Stress and Sleep, Part 2

Today Linda is back to cover part 2 of her 3 articles on stress and sleep. Today she will discuss why sleep is so important and its relationship with stress. Remember yesterday, she talked about the sleep cycle and some technical aspects of how the brain processes it. While this information is a little technical, it’s important stuff to know so that you can then learn how to regulate your sleep. If you have any questions or comments to share, I’m sure Linda would love to help me address them for you! Hope you enjoy. 

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Why do we need sleep?

As you saw in the explanation of the sleep stages above, the simplest way to think about why we need sleep is in terms of healing and repair. It’s almost as though getting a good night’s sleep is akin to regularly taking your car into the mechanic for servicing. While you are sleeping your brain becomes a mechanic, tinkering with processes that are important during your day-to-day functioning and require fine-tuning or repair.

For example, any damage to your heart or blood vessels is repaired while you are sleeping. Hormone production, metabolism, cognitive functioning and immune function are all processes that rely on a healthy night’s sleep, every night. Physical growth and the stimulation of new brain cells and neural networks take place while you sleep.

Sleep is actually a very involved process. If you are interested in understanding more about the sleep cycle I came across one of the most detailed and interesting descriptions here:

https://science.education.nih.gov/supplements/nih3/sleep/guide/info-sleep.htm

How does stress impact on sleep?

In an earlier post titled ‘Stress Hormones’ you learned about a very important part of your brain directly responsible for many of the processes in your body including your immune functioning, your mood levels and emotions, your digestion, your energy production and storage, your sexuality, and the stress response. This system is known as the hypothalamo-pituitary-adrenal axis, or HPA axis. You may like to go back to this post and check out the diagram explaining the functioning of the HPA axis.

Sleep only occurs when the HPA axis is calm and inactive. So when the HPA axis is active, as is the case with stress, sleep will be affected. And conversely, when you don’t sleep well, the HPA axis becomes activated. And on it goes.

When the HPA axis has been activated through ongoing stress, you are also more likely to wake either through the night or first thing in the morning feeling anxious. I have met many people who have described waking in the middle of the night or early mornings with panic-attacks, and a disturbed sleep cycle could explain why.

So already we are beginning to see how disturbed sleep can trap you into a negative cycle: you don’t sleep well, you feel stressed. When you feel stressed, your biological clock becomes disrupted and you struggle to sleep well.

This process occurs in part because when we don’t get enough sleep (less than 6.5 hours) our body increases it’s production and release of the stress hormone cortisol. Remember from previous posts that when you are experiencing ongoing stress your body is already pumping out excessive levels of this toxic substance. Usually in the early evening cortisol is decreasing however with chronic sleep loss these levels will elevate resulting in a chain reaction including increased insulin resistance and decreased glucose tolerance.

Sleep is actually really important for regulating appetite and food intake. One of the hormones, letpin, which is responsible for appetite suppression, actually decreases with a lack of sleep. At the same time the body increases it’s production of ghrelin, a peptide that stimulates appetite. This means that when we experience disturbed sleep our appetite actually increases and we are more likely to eat larger amounts of food than what we would normally need to get through a day. We are also more likely to crave foods that are high in carbohydrates. Increased cortisol makes you store fat in your tummy, your neck and your face, so if you are eating more carbohydrates you are more likely to gain weight. A spare tire belly is a good indicator of stress, and for many of us it creates further stress as we begin worrying about our weight gain.

Sleep deprivation has also been related to impaired glucose tolerance and insulin resistance. If you find yourself waking between 1am and 3am, a common feature of stress, it may be because your body is not using glucose properly and is signaling that you need to re-fuel already. This is why having a snack prior to bed can be helpful.

Even if you are young and relatively healthy, these hormonal changes can leave you in a pre-diabetic state following less than one week of sleep deprivation. This is an alarmingly short time frame! At the moment we are seeing an increase in sleep deprivation, an increase in diabetes, and an increase in Alzhiemer’s disease, which in some research circles has been labeled diabetes type 3.

Disturbed sleep can also leave you with confusion, impaired memory, headaches, impaired judgment and decision making ability, increased irritability, clumsiness, hallucinations, seizures, and even mania.

With ongoing stress and sleep disturbance your adrenal functioning may become impaired and this can be a factor in conditions like fibromyalgia, hypothyroidism, chronic fatigue syndrome, Cushing syndrome, arthritis, depression and premature menopause. Scary stuff! So what can you do about it?

Hang around and check out Tuesday’s blog post to learn how you can improve your sleep. As you can see, when you are stressed sleep is really the first step in attempting to help your system to down-regulate.

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Linda is an AHPRA registered psychologist and relationship counsellor with offices located on the Gold Coast. She has worked in mental health since 1994. Since that time, following a long and often trying journey, particularly given that she had not completed secondary school, she achieved a Bachelor of Arts in Psychology, a Diploma of Counselling, a Graduate Diploma of Adult Education and a Post Graduate Diploma of Psychology. Linda now enjoys specializing in helping couples to learn how to value their best asset, enabling people suffering from dementia to move forward in their lives, and supporting people who have experienced work-place injury in their recovery. She also has a passion for assisting people to heal from stress, anxiety and depression.

Linda values openness, authenticity, and acceptance in her work as a psychologist. She is a big believer in the power of the mind and recognizes that in many instances it is the activity within our minds that contributes to our psychological distress. Linda views the brain as an amazingly powerful organ: she is passionate about understanding how the brain functions and what each of us can do to maximize the brains potential.

You can find out more about Linda at www.eastqldcounselling.com.au.

Stress and Mental Wellness

I’ve had thoughts running through my head about what I wanted to talk about for this post. I think the message I want to get across to you all is about how you can either support your mental wellness, or allow stress to overwhelm you and ultimately reduce your sense of wellness.

I think the first thing we need to do though, is to understand what we’re aiming for when we use the word “wellness”.

