Advice on sleep deprivation

[maddison]

Hi Everyone!

I will try to make this brief!!

I'm really looking for advice on how seriously I need to be concerned for my friend.

(Long term mental health diagnosis that is being managed by treatment team in the community )

Over past few months he has developed symptoms, possibly similar to how I imagine bipolar disorder presents. (His treating team are aware)

My main issue or concern is that he goes several nights without sleep. He is deeply focused on his activity. I need to motivate & remind him to eat.

He is prescribed fairly strong sedative to help during these times, yet they have no effect.

Currently we are on day 2 (no sleep 2 nights). It generally lasts 3-4 nights. I have usually been calling triage on the 3rd night.

I am concerned because of the 4 day weekend ahead. His usual case manager will not be available.

I guess, I am asking - 'Is there something more I should be doing?'

I'm not sure how serious symptom this is considered to be. Has he been overlooked by the system? Or would this be considered a "managable in the community" type behaviour? - & what I'm doing (by contacting triage/case manager & providing information) is correct & enough.

Thankyou for reading. maddison xx 

[Youareworthy]

Hey Maddison, I’d love to give you some advice since I have also been in this situation! 

I can understand your concern for your friends situation, his sleeping deprivation seems to be escalating and this can be quite disruptive to his own healing of his condition. It does seem to be more on his behalf that he’s not communicating what’s happening with his mental health team. You are doing absolutely brilliantly with handling the situation and as much as I’d love to encourage you to keep it up, it can be rather straining on your mental health too. Please look after yourself, I know it can be hard since he is your friend and your thoughts are probably all over the place worrying about him, but you also need to place your own well-being first. It seems to be very distributive to your life too, which is a major concern on itself, and I hope you’re also seeking support for this. 

I would recommend having a serious conversation to him directly, I know you’ve probably already tried this but the more times you try the more likely it is to stick. He needs to be telling his team that his medication isn’t working, and keeping track of how long he isn’t sleeping, eating or doing any necessary self-care.

 
On your behalf, you are doing everything you can right now, and if anything you are going above and beyond to help him. But realistically, he needs to be putting in a little bit of work too. Since he recognises he hasn’t slept, that’s a good sign that he’s self aware of the situation but is probably very hesitant to talk about it. The next time you call the triage team, tell them to phone him directly and arrange some new temporary sleep medication so he can get the rest his body needs. After that, I’d hope that his case manager will be on top of providing him some more permanent ways to manage his sleep, since that is something that they are there for and need to do to support him.

 
This isn’t considered ‘manageable in the community’ type behaviour, it requires more direct 1-1 support and management, which it seems he has been lacking of for a while now. Yet again, as only his friend there is only so much you can do, he needs to step up and be encouraged to take a step to initiate the treatment and be honest about his life currently. This is a very serious symptom and even not sleeping for two days is a considerably unhealthy symptom, let alone not sleeping for even more than that. 

Again, you are doing the best you can with the resources you have right now, but please have a discussion with your friend directly (preferably in person) and to his case manager/triage team about handling this temporary situation. You also deserve support and it seems you have a very good relationship with the triage team, so it’s probably worthwhile asking for any programs or therapy you can attend to help you cope with this. They are there to also assist you, not just primarily your friend, and redirect you to the right path.

Please look after yourself, you are doing everything right and going above and beyond to help your friend. You are so supportive and brave for doing this, give yourself some credit for doing this and if you need to, continue trying to manage the support but be aware of the limitations that you have as his friend 

You are loved and valid for feeling this way and I hope you know that. 

[Former-Member]

Heya @maddison, this sounds super stressful! 

From the sounds of it, you're doing just about everything I can think of. And your planning ahead is a real strength in this situation. I guess my main question is does your friend want to sleep or staying awake because he is focussed on the activity? 

The main thing that comes to mind for me, are these podcast episodes on sleep. Not sure if you know the "Ologies" podcast, but in this one, the host interviews a sleep doctors.

The first episode could be useful as the doctor talks about how rest is just as valuable as sleep when we can't sleep. For example, being in a dark space with our eyes closed but not sleeping is still restful. It also has a lot of info on the effects of not-sleeping and the second ep has a lot of strategies for getting to sleep.

