3:00 AM: An Introduction to Semicolon and My Mental Health Journey

It’s 3:00 am, and like many 3:00 am’s, I’m awake. I’ve been awake since a little after 5:00 am.

Approaching the 24-hour mark is ominous. If I don’t fall asleep within that time, it often results in a period of insomnia that lasts 2-4 days. I tend to experience these extended periods of insomnia 3-5 times a year, sometimes more often in a particularly difficult year.

Sleep aids do not help. Due to the severity of insomnia I experience and the mental health conditions that I have that insomnia exasperates, my doctors, both past and present, have been willing to prescribe medication to help me sleep.

I have tried three different sleep aids, including Ambien. They did not help in any way. My general physician at the time was willing to color a little outside the lines and prescribed me a medication that isn’t a targeted sleep aid but has a side effect of drowsiness for many patients.

Surprisingly, it worked. For a time. It helped me fall asleep most nights. I did not always stay asleep. I would often wake up at 3:00 am and was unable to return to sleep. Other times, I would get as little as two hours of sleep and be awake until the next night.

Time went on but the effectiveness didn’t. By that time, I was on a psych med that resulted in considerable drowsiness. It didn’t help with my psych symptoms for which it was prescribed, but I stayed on it until it, too, stopped being effective for sleep.

I was then on a low-dose anti-anxiety medication that I could take up to three times a day as needed. Since it didn’t help my anxiety, I took all three doses at night to help me fall asleep. I never told my doctor.

But that was also short-lived. Each medication helped for about a year and then I developed a tolerance. So for three years, I was able to fall asleep around a consistent bedtime. I still experienced insomnia during that time but I was able to maintain something of a schedule.

It’s been a year and a half. Insomnia has increased and maintaining a schedule is more difficult.

I’m an owl. I’m inclined to late nights and late mornings. In fact, morning for me is more comfortable if it’s afternoon. I often sleep better during the day than at night.

However, the world around me doesn’t run on that schedule. My preferential time for sleeping is also known as “business hours.” And while I could bemoan how society isn’t structured to accommodate my sleep needs, admittedly, I’m not motivated to be productive when I adhere to a night routine. So it doesn’t work for me regardless of how I frame it.

In the time the medication has stopped helping, I’ve been to a sleep clinic. I was diagnosed with mild to moderate sleep apnea. I was given a CPAP machine, and unlike many, I found it fairly comfortable to use. It didn’t improve my sleep or help me to feel more rested.

My insomnia continued and worsened until it became impossible to use my machine. It got to the point that when I put on my mask, it had the effect of keeping me awake. I felt like I was trying to force myself to sleep and that has a way of resulting in the opposite.

The sleep clinic couldn’t be of any further help. Ironically, they didn’t help with insomnia. Their last option was to offer me a stimulant to take in the morning in the hopes I would be so exhausted in the evening that I would sleep.

Exhaustion isn’t the issue. I’m plenty exhausted. I declined.

In the past few months as I’ve recovered from a lengthy infection, I’ve tried other strategies. I began to establish a nighttime routine to both signal and prepare my mind for sleep.

I had a Sunday through Friday alarm set for 10:30 pm. It sounded like crickets. It was my notification that it was time to stop watching TV, which is what we most often do in the late evening, and begin my wind down.

I would turn some meditation/yoga type music on my phone, brush my teeth, and take a shower that I tried to embrace as a soothing, relaxing experience. After my shower, I would do an end-of-the-day “brain dump.”

While I might not have been thinking about much before going to bed, when I turn the lights off, I immediately start thinking about all my to-do’s and any other thought that could absolutely wait until the next day. But my mind tends to get fixated. The brain dump was an attempt to minimize the fixating.

I had a designated notebook, and on a clean sleet, I would jot down any to-do’s or thoughts or ideas that came to mind in no particular order. If I needed to plan something for the next day or week that I knew would occupy my mind when I tried to fall asleep, I would take the time it required to work on that. Grocery lists, meal plans, budgets, etc.

It was often very helpful. I knew my to-do’s and plans were written down so I wouldn’t forget them. It’s much easier to manage runaway ideas when their the only obsessive thought category and they’re not also cycling with “Get a box for the Christmas tree, buy dish soap, red beans would be good Monday…”

I then followed this by going to bed and listening to a sleep meditation or visualization. I would often fall asleep either during the guided meditation or shortly after.

And then one night about a month ago I was in the process of falling asleep listening to the “Seaside Village” visualization I frequently chose and I was frightened awake. The story had “come alive!” In reality, I had slipped into a psychosis and couldn’t recognize that, but in the moment, I thought the meditations were “evil” and were a wicked way of trapping me in my dreams. I haven’t been able to re-attempt my nighttime routine and meditations since.

I do not have a diagnosis currently that adequately explains why I sometimes experience psychosis. When I experience this phenomenon, it can last anywhere from minutes to months.