What does “mental wellness” mean to you? Is it the same as what it means for other people in your life?

As much as I’d like it to be as simple as referring to the dictionary, as we have for other definitions in this series, I’m not convinced it’s that easy. I think the definition of mental wellness is different for everyone.

For me, I think it overlaps and is impacted by our physical wellness. I certainly feel better if I don’t have any physical illnesses or injuries! And I know that my mental and emotional states are linked, for better or worse! I actually describe my mental wellness using my emotions. How can they not be linked, right?!

The first words that come into my mind to describe mental wellness are centred, calm & peace.

When my mind is chaotic, when I have a lot of stuff to get through, when I don’t know how I’ll manage it, and when I feel pressured, isolated and alone, it is much harder for me to call myself mentally well.

When my mind is well, I function well. I’m able to get up in the morning and I’ll want to face the day. I’ll be excited to go into work and do the job I love. I’ll look forward to interacting with clients, colleagues, friends and family. I’ll be motivated to do the things I need to do, even if they aren’t things I’m particularly excited about. I mean, who really gets excited about doing the dishes or doing paperwork? Not me!

And I’ll have the energy to do them. Energy is important, and if you don’t have it, it’s a sure sign that you’re probably stressed. I mean, there’s being tired at the end of a busy day, but when it’s that deep, bone weary fatigue that persists day after day and doesn’t lift, you may need to look deeper. And one of the first places to look is at your stress.

Back to wellness … My mind will be clear. I’ll be able to access my creativity. I’ll be able to solve problems. And I won’t feel particularly anxious or stressed. I’ll feel cheerful, will be able to appreciate and laugh at jokes and I’ll feel grateful and blessed to have my life, even if it’s not always smooth sailing.

So how do I get this feeling? Even though I’m not always good at it, and I’m a work in progress (aren’t we all), I get it by looking after myself. By recognising and acknowledging the signs of stress my body gives me (check back next week for a post on that).

These are some of the things I use:

• Eating healthily
• Regular movement (I don’t always go hard – look out for a post on this too)
• Regular time out (me time) doing things I love away from work
• Mindfulness
• Time with friends
• Journaling
• Plenty of rest
• “switch-off” time
• Pampering time (getting my hair done etc)
• Regular therapy appointments (while debriefing with someone objective is awesome for clearing my head and getting really clear on what’s important to me, I’m also including medical therapies here. For me these are with my General Practitioner, kinesiologist, acupuncturist, massage therapist etc.

I find that when I do these practices regularly and make my wellness a priority above everyone else in my life (including family and clients), I maintain my mental wellness. Which results in so much more to give to the important people in my life.

Do you make regular time to take care of yourself? I’d love to hear about it in the comments below!

Stress and mental illness

I think most people believe that stress and mental illness are separate entities. The truth is, they are inextricably linked.

Stress can impact on an already diagnosed condition, or it can also be the ultimate cause of specific mental health conditions.

For example, research on Borderline Personality Disorder (BPD), Dissociative Identity Disorder (DID) and Post Traumatic Stress Disorder (PTSD) states they often result from trauma. DID is the newest name for what used to be called Multiple Personality Disorder, which is where the brain separates, or dissociates, from yourself to protect your brain and body from the pain of trauma (usually severe abuse in this case). Research has found that many people diagnosed with BPD also often have a history of abuse in their childhood. There are some things we just don’t need to remember. And PTSD is obviously labelled PTSD for a reason.

If you’re interested in reading a little more on some of these conditions, check out the articles we published in January when we did a focus on mental health. You’ll find factual articles explaining specific conditions as well as some of our readers sharing their experiences with us. readers, Tegan and Kaye, shared their experiences with BPD. You’ll find them all if you search in the archives for January 2014.

On the other side of the coin, when you already have a diagnosis, such as with depression and anxiety, stress can make the condition harder to treat. It’s much more difficult to manage anxiety when your amygdala is being activated repeatedly. In fact, anxiety comes from this repeated switching on of the stress response. When you worry about stuff there is an element of fear that something will go wrong, which triggers our inbuilt survival mechanism. One of my colleagues also wrote a guest post for us back in January. In it she discussed how anxiety works. Note how Sam talks about the stress response and those pesky saber-toothed tigers.

One of the most important things to note for stress and mental illness is that with the help from your professional support team, it may be possible to manage your condition more effectively by using some simple techniques to down-regulate the response. Check out our previous posts over the last few days on Stress and the Triune Brain, Stress and the Amygdala, Stress and Trauma, and the down-regulation of stress. They will give you a good idea of how this response works and how you can help manage it.

On Saturday we’ll talk about stress and breathing, where a colleague and friend of mine will take you through simple breathing practices that can help.

Please remember that while these exercises can be of benefit, always use the guidance of your professional mental health support team. I’d encourage you to show them this post to give them an idea of what we’ve discussed.

Reaching for the Light

This was posted on Facebook on August 13 by Kat Lambert and in my opinion it needs to be shared. Widely. It especially needs to be seen by those that live with depression and thoughts of suicide. It’s a long post so you might like to grab a cuppa and settle in. And it’s confronting, so be prepared.

If you experience depression and suicidal thoughts yourself, or have someone close to you that does, please pay attention. These are not things to be played with. They are serious and people need support to get through it! If you’re concerned about yourself or a loved one please reach out. Treatment is available! Either contact your mental health professional or if in crisis after hours, please call Lifeline on 13 1114 from anywhere in Australia.

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I was somewhat reluctant to post this. Not because it’s something I am hesitant to share, but because a lot of other people are posting similar posts. Then I remembered the point of my post, being about breaking the stigma so people feel comfortable asking for the help they need to save their lives.

Obviously the suicide of Robin Williams has taken the world by surprise. How can this hilarious, wonderful human being, who has lit up our faces in lounge rooms and cinemas across the world, and made us laugh so hard that the tears have rolled down our face, have been in such a dark, depressing place that the only way out was for him to take his own life?