But I might also tag the other CGs to see if they have any ideas! @Anastasia  @AussieRecharger  @BPDSurvivor  @Faith-and-Hope  @HenryX  @jem80  @Judi9877  @NatureLover  @outlander  @Shaz51  @ShiningStar  @Snowie  @Hams  @wellwellwellnez  @Zoe7  @Aniela  @Boo13  @pinklollipop15  @Eve7 

[Former-Member]

@Youareworthy!!! What a stella first (?) post in the forums! So caring and understanding ❤️ 

Welcome to the forums ❤️ I hope you find it a really special community. I'm looking forward to getting to know you 😊 

[maddison]

Wow .wow...WOW!! @Youareworthy @ I agree with @Former-Member thankyou for this amazing response

Welcome to the forums! If this is your first post, I really hope you stick around.😊

You really covered all the aspects I'm experiencing. I think that's a great idea to start writing down & logging sleep etc. In the mayhem, it's easy to lose track. 

You have echoed my thoughts too - in that this is quite a serious problem that needs more intensive treatment... Thus why I feel apprehensive about the public hols. Getting him help is going to be next to impossible. It is only me and him here, & this issue is beyond my pay grade!

I love your idea about asking triage for a more effective medication. Honestly, they have been next to useless. Recently, they refused my request to encourage him to take meds we had here available in the home, due to the fact that the prescription was a couple months old. The lady at triage literally told me she was unable to 'enforce an old prescription '. (it was 2 months roughly! -maybe less) So inappropriate & ridiculous - it leaves me completely disillusioned when professionals behave this way.

Thankfully, he listened to me & took the meds in the end.

Anyway, that was few weeks/ month ago. We are basically still at the same point - yet I won't have any help for the next 4 days.

Thankyou for highlighting the importance of my own self care. I am certainly getting much better, & feel far less frazzled than I would have in the past. I appreciate the reminder to continue looking after myself. You really can't have too many of these reminders! 💜

@Former-Member @Youareworthy  I appreciate your advice so much & will check the podcast you mentioned.. Maybe for my own needs! The thing I seem to be having trouble expressing ( here in this post - & to health staff) is that, from what I'm observing there is an extreme inability to sleep. Perhaps if you can imagine a person who has taken illicit drugs (he hasn't). He flies around the house, doing random activities. He will lay down & try to rest, & then get up 10 mins later.

I have done my best explaining this to triage & his cm. In the past, triage response has been that ' there is not enough cause to escalate things further.' ( i.e assessment/hospitalisation)

I am generally always encouraged to call back if I feel like I need to. That helps somewhat, I guess!?

Thankyou again for your support. It certainly makes me feel better to express what I'm dealing with here. In general, I'm doing fine. I do feel worried that his sleep issues are not properly being recognised.

@Youareworthy I have discussed my concerns with him directly & exhaustively, & will continue to do so. The thing I like about keeping a log - is that it will also give him more awareness & it "might" encourage him to discuss with cm. He might not be avoiding - maybe not quite aware.

I was wondering, when you say that you have had lots of experience, is that personally, or as a carer? I guess it doesn't matter. Your reply is wonderfully supportive & helpful regardless! I guess I'm wondering how these 'manic' episodes feel & if anything helps to relax? It seems to happen as a wave that he has to ride. I feel sorry for him. I would hate not to be able to sleep. His mood is quite upbeat (part of manic phase?) The next 24-48hrs, his mood will decline severely.

I plan to encourage double dose of sedative meds tonight ( a previous triage nurse suggested this last week)

oh dear!

Thankyou again for your time & support @Former-Member @Youareworthy  

It's literally all I have, & I am so incredibly grateful ❤️

I am also superhuman strong!!😄 thx to a crappy life - don't worry about me - I am ok (& know how to say if I'm not) ❤️

You are loved and valid for feeling this way and I hope you know that.  thankyou xx

[maddison]

I can hear him snoring now. Thank goodness!!

[Youareworthy]

I am so so glad he’s sleeping now, he definitely needs it and the double dosage sounds like it might be more effective, he will just have to stick to the schedule of taking double and making sure he says this to his GP/mental health team

Triage teams are always quite hopeless with that, but their purpose is usually to help people in a crisis that are of immediate harm to themselves and/or others. I’ve found on multiple cases that they have told me in a crisis that they can’t do anything and to seek support from my psych team when my next appointment is, which is quite frustrating and very annoying. Unfortunately you have deal with a lot of those type of clinicians in the mental health system and it may discourage you, but just keep trying because one understanding person can change someone else’s life! 

