#and i feel like a lot of insomnia advice is geared more towards people who have a hard time falling asleep initially

[ravenkings]

putting a question out there: does anyone have the type of insomnia where you can go to sleep easily but then wake up frequently during the night/super early and then have issues going back to sleep? and if so, what do you do for it?

[todrokishoto]

late night conversations | shouto todoroki

summary: excitement leads to insomnia and insomnia leads to a conversation with mr. shouto todoroki

warning(s): mentions of fighting and poor half and half’s childhood. slight angst

a/n: ok but this is not where i was expecting this to go. it was supposed to be about something else lmao but enjoy ig 

your undeniable fatigue was overwhelming, but you were still unable to succumb to the sleep you so desperately needed. not yet, anyway. your body, albeit drained from the physical training performed today during class, was buzzing. 

demanding training was nothing new to class 1-a, and each and everyone of you were progressing with each round of drills the teachers would throw at you. add academic studies into the mix as well and you have the perfect recipe for exhaustion. 

your door slipped shut behind you, the excitement coursing through your veins making it impossible to remain in bed. the hardwood floor was cold underneath your bare feet, but you didn’t feel like going back to fetch your slippers. 

during class with mr. aizawa, you were finally able to nail the ultimate move you had been working on for the past couple of weeks. not only did it feel amazing to execute it flawlessly after so much practice, but it had scored you the victory in the fight against ururaka.

the auburn-haired girl had learned a lot during her internship and had put up more of a fight than you expected. you had seen her go up against some of your other classmates, but experiencing it in person was definitely something else. 

the ding of the elevator echoed, the doors moving apart, as you arrived on the first floor. thank goodness there were no rooms on this floor because you swore the sound would have been loud enough to wake someone up. 

fiddling with your phone, you moved mindlessly, trying to ignore the aches moving throughout your body. you weren’t entirely sure what you planned to do, to be quite honest, but anything seemed like a better idea than being stuck in your bedroom. 

most of your classmates were sleeping, you assumed, or at the very least tucked into bed. the unusual silence of the student dorms didn’t necessarily surprise you but it did make you feel slightly uneasy. it felt foreign. 

so when your name was called, you couldn’t contain the small yelp that escaped you. your phone collided with the floor, the sound once again echoing around the (almost) empty common room, and you winced. with a flick of the wrist, your quirk brought your phone back into your hand and you glanced up to inspect who else was awake at this hour. 

“shouto?” 

his bicolored hair fell into his eyes as he nodded. it was obvious the boy needed a haircut soon but you didn’t dare comment on it. instead, you swallowed the remainder of your shock and made your way over to the sofa he was seated on. 

“what are you doing up?” you questioned quietly, hoping you weren’t prying too much. 

“couldn’t sleep. my thoughts are a little overwhelming at the moment.”

you nodded, your lips pursing together as you tried to wrack your brain for an appropriate response. the two of you had shared a handful of conversations but he was always so formal, making it hard to decipher his true feelings about you. if anyone were to ask if you were friends, you had no idea what to say. 

he spoke first, “sorry for scaring you, by the way.”

“it’s all good,” you assured quickly, the corner of your lips twitching with hints of embarrassment. “i, uh, just didn’t expect anyone else to be awake. i can leave. if, uh, you know, you want me to.”

he shook his head, strands of red and white mixing together. he didn’t verbally protest but scooted over slightly, leaving more room on the couch for you to sit. you accepted his silent offer, not saying anything either, as you lowered yourself onto the sofa. 

the silence continued. you were itching to break it, each second passing making you feel more and more on edge. shouto didn’t make a move to talk like he had previously and you found yourself wondering if it was due to his preoccupied mind or an inability to find the right words. maybe he had just invited you to sit out of common courtesy, secretly hoping you’d decline. 

“great job—”

“so, how did—”

a smile tugged on your lips as his bicolored eyes widened slightly. you nodded, waiting for him to continue his sentence. he remained quiet for a brief moment and you wondered if he suddenly regretted what he was about to say.

“i just wanted to congratulate you on your win against uraraka. you did a great job,” he praised, his words being nothing but earnest. 

“thank you. i didn’t know you were, uh, watching,” you admitted. why were you suddenly feeling self-conscious about him watching you fight? most of your classmates had, so why was he different?

he nodded. “kirishima was able to knock me outside the ring, so i had some time to watch you both.”

“kirishima? really? i mean— he’s my friend and i love him, but he beat you? really?” 

his eyes closed momentarily as his left hand came up to his face. his fingers traced the scar framing his eye, seemingly subconsciously. you felt rude for watching him so intently but you couldn’t help but be mesmerized by the contrast of his bright blue orb compared to the red mark. 

only when his eyes met yours did you realize that you had been caught staring. you averted your gaze immediately. you desperately wanted the conversation to continue and you were inwardly scolding yourself when he spoke again.

“he made a comment and i got distracted, so he had an opening. he did put up a pretty good fight before that, though,” he recalled, his gaze flickering toward his hands now clasped in his lap. “i keep getting distracted when my past or family is mentioned, which is starting to mess with my focus and training.” 

you swallowed, your chest swelling with pride. out of all people, shouto todoroki had decided to confide in you. while you knew a lot about him, his family and his past, most of the information came from your other classmates or rumors. he, himself, had never really seemed interested in sharing those details with you and you refused to pry. 

“what did he say? i’ll beat his ass.”

a laugh. you hoped the surprise you felt wasn’t physically visible. his laughter was rarely shared and you could probably count on one hand how many times you had heard it. you decided right then and there that you would give anything to hear it again and again. 

“just something about my left side matching him. you know, with the red all? it was mindless, really. no need to give him a beating on my behalf. he apologized after,” he assured. “i just... i hate that no matter what i do, my father and the family name still has this affect on me.”

his brain was reeling. you could practically see the gears turning and his internal conflict was essentially radiating from his body. eager to offer advice, you had to bite your bottom lip to keep quiet. you wanted to give him some time with his thoughts. you had interrupted him earlier, after all. 

you knew about his complicated family dynamic. he inspired you, honestly. despite everything he had experienced so far in his young life, he was still able to be one of the top students. he was still able to get up in the morning and go about his day. other people weren’t that strong. 