And that’s just it. Depression, actually mental illness in general, affects people from all walks of life. Mental illness does not discriminate. Even those that seem the happiest, those that have the ability to light up the room with their enthusiasm, and those that seem to have it all can be fighting their own battles beyond their exterior facade.

Suicide is alarmingly, one of the highest causes of death in the world. Yet, unlike cancer, heart disease, SIDS, and other common illnesses where we raise awareness and we do everything we bloody well can to help our loved ones and the population in general, suicide is swept under the carpet.

Suicide is the “unknown”. People are scared of what they don’t understand. It’s easier to pretend it never happened, or to note the death of a loved one as “sudden” or “unexpected”. Because, God forbid, if you drop that “S” word into the conversation, guaranteed there’s always someone that has an opinion about it. So, on top of the guilt you already feel for not realising that your loved one was in such a horrible place, the guilt and the “what ifs” that run through your mind CONSTANTLY, you need to pretend like your son, your brother, your mother, your sister, died some other way, because otherwise people will judge you, and they’ll judge that family member, that friend, that you loved so dearly and couldn’t save. They’ll judge them for being weak, they’ll judge them for being selfish… And neither of these statements are true. It takes a fuckload of courage to step off that bridge, to pull that trigger, to swallow those pills, knowing that this will be the last time you take a breath, that you’ll never see your loved ones again, that once this has been done, it can not be undone. Once you’ve pulled that trigger it’s all over. Your decision is final.

Suicide is selfish. Are you fucking kidding me? Suicide is anything BUT selfish. Firstly, unless you’ve been in a place where you have not been able to see a way out, unless you’ve been in a place where nothing looks to ever get better, unless you’ve been in a place where you TRULY believe that your family would be less burdened if you weren’t around, then do NOT make assumptions that suicide is selfish.

How about instead of making ridiculous assumptions, we listen? We REALLY listen. Instead of judging people who constantly think about it, instead of judging those who’ve tried it before and failed, instead of making assumptions that these people are just screaming for attention… JUST LISTEN.

Listen to the people that have been there before, listen to those who have lost loved ones, listen to those who right this moment, need someone to listen. Listen to those who need someone, anyone, to tell them that life will get better. Someone to tell them that they are worth it, and that regardless of what they believe, the world would not be the same without them in it. Someone to hold them and tell them it is okay to NOT be okay.

And this is where the system fails. There are a very small amount of people in your life that you’ll feel comfortable opening up to when you’re in this state of mind. And even then, the information you give them is a lot less intense than those emotions, those thoughts that are running through your head. Then the guilt comes. “I’ve just burdened them with my problems. They have their own issues to deal with and I’ve just dumped all of my garbage on them. Maybe they’ll be better off without me. It’s not fair that I keep burdening them over and over again. At least if I’m gone, they won’t have to deal with the burden again and again. Sure they’ll be upset for a small while, but once the initial grieving to deal with my death is over, they’ll go back to their normal lives, and won’t have to worry about their crazy sister, daughter, friend. And I won’t have to feel this pain any more.”

I wish I could say that I’d never had thoughts like that. I wish I could say that I’d never even contemplated taking my own life. But I can’t. I have had thoughts like that, for many years at a time. And there was a time where it felt like suicide was my only option. I became ridiculously close to losing my life, and on more than one occasion.

Seeking help wasn’t always an option. The ironic thing is that if you present at Emergency telling them that you don’t trust yourself to control your suicidal urges at the moment, they’ll shrug it off and tell you that you’re just looking for attention, and to take these sedatives, go home and sleep it off. That courage that you worked up for the previous three hours has been crushed in a matter of seconds. That last hope of help you managed to reach out for, has been thrown in your face. And right then, you make that decision that if you can’t go to a health professional for help, clearly you can’t get help anywhere. The drugs they give you to take home may assist you in sleeping off this period of inability to give in to the urges to take your own life. But next time, and most times, there is a next time, you think about taking yourself to Emergency, you think about reaching out for help, but then you remember last time. You remember the shame you were made to feel, those feelings of little importance, and judgment. So instead of reaching out your hand for help, you reach out your hand for that bottle of pills, for that gun, for that rope, and you truly believe that this is your only way out of the hell that exists inside your head.

Then, after all this, if you’re lucky enough, you’ll end up in Emergency. You’ll be faced with those same nurses and doctors who made you feel ashamed because of your thoughts and feelings. Those who judged you and continue to judge you, those who turned you away, because your illness wasn’t real, and there were patients who NEEDED this service more than you did. If you thought that they’d understand now and things would change, think again. Now you’re the idiot that tried to kill herself when all the other people in Emergency are fighting for their lives. That patient next to you has been in a car crash, and is not expected to last the night. And here you are, distracting them from attempting to save the life of someone who doesn’t want to die. At that moment, the moment you notice their disgust, the moment you feel the shame that has been forced upon you, you make a decision that next time, you won’t fail and you won’t end up back here.

And that is where the problem lies. In our society, even though the stigma around depression has greatly decreased, suicide is still so much, a taboo subject. Clearly, like any illness, there are varying levels of symptoms, and whilst telling your friends that you’ve been depressed, and haven’t been able to eat and sleep is a fine conversation to have, if you dare mention that “S” word, if you dare mention how bad it is for you and how much suicide crosses your mind in a day, prepare to be judged. If you mention that the reason you can’t sleep at night, is because you can’t stop thinking of ending your life. The reason you can’t eat, is because you feel physically sick from the constant suicidal thoughts running through your mind. If you dare mention these things, you’ll be labelled as an attention seeker who is exaggerating your illness. You’ll be made to feel shame, on top of everything else you’re already feeling. And as such, any attempts to reach out for help, will be no more.

