Day 275

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Sleep

As you can see from this photo dug out at christmas; historically, sleeping has never proved too much of a challenge for me. The ability to close your eyes and properly re-charge the batteries is a useful skill, a useful skill that thanks to the accident i am now having a hard time trying to salvage…..


About six weeks ago something strange happened; I slept uninterrupted for eight hours. If the fact that I got up at 7 and made everyone breakfast wasn’t a give away then the to-do list I made for the day should have been. I genuinely felt like a different person, I spent the whole day on cloud 9 waiting for that crash to come, but it never did. It had been so long since id had a decent nights sleep that i had forgotten what it was like to feel ‘normal’. I spent the whole day getting things done, training hard, thinking ambitiously, but most of all just being positive, about everything!

It was at this point I knew I had to address my sleeping routine. I had spent the last seven months running on fumes, and now armed with the knowledge of how much more I could accomplish after a decent nights sleep I knew something had to change. I was under no illusions that I was sleeping well before, I knew it was an issue, I just thought that it was unavoidable. But what could I change? Why was I sleeping so poorly? To answer these questions I first had to think back and figure out what was to blame.

The first two weeks in intensive care saw a lack of sleep comparable to a week in Ibiza or Vegas except without the fun. The first issue was the light and the noise. ICU’s run 24:7, constant beeping and flashing lights drive you slowly into a state of delirium and leech out any concept of time. I was even provided with my own personal sleep deprivation device in the form of a vitals machine. Every time I managed to finally drift off my heart rate would drop below 40 bpm and set off a crescendo of alarms to make sure i wasn’t dead. If i had any energy left I’m sure I would have enjoyed the irony that the alarms that were taking great care to keep me alive were also making me want to kill myself. The second sleep torture technique being employed was the hourly turning that was going on to avoid pressure sores. Although this process is important when you can’t move yourself, they don’t take a break at night, its unrelenting 24 hours a day. I would try and stay in a slumber as this was happening however its difficult when six nurses and all of the lights are deployed for the job. The third and by far the most harrowing issue was caused by my inability to cough. The injury had disabled the intercostal muscles between my ribs and my abdominals. This meant that every time some fluid started heading down the wrong pipe i had no way of clearing it. You would be amazed how many times you’re faced with that scenario when you are spending every minute of the day lying on your back. I would wake up to the sensation of drowning, and as I couldn’t move my only form of defense was to make as much noise as possible to alert a nurse. Usually the most I could muster was a groan, and although the staff where very astute and came to the rescue with the suction tube quickly, there was the odd occasion when I must have come close to passing out.

These drowning episodes formed my first real lesson in hospital. I eventually learnt that the most effective way to control these situations was to stay calm, stay calm even though every fiber in my body was telling me to panic. Instead of gasping for air, if I relaxed and started to breathe gently through my nose I could buy myself a lot more time to call for a nurse. Keeping a calm head and making informed decisions in the mist of chaos is a skill I’m not sure i possessed in spades prior to this accident. Trust me I haven’t become Sun Tzu overnight but I’m sure I’m in a better place now than before.

After i progressed from intensive care I managed to leave most of the sleep torture machines behind. By the time I arrived at the RUH the hourly turning had become four-hourly and I had mustered just enough strength to start clearing my throat which offered me a great deal of reprise, but just as one problem was quashed another reared its head…. It was May, it was 25 degrees and the heating was permanently on, as was my foam lined neck and chest brace. I was a human baked potato. Looking back its a good job that I didn’t have the strength to take my collar off because they may have lost a few out of the window and I probably would have ended up needing another operation. There’s nothing worse than trying to sleep when you’re too hot, apart from trying to sleep when you’re too hot, have neurological temperature regulation issues, and can’t move to cool yourself down. Unfortunately the extent of the life skills I learnt from this episode were only to never wear scarves in summer and baked potatoes have it rough.

As time moved on my sensation was returning down my left side, fantastic for my recovery, not fantastic for sleeping. If your position in bed is causing discomfort then you role into a different position subconsciously, without waking up. The problem comes when moving is no longer straight forward. The aching would wake me up and I would have to try and drag myself into a position that I could fall asleep in again, the process repeating itself every 1-2 hours.

