Guided meditations by Tara Brach.

A lot going on, busy and exhausted. Nervous about my new job, starting Monday.

Here are some guided meditations by Tara Brach.

I know I should be doing them - but all I want to do is sleep. It's all I can think of.

I need a vacation. I just want to do little to nothing for a week.

I just want to sleep sleep sleep.

A proclamation of inflammation.

This morning I had a doctor's appointment. This past November I saw Dr. Rishi at his new clinic, and he said it was time for my yearly blood test, and I mentioned testing for inflammation, since my mother has been struggling with that recently.

We went over my blood test results, and we've finally stumbled across something that isn't right. I can understand that to someone who isn't sick, or who doesn't feel like shit, that might sound off. But if my bloodwork points to there actually being something wrong with my body, it validates me. I'm not entirely crazy, I do have symptoms and difficulties that stem from somewhere.

According to Dr. Rishi, my blood's sedimentation rate was alarmingly high.

According to Wikipedia:

The erythrocyte sedimentation rate (ESR) is the rate at which red blood cells sediment in a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation. To perform the test, anticoagulated blood was traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall was measured and reported in mm/h.

Again, according to the same page on Wikipedia, normal rated vary between 20-30 mm/hr.

In 1967 it was confirmed that ESR values tend to rise with age and to be generally higher in women.[5] Values are increased in states of anemia,[6] and in black populations.[7]

Age	20	55	90
Men—5% exceed	12	14	19
Women—5% exceed	18	21	23

According to my reading, I'm currently at a 75. That does seem very high. So, Dr. Rishi asked for an extended blood workup, and if I can get to bed early enough I'll go tomorrow morning. We then booked an appointment in 2 weeks to see what the results are. From there we can either do further tests or he can send me to a specialist of some kind.

I'm happy I'm getting some kind of answer, and that this might lead me to further discoveries that might help my health, but I'm also tired and discouraged at this new chapter of work, emotional labor and advocation that will come from new tests, new doctor's and just more time spent in the medical establishment.

My buddy JD said the anti-inflammation diet did wonders for her and her fibromyalgia. This is also a possibility for me, but it makes me nervous because of the cost, and the time and energy it takes to cook in such a precise, clean way. No wheat. No dairy. Whenever someone says the word "diet" to me I worry, I always feel I'm quite close to returning to ED territory.

I still think about it, and I still remember the high it gave me, I also know what it feels like to jump ship into the deep end, and remembering those sensations makes me uncomfortable.

AS usual, I'm getting ahead of myself. For now I'll start with a blood test. I'll try and go tomorrow morning. All I have to do is get up at the crack of ass.

Chronic Depression Fatigue.

A friend sent me What It Feels Like to Have 'Chronic Depression Fatigue' by Olivia James.

I've really been struggling with exhaustion and hypersomnia this past year. I mean, it's been ongoing, it's not new, but this year I was trying to change my eating and sleeping and found that no matter what 8 hours of sleep was not enough, and that there were some days where I could easily nap twice on top of a full night of sleep. 

James mirrors my experiences:

This is what I like to call “chronic depression fatigue.” In my experience, it’s the longest lasting of all my depressive symptoms, and unfortunately it’s one that affects my ability to do the things I want and need to do in a pretty serious way. No matter how much distance I put between myself and the more obvious symptoms of depression (anhedonia, listlessness, negative self talk, black and white thinking, isolation), I find that my energy remains low, and my body just can’t keep up with other people.

I’m a relatively young, physically healthy person. There is no reason I should wake up every morning feeling miserably tired. There is no reason I should regularly find myself so tired at work that I’m fighting my eyelids closing. There is no reason I should have to down cups of coffee to stay aware enough to make it through the day. 

For me, work has been an issue. Every afternoon I need a nap. I get slow. My eyes close. I feel as though I'm fighting the urge to sleep and thus feel blinky and impaired. I don't want to drink too much caffeine though because that aggravates my anxiety.

It’s frustrating to realize there may be no end to struggling with energy and sleep. I feel less intelligent than I used to be because I always feel as if I’m barely awake. Am I going to be stuck as a subpar version of myself forever? Especially as someone with a history of an eating disorder, exhaustion can really screw up my self-care routines, as it makes exercise and balanced food difficult. Exercise is a good preventative measure for me, and having to skip out on the gym to go take a nap feels awful, even when it’s necessary. 

I'm still navigating this reality. Eating disorder, exercise, exhaustion. Right now exercise is getting no time or space, I can't even fathom it. I walk when I can. I cook to try and eat in alignment with my values and budget, but it takes so much time and energy. On the Sunday's I volunteer I can't always batch-cook afterward. It becomes about choices. I completely understand that exercise will benefit my mood and my energy, but if I'm running on empty the thought of exercising is inconceivable.

