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.