“i’m going to speak freely for a moment, if you don’t mind,” he didn’t object, so you continued. “no matter how much you wish he wasn’t, endeavor will always be your father. there’s not a single person who wouldn’t agree that your childhood was horrible, but you can’t change what happened.”

he listened, almost clinging to every word, desperate for validation. so you kept going,

“what i’m trying to say is that you’ve come so far. when school started, you were so reserved, obsessing over how your family name defined you. now, i see you laughing with iida and deku during lunch. you use your left side with, what seems like, no hesitation. children can’t choose their parents. you just need to keep proving that you’re better. that you’re able to come out on top. but you have to do it for you.”

you weren’t sure if your words had efficiently conveyed what you truly wanted to say. there was so much more you wanted to tell him. you wanted to praise him, encourage him, let him know that while you two weren’t the closest - you would always be there for him. 

but as he remained quiet, you couldn’t help but worry that you had crossed a line. that was it. if your relationship could be considered friendship in the first place, you had definitely ruined it now. each second of silence ensuing was like a stab to your heart, which was already thumping from nervousness, mind you. 

“thank you,” it was no louder than a whisper but you heard it clear as day. “i needed— thank you.” 

the double-quirked boy wasn’t one to openly show his feelings. everyone knew this. whether he was angry, sad or happy, his face always appeared to successfully hide it. so you pretended not to notice the tears welling up in his eyes, offering him a smile instead. 

once again, there was a silence engulfing the two of you. this one, though, wasn’t thick and awkward. it was welcome and comfortable. the kind of silence that happens between best friends and neither one of them mind. 

you were the one to break it, albeit involuntarily. you know how bodies do things that you don’t necessarily want them do? yeah, well your body did just that. shouto’s bicolored eyes met with yours as a violent shiver coursed through you. was it really that cold? 

he seemed to study you briefly before holding out his arm and angling his body slightly toward you. you weren’t sure if he was just that oblivious or if he was being bold. this time, it was your mind going into overdrive. it seemed innocent enough but you still felt hesitant to accept his offer. 

before you were able to either accept or decline, his arm had wrapped around your shoulders. with a gentle tug, you practically fell into his embrace, immediately feeling the warmth from his skin. your tense muscles relaxed and you let his heat melt away your worries. 

“my left side’s not all bad, i guess,” he mused and you swore you could hear a smirk. your face was pressed into his chest, making it impossible for you to check. 

instead, you readjusted your arm, placing it on his abdomen. he tensed up ever-so-slightly when you did, his muscles flexing beneath his shirt, but neither of you commented on it. his chest continuously rose and fell with each breath, creating a rather comforting rhythm. 

“so, what did you think about my fight? did i impress mr. shouto todoroki?”

yet another laugh escaped him, his chest rumbling underneath you. you swore it was one of the most beautiful sounds you had ever heard and it was easily becoming one of your favorites. you would, without hesitation, fight anyone who dared take it away from him. 

he began telling you about what he had noticed during your fight and you listened. you knew he was giving honest advice, and honestly, you could probably use the pointers but you found yourself more captivated by his voice than anything else. had it always been this smooth? 

your conversations continued. they were random and sometimes one-sided, and you had no idea how they lasted but you didn’t want them to stop. he didn’t either, it seemed, occasionally bringing up new topics himself. they continued long into the night, you were sure. 

and, eventually, fatigue caught up to the both of you. the conversations more and more scarce. his breathing growing more and more shallow, barely moving underneath you. your eyelids getting heavier and heavier. 

neither one of you retreated to your respective bedrooms. neither one of you moved; your bodies just melting together like missing puzzle pieces finally finding each other. and neither one of you heard the snickers and camera shutters from your classmates in the morning. 

[albatris]

ik this is probably an inappropriate question to ask but i deal with stpd and just recently discovered this. Previously thought it was just depression/anxiety but ive been on like 7 antidepressants/2 of which were more geared towards anxiety. I was wondering if you take any meds or have any advice you might recommend. Id really appreciate it. Im running out of ideas lol.( Sorry to bother and thank you)

nah you’re all good, I don’t have any problem with questions like this n I’m happy to share any experiences of mine that people might find useful!! though in this case idk how much help I’ll be, sorry D:

mostly about meds but my bad for goin on a whole ramble in the middle about therapy?? I talk a lot and have trouble staying on topic

'cause meds n therapy both have been useful to me but both probably would've been pretty useless without the other

under cut for personal rambles

so I was in the same boat as you for several years, I was in treatment for depression and anxiety and then borderline later on, way way way before anyone landed on schizotypal

as such I’ve been obviously dealing with stpd symptoms for basically my whole life but I only got diagnosed early last year n it’s the first time I’ve been. like. actually in any sort of therapy that addresses it properly and I’m still getting a feel for it

in terms of meds, I’ve been on a whole slew of different antidepressants, didn’t find one that worked until I was maybe 18 or 19? so I’ve been on the highest dose mirtazapine since then....... helps with that kinda baseline anxiety background hum, helps with obsessions and guilt spirals..... I didn’t think it did much for depression until I tried coming off it??

like, it gave me a slight boost in terms of energy and motivation, not a huge one, but definitely noticeable once it was gone

but yeah, it was kinda..... yeah, this med is about as helpful as I’m gonna get, so I decided to stick with it. I recently have considered coming off it ‘cause the sedation was a nightmare, but that’s on hold for the time being