The final and most obvious issue with trying to sleep in hospital was realised when I joined the 8 bed ward in Salisbury spinal unit. By this time I had stopped having to be turned by the nurses as I could move enough to relieve the pressure myself, however that wasn’t the case for everyone on the ward. There was rarely half an hour without a crack team of body shifters piling in to flip their target. Earplugs and an eye mask solved most issues, however they don’t filter smell. Every evening on queue, as people settled in for the night and the lights were dimmed, a dusk chorus of farts would fill the air. Now luckily being a boy I used to find this rather amusing and would often try to offer my own instrumental, however when sounds faded to smells it didn’t take long before we were all regretting playing our part in the gas orchestra.

Finally it was time to leave hospital and head back to my own bed for a decent nights sleep, or so I thought. The mattresses in hospital may not have been the most comfortable however don’t underestimate the difference that being able to move the playing surface into different positions makes. I spent my time in hospital sleeping with the bed positioned so there was a slight bend at the hip and knee, and now all of a sudden I was lying down completely flat which seemed to result in one thing, spasms. I could get myself comfortable enough to fall asleep but staying asleep for any length of time without being woken up by a pneumatic leg was a different matter. My only form of defense was to sleep on my side however that would usually end up with me waking up with an aching shoulder or hip every couple of hours. On top of all of this the catheter was out. Look I certainly don’t want to complain about that as it caused nothing but problems for the four months that it was in residence. However for all of its shortfalls it did allow me to go all night without being woken up by a full bladder. Now it was out and instead i am using convene (condom) catheters connected to a 2l bag at night. The reason I’m wearing them is mainly to do with muscle tone and the frequency i am waking up with a full bladder. My tone goes through the roof at night and if i had to try and navigate my way to the toilet 10 times, chances are I would end up in a heap on the floor at least 8 of them. Also my bladder has shrunk and is overactive since the accident so it simply isn’t worth the risk, besides it offers me that piece of mind which helps me relax and sleep better.

So there are the issues that I am facing but the question is why did i sleep so well that one night and how could I recreate it?

Spams..

I started by monitoring what I was doing during the day and comparing it to how well I was sleeping. Common sense told me that the more I did throughout the day (the more tired I was), the better I would sleep, wrong. What I actually found was if i was more physically and/or mentally tired then my tone and spasms would increase, leading to a worse nights sleep. This would often spiral into a vicious cycle of tiring days compounded by bad nights until eventually I would just end up delirious or ill. When I have been stuck in these ruts in the past I have resorted to sleeping tablets, however I don’t have an issue falling asleep its the waking up throughout the night that’s the problem and they don’t seem to defend against that. Besides going down the medication route is a risky one, particularly when it comes to sleepers as they can prove highly addictive. It is possible to medicate against spasms also and i think opinion is split on the positive vs negative benefits of these drugs. My spasms aren’t crippling, therefore since day one I took the approach to avoid medication as much as possible, particularly in regards to neuro suppressors. The spasms are slowly becoming less frequent naturally as I recover but on top of that I have started to manage my workload better. I now ensure that I am getting the same amount of input but spread more evenly throughout the week so as to avoid the really intense days that drive tone up and impact on my sleep. On top of that I have found that a hot bath with Epsom Bath Salts and a good stretch before bed works wonders.

Bladder..

There is no quick fix to deal with the size of my bladder and the fact that it is overactive, however by managing my fluid intake in the evening I can minimise the amount of times it will wake me up throughout the night. The usual mandatory pint of tea and a biscuit after dinner has sadly had to be disbarred. It has been replaced by no tea and two biscuits so its not all doom and gloom.

Aching..

After spending three night at my mums I realised that although the bladder and the odd spasm were still waking me up, the aching hips and shoulders didn’t seem to be an issue. This threw the bed itself into the limelight as the main suspect. Sure enough the mattress we were sleeping on at home was a lot older and firmer than the one at my mums, and since we’ve changed it the aching joints are thing of the past.

……………

From physical health and disease prevention to brain function and emotional well being, the importance of sleep is well documented. Even so most of us don’t put enough emphasis on it. The loss of just 1-2 hours a night from the recommend 7-8 over a sustained period can have serious consequences, ranging from heart disease to depression. If any of you want any more immediate encouragement to address your sleep patterns in the New Year; a lack of sleep has also been proven to alter your gut biome, slow down your metabolism and increase your appetite, making that dry January all the more pointless.

Since I made these small changes I am sleeping so much better. I still have the odd rough night but I reckon I have gone from waking up 8-10 times down to 2-3, and the difference that is making to my productivity and general well being is simply game changing. I even had the Xmas presents wrapped and under the tree before the 24th… unheard of.

P.s. If you want any more information on sleep or just don’t believe a word I’ve said, this is a pretty good resource…. https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency

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