Jonathan Tullett

Last night I had one of the worst night’s sleep I’ve had in the last fortnight and as a result woke up tired, achy and in a pretty bad mood. I decided against laying in bed for hours, being unproductive, in exchange for getting up and doing some chores around the house.

After my morning chiropractic appointment – where the Caribbean theme is in full swing – I headed to Waterstone’s for some reading material.

I picked up a couple of ‘Where’s Wally?’ (‘Where’s Waldo’ in the US an Canada) books for Zachary, Sitepoint.com’s book HTML Utopia: Designing Without Tables Using CSS and book on Pharmacology. The latter so I can research fully the medication Jeremy Broadhead is prescribing, and also get a better understanding of the causes of the conditions.

I saw Dr Broadhead in the afternoon and we discussed my (lack of) progress. I put forward the hypothesis that the anxiety I’m suffering is causing the insomnia which is then causing further anxiety; a Catch 22 if you will. He agrees with me.

I am, unfortunately, very quickly becoming tolerant to the usual treatments which would help break this cycle: benzodiazepines stop becoming effective in 3-4 days, hypnotics (which help induce sleep quickly, but can interfere with REM sleep) stop becoming effective within 5-6 days, and even the antihistamine effect of the mirtazapine stops doing its thing in around the same period. So the pattern is: 3-6 days of good sleep where I feel fantastic, then a regression to the old sleeping pattern (previously.)

We’ve mapped out a future plan of action in terms of altering (switching) medication, if necessary; but we’re going to persist with slightly modified doses of my existing lorazepam and mirtazapine prescriptions.

From initial instructions of 1mg lorazepam twice a day, I’d altered that to 0.5mg four times a day in an effort to maintain the levels in the plazma and too because 1mg was knocking me out for 4 hours when I took it in the morning. As my tolerance has now increased, the sedative effects should be greatly reduced and it’s been recommended I try switching back to 1mg twice a day – morning and mid to late afternoon (but I’ve been given leeway to dose as I find most effective, within the bounds of 2mg max per day.)

The mirtazapine has been increased to 45mg, which in trials has shown frequent improvement in encouraging sleep compared to the 30mg dose.

In addition to the above changes, I’m to get 30 to 60 minutes exercise (eg. running) a day. This will help counter the weight gain from the mirtazapine and is one last sleep hygiene tweak I can make in terms of lifestyle changes.

On the non-pharmaceutical side of things, I’m still on the list to receive CBT which will aid the management of anxiety symptoms when they occur. This is also key for my getting better.

He’s encouraged by my academic interest in what’s happening and my being able to suggest some alternative treatments or question his theories and ideas.

In a potential bit of good news on the Bupa front, Dr Broadhead has written a letter explaining I’m not being treated for any ‘mood disorder’, eg. depression, which were their grounds for refusing to pay for my treatment initially. This has been forwarded to them and will hopefully result in them agreeing to pay for the (very expensive, but necessary) treatment.

My next appointment is in two weeks.