I’ve been on two different antipsychotics, first quetiapine, which did absolutely nothing and was even more sedating on top of the mirtazapine, and currently I’m starting on aripiprazole. still on a super low dose, but working up to something that will hopefully ease some psychotic symptoms. side effects of insomnia and nausea but eased off mostly after the first week

but yeah, I haven’t really had much experience with antipsychotics or how helpful they are yet, atm I’m gonna wait and see whether there’s any real positive effects

but meds are super hard to give advice about, ‘cause different ones work for different folks, what works for me might not for you, what works for you might be something I tried and hated, etc etc etc, y’know

honestly the most helpful thing for me has been therapy, I’ve pretty much been in therapy since I was like 5 and I’ve done a lot of it

meds might be helpful to some people on their own but for me I think they would have been mainly useless without some form of therapy

meds kinda helped with some of the “edges” ie, the resulting depression and anxiety of the personality disorder, hopefully will help with some psychotic symptoms too, therapy has also helped with some of these issues on the edges, and I’m currently addressing some of the more specifically schizotypal core issues, although I will likely have to continue doing the work on those issues for most of my life

if you have a good doctor who listens to you, if you want to continue trying out meds then you might still find one that helps you out! I don’t really have a lot of advice here, because the effects can be so different from person to person. but I’ve found that meds only help on a really small scale, they kind of take a little bit of the weight off but it’s still a whole lot of heavy lifting on my own

so therapy was real good for some of that stuff too, skills for easing some of the load. therapy for me involved Other People, but for others it could involve other resources, such as online workbooks n that kind of thing....... ‘cause I know personally for me I fuckin HATE meeting new people and having to bare my soul for them, so therapy gets. interesting

and I know therapy is not realistic for some folks (and also not what this question was about but I’m just rambling now)

n I know especially that that shit gets fucking HARD when any sort of psychosis and paranoia is involved, in terms of stpd, I flat out refused to speak about certain symptoms with professionals due to paranoia and fear, and had a lot of issues trying to come into a therapy environment and immediately having complete strangers be like “ok tell me about what’s up”

like, no???? fuck off?? I don’t even know you??

n until recently all my therapies where only tangentially useful as a schizotypal, like, I did a bunch of social anxiety stuff which helped with some of the surface level day-to-day social anxiety (not so much the more deep-seated stpd social anxiety, that whole “it gets worse the closer you get to people” type, very fun), I did a lot of work around depression and suicidal urges and goals and meaningful living and whatnot, I did DBT which also encompassed a lot of work on interpersonal skills and handling dissociation and paranoia

n like. some of it was helpful? none of it got to the core of the issue or addressed what I really needed to address

I got super lucky with my current psychiatrist in that she was someone I already knew for around a year and a half beforehand ‘cause she helped out in my DBT group therapy. so I was able to get a feel for what kind of person she was beforehand and got to find my feet in trusting her in a more distanced context before entering one on one therapy. she also specialises in personality disorders and was the one who actually diagnosed me so it wasn’t like she was like “oh you’re definitely schizotypal, I’m gonna just pan you off to someone more experienced now” which was nice

she’s also the one who’s helping me out with meds currently

but ya, therapy can be A Lot, ‘specially for schizotypals who tend to isolate and get uncomfy in those vulnerable scenarios. in order to make the most out of it I have to practice an extremely uncomfortable sort of “radical openness” which is like..... well, I’ve spent most of my life being miserable and unhappy and feeling trapped and stuck in these patterns, and this has gotten me nowhere, in order for something to change I need to be radically open about my experiences

which gets HARD because the knee-jerk reaction to paranoia and delusions is often to pull back and isolate, and often I’ve struggled with the idea that it’s not “safe” to speak about certain things or that something bad will happen if I do

so it’s difficult, but I have to continually commit myself to being open and placing myself in intensely uncomfortable scenarios, getting used to the idea of trust being An Action, and practicing trust even when I don’t necessarily Feel It

that’s been a really helpful outlook for me and the only thing that’s kept me involved with therapy and meds and treatment. idk if it’ll be useful to others. I also know that some therapists and psychiatrists are shit and being radically open with the wrong people can be a nightmare

but it’s something that applies in my other relationships too and with my relationship to myself, so. *shrug emoji*

but yeah. that’s been what’s helpful for me

meds do a little bit of the work, but honestly I still have to pull a fuckload of the weight on my own, I kinda got to the point with meds where I was just like “ok this is obviously as good as it’s gonna get” and just stuck with it......... which is kind of a bummer of an answer

ik that kinda turned into a whole unrelated ramble in the middle there but I hope this kinda answers a bit of your question maybe or maybe not ‘cause I don’t really know what I’m doing

but also

I hope you have a nice day

[welcome-to-the-petting-zoo]

Hey guys! I was wondering if any of you could offer me some tips on calming yourself down or lessening stress? Because of my contamination fears and the fact that I live in the U.S. everything has been piling up. My family doesn’t rlly take me or anything seriously either. So I’ve been falling into fits of “I’m not going to be able to leave the house in years, what’s the point in being here” and general other bad thoughts so I wonder if anything you known could help calm me down? Thanks!

Hey there Anon,

TP here. I'm so sorry you're struggling like this, and especially that your family can't/won't provide you with the support you need.

I'm going to try to collect some general advice and some healthy coping techniques, maybe you can find something here that can relieve your stress. I don't know enough about your lifestyle, specific issues and circumstances to tailor the list to your needs too much, but I'll try to bring up some varied points so maybe there is something you'll find useful.

There are things you can do in the moment to relieve stress and then there are things that are more preventive or work over a longer period, I'll try to cover both categories.

Let's start with in the moment relief:

Grounding. The same way grounding techniques can help with dissociative symptoms, they are also a great tool for stress relief. If you can take a moment to collect yourself, it can help you avoid blowing up or imploding into a depressive mess. There are great breathing exercises geared towards stress relief, but you can also do some physical practices, like putting your hands together in front of you like you were praying, and pressing your palms together as hard as you can, for as long as you can. This will release the physical tension in your body and with that, some of the emotional charge will dissipate too.

Depending on whether your stress manifests as anger, you can also do anger relief exercises, such as trying to rip a piece of cardboard in as many pieces as you can, or, my personal favourite, taking an old pair of sneakers and throwing them against the ground or an outdoor wall, because that won't harm either the wall or the shoes, and it's loads better than turning that anger on yourself or another person. Of course if you can manage your anger without having to act on it, all the better, but if you feel like you're about to explode, blowing off the steam in a non-dangerous way that still allows you to express your destructive urges can work.