I’ve heard from others that they have this long-lasting fatigue, even when the depression is in remission. And yet I’ve never heard a therapist or doctor mention it or potential solutions other than treating it like any other exhaustion. I feel bad even bringing it up because I know compared to being in the midst of depression, this is a cake walk. But even in recovery, I think we can advocate for improved quality of life, and helping those with mental illness manage energy is huge to keeping us on our feet and fighting our brain demons.

I think my depression is more of a constant. It's cyclical but on a monthly cycle - not over a period of years, now that I understand right now anyway. Exhaustion and managing my energy is a major part of trying to figure out how to live my life.

That's where I'm at now. Still trying to figure it out. How (increasingly) exhausting.

Back to broke.

Well, it's been a time.

I spent christmas sleeping and watching movies with my family at my brother's house. The gift exchange went well, I love giving presents, and they all seemed to be a hit. Even all the books I got my nephews, they seemed happy with them, which was a surprise. I got one of my nephews a large jar of pickles from Costco as a joke and it was a real hit. The holiday season cost me a fortune. I have to try and by little-to-nothing for a few months in order to get back to broke.

We then came back home, my mother and I, on the 27th. I updated my Etsy store and did a few things, but mostly I slept. My birthday/christmas gift this year was a Fitbit, I thought it might be helpful to track my heart rate and sleep patterns, try and get more walking in, try and have a way of following my (physical) health since it's been such a crap-show. It's kind of sobering to see how much I've been sleeping. Hypersomnia is real.

I have one day in which I slept for 11 hours over night, then took a 2 hour nap and a 1.5 hour nap. That seems excessive, doesn't it? But I couldn't wake up. I had that "impending sleep" feeling where you eyes are heavy and you just need to find a safe space to pass out.

On new years eve I babysit my nephews, went to bed early, and made a big breakfast for my family, they left around 11 in the morning, and again, I took a nap, then took another nap. I slept most of the day, and was still in bed by 10 pm. Today I got up around 9 and went for breakfast with my mother. I made a point of walking home from a nearby strip-mall to get some sunlight, some fresh air and some walking in.

Here I am now, it's 12:26 pm and I'm writing, seemingly alert and functional, but I'm worried I'm going to hit a down and have to nap again. How the fuck do I get through a workday?

I never like the beginning of January. It's the new year, and in a few days it's my birthday. Both bring with them a lot of reflection, and with reflection comes a lot of self-judgement and criticism. I try to limit this, I try to change the narrative, but it's there. Just in the last few days my day-naps have brought with them dreams of public nudity, exams I don't understand, living in a basement garage forever, being engaged in some type of turf war with a large violent group of teenagers and a string of other fucked-up dreams that scratch at my neurosis and lack of self esteem.

It's hard not to take stock of my life, and it's hard not to be hard on myself. My heart hurts.

I'm exhausted. I am feeling the weight of my body. I feel stuck and sad.

My weekend.

On Friday I went to bed around 9 pm, and I woke up Saturday past 11 am.

I then ran a few errands and napped for another 2 hours.

Hypersomnia is real.

I then went to bed around 10 pm on Saturday since I had a morning volunteer shift at the refuge, so I was with the dogs 9 am - 12 pm and then got home, napped for 2 hours and got up to try ans do some cooking and meal prep for the week.

My weekend was an unconscious one.

Nap all day, sleep all night.

This is me lately. I feel like the walking dead. I say "lately" but it's been ongoing. In the winter I could go to bed at 8 pm and get away with it since it was dark and cold, but now it's summer and I still can't handle long days.

Original illustration by Nation of Amanda - who seems to be getting her work ripped off left and right. I can't seem to find an active recent website for her.

Her illustrations are on-point. Tattoo quality!

I adore her dog one:

Optimism, once removed.

Yesterday I took the day off. I had an appointment with Dr. Rishi, and a dentist appointment. So, all the travelling meant it made more sense to just take the day off. This past weekend I was in Bromont with S, "taking it easy" so it was nice to have the extra day to putz around.

It was a nearly incomprehensible doctor's appointment. As usual, Dr. Rishi was engaged and talkative. We talked about some of the literature I mailed him (legit mailed to him, since his office doesn't work with e-mail). I had sent him a report on ECT (and explained that I like knowing it's an option if things get bad again) and also mentioned my readings on hypersomnia and inflammation.

I talked about my wanting an official diagnosis, because I feel it adds legitimacy to my struggle, and that in the future if there's ever a need for official documentation, I want my struggle to be legitimate. He thinks I suffer from Major Depressive Disorder and Hypersomnia. This is what I would have self-diagnosed as, but it's nice to have a confirmation of my own readings.

The conversation was lightning fast and dense. He asked that I book another appointment for him at the beginning of November, since he's off all of October. We decided to keep me on my current dose of Effexor, and stabilize, to re-assess if an additional increase is necessary. 

