Daily Archives: September 18, 2009

The Art and Science of Staying Awake and Going to Sleep When You Have PTSD

“The blood level in my caffeine is getting too high” Woody Paige on ESPN’s Around the Horn

opus coffeeToday: 3 24 Ounce Cups of Southern Pecan Coffee with French Vanilla Creamer and Splenda

Which came first the chicken or the Egg McMuffin?  That is the type of life I have when it comes to a little thing that you never notice until you can’t do it…something called sleep.  Today is one of those days where the inner Chinese kids, Yin and Yang are trying to get themselves into some kind of equilibrium, or maybe even equilibriumnumnum after a pretty rough week and a night on call at the medical center.  As usual my insomnia and anxiety have joined their ever loving hands together to ensure that I have had less than optimal sleep.  Yesterday’s on call duty and that of last night was fairly relaxed.  I had my new residents with me getting oriented to pulling duty and I have to say they are a fun bunch. We have two Americans and two Canadians all with great senses of humor and all who have had some kind of combat tour.   I actually like being around them which I cannot say of everyone that I have worked with in 28 plus years in the military.  They are a joy.  Likewise I love being around the hospital staff doing my rounds at night and to top things off there were no tragedies.

This being said I still could not get to sleep last night which kind of tops off a week of crappy or too little sleep.  Love them or leave them crappy or insufficient sleep over a long period of time beat the hell out of you.  I know, it has me and to make an astute observation it makes me tired.

My battles with insomnia began about a third of the way into my Iraq tour. When we came back from a mission I would go to my “Can” and just sit awake either reading, playing chess on my computer or going out and watching the Dustoff helicopters coming in and out of the Surgical Shock Trauma Platoon helipad or looking off to the perimeter to see illumination rounds lighting up the night sky and hearing occasional gunfire and explosions.  It was incredibly hard to get to sleep no matter how tired I was.  That continued the whole tour and got worse.  Part was the late night flights that we so often took, part the danger that we faced and part the conditions that we slept in. At one FOB in Ramadi we stayed in an old trailer that we could hear the rats chewing on the ceiling. When we had to stay in Al Asad to catch a morning flight after having flown in our tents were near the flight line and F-18s flying in and out all night do not make for a quiet and restful night’s rest.  In some of the more remote FOBs the isolation and vulnerability made it hard to rest.  I think that it was about two-thirds of the way through that the dreams and nightmares started.

Doonesbury-082108Too True I can Relate

Having talked to others with PTSD or other combat related injuries of the brain and nervous system I find that I am not alone and most of us are mid-grade to senior career officers.  It’s kind of weird because when you are young in the military you are taught just to “suck it up” and as you go through your career you tell others the same thing until it happens to you. Thus for us old guys I think PTSD is actually harder than for young people because it destroys our world view and our tough personas which most up us have cultivated over a long period of time.  My friends and I share the same or similar experience and we all are trying some way of managing it.  All of us have some drugs, the legal kind of course to help us with anxiety, panic, depression and insomnia.  However there are times when the drugs don’t work as well as they should, or they need to be adjusted or changed.  In those times you still have to find ways of getting to sleep and for the times where you can’t sleep ways of keeping sharp so you can stay in the game and not screw anything up.

bean church 1Staying Awake

Some guys I know have added to the mix other kinds of over the counter drugs and supplements.  I don’t do that, not that there’s anything wrong with it, but I guess I never grew up.  I like my medicine whenever possible to taste good.  Thus my self-medication is limited to caffeine and really good beer.   My choice in caffeine is coffee which I have been drinking since I was 12 and I believe that by my junior year of high school Navy Junior ROTC my index finger was beginning to mould itself into the shape of a coffee cup handle.  With caffeine there is little moderation because since I don’t sleep I need to stay awake.  My alcohol consumption is moderate and I don’t drink hard liquor.  I always try to maintain the Yin and Yang of the blood to medicine to caffeine and alcohol at some kind of balance so I can get to sleep and then not be exhausted the next day.  I make sure that I don’t mix alcohol with my meds since I don’t want to do the Karen Anne Quinlan thing and end up in a coma, and end up in a broccolitative or asperagative state (I don’t do just any vegetables thank you).  However I know guys who have a lot heavier load of meds than I do who have no problem ingesting them and alcohol close together and most of these guys don’t just drink limited amounts of beer.  I’m quite happy not to be there and mixing meds and alcohol.  So for me the equation looks like this.  Please note I am a historian and not a mathematician and that since this is a new field of study for me that it does not yet factor in sleep quality:

