April 27, 2004

On sleep... medications... and peace...

Having dealt with Dalton's bipolar mood cycles for several years, I have become very familiar with changes in sleep patterns. This often heralds a shift up or down with times of stress, changes of seasons, and sometimes, for no apparent reason at all.

Typcially, as time passes, it is common to see an emerging pattern of less and less sleep being necessary. He feels good. Almost, too good! We find him going to bed a bit later, then, as days pass, he begins to fight bedtime a bit. He will not go to his room without a fight, unless Gene and I are heading to bed as well. Next, we begin to see him waking earlier in the morning. This is always interesting as it places both boys awake and moving around in the morning as David is supposed to get ready for school. It also means that Dalton has usually turned the television on before he is ready for shcool. Unfortunately, this leads to a struggle to get ready, since his attention is divided. Strange as it may seem, I have a much easier time waking Dalton 40 minutes before the bus is to arrive than I do if he is awake 2 hours before the bus gets here. With the shorter time period, I am able to control the sequence of events, once Dalton has some control, we're lost.

Coinciding with this decrease in sleep, is a general increase in irritibiity, oppositional and defiant behavior, resistance to authority, mouthiness, and even aggressivity. Though Dalton rarely gets truly manic anymore, these times are hallmarked by an increase of hypomania, that should we be unable to get a handle on it, could easily escalate out of control. Thank God for his Lithium and Seroquel!

His typical pattern of cycles have evolved to show a 1-2 weeks timeframe. As the cycle begins its' ascent into mania, and his gradiosity escalates to boundless proportions, after about 5-6 days, the inevitable descent will occur. After approximately 5-6 days of too much sense of self, we see a afternoon of respite! Unexpectedly, without warning, he will come home from school and simply crash. He will fall asleep before 5pm, never to surface until the next morning.

Sometimes these sleeping jags, may last a couple day, and then evolve into long naps, to culminate into a more normal pattern. I find these sleeping periods to be God's gift to us parents so we can recuperate from the additional excitement from the preceding week. For Dalton, the additional sleep seems to reset his clock into a more normalized equilibrium, as he once again becomes the fun-loving, relatively well-behaved, excitable, but stable child we know. This period of stability usually lasts for periods of about 1-3 weeks at a time. Then, we repeat the cycle again.

The most notable times of mood cycles for Dalton, generally occur in January-February, and again April-May. Usually, we see a resurfacing during the transition of summer to fall, with the onset of school, July-September.

I am very happy to say that with appropriate medication and maturity, Dalton has improved greatly. Where he used to be up and down, from raging and psychotic, to deeply agitated and depressed fifty times a day, now his symptoms are manageable. Now that we are familiar with what workd, and have good medication in place, we are able to adjust medications accordingly, up or down, to assist in minimizing difficulty. Additionally, we know that when we see these patterns emerging, to keep responses to his behavior low-key but firm with the hypomania, and allow the additional rest to recover.

With Schizophrenia, I am not as familiar of the cyclicar patterns. I've been told there are cycles common to the ebb and flow of symptoms. I have certainly seen this is the pattern of increased agitation on Mondays, following a weekend leading back into the school week. The cyclicar pattern of school and transition from less to more structure is often overwhelming for David. I have learned to dread and be extremely cautious of afterschool behavior.

Sleep, on the other hand, has not seemed to be a common issue for David. teens typically seem to go thru periods of need for increased sleep, due to growing. However, I do not see a clear pattern of sleep which will forcast moods to come.

Unfortunately, many of the medications we have to use for both these disorders can cause sedation as a common side effect. The antipsychotic medications and benzodiazapines, both fallinto the category of major tranquilizers. For we "Normal" folk, these medications would like put us out! As I like to say, they would put me in a "Coma". Since people who suffer from Bipolar and Schizophrenia, have brains which are in a constant state of unheaval, these medications act to calm the raging fires of their minds to a more normalized and functional level. Rarely does the correct medication cause severe sedation. If sedation with a medication is a big problem, then a differnt medication is likely warranted.

Choosing which medication to use is an educated "craps shoot". Although there are "Families" of medication, like atypical antipsychotics, first generation antipsychotics, benzodiazapines, anticonvulsants, antimanic agents, antihypertensives, beta-blockers, stimulants, and antidepressants, choosing which of these "Families" to use may be relatively simple, but each medication within the category has a slightly differnt mode of action. finding the correct individual medication, or combination of medications, is usually trial and error.

Weighing the pros and cons of a given medication is a constant thought in the back of the mind, when treating a mental illness. Especially, as a parent, we do not what to overmedicate our children, but we want to help them to be children and enjoy life. We want them to have the opportunity to live, love, grow, and simply be. We do not want to see them turned into zombies byt the wrong medications, or too high a dose, but we cannot bear to see them fighting their minds, so out of control that hey are a danger to themselves or others. We cannot bear to see them in pain.

I do not like the sedating factor many of these medications can cause, but sometimes, we have to put up with a bit of sedation as the price for a higher level of benefit. We are still in this trial and error period with David. We have been here now, with him, for over 5 years. The time frame has been this long, partly in our struggle to find the correct diagnosis, and now to find a mediction which minimizes his symptoms while having few side effects.

Currently he is on Risperdal and Clonopin, an atypical sntipsychotic (the fifthe we've tried) and a benzodiazapine (anti-anxiety). Sicne we increased his dose of both last week, we did not initially see much increased sedation. However, now I am wondering. He fell asleep last evening about 5pm, and did not surface until this morning. Is this the medication, or was this a fluke? I am not used to seeing a delay of 3-4 days between an increase and the onset of sedation... but time will tell.

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