The Essentiality of Sleep Through the Recovery of Depression

When I think of how important sleep is, I am reminded that sleep deprivation is often used as a form of torture. In Kelly Bulkily’s article titled, “Why Sleep Deprivation is Torture: Prolonged Sleep Deprivation is a Cruel and Useless Method of Interrogation”, he notes that, “The first signs of sleep deprivation are unpleasant feelings of fatigue, irritability, and difficulties concentrating.  Then come problems with reading and speaking clearly, poor judgment, lower body temperature, and a considerable increase in appetite.  If the deprivation continues, the worsening effects include disorientation, visual misperceptions, apathy, severe lethargy, and social withdrawal.” He goes on to say that, “One of the first symptoms of sleep deprivation in humans is a disordering of thought and bursts of irrationality.  Beyond 24 hours of deprivation people suffer huge drops in cognitive functions like accurate memory, coherent speech, and social competence. Eventually the victims suffer hallucinations and a total break with reality.”

It is clear from the depiction above, that decent sleep is an absolute necessity. Often times, when a new patient meets with a doctor regarding depression, sleep is the first issue they attempt to get under control. This is often done with the support of medication. Prescription sleep medication should only be taken upon consulting with your doctor, as it could interfere with other medication that one is taking and may have side effects.

In my case, I became overmedicated. When I entered a partial hospitalization program, I explained that I struggled falling asleep, but once asleep I could stay asleep. The psychiatrist added a prescription antihistamine to my regimen. He believed that the antihistamine would help me fall asleep (induce drowsiness) and the sleep medication that I was previously on would keep me asleep, as it had been doing.

For several weeks, the medication seemed to be just fine and I was sleeping well. However, eventually there were two separate evenings in which I had to get up in the middle of the night. On these two occasions, I experienced fainting spells. The first evening was when our daughter woke in the middle of the night and thought my wife and I were still awake. She went downstairs to the main floor of the house, accidentally setting off the house alarm. I shot out of bed and made it downstairs to the alarm panel. I quickly canceled the alarm and grabbed the phone to call the alarm company to ensure that it had properly been canceled. As I waited for them to answer, I collapsed suddenly to the ground. I came to, I believe a minute or so later, with my face inches from the bottom of the coat rack. Little did I know, that fall would give me a permanent shoulder injury that I still deal with today. After getting up, I walked about six feet, falling to the ground and fainting a second time. After coming to, I again got to my feet, started up the stairs banging off of the stairwell walls like a ping-pong ball, and fainted a third time, falling through the cracked-open door to my bedroom. By this time, my two oldest daughters were in the room with my wife.  I pulled myself up to the bed, lay down on my back, and told my wife I was just fine and needed some sleep. I was apparently as white as snow.

Since I serendipitously had to bring my daughter for a strep test the next day at Urgent Care, I decided I would mention my fainting spells. They checked me out, found nothing wrong, and asked me to call 911 if it happened again. Sure enough, two nights later, one of our two-year old twins was crying in the middle of the night. I got up to tend to Sam. I tried rubbing his back, singing to him (which understandably made him cry even louder), and rocking him. Nothing worked and he continued to kick at me. Getting frustrated, I turned to leave the room. Before I could take a step, I suddenly collapsed to the ground, fainting once again. This time, having fallen flat on my face, I ended up with a slightly bloody nose. My wife came quickly into the room when she heard the thud and attempted to wake me up for a good couple of minutes. After coming to and calling two family members who are doctors, my wife decided to contact 911. An ambulance arrived and two young EMTs were at my side taking my pulse and checking my vitals. After a short, bumpy ambulance ride through a Minnesota winter storm, I ended up in the Emergency Room (ER). I didn’t notice the sarcasm the ER doctor had used until I was walking back to my car. He had explained, “You don’t have to change your medications at all. All you’d have to worry about is death by bumping your head upon another fainting spell.” I quickly weaned off of the sleep medication.

Another possible side effect to be aware of with sleep medication is daytime drowsiness and confusion. It is my understanding that some of the sleep medication can build up in one’s system, making it difficult to wake up, causing drowsiness in the mornings, and adding to confusion. In my case, it was difficult for me to decipher whether some of the confusion and cognitive issues I was having were due to the medication or to the depression. Again, it’s important to take these medications under the consultation of a doctor and to let the doctor know of any possible side effects one may be having.

Some therapists believe that by treating insomnia alone through talk therapy, much of one’s depression may be cured. This type of talk therapy is called Cognitive Behavioral Therapy for Insomnia (CBT-I). According to the Mayo Clinic, “Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems” (Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills). The benefits of the CBT-I also seem to be long lasting. According to Colleen Carney, associate professor of psychology at Ryerson University in Toronto, “…those who successfully resolved their insomnia with cognitive-behavioral therapy were twice as likely to shake depression as well” (Healthline.com). Some of the techniques used in CBT-I include:

  • Stimulus control therapy
  • Sleep restriction
  • Sleep hygiene
  • Sleep environment improvement
  • Relaxation training
  • Remaining passively awake
  • Biofeedback

Typically, the therapist and patient would select a combination of some of the above-mentioned techniques to work on. There are many resources on the worldwide web that explain each of the above techniques in details.