Sure, we can just continue to pretend that suicide doesn’t happen. We can pretend that nobody thinks about it. And that there’s nothing we can do to stop people anyway. But where’s that going to get us? Where will we be in 20, 50, 100 years’ time? At exactly the same place we are now. At the exact same fucking place where it is not okay to reach out for help. At the exact same fucking place where we constantly lose loved ones to something that could have been prevented. At the exact same fucking place.

So why don’t we do something about it? I don’t believe human kind can all be so stupid to believe that the current way is working. Talking about suicide doesn’t make people decide to attempt suicide, any more that talking about cancer gives people cancer. Talking about cancer, allows people to look out for the signs, and limit the severity if they notice them. Talking about suicide will do the exact same. Talking about suicide will bring it out of the shadows. Talking about suicide will mean that the person consumed with suicidal thoughts and feelings won’t feel ashamed about talking about it. That the person in this state, won’t feel ashamed to reach out for the help they so desperately need. Talking about suicide will mean that the stigma will be reduced, and when your mother, your child, your dad, your best friend, get to a point where they don’t think they can go on any longer, they will be able to reach out for help. In that split second, the fact that they can reach out for help without feeling ashamed, will save their life. In that split second, that very fact, will save you from heartache of losing someone you love so much and never understanding why. That split second, will save you from feeling such guilt and wondering if there was something you could have done differently, wondering why you didn’t figure out how bad it was for them, wondering “if only” for the rest of your life.

I’m not going to make out it’s an easy task, let’s face it, this is huge. This is massive. This is going to take a tremendous amount of funding. The Government is going to have to step it up a notch so that people can afford help. The Government would have to ensure that help was available to those in need, as so often, too often, patients are turned away due to a lack of available beds. But isn’t it worth a try?

Keep turning your back on suicide, and sweeping it under the carpet if you like, but what you’re really doing is turning your back on loved ones and judging, dismissing their feelings. I’m not telling you have to change your way of thinking, all I’m saying is, at some stage in your life, you’re likely to have a close friend or family member take their life, or at least attempt it, and in that moment, I want you to remember the decision you made right now, to keep this under the carpet. The decision you’re making, which means that your friend and family member hasn’t been able to source the help they need.

Who cares for the carers?

People with mental illness usually have a support team around them. Psychologists, psychiatrists, mental health nurses, social workers, general practitioners. People in mental health organisations such as the Richmond Fellowship (this link is QLD but you can google other states). People handing out medications and people providing emotional support. For the most part, these people do fabulous work in paving the way to wellness.

But there is a whole other population that often gets overlooked. The family and friends. Husbands, wives, sons, daughters, mothers, fathers. The carers. They are often excluded from treatment due to “confidentiality”. How do carers help monitor medications if they don’t have accurate information about which prescriptions to fill or how many tablets are needed? How do they help regulate moods if they aren’t up to speed on which strategies have been used in therapy? And that also means they are unable to provide feedback to give the professional team a full picture of what is happening for their loved one. While I can’t speak for all carers, I know that the ones I have spoken to genuinely want to help support the road to wellness. And they want to respect personal space and privacy.

During periods of illness, carers are often confronted with some pretty tough stuff. Major mood swings. Irrational demands. Thought processes that aren’t based in reality. An inability to reason. Violence; to self and others. Hospital visits. Self-harm. Suicide attempts. Manipulation. Sometimes even homicidal tendencies. And they are often in the middle of the fray, caught up in the maelstrom of chaos.

Chaos

Watching the people they love most in the world go through these experiences is heartbreaking. You watch your spouse with depression stay in bed day after day, week after week. You know that they are in pain and you try everything you know to help them. Encouragement, tough love, praise, cajoling, bringing friends in. You try talking to the doctors but you don’t get anywhere because they can’t talk back. You take over the running of the household, managing the children, cooking, cleaning. And you listen to your husband or wife talk about their inner pain and how much better off you and the children would be without him or her in it. You feel helpless and scared. What if they kill themselves? You wonder what else you can do to help. You don’t always understand why they can’t get themselves out of bed and rejoin the family. You feel lonely because the partner you knew isn’t there anymore. You feel alone because you don’t have your best friend to bounce things off. And you feel hopeless and helpless because the professional team won’t talk to you and tell you what you can do to help. Not to mention feeling guilty, fearful, resentful (of the illness), and a whole host of other emotions.

If you are a carer and can relate to this, please understand. You are not alone. There are hundreds of thousands, or even millions of people with mental illness, and each of them very likely has a group of family and friends around them, feeling exactly the same way you do. That is a lot of people feeling like you.

Exhausted. Stressed. Alone. Afraid. Confused. Helpless. Guilty. Isolated.

That is a lot of stress to deal with. And when you feel it for long periods of time, it is really important that you take care of yourself. Some very simple strategies can make a big difference in how you well you bounce back from the stresses and ultimately in the quality of your life.

When you’re looking at specific strategies there is one thing to keep in mind. Given the amount of stress most carers experience, sometimes thinking about doing extra can be overwhelming. So keep things really simple and you’ll be able to incorporate some of them into your normal routine. Try these:

• Take 3-5 long, slow deep breaths. Try to focus on slowing your breaths down and smoothing them out. This will get some oxygen into your brain and help you think more clearly.
• Pamper yourself. Take a bath, paint your nails, get a massage. This helps you relax your muscles and allows those stress hormones to dissipate.
• Surround yourself with nature. Visit a garden, sit under a tree, get your hands dirty with soil. This will help ground you and release the stress.
• Slow your brain down. Meditate, do yoga, or simply sit on your own for a while and breathe.
• Do something you absolutely love.
• Laugh.
• Connect with other people. Often speaking with other carers can help you realise you aren’t in this on your own and give you a chance to pick some brains about strategies that others have used successfully.
• Talk to someone. Sometimes seeing a professional can help you sort out the jumble in your head and give you some direction.

