomorrow and NYC in a couple of weeks, and I thought maybe this was a chance to get on a more easterly schedule to make those trips easier.
So I sucked it up and went to bed. I was fast asleep by 9:00pm. The last time that happened was when I was climbing mountains all day. So far, so good.
In the morning, I opened my eyes. It was light, and I could hear my neighbors starting their day. The woman behind me was setting her kettle on the stove and Superman was bouncing a ball above my head. But it's Saturday...these are the noises that I usually hear around 9:00am on a Saturday. It should be much earlier than that!
I turn my head toward the clock - it's 8:50am. Instead of advancing my sleep cycle, I simply slept for 12 hours. I'm so frustrated that I just want to cry.
I give up. I'm at a loss. I don't know what else to do. I really don't.
Thursday, February 5, 2009
Waking Up is not Getting Up
Nobody talks about this.
I'm starting to question what "awake" means, and I'm pretty sure it depends on who you are. Doctors define it one way. Our lark friends define it another. If you're like me, you find that it's virtually impossible to define, and it changes on a day-to-day basis.
So when someone asks me, "Is the melatonin therapy working?" I'm not quite sure how to answer. Waking up on melatonin is a very different experience from waking up naturally, or even from waking up to an alarm clock or to a screaming child upstairs.
Yeah, I'm getting to sleep a bit earlier and for the most part I've adjusted back to 1-9am - as long as I take the melatonin at the right time every single day. There's no room for error, no room for a late night out, no room for forgetting to take it while I'm out in the field or out on the town. I missed one day so far and that night it was right back to a 3:30am bedtime.
Other than that day, I've naturally been "awake" between 8:30 and 9am. Now you might think that's a good thing, that it's a "success." Well...think again.
What is "awake?" What does it feel like? I can't find words to describe it, and as I read through other people's thoughts and feelings about DSPS and listen to my interviews with fellow sufferers, I realize that I'm not the only one who can't quite express myself on this seemingly simple topic. We talk a lot about getting to sleep. We talk a lot about trying to wake up and not being able to wake up - but we don't talk about the process.
I long for those few days in my life that I wake up feeling rested and refreshed and ready to jump right out of bed. I know what that kind of awake feels like, but I can count those days on one hand. That's for my whole life. I think back on each one with awe and wonder and comb my brain for what made that morning different. I still don't have any answers.
When I wake up naturally, the sleep inertia is still pretty bad. Sometimes I wonder if that's a separate issue from DSPS entirely. I'm technically "awake." I know that I'm awake, although my brain is barely registering this fact. My actigraph showed increased tossing and turning movements during those times, sometimes more than an hour before I actually had the energy to get up and out of bed. Usually it's somewhere between half an hour and one hour, where I'm conscious - or more accurately, where I slip in and out of consciousness - but I can't actively tell my body to move in a focused way without a concerted effort. I have to concentrate hard on being awake because if I drop my attention for a second, I'm asleep again. When that happens, I'll sleep for about two more hours, way past my "natural" wake-up time. So I struggle hard in the morning to open my eyes and keep that from happening.
On melatonin, it's worse. Sleep hangovers every day. This morning, I was lying there struggling to get my eyes open. I felt like I was surrounded by a mist or a fog and as I actively focused my attention on becoming more conscious and aware I could actually feel it clearing around my face. I could feel the air hitting my skin, and a tingling feeling on my cheeks. I became aware of my breathing and of noises around me - but I still could not open my eyes. I could not move my arms. Was I "awake?"
As the "mist" cleared, I felt an accompanying sensation in my stomach - the morning nausea that so many of us experience. It felt intimately connected to the clearing - as I became aware of my own face and the fog clearing, I felt the nausea rising. Eventually, I was able to open my eyes and glance at the clock, where I saw it was 8:55am. I'd probably been "awake" in the sense of being able to have conscious thoughts for at least half an hour, but I was nowhere near "awake" in the sense of being able to move and get out of bed and function. I didn't get out of bed until 9:35. I wanted to, desperately, but I just...couldn't.