Another way to get sleep under control without the use of medication or talk therapy is through better sleep hygiene. Although this is one of the possible techniques mentioned above that may be used in CBT-I, some people focus solely on improving their sleep hygiene on their own. Sleep hygiene involves changes in lifestyle that will increase your chances for a better night of sleep. Some of the common strategies to improve one’s sleep hygiene include:

  • Limit naps during the day. Naps should be no longer than twenty minutes per day and should be taken well before your evening bedtime.
  • Limit your caffeine intake. Do not consume caffeine after 2pm or so.
  • Have a relaxing nighttime ritual such as reading, taking a warm bath, meditating or drinking some warm tea prior to going to sleep.
  • Use the bed for sleep (and sex) only. Do not read or watch TV in the bed. It is important for your brain to make the connection that equates your bed to sleep.
  • Do not use screens (computers, smart phones, TV, etc) just prior to going to bed. These stimulate the brain and make it more difficult to fall asleep.
  • Exercise, but not immediately before going to bed. Exercising just prior to going to bed will increase your heart rate and, again, make it more challenging to fall asleep quickly.
  • Be sure the room is dark and comfortable for sleep.

Whether it is with sleep medication under direction of a doctor, talk therapy, or better sleep hygiene, the importance of sleep when working towards recovery from depression cannot be over-emphasized.

As with all of my posts, comments are welcomed and encouraged!

(Note: This post was originally published by Psych Central at the following link)

Giving a Voice to Men with Depression: New Podcast Coming Soon!

I have been a mental health advocate for just over one year. I’ve been blogging, tweeting, and speaking publicly for NAMI. I’ve been invited to attend a conference for online advocates of chronic illnesses, interviewed for podcasts and radio shows, and have been published or quoted in several publications.

Several months ago, I decided that I wanted to do more. I’m in the process of producing a new podcast: The Depression Files. I believe that men experience depression differently. There is often a belief (including by men themselves) that men need to just “be tough” or “pull themselves up by their bootstraps”. Men aren’t “supposed” to talk about their feelings. These stereotypes and this stigma make it more difficult for men to face their depression. Men tend to isolate themselves and are less likely to reach out for the help they need.

I hope that the podcast helps to educate those who have never experienced depression. Depression isn’t just feeling sad. In fact, sometimes sadness isn’t even the feeling at all. It’s been described by many as a feeling of numbness. Hear stories that give a first-hand perspective on how it feels to go through some of the very challenging times of depression and just how debilitating it can be.

I also hope that the podcast gives hope to those who may be struggling currently with depression. These are stories of hope. Stories of living with depression. Managing depression. Overcoming depression.

Please check out my podcast at allevin18.podbean.com. If you are a man who has dealt with depression and would like to be interviewed, please contact me at levi1818@yahoo.com.

 

An Open Letter to Anyone Experiencing Depression

Dear you,

In my case, depression seemed to come out of nowhere. I remember dropping off a good friend and saying to him, “Something’s going on. I just don’t feel like myself”. From that point on, things went downhill. I wasn’t communicating well with people, I was struggling to get sleep due to my racing mind, and I could barely eat. Any time I was out with my wife, when we returned home, I’d ask her if I had done alright (socially). I began to take medicine and see a therapist. Things continued to deteriorate. I would somehow manage to mask my depression at work, hold it together fairly well with my kids when I returned home, and eventually break down and have uncontrollable crying bouts in the evenings.

I went back to the psychiatrist to inform him of my suicidal thoughts. He increased the medication. My crying bouts increased and my suicidal thoughts became more detailed and pervasive, occurring throughout the day and even in a dream. I brought my wife and sister to my next psychiatrist appointment so that they could help communicate just how bad things had gotten and advocate for more support. I made the decision to take three weeks off of work and checked myself into a partial hospitalization program.