Australia has a network of carers organisations in each state that provide support for carers. They offer a variety of services, including access to support groups, workshops and counselling. They can also link you in with other services you may need. You can find details on each state’s organisation here, or call 1800 242 636 from anywhere in Australia. Some other countries also have carers organisations, including the UK and USA. Other support organisations in Australia include ARAFMI and COPMI (for the kids).

 

Dementia

When people think about dementia they usually (accurately) think about memory loss, forgetfulness and not recognising others, particularly family members. What most people aren’t aware of is that dementia is classified on the DSM. If you remember from our very first post in this focus month on mental health, the Diagnostic and Statistical Manual is a system for classifying different mental illnesses. So, this means that dementia is a mental health issue.

Dementia can be a complex and confusing illness. Most people know of two illnesses, Dementia and Alzheimer’s, and use the two titles interchangeably. However, they are different. The simplest way of thinking about it is that Alzheimer’s is a type of dementia. This website from a Gold Coast Psychologist shows a youtube video on the essential differences.

So what actually is Dementia? According to this site, dementia is:

“a collection of symptoms that are caused by disorders affecting the brain. It is not one specific disease. Dementia affects thinking, behaviour and the ability to perform everyday tasks. Brain function is affected enough to interfere with the person’s normal social or working life.”

That covers a pretty wide scope!

The early warning signs of the disease are:

• Progressive and frequent memory loss
• Confusion
• Personality change
• Apathy and withdrawal
• Loss of ability to perform everyday tasks

But, these symptoms don’t necessarily mean it is dementia. They could be caused by a number of things, including other neurological disorders and brain tumours. So it is very important to get a proper medical assessment from a qualified professional.

Some of the symptoms common to people who are further along in the illness are:

• Wandering
• Random noises
• Irritability
• Verbal and physical abuse
• Incontinence (both with bladder and bowel), sometimes including smearing of faeces
• Depression
• Hoarding (collecting random items or objects, including those that most would consider useless)
• Repetitive behaviours
• Anxiety or aggression
• Agitation
• Hallucinations, paranoia and delusions
• Inappropriate or offensive behaviours
• Sundowning (becoming restless, particularly in the evening)

Each of these may cover a variety of symptoms under one particular category. One of the most important things to remember is that every person with a type of dementia is different. One person with the disease may show a completely different set of behaviours to the next person. There are specific strategies that can be used to manage category and the Alzheimer’s Australia website has fact sheets on them.

To describe specific behavioural disturbances, strategies to deal with them and how best to treat the dementias would not only take forever, but would also be very complex and long. I was sent an article that covers a lot of that information so thought I would share it with you. It is an academic article with an American focus and is quite technical and lengthy, but it gives really good information. If you would like anything in the article clarified, please seek the advice from either a dementia specialist or a doctor skilled in the illness.

If you have a loved one experiencing these kinds of disturbances it can be very tough to cope with. Often, as one of the closest people to the person with the disease, the behaviour can easily be directed toward you. When you face constant aggression or the need to settle anxiety, or even managing frequent wandering, it can send your emotions into turmoil and your energy levels spiraling downwards. You can feel guilty, overwhelmed, like you aren’t coping, and you can blame yourself for being unable to control the behaviour. All of these emotions are a natural response to the situation. I work with family carers on a daily basis and often see the impacts of caring for someone with dementia. It is very important that you seek support. In Australia there is a network of carers organisations around the country that offer free counselling services along with more practical assistance. You can find contact details for them on our resources page. If you are in a different country, you may also find assistance from a similar organisation. I am aware that the UK and USA have carers organisations. You can probably find them using google. If searching in the USA, try using the term “caregiver”. There are also often dementia specific organisations that offer support and information.

 

Leonie’s journey with Bipolar

It’s been several days since the last post was published on Kate’s life with Bipolar Disorder. Leonie has the same diagnosis and the other day she spent some time telling me of her experiences. Leonie’s story is one of suffering and sadness. And it is also one of strength, perseverance and triumph. She has taken her illness and the darkness it produced, and has found a way to use a variety of strategies and to create the light of her life. As always, if reading Leonie’s story triggers your own illness, please speak with your mental health professional or call Lifeline on 13 1114.

Leonie was first diagnosed with depression in 2003 and was prescribed an antidepressant. This led to a psychotic manic episode, which was followed by a period in hospital a month or two later. Even though she was heavily sedated and experiencing delusions, she clearly remembers the moment she left the doctor’s office after hearing him say the phrase “it seems likely you have bipolar”.

When she shared the diagnosis with a close friend from her early university days, she was told, “hindsight is 20/20”. Other friends and family agreed. Leonie had been living with bipolar since she was a teenager. Fast forward to 2003 and much of her life had masked the illness.

Leonie gave birth to a son in 1998 and a daughter in 2001. In September 2001, when planes hit the World Trade Centre in New York on 9/11, her daughter was two months old. Leonie remembers her prevailing and repetitive thought was, “how could I have brought my baby into such a brutal world?” Her general practitioner realises now that she was living with post natal depression at the time. In fact, she lived with it following the birth of both children.

With friends living in the state next to the World Trade Centre, and a 2 month old baby, 9/11 hit Leonie hard. Her existing depression led to her spiraling further into the illness.

Not quite that simple, Leonie’s transformation has taken many years

She returned to work part-time at the beginning of 2002 and found it very stressful. She ended up on indefinite long service leave. She felt unsupported, confused and lost.

Then, in January 2003, when her daughter was 18 months old, she looked up to the air conditioning duct in her house to see flames. She got herself and the children out and by the time the fire brigade arrived smoke was billowing from every orifice of the house. While most of the damage was confined to the roof cavity, the rug where the children were sitting when the flames were first seen was burnt by a molten air conditioning vent that had fallen. Leonie became fearful of staying in the house, and also fearful of leaving it at the same time. How much turmoil and confusion she must have been feeling at that time!