The sleep tracking log is amazing, I personally have three sleep disorders on top of many mental illnesses and have watched my mother struggle with trying to deal with my sleep issues, I can go up to 5 days without sleep if I don’t take my medication so his situation sounds very familiar to me. Try your hardest to stick to the double dosage that was recommended over the long weekend and public holidays, it’s going to be a tricky ride but just know you always have here to update on the situation and seek some support and validation. If in doubt, you can also call any of the support hotlines (headspace, beyond blue, etc.) who can give you some great advice and strategies, and even pass through messages to his psych team in the process! 🙂 

I never want to alarm you, but his sleep problems aren’t being recognised properly and that’s not your fault whatsoever, that is on his treatment team and they are extremely unprofessional for not looking into it any further. Further assessment needs to be done to try and help this otherwise it’s only going to get gradually worse, and it’s their goal to make sure that doesn’t happen. Have you thought about recommending a different treatment team to him? I know what it’s like with my friends, it can become exhausting always having to bring the conversation up and them saying the same thing but never really doing any action towards it. But you are doing all you can, which is positive encouragement, and that’s exactly what he needs right now so he can be reinforced regularly to go through the process of self-awareness and realising he’s not going okay.

Do these ‘manic’ episodes that have erratic behaviour and an inability to sit still last long? Or does he go through these all through these moods interchangeably on and off through the week? I have BPD and can experience hyper periods where I am the exact same, they can last a few hours or even a day or two before fading off into a very low mood where I don’t get out of bed or do anything. Sometimes I can go through switches of these moods 9-10 times a week which is exhausting, so I can’t express how much empathy and respect I have for how much care you have for his moods.
Bipolar is typically categorised as manic episodes that last weeks, even months or years at a time followed by extremely low, depressive moods right afterwards, again these can last a long time and typically don’t happen all in one week (something to discuss further or do some trustworthy evidence based research into). I am not a professional obviously, I can only speak from experience, so I can’t make anything but an opinion and suggestion that might lead you to do more research and discuss with professionals. 

Also in terms of relaxation techniques, it’s a matter of a trial and error process, if you know a particular comfort show he has maybe recommend him watching that, but sometimes it’s best to let him ride the wave out which is very hard to watch but it will get better once he gets proper guided treatment. 

You are very welcome for this, you deserve all the support and love right now, you are doing incredible and I can tell you really do care for him so so much! That sure is my first post and I absolutely love sharing my own experiences and providing insights and advice to others, I will most definitely be sticking around 🙂 

I really do hope you’re taking care of yourself @maddison you need the rest too, I know worrying can also interrupt your sleep schedule and your mental health so please make sure you keep on top of that. You show a lot of courage and resilience which is a trait I really do admire, I wish I had a friend like you to help me through tough times xx 

[maddison]

❤️

Reading your reply made me emotional @Youareworthy 

I won't touch on the many amazing points you mentioned. It will take me too long! I might follow up in a future post. I want you to know that each word you wrote is acknowledged, & special to me.

You have a gift.

I'm really happy to read that you won't be going anywhere. You have so much to give to this community -& hopefully gain-as I have.

I'm almost at a loss for words, with how much you have been able to relate to what I'm going thru, & insights you could offer me from your own personal experience. You have provided me with tangible knowledge re: symptoms, that I was unaware of.

I don't know what else you could have possibly said that would have made me feel any more understood, & supported.

Kudos to you xx 

You are likely one of my many angels watching over for me.

Thankyou so much for taking the time to chat with me. You are valued & loved💜❤️

[maddison]

Thankyou also @Former-Member for mentioning the importance & benefits of rest.

I think I may have accidentally overlooked that, in my haste of reading. Oops.

It does make me feel better to know that laying in dark room & resting is providing him benefit.

I had been continually encouraging this - yet possibly may have given up due to not getting results of sleeping.

I know now, that it is worth continuing encouraging for the benefit of rest. Thankyou.

[Former-Member]

aww this thread is so lovely @maddison and @Youareworthy ❤️

How are you feeling about this info today @maddison? Any new developments last night?