Please know that you will get better. I did and many, many others have. It takes work and effort. I would urge you to consider multiple strategies to work towards recovery, rather than relying on just one. Here are some of the suggestions I have for you to consider:

  • Contact one or two close friends and share with them what is going on. Ask for their support. This may just be requesting that they send you a hopeful text a couple of times a week or invite you out for breakfast or a coffee.
  • Reach out to family members (your parents, siblings, cousins, aunts and uncles, significant other, etc). Have trust that they will care about you and your situation.
  • Join a support group. The more narrow the focus, the better. While others may not be able to really understand what you’re going through and how it feels, these people will. This is a great way to receive support and to support others once you are feeling better. It’s instantly a group of trusted individuals who have been through similar challenges. I still attend a men’s depression support group twice a month.
  • Try to exercise, even if it means a short walk around the block in the beginning. Little by little increase the amount of time you’re exercising and/or the rigor.
  • Consider journaling. I journaled every night while going through my depression. At the end of every entry, I included a piece in which I wrote, “Today, in order to work towards my recovery, I…” Sometimes, it may have been a very short list of something quite simple, such as, “I drove my kids to school”. This is one way to recognize your small successes!
  • Consider medication and talk therapy. If you are trying talk therapy for the first time, do not give up on it if you do not like your therapist. You may need to “shop around” a bit, unfortunately, in order to find a therapist with whom you really click.
  • Try to get back into an old hobby or start a new one. While I was in the partial hospitalization program, I began to make pictures with pastels. I continue this new hobby and share it with my children. I also started to play the guitar.

These are just a few ideas to help you begin to move in the right direction. I believe the more strategies you utilize, the quicker the recovery. It’s critical that you seek out help.

Too many people mask their depression and many begin to self-medicate. Reach out for the help you need. Accept the help. Make the effort necessary to recover. I know that is easier said than done, I’ve been there.

Small steps. You will get there. You will recover. You’re not alone!

With compassion,

Al


The letter above was included in “The Recovery Letters: Addressed to People Experiencing Depression”, Edited by James Withey and Olivia Sagan (2017), p. 93.

This is an incredible book of hope for those currently suffering from depression. There are many more letters much more brilliant than mine. As author Gwyneth Lewis describes, “This book will save lives…”

I want to thank James Withey and Olivia Sagan for including my letter and for creating such a powerful, inspirational book!

You can order your copy by searching Amazon. The following two links are for Amazon US & Amazon UK. For additional information on the book, you can email James Withey directly at therecoveryletters@yahoo.co.uk.

The Catch-22 of Depression

One of the most challenging pieces of dealing with depression is the Catch-22. Everything one needs to do in order to overcome (or work towards the recovery of) depression is compromised by the very symptoms causing the depression.

Here are several examples. In order to recover from depression, one should…

  1. Eat a healthy diet, yet many people are unable to eat (or overeat) due to the depression.
  2. Exercise regularly, yet depression often takes away one’s energy.
  3. Socialize, yet many of those suffering from depression tend to isolate themselves.
  4. Attempt to get a good night of sleep, yet many with depression struggle with getting enough sleep.
  5. Enjoy their hobbies, yet most people with depression tend to lose interest in their hobbies.
  6. Get outside for fresh air and sunlight, yet many times those with depression are also faced with anxiety that tends to keep them inside their home.
  7. Monitor and stop negative thinking, yet many with depression ruminate and see only the negative side of things, even when there may not realistically be a negative side.

While the purpose of this post is to acknowledge that recovery from depression can be very challenging, it’s essential to maintain hope. Depression is treatable! Reach out for support. Connect with trusted loved ones. Acknowledge small successes! It takes time and effort, but you will recover!

Please see my post titled, “Tips for Dealing with Depression” for more suggestions on how to work towards recovery. If you are attempting to support someone else with depression, I would recommend my post titled, “Supporting One with Depression“, where I offer differentiated tips for supporting a loved one, a close friend, or an acquaintance.

I would like to credit the incredibly informative book, “Coping with Depression: From Catch-22 to Hope” by Dr. Jon G. Allen for many of the ideas in this post.

As always, I welcome and encourage comments to this post. Thank you!

 

A Conference for Online Advocates of Chronic Illnesses

I feel incredibly lucky to have been invited to a conference in Chicago for online advocates of chronic illnesses: HealtheVoices. Approximately three days prior to the deadline to apply, I received a message in LinkedIn. At first, I had wondered if it was an automatically-generated message that went out as a huge message blast for advertising purposes. However, after reading it a second time, it certainly sounded a bit personalized. A Janssen employee, Kristina Chang, had contacted me directly to apply, as this was their third year in a row of the HealtheVoices conference and they hoped to increase the number of advocates representing mental health. She offered to answer any questions I had by phone.

I decided to take Kristina up on her offer and called her directly. I was able to learn a great deal more about the conference through this conversation. I was a bit skeptical, at first, learning that Janssen was a pharmaceutical company. However, she explained that this is Janssen’s way of giving back to the community they serve and that Janssen would not be marketing to the advocates. I decided to apply. I found out a few weeks later that I had been accepted. All expenses paid by Janssen. I was thrilled and really didn’t know what to expect.

The conference was primarily structured by advocates themselves, with great support (not only financially) from Janssen and Tonic Life Communications. The conference was very well organized. The diverse needs of the advocates attending, many of whom were living with the illness for which they were advocating, were well accommodated.