While Leonie was taking a shower one day in June 2003 she distinctly remembers not being able to work out why she was in there or knowing what to do next. She couldn’t work out how to turn off the water or grab a towel. She managed to call a friend, who gave her instructions to “hang up, don’t move and pick up the phone when it rings”, after promising to help. Together they dressed and breakfasted the children and took them to day care. They made a doctor’s appointment to see her General Practitioner and went with her friend’s support a couple of days later. Leonie was diagnosed with depression and prescribed Zoloft, an antidepressant. Within a month Leonie experienced psychosis, which is apparently a common result when that type of antidepressant is prescribed to someone with bipolar.

The 5 years between 2003 and 2008 were very bleak for Leonie. She spent most of the time severely depressed, with a few severe manic episodes. Christmas 2008 was very bleak. A few months earlier Leonie experienced a manic episode involving some friends, which affected their friendship in a negative way. Whilst attending the Christmas assembly at her children’s school she experienced a full-blown panic attack. She felt like the worst mother in the world and completely demoralised.

Leonie began thinking about suicide as an option so her family would no longer have to feel the shame she felt she brought on them. She felt they would be better off without her. Even though her husband and mother knew she was low, she hid the extent of it from them.

By this time her file at her mental health centre was an inch thick. Between 2003 and January 2009 she felt like the mental health professionals came through a revolving door.

Bottom: 2008, Top: 2013

The day that produced the turning point came when she saw one specific psychiatrist in that very long line of professionals. She walked in the door at her lowest ever point and was asked to tell her story yet again. The thought of rehashing all the pain and suffering was unbearable. Two minutes in, the psych was on the phone asking for a bed in the closest inpatient unit.

Leonie was in hospital for a month so that her new doctor could observe her closely as he fine tuned her medication. She felt lucky that she had finally found the right fit with a mental health professional. He was intuitive and understood her well.

She was out of hospital another month before another manic episode hit as a result of coming out of such a low. Bordering on psychotic again, she ended up in the emergency room with police hovering for most of the day while waiting on a bed in the inpatient unit. For another month, her doctor once again monitored her closely as he readjusted her medications. Leonie remains on these same medications to this day.

Career wise, traveling back in time briefly, in about 2005/6, Leonie was working 2 days a week as a teacher. She struggled because she was so depressed. Despite her then psychologist strongly suggesting that she submit a medical retirement, she resisted. The thought broke her heart. In a job that she had previously loved, she felt that she was unfit to do that work forever. But she couldn’t bring herself to submit the paperwork.

Leonie’s doctor discharged her from hospital at the end of May 2008. She experienced one minor depressive episode which lasted approximately a week. At that point she participated in her second, 10-week mindfulness course. By October of that same year she was once again doing 2-3 days of casual teaching each week. She chose her schools carefully as she made these tentative steps, but felt like she had her life back.

The entire year of 2009 saw her regularly working 3-5 days per week (at various schools). In the final term one school invited her to work 3 days a week for the rest of the year. In consultation with her team of professionals and close family, by October she decided to go back to full-time work.

At the beginning of 2010 she began her new job, a position she retains today. At first she didn’t tell anyone at her work about her illness due to feelings of shame and fear of judgement. But after she felt she had proven her wellness, she received incredible support from her boss.

Other than one minor and short-live depressive episode in 2012, which included anxiety attacks, she has been free of mood swings. While she doesn’t consider herself “cured”, and she will be on medications for the rest of her life, her condition is now successfully being managed. She utilises a team of professionals.

The joy after conquering a long-held fear of going down a huge water slide

Psychiatrist, Psychologist, General Practitioner. She combines medications with regular mindfulness training and sessions with her psychologist. She has made significant changes to her lifestyle by exercising and eating healthily. She now gets adequate sleep after discovering that the lack of it contributed to her manic episodes.

Leonie also calls on the support of close family, colleagues and friends. She feels blessed to be a part of a wonderful circle of social support. She now knows, thanks to this amazing support, that she no longer needs to keep the secret and shame.

Leonie feels that the key to beginning her path to wellness was to find that one professional that she could really connect with.

Christmas 2013 and Leonie’s new way of being

Bipolar – The Rollercoaster

Please join us and help me welcome Kate to The Mindset Effect! She shares her experiences in living with Bipolar Disorder. As always, if Kate’s story triggers your own illness, please either see your mental health professional or call Lifeline on 13 1114 for immediate support.

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Living with Bi-Polar is like riding a roller coaster – blindfolded! You never quite know what is coming next and both the ride up and the ride down are equally scary – though for different reasons. On the ride up, well it’s a much better feeling then the ride down, but I just never know when I’ll flip over and start my next descent. Also, out of nowhere every now and again there is a sharp and unexpected turn or the serene hope of a plateau where life just rolls along for a while. The ride down though is always hell. You never know just how low you’ll go or how long you’ll be down there and the sense of being out of control is terrifying some days.

 The first time I truly knew something was not right was about 12 years ago now. I was sitting on my back steps, sobbing so hard I could barely breathe and my flatmate sat beside me, put her arm around me and said she could not understand; I’d been so happy just a few moments before. And I realised I had been and I literally could not explain why I was now crying my heart out.

The mood swings are the most well-known symptom and the roller coaster analogy is obvious there. Sometimes, usually in the low times, these mood swings can occur several times a day as I talk myself out of panic attacks, force myself to get out of bed and try desperately to distract myself from negative self-talk by something more fun, such as painting with my small child or walking my dog along the beach. Then, just for a few moments, sometimes an hour, even on the darkest days, I am truly conscious of a sense of peace, self-worth and activity of which I can be proud. This is on the bad days. The days when I will go and have a shower five, six, ten times a day so I can cry without my child hearing me. Days when I can only force myself to eat something because my child is looking at me, waiting for me to eat too, and it tastes like ash in my mouth. Days when I force myself to get out bed and the idea of dressing is so agonising I just put on the dirty clothes from yesterday (and the day before, and the day before that – I have been known to wear the same clothes for about a week before my partner would literally hide them and put something different on the floor where I’d dropped my dirty ones the night before), and pull my hair into a ponytail.