This is extreme, but if you have the environment (e.g. you can go to a place away from humanity), you can even try to just scream as loudly as you can. I've never tried this method, but some people swear by it.

Remove yourself from the situation/environment. I know it can be super hard during the pandemic, but if you have the chance, just taking a walk, especially if you can go somewhere devoid of people in nature, is one of the best ways to clear your head and give yourself the space you need to calm down. What I often do is, I get on my bike and take a long ride on some abandoned back roads, which of course is a very special privilege most people don't have, but if you can carve out a little space for yourself somewhere, that can do wonders.

If you can't leave the house because of your fear of contamination or any other reason, I would advise you put on a pair of headphones, if you have noise cancelling ones, those are the best, but basically any pair will do, lie down on your bed and listen to music or nature sounds for a while. I live listening to the sea, or forest noises. There are several free apps you can download that let you create your own sound scapes from different sound elements, so you can tailor your experience to your specific tastes. If lying still is too hard or distracting, you can also try pacing while listening, just make sure you keep to a slow and steady stroll so you won't end up accidentally winding yourself up even more.

You can try doing some yoga, workout or sport. There are a lot of exercises you can also do indoors and generally, moving your body is a wonderful thing, it relieves stress, releases some happy chemicals and tires you out so you won't feel anxious anymore. Basically how this works is, emotions have physical "symptoms" and they work both ways. If you're experiencing the bodily sensation, you'll get the emotion as well, which also means, if you can stop the physical symptom, the emotion will go away too. For example, if you make yourself smile even though you're in a bad mood, you'll soon start feeling better, or the thing when people get anxious or angry because they are hungry and they can feel a knot in their stomach... It works just like that with anxiety/stress as well, if you can relieve the tension from your body, you'll also feel less stressed.

You can try stim toys or other equipment that's geared towards people with sensory integration issues. These tools were developed for people who get easily overwhelmed, so they are extremely efficient for relieving stress. There are tons of different kinds, so you can experiment with what feels right for you. Maybe it's a squishy toy, maybe a weighted blanket, or something you can bite into or a logic puzzle to stimulate your brain. As I said, there are loads of resources out there, and I'm positive there is something you could benefit from, and well, these tools are there for anybody who needs them, so feel free to experiment with them!

Okay, so let's take a look at the longer term things.

Meditation is one of the most awesome things ever. If you're not into spirituality, or if you think it's bullshit, rest assured, that's where I came from too... Until I've tried it. It helped me so much with my insomnia and other stress related issues, and well, it's not like I'm suddenly a hardcore Buddhist or something (not that there is anything wrong with that either, meditation and spirituality/any religion can absolutely go hand in hand), because in the end I like being my weird pragmatic self, but even so, meditation is something I love doing, it gives me peace and teaches me how to relax and come closer to understanding what my body needs and how to pay attention to it. There are also very cool resources for that, both apps and podcasts/YouTube channels that have guided meditation materials or that teach you different techniques.

If you have the spoons, please, do exercise! It is so damn helpful and important, but I also know it's something that can be super hard and I also struggle with it a lot, but whenever I actually manage to move around just for a few minutes, I feel so accomplished and so well physically and mentally.

Try to express your emotions in different ways. Create awesome vent art (your skill level doesn't matter, you can literally be scribbling on a piece of paper, or squishing a block of clay into a shapeless lump, it's not about artistic quality)! Experiment with different media and techniques, write, draw, sculpt, make collages out of magazine cuttings, press flowers, knit emotional sweaters, whatever your preferred method is, creating is a truly healing experience. It allows you to collect your thoughts and emotions and express them in a way that engages your brain in a different way than just thinking about it does, and it turns the negative emotions into positive experiences of creation and relaxation.

Ask someone to give you a massage. Again, back to the whole body and mind influence each other thing, not to mention that massages feel awesome and if it's a friend or loved one giving it, it also creates intimacy and a shared good moment which in and of itself can help a lot.

Talk about it! Seriously, fuck those people who tell you it's somehow wrong to talk about your issues or that you're being a burden. YOU'RE NOT! If you're in distress or you just feel like you need a talk, just do it! If you have noone to talk to, just get back to me, I'll be happy to listen if that means you're feeling better. There will ALWAYS be people who would happily listen to your venting if that would make you feel relief.

Finally, if this is something that's an option for you, consider talking to a therapist or your healthcare provider. They might be able to point you in the direction of some resources or talk about the possibility of temporary medicinal treatment until the pandemic blows over.

I hope this helps a little bit, and of course, if you have any follow-up questions, I'll be happy to elaborate on any of the points. I'm sorry for not including specific links or resources, but I'm a disabled weirdo and right now typing this out is all I have in me. But if you can't find something, or would like specific recommendations, get back to me and I'll look into the specifics for you.

Best of luck,

TP

[lettersandinkstains]

Writing Advice II: Depression

So, my other post on writing trauma seems to have taken off and been fairly well received!

Another misconception I see among media is things on depression. They believe it’s always a young white girl who cries a lot, wears all black and maybe hurts herself. Bonus points if she’s an artist. Extra bonus points if there’s some sort of resistance to therapy, medication, and, “You won’t be as creative on anti depressants!”

Disclaimer: Mental illness comes in all sorts of ways, so how it may appear in me might be different for someone else. These are based on experience as well as the diagnosable symptoms that are common.

Warning: There is some discussions of s.uicide, so please be cautious when going forward.

Clinical depression, major depression. We’ve all heard those words, and we quite likely know someone who has a diagnosis or we, ourselves, have it. But what does it mean exactly? Everyone assumes it’s just feeling sad, and you don’t always feel sad, heck, maybe you feel good a lot of days!

That’s because depression is a persistent feeling of sadness. It usually leads to physical and behavioral changes.

Well, what are the symptoms?