There were 106 advocates from 30 different states and at least four different countries. The amount of energy at the conference was palpable! I was so privileged to be at a conference with such caring, passionate, and inspiring advocates! I quickly realized that these advocates were not only advocating for an illness, but for so much more; racial equity, poverty, gender equity, and social justice, to name just a few.

There were sessions that included a panel of advocates who shared advocacy strategies and answered questions. There were sessions on tips for blogging, working with the media and engaging legislators. Youtube and Facebook representatives presented on how to maximize their tools as a way to further our advocacy. Two well-known Youtube advocates that were highlighted in the presentation (therapist and mental health advocate, Kati Morton and psoriasis advocate, Huy Ngo)  just happened to be attending the conference. At that moment, I felt as though I was surrounded by celebrities. It confirmed my thoughts; that I was privileged to be a part of a group of passionate people who advocate at a very high level.

Upon returning, I have now created a Facebook page.  I have to admit, one advocate was so amused that I had no Facebook page, that she snapped a shot of me and Tweeted it out. If that’s not incentive to create a Facebook page, I’m not sure what is! I have also registered with a couple of organizations that I had learned about to help expand my advocacy work.

I want to thank all of the the amazing advocates who were a part of the conference. Participating in a conference with them was incredibly inspiring and empowering! I want to thank Janssen for creating such an amazing conference that allows the online advocates to meet in person, learn together, and share ideas. I also want to thank TonicLC for being caring supporters and organizers who helped create such a smooth-running conference. Finally, I want to thank those organizations who sponsored the event and made it all possible! I hope to be invited back next year!

As always, I welcome and encourage comments to this post and any other!

Note: Janssen Global Services paid for my travel expenses for the conference. All thoughts and opinions expressed here are my own.

My Thoughts on the Word “Stigma”

I have recently heard of the idea of getting away from the word “Stigma” when speaking about mental health. There are various articles that speak directly towards eliminating the word from the conversations altogether. For example, the article titled, “The Word Stigma Should Not Be Used in Mental Health Campaigns”. In this article, the author makes the case that “The focus of our efforts should be upon society and the perpetrators of this discrimination, not the subjects of it. If we accept the concepts of parity of esteem, then we should describe not stigma, but rather bigotry, hatred, unlawful and unjust discrimination.”

I prefer the definition offered by Kristalyn Salters-Pedneault, Ph.D., “Stigma is a perceived negative attribute that causes someone to devalue or think less of the whole person.” in an article titled, “What is Stigma?

In my opinion, the stigma is the negative feelings that some have regarding mental illnesses.  When one mentions that they have depression, bipolar, schizophrenia, or another mental illness, the stigma is what causes people to take a step back. The stigma causes people to begin to whisper when they discuss a mental illness. Another example of stigma is when someone tells a person who is suffering from depression to “Just go for a jog” or “Watch a funny movie”. This minimizes the serious and often times debilitating nature of the illness.  Stigma also creates shame and/or fear in people and often times prevents them from seeking the support they need.

The stigma, I believe, is what leads to the discrimination and bigotry and, yes, this certainly needs to be addressed as well. The discrimination and bigotry are the actions one takes towards a person living with a mental illness. For example, an employer not hiring a prospective employee because the employer discovers that the person has a history of depression. Another example would be a landlord choosing not to rent to someone due to the fact that they discover the possible tenant lives with schizophrenia or bipolar disorder.

In summary, I do not believe that we need to stop using the word “stigma” in our conversations around mental health. I believe that both the stigma and the discrimination/bigotry need to be addressed. If we are able to minimize or even eliminate the stigma, we would see much less of the discrimination. We need to continue to talk about mental illnesses, share our stories of living with a mental illness, and help educate others. These are a few of the ways that we can help end the stigma…and the discrimination.

As with all of my posts, I welcome and encourage comments. Thank you!

I’m “Depressed!” – A Poem

The weather outside is depressing.
I failed my test…I’m so depressed.
My soccer game got rained out…how depressing!
Really? REALLY?!?

I couldn’t get out of bed.
I lost 60 pounds because I couldn’t eat.
I was only able to sleep four hours for an entire week, yet laid in bed for hours throughout the day.
I couldn’t do the simplest of household chores.
I got lost driving to a neighbor’s house three blocks away.
I couldn’t concentrate.
I couldn’t read.
I couldn’t watch TV.
I lost all interest in my hobbies.
I couldn’t socialize, although I’ve always been outgoing.
I had delusional thoughts.
Finally, I had thoughts of suicide that I couldn’t escape and eventually a detailed plan of taking my own life.

And you’re depressed about the weather? Your failed test? Your soccer game getting rained out?
Really? REALLY?!?