Then we flip to the mania – the “up” side of the roller coaster. On these days I will be up two or three hours before I need to be, living off adrenalin with very little sleep. By the time my child and partner wake I will have scrubbed the kitchen, showered, shaved, changed outfits half a dozen times until I am in just the right colours for the day, done my make-up, blow-dried my hair, made fancy lunches and been through half a dozen cook books to find something “exquisite” for dinner. I will spend all day in bursts of activity, rapidly moving from one to another with the attention span of a gnat. My child and I will paint, make up a show, play with the building blocks, go swimming, play the Wii, bake cookies, paint again, play with other toys, kick a ball around or play on the swings, until the child throws a massive tantrum and I realise I have run the poor mite ragged all day, totally forgotten to let them nap and there has been no actual meal but just snacks as I rush from one thing to another.

Other days I will shop all day, spending money we should be spending on bills and scheming on how to either hide it from my partner or justify why it was “necessary”. I will spend hours making a three-course meal only to throw it out because one part was not quite perfect and start again on a totally different set of recipes. Strangely enough I have come to recognise these as obsessive behaviours. I tell myself a good mother stimulates a child. Or a savvy woman enjoys shopping for bargains. Or a good wife presents her husband with a good meal when he gets home from a hard day at work. I get an idea in my head and just run with it to the absolute extreme.

Over the years I have often found myself in conversation with myself – this little objective part of me that seems to sit just above my head and questions my actions. In the past I have tried to explain, excuse or escape from its questions and other times I have just yelled at it shut-up, there is no reason, it just is.

With the help of some good Cognitive Behavioural Therapy I have learnt to recognise and listen to that little voice – it is usually the voice of reason, alerting me to unreasonable behaviours, depressive or manic. I have learnt some great coping techniques and some ways to challenge and divert my negative self-talk. I have accepted I will be medicated for the rest of my life and I have become far more spiritual in my search for ‘sanity’ or peace with myself.

It has not happened over-night. In fact there have been some pretty awful times in the last 12 years, but these days I am pretty happy in my skin. I have come to accept that mental illness is actually a lot like physical illness – no-one chooses to be sick, and medication really does help. Attitude is a huge factor in coping as well. To deny, denigrate or despise myself is not helpful.

To accept, challenge and celebrate myself is.

These days, when I don’t want to get out of bed or clean my teeth, cause really they’re just going to get dirty again and who cares? I remind myself that I care. I care about me. I engage in some positive self-talk, I set myself small achievable goals and I remind myself that “this too shall pass”. On days when I am up at 4am and have enough energy to run the New York marathon twice, I drop anchor and breathe, I notice five things and consciously slow myself down. Then I pull out a list of projects I’ve been thinking about, pick a couple and use the energy I have in positive ways – after all, this too shall pass.

And really, that’s the message – this too shall pass. Both good and bad are only passing moments and I do the best I can with them and let them go. I am who I am and, strangely enough, I have learnt that is all I have to be.

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Kate is a mother who is doing her best to parent her child whilst caring for herself through this illness. She sometimes faces the daily challenges of this rollercoaster ride difficult but usually finds peace by walking along the beach and connecting with the water.

The 101 of Bipolar Disorder

Bipolar Disorder is the new version of what used to be referred to as Manic Depression. As the name suggests, it has two states that essentially are opposite in nature; Mania and Depression. The word “bipolar” basically means two poles. Or two opposite states of being. When we think of poles we might think of the north and south poles of the earth, or the poles of a magnet. A person with this illness will cycle between being manic or depressive. The shift from “high” to “low” could happen quickly or slowly. From just a few hours, up to a few days, usually. Sometimes the depression (particularly) could last several months.

Let’s tackle Depression first. If you need a reminder, see our last post on depression and Debbie’s experiences. The major features of depression are a low mood that lasts a long time. It’s often very difficult to get out of bed in the morning, you end up sleeping most of the day and still feel tired, and you avoid many social activities due to very low energy levels. It’s very common to have suicidal thoughts as well. Depression is probably one of the most common and well-known mental illnesses, with 1 in 5 people in Australia experiencing it in their life time.

Mania looks very different. Rather than sleeping for much of the day and avoiding social situations, people in the manic phase will spend most of their time awake. They will be super productive and believe they can do absolutely anything. They might start tackling one task and get distracted by another and transfer their attention to that, leaving the first incomplete. If this happens a number of times in quick succession, you might imagine that a lot of stuff can be left undone! One of the keys about getting lost in this kind of “productiveness” is that a lot of the time it’s not productive at all. One might start washing all the dirty clothes, but in reality the clothes being pulled out don’t actually need washing. Or the dishes don’t need cleaning. So the house could end up rather chaotic. Mania may also include disorganized, racing thoughts which often lead to rapid speech.

Sometimes people in a manic phase may convince themselves that they need the next big thing from the stores. So they purchase expensive products (bags, shoes, clothing, electrical appliances and so on) that they never use. Or they may convince themselves that gambling is the answer and end up with a problem with that.

Severe manic episodes could result in some psychotic symptoms such as hearing voices and hallucinations. Or even the false beliefs of some kind of super human ability.

There are two types of bipolar disorder – 1 and 2. You can find more on the differences at this site. Essentially, people with bipolar 1 experience what I have described above, and people with bipolar 2 have less severe manic episodes called hypomania.

The causes of bipolar are not well-known. Family history is said to play a part, as do environmental factors. Sometimes significant life events can be a factor for people who have a predisposition (family history) to it. Drug and alcohol abuse may trigger bipolar episodes in people who already have it.