According to the DSM:

The Mood Symptoms:

Anxiety, apathy, general discontent, guilt, a sense of hopelessness, a sense of helplessness, loss of interest in things you may have found pleasurable in the past, mood swings and sadness.

The Behavioral Symptoms

Agitation, excessive crying, irritibility, restlessness or social isolation.

Sleep-wise:

Insomnia, excessive sleeping, early wakening, or restless sleep.

Whole body:

Excessive hunger, fatigue, or loss of appetite

Cognitive:

Lack of concentration, slowness in activity, or thoughts of suicide.

(Please note: this is just a simplified list--there’s quite a few more things to go with it)

How these things will appear in people vary. For me, I would cry excessively and for absolutely no reason. I opened my fridge one day to make chocolate milk, because for once, something sounded good and found it had spoiled two weeks prior. I sobbed for an hour. For me, that spoiled milk had felt like I was an absolute failure of a human being and adult.

I mean, I let the milk spoil. I felt utterly worthless. This may perhaps be dramatic to the outsider, after all, it is just milk, but often times, it’s not just milk or a dropped pen or even a bad day, it’s a series of things that mold up into a mountain and that little insignificant thing causes the avalanche. Perhaps, yes, it was an overreaction, but for me, it felt as it was a testament as to who I was as a person then.

When the sickness (because I consider it a sickness) first showed up, I was probably around nine or ten. The symptoms were subtle and could have easily been brushed off as being shy. I started to isolate myself from my peers, I preferred to be on the computer and away from everybody. I had thoughts of suicide, even if I didn’t quite have that word in my lexicon yet.

For me, at that age, death meant the end of suffering. I was raised in a religious household, and the church I attended was pure doom and gloom. If you died, you would be with god and nothing would be wrong. Religion wasn’t a factor, but it sure as hell was an enticer to try.

Do I think religion such as Christianity to be bad, now, as an adult? No, I do have my hang ups with it, but I’ve known religion to help a lot of people overcome or even deal with their mental health issues. And to them, I give them props.

The emotional pain I feel and had felt was something I could not, and still cannot describe to this day. The closest I have gotten to describing it was to a therapist, and it feels like there’s a giant ball of scribbles in my chest that’s constantly turning and growing bigger. It always feels like it hurts and it’s suffocating. I picked up cutting because if I could just get it out, it would go away.

It never really went away.

I stopped being able to sleep around age thirteen. For others, they sleep too much. For some, it’s disruptive, and it’s restless. But for me, it manifested itself as insomnia (anxiety played a major part in this too). The nights were long and restless, and I would often cry. Because wow, sleep is another thing I’m failing at! My weight dropped due a lack of appetite, food tasted like cardboard, and the smell made me want to vomit (I would later be diagnosed with EDNOS).

My grades suffered. Focusing was hard. Words felt like gibberish most days. Hobbies felt bland, awful, and stupid (it didn’t help I had brothers who made fun of my interests). The sociable little girl I had been, the one my parents sang praises for being smart, friendly, and witty all felt like it died when I became a teenager. Part of it had to do with my period at age nine. I would later learn this is likely a part of dysphoria.

Writing felt like my only outlet, as depression ate and took away a personality. I’m still discovering my interests today, at aged 27! And you know what? That’s okay! It’s okay to have overcome a shadow and relearn things, this isn’t a race.

So, how do you write things like this in a character? You may wonder. Surely, nobody with depression is always crying and locked away from society.

No, of course not! Give them a personality. Much like with anything else, depression isn’t a personality, it’s an illness. 

Let your characters still experience happiness. I still felt some joy and excitement at things. When I did theater in high school, I felt a rush of pride when I was able to memorize silolquies and impressed my classmates, my heart still beat fast when my then girlfriend would kiss me. Calling my friends (because texting wasn’t much of a thing in 9th and 10th grade! I don’t think it became ubquitous until I was about to graduate?) was still exciting, and I would always look forward to weekend long sleepovers.

As an adult, the things that still made me excited and got me out of bed was volunteer work. I would later foster cats and then lose that after a second suicide attempt. But there were still things that made me happy.

Because with depression, you can still experience happiness. The sadness is persistent. 

Give your characters interests, but let them have their struggles with it. I still message friends with my frustrations and anger when nothing seems right and everything I do is bad. Let this be a thing with your characters where they’ll go days without experiencing the adrenaline rush from their interest. 

Your hero in your fantasy adventure story doesn’t always have to be strong and courageous. Let them struggle with the trauma of having watched So and So die or get hurt. Let them feel the guilt. Have days where they can’t get out of bed because it’s just too much, it’s too hard. Their chest aches, their heart aches.

But force them anyways. And as usual, make sure it fits with your story. Don’t fret because you’re writing something and the character isn’t responding to a terrifying, traumatic event like you believe they should. People process things differently. If it fits in the story, do it, but do it well.

Your main character in your romance story has major depression. Okay, cool! When you bring in the love interest, and the romance blossoms and there’s roses, maybe they confess their love to each other. Maybe there’s that little bit of drama, a misunderstanding, or whatever your conflict is. Don’t go Hollywood. Do not let the love interest be the thing that “fixes” the depression.

Because that’s not how it works. Your character may decide to live, or get better for that love interest--PERFECT! GOOD! People do that all the time! I’m doing that for my cat! Let the love interest help them, but do not say that the character was now healed by love and they lived happily ever after. That doesn’t feel real, and feels very, very misleading. I’ve destroyed relationships because I was severely depressed. 

“But what if I want to write something like that? Real life isn’t always fun.” No, it’s not. It’s okay if you want to write something like that, but we already have countless movies geared towards things like that. I can guarantee the next Lifetime movie has that sort of plot. And while you’re free to write as you please, it gives people an incredibly wrong idea. You cannot heal someone by the “power of love”, they have to want to get better, and it’s an uphill battle.

I can’t tell you the countless times I’ve heard people in support groups express frustrations with themselves or their partners because they’re not better yet. “They said they love me, but they’re mad I’m still depressed.” or, “I have this person in my life now, I’m in a relationship. Why aren’t I happy?” 