So is the melatonin really helping? Is it worth it? I downed a full pot of coffee before my 11:00am conference call and got through it just fine. Still, it was two and a half hours after I woke up and I was just beginning to feel something close to normal. Melatonin is a trade-off for me. Yes, I can technically wake up a couple of hours earlier with it than I can without it, but the fog still doesn't clear for those hours. Even after I drag myself out of bed, I'm sleepwalking in a sense, feeling sensations but not processing them, noticing things but not being truly aware of them.
Is that really "awake?" I just don't know.
I'm starting to question what "awake" means, and I'm pretty sure it depends on who you are. Doctors define it one way. Our lark friends define it another. If you're like me, you find that it's virtually impossible to define, and it changes on a day-to-day basis.
So when someone asks me, "Is the melatonin therapy working?" I'm not quite sure how to answer. Waking up on melatonin is a very different experience from waking up naturally, or even from waking up to an alarm clock or to a screaming child upstairs.
Yeah, I'm getting to sleep a bit earlier and for the most part I've adjusted back to 1-9am - as long as I take the melatonin at the right time every single day. There's no room for error, no room for a late night out, no room for forgetting to take it while I'm out in the field or out on the town. I missed one day so far and that night it was right back to a 3:30am bedtime.
Other than that day, I've naturally been "awake" between 8:30 and 9am. Now you might think that's a good thing, that it's a "success." Well...think again.
What is "awake?" What does it feel like? I can't find words to describe it, and as I read through other people's thoughts and feelings about DSPS and listen to my interviews with fellow sufferers, I realize that I'm not the only one who can't quite express myself on this seemingly simple topic. We talk a lot about getting to sleep. We talk a lot about trying to wake up and not being able to wake up - but we don't talk about the process.
I long for those few days in my life that I wake up feeling rested and refreshed and ready to jump right out of bed. I know what that kind of awake feels like, but I can count those days on one hand. That's for my whole life. I think back on each one with awe and wonder and comb my brain for what made that morning different. I still don't have any answers.
When I wake up naturally, the sleep inertia is still pretty bad. Sometimes I wonder if that's a separate issue from DSPS entirely. I'm technically "awake." I know that I'm awake, although my brain is barely registering this fact. My actigraph showed increased tossing and turning movements during those times, sometimes more than an hour before I actually had the energy to get up and out of bed. Usually it's somewhere between half an hour and one hour, where I'm conscious - or more accurately, where I slip in and out of consciousness - but I can't actively tell my body to move in a focused way without a concerted effort. I have to concentrate hard on being awake because if I drop my attention for a second, I'm asleep again. When that happens, I'll sleep for about two more hours, way past my "natural" wake-up time. So I struggle hard in the morning to open my eyes and keep that from happening.
On melatonin, it's worse. Sleep hangovers every day. This morning, I was lying there struggling to get my eyes open. I felt like I was surrounded by a mist or a fog and as I actively focused my attention on becoming more conscious and aware I could actually feel it clearing around my face. I could feel the air hitting my skin, and a tingling feeling on my cheeks. I became aware of my breathing and of noises around me - but I still could not open my eyes. I could not move my arms. Was I "awake?"
As the "mist" cleared, I felt an accompanying sensation in my stomach - the morning nausea that so many of us experience. It felt intimately connected to the clearing - as I became aware of my own face and the fog clearing, I felt the nausea rising. Eventually, I was able to open my eyes and glance at the clock, where I saw it was 8:55am. I'd probably been "awake" in the sense of being able to have conscious thoughts for at least half an hour, but I was nowhere near "awake" in the sense of being able to move and get out of bed and function. I didn't get out of bed until 9:35. I wanted to, desperately, but I just...couldn't.
So is the melatonin really helping? Is it worth it? I downed a full pot of coffee before my 11:00am conference call and got through it just fine. Still, it was two and a half hours after I woke up and I was just beginning to feel something close to normal. Melatonin is a trade-off for me. Yes, I can technically wake up a couple of hours earlier with it than I can without it, but the fog still doesn't clear for those hours. Even after I drag myself out of bed, I'm sleepwalking in a sense, feeling sensations but not processing them, noticing things but not being truly aware of them.
Is that really "awake?" I just don't know.
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