Drugs- caffeine² ± beer÷ “defensive factor” (anxiety+ hyper-vigilance) + normal work and life stress ÷ spirituality factor² = sleep

Now also since I am a Priest and Chaplain there is the spirituality factor which is hard to quantify but can be stated very simply “Please God let me sleep + have I been to a baseball game.”  This is hard to quantify but I have given it a numeric value for the sake of argument. Now I’m not a mathematician by any means but this seems to work somehow.

axieties and dreamsYep…Them Iraqi Snorklewackers Show up Often

Now back to me and the guys I know who struggle with this.  Pretty much to a man we all still manage to do our jobs.  In fact we all love what we are called to do which probably helps us as far as the management of our situation.  Many of the folks I know are like me and if we had the chance would go back to the fight.  You put us together with men and women who have similar experiences in combat and we are in our element, there is a shared brotherhood because of the real dangers that we faced.  However that is not necessarily true of others that we serve alongside who have not been, as is oft said “in the shit.” Within that category there are those who are people that help us and care for us, they are appreciated even if they have not been in our shoes.  The often exude a kindness and love that helps us make it when we have bad days.  But there are also those that don’t always seem to have our interests at heart or who would appear by their words and sometimes their actions to use our injury against us.

garfield show me the coffeeAmen!

So this whole deal gets weird when you can’t sleep due to anxiety or insomnia and have to maintain your ability to do your job.  Now this is where the art and science of self medication come together. You have to be able to figure out how things balance out. Medications are set by prescription unless you throw in a wild card of over the counter meds and supplements.  Thus for me they are a relatively stable factor.  Then you factor in the caffeine factor.  This may vary but in my case I drink 24-72 ounces a day of coffee which is usually spread over a 4-8 hour period, and maybe 12-24 ounces of Diet Coke, Coke Zero or Diet Dr Pepper later in the day.  My caffeine level is variable based on how tired I am. If I am well rested the amount consumed goes down.  Today I was maxing out the caffeine factor because my ass was whipped and it was all I could do to get through the day.  Today I was so wiped that I added in the Skittles factor to get the quickie sugar rush.  I hate skittles, when we were poor in seminary it was the only candy we got because the church food bank gave them out.  Skittles, Boston Baked Beans, Swee Tarts and Smarties are all great instant energy, the problem with them is that they are like lighting the afterburner; they are only good for short spurts.  Beer varies but if I am home I might have two beers at dinner.  I have stopped any late night drinks.  Then there is the “defensive factor” which for me includes my anxiety and hyper-arousal levels.  This is combined with normal life and stress and divided by the spirituality factor to get a night’s sleep.  That is the science.  The art is how to make the adjustments to the factors that are variable fit the current life situation and find those illusive Chinese kids, Yin and Yang.

pub1

So the week is coming to a close, I have now been up 36 of the last 40 hours and have worked every day since last Monday, though Saturday and Sunday were just a few hours each despite having the duty pagers. I am tired I had a decent meal complete with vegetables, several portions of fruit and other healthy things.   As soon as the Orioles game is over I plan on heading to bed and hoping my meds and my general sense of exhaustion will overcome any anxiety or insomnia that might join hands to interfere with me.  I think I have managed to bring old Yin and Yang into balance for the evening and if I didn’t I I do hope that the Deity Herself will assist this effort tonight.

Peace, Padre Steve+

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