So as you write this story, keep in mind, you are adding a real life element to it that people struggle with on a daily basis. And we all rely on escape fantasies, but there are still those who think those can be true. And it’s dangerous. A former friend of mine believed that if she loved this guy enough, if she stuck around, he would get better. She just not trying hard enough. He never got better. And she suffered all the more for it.

Alternatively, I watched one of my friends flourish in a relationship. She passed away this summer because she still had her demons, and those demons got the best of her. But you know what happened instead of ~love~ healing her? She worked to get better, she relied on her partner when she needed to. She used the support net she had, and strived towards healing. And she did amazing because she felt she had something to live for. 

So, if you want to add in that real life element where people struggle with, and has claimed lives, write it so that love interest is someone they decide to live for. And I think that’s a more interesting romance story instead of, “Mentally ill character falls in love, suddenly cured” trope!

The people I know who struggle with depression either do seek professional help (therapy, psychotherapy, medication) or self medicate (drugs, alcohol, etc).

Family members are alcoholics, for example. One uncle would prefer to see the bottom of a bottle starting at 7 am and going until 12 am. He only got better from alcoholism for four years, until his kids graduated. Being drunk is preferable state of mind for him than whatever reality he may be having to face (and yes, some of us are trying to help him--he doesn’t need an early grave at 65).

A friend of mine used drugs to escape the world and the demons that followed. Last year, he got clean for good. This year, he started anti depressants. This month, he is soaring.

I know someone else who uses religion. They are happy in this state, and I cannot find fault in that. If someone finds peace, contentedness, happiness when believing in a higher power, let them be. Unless it is so obviously hurting them or others.

Lastly, a small note on medication is that it’s not one size fits all. Medications can be a bitch to deal with, I had to mess around for a long time before I found something that works, which is ativan. If you want your character to go on meds, keep in mind that taking that first pill doesn’t automatically mean they’re suddenly happy and cured for life.

For some, medication means it’s a lifetime thing, and others, a short while. However you decide to do this, is up to you.

Make sure to research it. Make sure to do it well. And if you have struggles and asking if you’re doing it right, reach out to someone about it and ask questions. It’s okay. Nobody should fault you for that.

And as I’ve said before, we can have our happy ending. But it’s your choice on the characters ending because there is no “wrong” way to do it, because some people lose their battle. Some people live to survive it and tell about it, others will battle tooth and nail for the rest of their lives.

So, with this very long post ending, readers, writers, everyone, if you struggle with depression or know someone who has and wish to add on to this post (about your experiences!), feel free to do so! After all, it rears its ugly head differently in everyone, and well rounded information is often given by a multiude of people!

And if anyone has questions, you are free to send me an ask or a message!

[killthewolf-blog2]

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What’s Next for Sleep Disorders Centers?

The post What’s Next for Sleep Disorders Centers? was originally published to https://www.ellymackay.com

Even as the United States reopens, it’s not just exposure to COVID-19 that sleep professionals need to worry about. With sharp increases in unemployment and many facilities seeing drops in revenue, the road ahead for sleep labs is likely to look different than what has been traveled before.

By Yoona Ha

To learn about how the landscape of sleep medicine might change, Sleep Review interviewed a dozen business owners and clinicians on what the new normal in sleep will feel like. What trends are here to stay? How will infection control practices grow and develop? Who’s left out of treatment? Which innovations will stick around post-pandemic?

Sure, the pandemic may be unprecedented, but there are patterns in how the sleep industry is responding that gives us hints to what to look out for when the virus subsides.

A Future of Digitally-Enabled Care

Even long-time advocates of telemedicine didn’t foresee that the explosion of sleep medicine practice over the Internet would happen so suddenly.

“Part of me feels like people have been almost forced into adapting telemedicine before they were ready, but then the other part of me feels like people were extremely ready for this change,” says Seema Khosla, MD, FCCP, FAASM, medical director of the North Dakota Center for Sleep, who has offered virtual visits for more than a decade.

A COVID-19 impact study conducted by artificial intelligence-powered diagnostics company EnsoData found that 64% of sleep center interviewees are using telehealth platforms during the pandemic. Uses include video and phone appointments, diagnostic evaluations, treatment discussions, and CPAP education. “Forward-thinking sleep centers may focus on sustainable changes to the gross proportions of at-home versus in-clinic care in a post-COVID-19 world,” the study notes, which may signal a new era for digitally-enabled care.1

Khosla, for one, talked about her mother, a primary care physician who had never imagined video chatting being a replacement for in-person visits.

“It’s not uncommon for providers needing to acclimate to tech-enabled solutions, but what’s interesting is that I’ve seen people like my mother start from a place of having trouble with telemedicine platforms getting better at it,” Khosla says. She has even seen her mother’s personal calls improve. “I used to stare at her ceiling a lot during video calls, but now her experience with telemedicine has translated into better Facetime sessions,” she says.

Long-term, Khosla anticipates providers will continue to leverage telehealth while also addressing gray areas. For example, they may direct patients on how to aim a phone camera to show the back of the throat.

Kholsa recommends setting up multiple telemedicine platforms in case technical glitches emerge on one. “Technology is supposed to improve our healthcare experience and sometimes we tend to get ahead of ourselves and forget that it’s the human behind these platforms that can be transformative for the patient,” she says.

Video visits have also proved to be transformative for some clinicians, particularly those who are caregivers for young children or older relatives.

Of course, in-person alternatives depend on clinical discretion. “Initiating therapy based on clinical judgment requires excellent follow-up to ascertain the effectiveness of therapy; this is possible using telemedicine, but triage is needed to ensure that patients are seen in a timely manner,” says Shannon Sullivan, MD, vice chair of the American Academy of Sleep Medicine (AASM) Public Safety Committee and medical director of the EVAL Research Institute in Palo Alto, Calif. “In addition, in many cases when labs are reopened, it will be important for clinicians to consider completing missing elements of the workup. A silver lining in all of this is that sleep physicians may, in some cases, welcome the opportunity to do what they do best—practicing sleep medicine based on their expertise and experience rather than checking the boxes of payer requirements, which may at times be overwrought.”