Like many mental health conditions, people with bipolar respond well to specific medications, some kind of psychotherapy such as working with a psychologist, and lifestyle changes such as healthy nutrition, exercise and limiting alcohol.

Tomorrow I will publish the experiences of someone with bipolar disorder. This lady is a parent and works hard to balance her illness so she can be the best parent possible to her young child.

 

Emma’s experience with OCD

I’d like to introduce you to Emma. She does her best to parent her beautiful children while living with OCD. She copes with constant obsessions and compulsions every day. Hopefully her experiences will resonate with some of you. Please remember that if you are dealing with similar situations you may benefit from some support from a mental health professional. If anything in Emma’s experiences triggers you, please consider calling Lifeline for a chat on 13 1114.

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When my psychiatrist first suggested I might have OCD, I laughed. Of course not! “People with OCD don’t know the things they do are crazy, that’s why they do them,” I told him. “I’m fully aware that these things I do are crazy, I’m just not sure why I can’t stop doing them.”

In my mind, OCD was Adrian Monk, obsessed with hand-washing and germs and totally oblivious to the fact that he’s completely batshit crazy.

And me? I just have a bit of a thing for even numbers and I’m fussy about how I hang the laundry. Eccentricities. Quirks. Not a disorder.

It wasn’t until the psychiatrist pointed out just how much time these little ‘quirks’  (or as he called them ‘rituals’) take out of my day, and how much of the in-between time I spend feeling anxious about them, that I began to concede that he might be right. In fact, OCD is by definition egodystonic – sufferers are well aware that their actions are irrational and that awareness is the basis for a lot of the anxiety that comes with it. The hand-washing and obsessive cleanliness? A common symptom but not definitive.

When my OCD it was at its worst, I spent most of my waking hours either performing rituals (that’s the compulsive part), or thinking about performing them (that’s the obsessive part). I couldn’t have the volume on my television or radio set to an odd number. I couldn’t take my baby out of the bath unless the digital clock above the bench where I bathed her read an even number. If I arrived home and the clock in the car was on an odd number, I’d pull over to the side of the road just outside my driveway and wait for them to tick over to an even number. When I did the groceries, I had to buy two loaves of bread or four, not three, although I rationalised in my head that one wasn’t technically an odd number because it’s just one. See, totally irrational!

Why did I do all these things? Because in my mind, I believed that if I didn’t do them, bad things would happen. The bad things were rarely directly related to the rituals themselves; I think the rituals were more just a way of keeping my hands and mind busy and in doing so, keeping the churning anxiety at bay.

Perhaps even more distressing than the obsessions and the compulsions however were the intrusive thoughts – thoughts which had no basis in reality but which came crashing into my conscious mind in the most upsetting manner. Perhaps most vivid is the night I was lying in bed trying to get to sleep when I suddenly thought, ‘I’ve never wanted to harm myself because I couldn’t stand the thought of someone else raising my children. But if I kill myself and the children I don’t have to worry about that’.

 

I’d never, not once in my entire life, ever consciously thought about hurting myself. And the idea that such a thought had even occurred in my mind, regardless of how completely ridiculous it was, made me so desperately upset that I lay awake for the rest of the night, terrified to go to sleep lest I wake up to find those crazy intrusive thoughts had invaded my reality.

That was my tipping point, the point where I realised that the OCD was controlling me and not the other way around. I started on medication, and while I was skeptical about whether it would work – in my mind, I still saw the compulsions as behavioural and I couldn’t see how altering the chemicals in my brain could fix that – it did. After about three days, I suddenly found my anxiety levels dropping. That in itself was disconcerting. I’d worn the anxiety for so long like an old familiar coat that living without it took some adjustment. At a fundamental level, I still believed that I needed the anxiety in order to provoke the rituals which prevented the bad things from happening.

In addition to the medication, I also started regular CBT sessions with a psychologist who specialised in OCD. These sessions taught me techniques for living my new, medicated life without the anxiety cloak. I don’t know that medication or the therapy would have worked as standalone treatments, but the combination of the two was incredibly effective.

It’s been nearly seven years since I was diagnosed with OCD, and while it’s still there affecting my life in little ways, the medication and therapy combo continues to help me keep it somewhat under control. I’ve also learned some creative ways to avoid the compulsions – for example, I have a lot of rituals around hanging the laundry on the line. The washing must come out of the machine and into the basket in a certain order. It must then be hung on the line in a certain order, the pegs must all match and certain items require specific combinations of pegs. It can take up to an hour to hang a single load, and with five small children, there’s simply too much laundry and not enough time, so instead of battling with my head to try to combat the rituals, I avoid them altogether by drying all the washing in the clothes dryer. Yes, it’s an expensive exercise, and no, it’s not great for the environment, but if there’s one thing that living with OCD has taught me it’s to save my energy for the big stuff and not sweat the small stuff.

I’m open with my friends and family about what it’s like to live with OCD, and it’s even been the source of some amusement – my husband regularly tells people that he got ripped off because I don’t have the obsessive cleanliness thing going on. He reckons that if he has to live with the darker side of the condition, the least he deserves is the perk of a clean house!

I’m also realistic about the fact that I’ll probably need to keep taking medication for the rest of my life. I’ve had a few breaks from it over the years and they’ve generally not gone so well. Without the medication, the anxiety is simply too overwhelming for the CBT techniques to touch. Do I love the idea of pumping my brain full of drugs? Of course not! But it keeps the playing field level, it gives me the upper hand over my OCD and that makes it worth it.

I own my OCD, I will not let it own me. 

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One-time high-flying journo turned SAHM, Emma blogs at Five Degrees of Chaos about parenting on the edge of sanity – navigating her own personal mental health minefield while raising five girls, one of whom lives with chronic illness. You can find her blog here.