Psychosis inevitably is a unique experience for each person that has to endure this trauma. For me, I recognize I am experiencing something that is not part of my normally perceived reality. I don’t usually have visual or auditory hallucinations, though that does occasionally happen—I’ve even experienced olfactory hallucinations. The “hallucinations” I experience, if that’s the proper term, are a combination of mental images, voices in my mind, emotions, physical sensations, and compulsions. I often become fearful someone or something wants to harm me, and this leads to paranoia that can linger long after the psychosis. These experiences can be so frightening for me it becomes a traumatic event. I equate it to a waking nightmare.

Imagine if you were to experience your worst nightmares while you were awake. Someone is trying to kill you? Eternity in hell? Being locked away? Rape? I face these threats repeatedly in a psychosis. It is 100% without a doubt traumatizing.

I don’t immediately recover when it stops. Nightmares usually quickly fade when I wake up. Within minutes, my memory is fuzzy and the experience feels distant. Days later, I’ve often forgotten all about it.

But I’m awake during a psychosis. My conscious mind records most of it. A nightmare happens in minutes. My last psychosis was 7-8 days! It is terrifyingly more real.

I have an amazing, invested therapist of over 5 years. It took longer, but I eventually found a psychiatrist that I trust and takes time to really listen as I discuss any symptom or issue I’m struggling to overcome and usually goes over time. He is thoughtful and honest about not having all the answers instead of what too many doctors do and stand boldly and confidently in any answer just to offer an answer.

Unfortunately, mental health is a fairly new discipline and is still very much developing. It’s also vastly underserved in most locations, including my state. It’s often a long process of trial and error to find medications or treatments that help, which is frustrating and expensive. I’ve started probably two dozen medications only to discover they have no effect or have intolerable side effects. I had vision problems and tremors for about three years after one medication.

And after happening upon a miracle pill that has the patient upright and functioning and even happy sometimes after years of depression, the pill may suddenly stop working, and the process starts all over. I have been that patient.

My current diagnoses are OCD with psychosis, bipolar II, general anxiety disorder, and PMDD. My current psychiatrist changed my previous diagnosis of schizoaffective disorder to OCD. He’s also considered ADHD as a possibility. My experiences with ADHD didn’t suggest that to me, but the more I learn about ADHD, the more I discover I do experience many of the signature symptoms, including executive dysfunction.

I experience psychosis, but I’m not schizophrenic. (Schizoaffective disorder is essentially schizophrenia paired with a mood disorder, which in my case would have been bipolar.)

Recovering from a psychotic break that occurred in 2016, which is more severe both psychologically and physiologically than psychosis, I was limited in my ability to comprehend and to advocate for myself in my medical treatment. As I have healed from that and improved other symptoms through therapy and medication, I have had a greater capacity to aid in proper diagnosis and effective treatment.

I have an idea about a potential cause of the psychosis I’ve experienced for the last 15 years. I’m anxious to discuss it with my therapist and psychiatrist because I’m hopeful. I’m hopeful there’s a cure. I don’t want to endure psychosis and ongoing trauma for the rest of my life. So I’m afraid the epiphany I had is wishful thinking. I’m afraid they, too, will think it’s a likely cause and I will receive treatment only to discover it wasn’t the source. And yet, I’m hopeful. I’m presently hopeful for a cure for my most severe symptoms, but even if not, I will remain hopeful for continued progress.

I hope to find the bravery soon to restart my nighttime routine and bedtime meditation for better, more consistent sleep.

I see my therapist for the first time after a long break next week.

But right now, it’s approaching 5:00 am and 24 hours without sleep. Lack of sleep is already causing a headache that is likely to become a migraine. But sometimes the sunrise makes it easier to sleep, so hopefully…

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This has been the official introduction to my blog Semicolon: A Mental Health Journey.

Why Semicolon? The semicolon (punctuation mark) has become a symbol among people with mental health struggles to signify our struggle but also that we choose life. Sometimes mental illness creates a pause in our lives, but not a period.

As a writer, I love punctuation. My Twitter bio currently includes that I am a “punctuation rebel.” One of the Dalai Lama’s is quoted as having said, “Know the rules so that you can break them effectively.” If you are a proficient or advanced student of English language punctuation, you may notice in my writing I don’t always adhere to formal guidelines. I know the intent of commas and semicolons and ellipses and add or omit the pauses and breaths as I intend my words to be read. (However, considering I’m my own proofreader, human error is also always a possibility for a misplaced mark.)

While I would like to post to this blog once or twice a week, I’m not presently committing to a schedule. The mental health challenges I experience can be severe and I experience lengthy setbacks devastatingly often.

Writing thrills me. Sharing my journey in hopes of de-stigmatizing mental illness, comforting those in the throws, and offering actionable strategies to make progress in healing is a passion. And sharing heals me, too. Writing my thoughts adds clarity to my experiences that amplifies my understanding.

Thank you for reading. I hope you return as I continue the journey.