But still, given that insurance coverage for ongoing care in a post-pandemic world is not yet defined, it’s hard to predict how coverage for telemedicine will continue to evolve.

Is the Surge in Home Sleep Testing Here to Stay?

[RELATED: “Unprecedented Demand”: Sleep Medicine Scales Its Remote Offerings]

Pre-COVID volumes were 70% in-lab and 30% home sleep testing (HST), according to EnsoData’s survey, which found this in-lab to home testing ratio flipped during the pandemic.1

“It’s a big question—whether we’ll see the reversal of the prevalence of HSTs versus in-lab sleep studies continue after the pandemic,” says Chris Fernandez, EnsoData co-founder and CEO. “But I do think that the trends we see in sleep medicine—increases in HSTs and the accelerations we’ve seen in telemedicine—won’t go away post-COVID. We believe that sleep providers with a bias towards action and a care delivery model that enables them to shift gears when they need it will be the most resilient during and after a pandemic because this won’t be the last outbreak we’ll ever see.”

Indira Gurubhagavatula, MD, MPH, chair of the AASM Public Safety Committee and associate professor in the Perelman School of Medicine at the University of Pennsylvania, says sleep medicine has long been poised to adapt to telemedicine approaches. “Our primary diagnostic and therapeutic data, which comes from sleep studies and positive airway pressure devices, can be accessed electronically by leveraging remote, cloud-based networks without relying on smart cards and face-to-face appointments to retrieve data,” Gurubhagavatula says.

Ingvar Hjalmarsson, chief product officer of sleep diagnostics company Nox Medical, says Nox has helped patients on lengthy waiting lists gain access to OSA treatment through a “rental relief” program, which provides sleep centers short-term device rentals until they are able to reduce waits to manageable levels.

“We believe that our innovations are a great fit for the opportunities that the post-COVID-world introduces,” Hjalmarsson says, adding that its new dual PSG-HST device provides sleep professionals with more flexibility on study location.

“The trends we see in sleep medicine—increases in HSTs and the accelerations we’ve seen in telemedicine—won’t go away post-COVID”

Chris Fernandez, EnsoData

Businesses that offer HST logistics have been popular.

“Our focus is on figuring out what sleep centers need, and we’ve identified pain points in the logistics: mailing, keeping track of monitors and supplies, scheduling studies, just to name a few,” says Hani Kayyali, CEO of CleveMed, which offers a mail-order service. “What health systems are finding out are the financial benefits of streamlining HST offerings. Some of the health systems we work with have doubled or tripled their volume of patients with existing staff, and that’s probably one area that’s become more obvious since the pandemic.”

Some HST providers who relied on in-person patient training or a classroom model could not continue to provide services during the pandemic, says sleep physician Dominic A. Munafo, MD, FABSM, chief medical officer of BetterNight, which offers sleep telehealth screenings, in-home testing, and remote initiation of PAP and insomnia therapies. “The ability to provide diagnostic and therapy services safely was the primary concern,” Munafo says. “Our existing protocols for sanitizing diagnostic recorders and offering ‘no-touch’ PAP setups were quite reassuring to new clients. Also, the use of disposable sleep recorders [Itamar WatchPAT ONE] was a vital tool to reassure both patients and doctors.”

Southern Sleep Society manager Marietta Bibbs, BA, RPSGT, CCSH, FAAST, says it makes sense for providers to shop around for better deals and partner with companies that provide leasing or renting options. “With the focus on infection prevention, the only place to really manage budgets is to manage staff like decreasing overtime, shorter work shifts, and making sure that night technologists score their sleep studies so that day staff can concentrate on patient follow-up and other accreditation requirements,” Bibbs says.

Advice for Resuming Operations

Managers also have to navigate how to protect staff and patients from potential exposure to coronavirus.

“Increasing telehealth availability, and all the coordination, staff training, hardware and software adaptations, and patient education this entails, is one arena,” says Sullivan, clinical associate professor of psychiatry and behavioral sciences at Stanford University. “In a field reliant on lab testing for complex respiratory disorders, hypersomnias, and some types of parasomnias, figuring out how to safely reopen has become essential.”

Since home sleep studies are only indicated for patients with a high pretest probability of sleep apnea, people who have symptoms of other sleep disorders have in many cases been waiting extra months for their diagnosis.

“Polysomnography and/or MSLT [multiple sleep latency test] are indicated in the work-up of non-respiratory sleep disorders as well, so I think there are burgeoning, unmet needs among all sorts of patients right now,” Sullivan says.

Challenges for sleep practices, according to Sullivan, include staff retention, procurement of personal protective equipment (PPE), cleaning services, altered staff-to-patient-ratios, and altered reimbursement profiles. Sleep labs may also face productivity reductions from keeping equipment out of service, reducing patient flow to minimize contact, deploying triage strategies, and addressing cancellations.

“There isn’t a one-size-fits-all approach to tackling this long list of concerns, but instead providers should continue to remain agile and creative in addressing these challenges for the foreseeable future,” Sullivan says.

Even before the pandemic, insomnia resources were inadequate to meet patient needs, says BetterNight’s Munafo. “With the advent of COVID, there has undoubtedly been an uptick in insomnia complaints,” Munafo says, adding that BetterNight’ makes a cognitive behavioral therapy for insomnia (CBT-I) app that can eliminate the need for in-person CBT-I.

Heightened Infection Control

[RELATED: Will the Pandemic Be a Tipping Point for Disposables in Sleep Medicine?]

Heightened scrutiny over anything that comes into contact with patients is likely to remain a priority for the foreseeable future. Managers will likely have to spend more money on PPE, hand sanitizer, thermometers, disinfection, on screening patients and staff for COVID-19 symptoms, and potentially on new equipment or supplies that may reduce transmission risk.