The conversation ended with Dr. Rishi focusing on goals. This is still off-putting to me, and kind of shocking since being goal-oriented has not been something I've felt for years. In fact, he used the word ambition and I probably stared at him like:

Look, I understand words are important, but so are gifs. They can say things words can't. I mean, it's faster. Whatever. Gifs.

Rishi started talking about short-term goals. Since our next session would be in November, he wanted for me to have goals in regards to my physical health. To find ways to exercise. He also wanted me to schedule my trip to Victoria in February to visit C, since he says having something to look forward to would be good for me, and also leaving Montreal for Victoria in February would be a nice mood booster, since it'll be -30 here and spring-like in Victoria.

It's just all so odd. So alien. I have been taking things "one day at a time" and really just managing my life day to day. 

He ended up writing a bunch of stuff down for me, he pretty much said that he's worried things'll get worse for me in the winter, since statistically speaking they do. Seasonal Affective Disorder compacts whatever mental illness we're already living with. So he said I'll have to make an effort to go outside and walk around, to get some daylight in. 

Obviously (to me), I also need to figure out exercise. It's been difficult to commit to anything because of how far I have to go. He'd like to see me have something I can commit too that might be kind of social, like a class. I'm not sure about that, since I don't have much money. I have to figure out what might work for me. It's important that it be regular. Maybe I could just start going to the gym again - but the gyms in my area are such bummers. Douche-nation.

He also said to focus short-term, and to let go of my planning. Basically, try and take steps to cope with the winter as best I can, and then to re-evaluate in the spring. Which technically, is when I'd be looking to move out, anyway. Ideally. 

I always walk out of my appointments with him as if I've been spun around in an office chair. I haven't had a family doctor in over a decade. The doctor experiences I have had have been primarily negative. This is the first time in a really long time I feel handled. 

He's very optimistic about my diagnosis, and my ability to move forward. Sure, the optimism isn't mine, but it's optimism. Just having optimism in my bubble is discombobulating.

Mostly I'm just tired.

Well this is apt. Especially after my post on hypersomnia.

Source is the very talented Lauren.

Sleep and depression.

So VanWinkle (?) has two articles up about depression and sleep. The first talks about hypersomnia as a symptom of depression. The article quotes a Dr. Trivedi:

Hypersomnia, as well as insomnia, have been linked in the development, treatment and recurrence of depression. Sleep disturbances are also some of the most persistent symptoms in depression. Identifying these biomarkers, combined with new understanding of the important role of exercise in reducing hypersomnia, have potential implications in the treatment of major depressive disorder.

First of all, I think it's highly likely I'm living with hypersomnia. At any time during the day I can fall asleep, easily. Just let me rest my head, and I can fall asleep. I've fallen asleep while driving once in the last year, and it's a threat, and I have to keep it in the back of my mind when planning a trip or drive. I just can't seem to get enough sleep, and I could sleep most of the day away. I feel like I would need two naps a day. I'm like a fucking cat. 

I took a look at the actual article Van Winkle (seriously guys, try harder) is sourcing, a study coming out of the South Western Medical Centre, and stopped at this bit:

People with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at work, during a meal, or in conversation. They often have difficulty waking from a long sleep, and may feel disoriented upon waking, according to the National Institute of Neurological Disorders and Stroke... Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking, slow speech, loss of appetite, hallucinations, and memory difficulty. Some patients lose the ability to function in family, social, occupational, or other settings.

Wait, are you all up in my life? I can't nap. I legit fall asleep for 2-3 hours, dream, and wake-up like I've been hibernating - I don't know what year it is and I don't remember who I am. 

Researchers had previously found a negative loop in which sleep, inflammation and depression interact and progressively worsen. The results of the current and previous research on insomnia suggest that exercise may be resetting this negative feedback loop.

I guess the good news is that exercise can help. The difficulty these articles fail to mention is how it's difficult to exercise if you're perma-exhausted.  Another article points to the opposite of hypersomnia, insomnia as a major factor in depression and suicide.

At least three-quarters of clinically depressed people struggle with sleep, and insomnia is a well-proven risk factor for suicide across different cultures and age groups.

So whether hypersomnia or insomnia, sleep is a major symptom of, or indicator of something being wrong. It's currently about 2.30 pm and I indeed could fall asleep here. The office is quiet, my work is done for the day, and we're only 4 or 5 active bodies in the place. I want to curl up under my desk. I want to cover my head with my shall and go elsewhere.

All I want to do now (and any day really) is go home and go to bed. It's Thursday. This weekend I'm planning on going out to the Eastern Townships with S. Can't wait. She's basically the only person I can be brutally honest with about my mental health. We'll be in the country, and we can sleep and take it easy. It'll be nice.