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The beckoning of a comfortable bed promises a deep sleep and a refreshed, alert body the following morning. Anyone who has experienced a restless night can attest to the lethargy and moodiness associated with sleep deprivation. But, what happens when sleep deprivation is a persistent evil toying with the mind repetitively for weeks, months, or even years? Insomnia has a vicious way of altering its shape from restlessness into a perverse form of physical and mental misery. Sleep deprivation was used as a form of torture by the KGB, and in Japanese POW camps, for a very good reason. Reports of its use in Guantanamo Bay show it is still a favoured form of torture in the twenty-first century. Why wouldn’t it be? Deny someone sleep for a few days and pretty soon the mind goes out on its own agenda and the prisoner is revealing top-secret information while submerged in a sleep-deprived psychosis. The brain needs sleep. Sleep is not an option to good mental and physical health, it is an absolute prerequisite. Unfortunately those who already suffer from mental health problems also fall victim to comorbid sleep disorders. Many of my articles in relation to mental health are written from personal experience. Sleep deprivation is no stranger to me and I’ve suffered with chronic insomnia for over a decade. I also suffer from bipolar, social anxiety, and Post Traumatic Stress Disorder (PTSD). I know first hand how quickly the mind can flick the switch off to rational thinking and flick it on to pervasive irrational thinking. Soon the very act of trying to fall asleep becomes, in itself, a type of phobia. Rather than relax to the process of falling asleep the body starts to react with anxiety. Sleep consists of five stages. During the night the body cycles through these stages several times. Very quick summaries of these stages are as follows - Stage one: Is the drifting stage, where you doze off but can be awakened easily. A person may experience myoclonic jerks (body spasms) and/or the sensation of falling. Stage two: Is where eye movement ceases and the brain waves slow down. Stage three: Is a deep sleep in which the brain waves have slowed considerably. Stage four: Is an even deeper version of stage three. REM: (Rapid Eye Movement) Most commonly known as the dream state. Breathing becomes quickened and shallow, the eyes move rapidly, brain waves increase to that of a wakened stage, heart rate increases, blood pressure rises, and people dream. For a chronic insomniac getting passed stage one is a stressful, almost impossible venture. Anxiety causes the body to react to this stage almost as if the onset of sleep is dangerous and threatening. It panics. The mind refuses to drift into stage two, it wants to keep hypervigilant, it wants to be able to save you from danger should the anxiety felt turn into an actual threat. All the while, as it’s doing this, it is setting itself up for sleep-deprivation. Add this frustrating ritual to an already diagnosed disorder like depression, bipolar, and anxiety to name a few, and the victim is on a way one street to meltdown. Even more frustrating is the fact several drugs used to treat depression and bipolar actually have insomnia as a side effect. Certainly this it the ultimate in catch-22 situations! Take bipolar as an example; sleep-deprivation is a major contributor for triggering the condition to cycle into a depressive or manic phase. Mania presents many different signs and symptoms, including a decreased desire to sleep. The problem of insomnia feeds the mania phase. The person feels less desire to sleep and sleep-deprivation worsens the manic episode. Although those suffering depression often seem lethargic and tired, they too can often suffer insomnia. Again, this only fuels the problem tenfold. The brain cannot begin to regulate into a stable state of mind while it is sleep-deprived. It turns against itself. Here is where sleeping medication becomes a much debated issue among those who suffer insomnia and medical professionals alike. First and foremost a psychiatrist will treat the primary condition, that being the bipolar, clinical depression, schizophrenia, anxiety disorder, etc. In some cases treating the primary disorder will nullify the comorbid insomnia. Many antipsychotic drugs have the side effect of drowsiness and this can be enough to induce sleep. Unfortunately, sooner or later, the body becomes immune to the drowsy side effects and insomnia rears its ugly head again. Psychiatrists and patients are faced with a conundrum. To improve the quality of life of the insomniac, and thus lower the chance of sleep-deprivation triggering the primary condition, they have to consider medication targeting the sleep problem separately. Improving the quality of life will inevitably result in a reliance on sleeping medication. The most common form of medication used to treat insomnia is benzodiazepine. Benzodiazepines are a psychoactive drug; they alter the brain function and work on the central nervous system. Psychoactive drugs include stimulants, depressants, narcotics, and hallucinogens. General anaesthesia is a form of psychoactive drug. Benzodiazepines are highly addictive and should only be taken at the lowest possible dose and strictly monitored by a health care professional. It is certainly not an easy decision for either party, patient or doctor, to consider going down this road as a treatment for insomnia. There are thousands of people currently addicted to this drug, as there are thousands of people enduring the withdrawal of beating the addiction. For those who do not suffer chronic insomnia and/or mental illness, the decision to start taking such a powerfully addictive drug would be a clear-cut ‘no’. But, for those of us who do suffer the afore mentioned conditions the decision is not quite so straightforward. Already quality of life is diminished due to mental illness and diminished further when teamed up with comorbid insomnia. A good night’s sleep means more than simply awaking refreshed. It means lowering the chances of bipolar rapid cycling and it means depression can be considerably improved. Benzodiazepines ARE addictive and the body WILL become reliant on them if they’re taken for an extended period of time. Just like the drowsiness side effect of some anti-psychotic medication, the body can also become immune to a low dose of benzodiazepine and thus it begins to stop working in the way it used to. When all other avenues to beat insomnia have been tried and tested – relaxation, herbal remedies, sleep-schedules, pharmacy medication, etc – it does become a desperate matter of ‘where else can I turn, what else can I do?’ Benzodiazepines should never be the first option to beating insomnia; they should best be used only as a last resort. A thorough discussion with a medical practitioner is imperative and the patient should know in advance of the down side to benzodiazepines. Never should this medication be taken without doctor consent and both patient and doctor need to take an active role in monitoring the amount taken. Is this quality of life worth the addiction? There are horror stories in concerns to people who have become reliant on this medication. Their experiences in trying to beat the addiction are harrowing to hear. Yet, the improvement in relation to quality of life gained for others is also well documented. Everyone who takes this medication regularly will form an addiction, but not everyone who forms the addiction will suffer as a result of it. In the end it is very much an individual evaluation of the pros and cons, being educated on medication, no matter what it is, it always far better than ignorance. Prior to agreeing to begin benzodiazepines it pays to research both sides of the story, read the experiences of those for which benzodiazepine became a nightmare, and read the experiences of those for which this drug had aided. Only then can you make a well-informed choice on a powerful drug that is very much a double-edged sword.
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