“Moving forward there will continue to be a need for in-person studies,” says John Blackburn, marketing operations manager for Sizewise. The mattress company makes a medical-grade wipe-down top that doesn’t degrade with the use of harsh cleaning chemicals, which Blackburn characterizes as “an important preventative piece for every facility’s infection control protocols.”

Even before the pandemic, Todd Eiken, RPSGT, FAAST, vice president of product development at Dymedix Diagnostics, saw increases in sales for disposable sensors. He described the boost during COVID-19 as the tipping point. “What we’re asking providers to consider is the costs: compare the costs of cleaning and disinfecting reusables along with the time costs of providers in charge of disinfection with the cost of using disposable sensors,” he says.

Eiken says the looming risk of liability combined with lingering concerns regarding sensors that sit under a person’s nose convince many to switch patient-adhered sensors to those that are discarded after single-use.

Managers may also need to reeducate team members on best practices, for example, halting the practice of using a reusable electrode to scoop skin prep gel out of the jar. New practices may also need to be deployed, such as doing electrode and sensor hookups from the back of the patient, instead of the front. For procedures that can potentially aerosolize viruses, such as CPAP titrations, some sleep labs are opting to add bacterial/viral filters or blocking ventilation ports, though it’s best to check with your device manufacturer before making changes.

Some clinicians are also switching to disposable home sleep test devices, though AASM guidance states that as long as devices are disinfected properly and the time between patients is sufficient, switching to a disposable device like Itamar Medical’s WatchPAT ONE is not essential. “The WatchPAT ONE uses Bluetooth and so eliminates the need to return shipment, cleaning and preparation, which significantly reduces patient and staff exposure to infection,” says Amit Shafrif, vice president and general manager – cardiology at Itamar Medical.

Economic Losses Will Linger

Bibbs, who is also manager of sleep and neurodiagnostics at Morton Plant Mease Healthcare, says the closure of sleep clinics has placed some sleep techs in a position of concern about future employment opportunities. “Those employed in freestanding facilities that are without pay are concerned that these facilities will not reopen again, and this has indeed been the case for some facilities,” she says. “I think that hospitals will reassess many of their outpatient services related to profitability due to the substantial losses resulting from the pandemic, and sleep services may be included in that model.”

On the other hand, hospital-owned sleep centers were better able to deal with the closure, according to Bibbs, with some sleep techs attending to other areas of care, including temperature screening and respiratory equipment.

Health Disparities Brought Forward

Bibbs says the pandemic’s disproportionate effect on Black patients has further highlighted the necessity of sleep clinicians to address the health disparities that medically underserved populations face.2

Reduced capacity and closed sleep clinics translate into reduced access to care; for some, the pandemic’s effect has proved fatal, according to Bibbs. She cited an example of a family member who passed away in their sleep after dealing with multiple comorbidities and sleep apnea.

Providers need to stay vigilant about providing equitable care to patients in all communities, Bibbs says. Before COVID-19, community health facilities that connect patients with devices and care would help uninsured patients, and in light of recent concerns about how CPAP could spread COVID-19, many facilities now also sanitize donated CPAP machines. She also sees telemedicine playing a role to reduce those gaps in access during and after the pandemic. “Sleep providers concerned in closing the gap in disparities can volunteer their time at these community medicine clinics and become visible members in their communities to earn the trust of those medically underserved patients,” Bibbs says.

“Sleep providers concerned in closing the gap in disparities can volunteer their time at these community medicine clinics and become visible members in their communities to earn the trust of those medically underserved patients”

Marietta Bibbs

Accreditation Surveys Go Virtual

Throughout his many years with the Accreditation Commission for Healthcare (ACHC), program director Tim Safley’s focus has remained on the patient. During the pandemic, the accreditor started conducting its surveys virtually (in conjunction with limited on-site reviews in areas with less than 500 reported cases of COVID-19).

“From our standpoint, we know that in-person site visits will never go away, site verification is incredibly important so to ensure that we’re meeting safety protocols we are conducting virtual visits with the expectation that we can validate that they’re meeting our standards at any time without notice,” Safley says.

The experience of these virtual site surveys has been facilitated by secure, encrypted video platforms. “It’s no different from an on-site survey in terms of the thoroughness and what we’re looking for and the good news is that we have seen no pushback from providers,” he says.

Dottie Covey, RPSGT, an ACHC surveyor advocated for sleep clinics to look at their existing vendor relationships to identify opportunities for cost savings during a webinar on infection control in sleep labs that was attended by more than 400 people. “You need to be thinking differently about your current processes and what else you could be doing to improve,” she said in the webinar. “We should and always continue to operate as if the next patient that comes in could be a contagion; it’s not just during a pandemic that we need to heighten infection control practices.”3

Moving Forward

This moment will serve as a unique time in history for incoming trainees in sleep medicine, which was heavily impacted by COVID-19, says Gurubhagavatula.

“With the move to telemedicine approaches, educators and learners have had to adapt quickly to achieve required metrics and competencies,” says Gurubhagavatula, director of the Sleep Disorders Clinic at the Crescenz VA Medical Center in Philadelphia. “Some challenges, as well as opportunities, exist in this new environment. Moving forward will require dynamic, innovative, and collaborative learning models.”

Yoona Ha is a freelance writer and healthcare public relations professional.

References

COVID-19 sleep center impact study. EnsoData. 2020. Available at https://www.ensodata.com/landing-pages/covid-19-sleep-center-impact-study.

COVID-19 in racial and ethnic minority groups. CDC. 4 June 2020. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html.

Infection control in the sleep lab. ACHC-U. 21 May 2020. Available at https://register.gotowebinar.com/register/7672731193098899211.

Image: © Mast3r | Dreamstime.com

from Sleep Review https://www.sleepreviewmag.com/sleep-diagnostics/in-lab-tests/sleep-disorders-centers-pandemic/

from Elly Mackay - Feed https://www.ellymackay.com/2020/07/17/whats-next-for-sleep-disorders-centers/