Sunday, March 1, 2015

Sunday Stroke Survival: To Sleep Perchance to Dream

antique postal card
As many of you might know, I haven't been able to sleep too many hours in a row for the past few months. This is mainly because of my husband's medication schedule. He is now on 45 mg of morphine every two to four hours. The schedule is exhausting and I suffer quite a bit of sleep deprivation.

As a result, I don't dream. At least not that I can recall. So Shakespeare's line is lost to me. There's a couple of things to be said for not dreaming. I don't have nightmares which is a good thing. But my subconscious mind does not get a chance to work through the stresses of the days or weeks either. This is a very bad thing. The stress has nowhere to go to seep out into conscious mind for me to deal with so it just builds up.

There's also the chronic fatigue I've had since my first stroke. If I sit down and stop
moving for fifteen minutes, I'm drifting off to sleep. Usually, at my desk, but other times across the foot of his bed or the rocker by his bed. None of these places give a restful sleep that my body craves. Another problem of napping like this is the odd positions I find myself and jerking awake a half to an hour later. My spasticity has loosened somewhat thanks to the dry needling, but jerking awake causes the muscles to spasm up tight and I'm groaning like an old woman.
Like this

One time I found my paralyzed arm wrapped behind my head. When I jerked awake a spasm hit so hard my arm was stuck behind my head for half an hour. Granted, it's a good tricep stretch, but not fun when the medial bicep is in spasm. It was down right painful! By the time it was over, it felt like my shoulder had dislocated. It hadn't, but the arm was exhausted and over stretched. I spent several hours with bags of frozen peas on it.

There's also critical thinking that is impaired when dealing with this kind of schedule and lack of regular hours of sleep. This can be dangerous because I'm running errands, shopping, administering drugs, cooking and assorted other things during my awake hours.  Besides my normal forgetting what I was doing and why I came into this room in the first place, there's the stopping in the middle of prepping the salad to stir a pot and forgetting about the salad totally. Driving to therapy at the new office but driving to my old therapy center instead.

And no, this is NOT me!
But with the judgement lapses I'm always erring on the side of caution like forgetting what the speed limit is and driving 5 mph slower than the rest of traffic because I can't remember that the reduced speed section is five mile farther down the spur. Yep, I've become that little, old lady that can barely see over the steering wheel, but I'm in a van. The one other people yell not nice comments to as they pass. If I really am too tired to drive... I don't. It can wait until tomorrow if I risk hurting myself or others. Common sense rules.

No, I haven't totally gone without a six-eight hours of sleep for months. I have caught a few breaks thanks to my children or grandchildren every couple of weeks. I can premeasure a dose or two of liquid morphine for someone else to administer. Or, my husband could give it to himself if the need arises. I always predraw the next dose as a matter of habit. All it would take is once being too groggy and killing him with an overdose. I'm careful that way. You can do all sorts of crazy things with lack of sleep.

Someone asked me once why hospice didn't order Fentanyl patches for him. Of all people, it was my sister the RN. I told her, "Doh! You have to have body fat for it to absorb into." He has the ideal body of zero percent body fat. It's just rolls of skin over shrinking muscle mass over his bones. There is nothing or no place with even a smidgen of body fat to place the patch. He also has tried an increase of his long acting morphine tablets that agitated him so bad that I was ready to leave him after three days of abuse. We are discussing adding Methadone to his morphine to boost the length between the liquid. But right now, it working the way it is. If it ain't broke, don't fix it. Although, I'm doing without sleep.

To top all this off, my Botox is wearing thin so the spasticity is back. Not totally thanks to the dry needling, but it is making sleeping comfortably troublesome. It seems that just when I get into a comfortable position, I'll have to pee or administer drugs. Not really, it just seems that way.

My next series of this poison is the middle of March. I'm hoping for an uneventful series unlike last time. My dry needling therapy hasn't progressed as well as my fellow strokee and needling buddy who plans to forgo his Botox series. But then he's three treatments ahead of me. In my mind, this does not make sense because I'm only about three years post stroke and he's seven years out, but every stroke is different. Oops, did I just say that?! Yep, I did and my spasticity is worse than his...not that I hold that against him. I'm happy for him that it's working so well. I'm just not that confident or brave yet.

So in the mean time, I'm doing without restorative sleep for the duration. I'm sleeping only enough to keep from having severe sleep deprivation. That would be a waking nightmare, but...
Nothing is impossible with determination.



4 comments:

Zan Marie said...

Sleep deprivation--even with 8 hours of down time--is my norm and I can't imagine carrying the load that you are, Jo. {{{hugs}}}

Barb Polan said...

Please stay cautious: pretty much everything can wait until tomorrow, especially if you're cautious (and have spare meds, etc.)

S.P. Bowers said...

Oh, man. I'm sorry you don't get to sleep much. The constant waking up is such a strain. Here's hopeing you get some consistent shut eye.

Hilary Melton-Butcher said...

Hi Jo - I admire your courage and practicality in dealing with all things ... lack of sleep is not easy. My thoughts - you are coping with so many things ... thank goodness the family are around at times and there for you - take care and here's to the next dry needling session ... Hilary