And yes, I’m cranky, so I’m going to leave the post title encheeseburgered. 😛
Why cranky? Well, turns out today’s a good day for discussion of the interaction between insomnia and pain tolerance. If there were a hell, this would be it.
So, for me anyway, it works like this: iff* I get the six hours’ or so that I need in a night, then my pain tolerance will be at its maximum in the morning. I take my meds, wait the two hours for full effect, and then off I go with my day.
But, and it’s a big but (and yet I still enjoy the way I look in minis, so 😛 ), there’s what I like to call a “viscous circle” here, because the more turns one takes on the Viscosity-go-Round, the higher becomes the initial energy needed to make me into a moving object again. I avoid ‘vicious’ circle, because there’s no malice in this. It’s just a function of various physiological responses to pain.
It’s hard to sleep when I’m in bad pain. Like, for me an eight or more. Most people would probably rank it somewhat higher on a ten-point scale, but as Ania mentioned in the FTBCon panel, chronic pain people use a different scale, because we’re used to operating with higher levels of it**. And what might be a ten for you, for me is Tuesday, and it’s maybe a six or seven. So when we go to hospitals? We inflate those numbers a touch, because people judge by what they themselves consider the ten-point scale to mean, and if i say it’s a six, they’re reaching for the aspirin rather than the demerol.
So, an eight or better, and I’m struggling to sleep.
Problem 1: the opiates dull my sensitivity to most sleep aids. That is, I can usually take enough tranqs to get a stegosaurus feeling like a trippy rave kid without falling asleep, if I’m in bad pain. Recently I found one that does have some effect, which is deliriously delightfully de-lovely. Until this, though, we had neologism the first: painsomnia. Painsomnia is when the pain is so bad, you can’t sleep.
Problem 2: If I may mix my sporting metaphors*** here, the painsomnia is the crossed ball from the wing, and the insomnialgia is the slam dunk. The insomnialgia is “the amount of pain tolerance depleted by sleep deficit”.
It works like this. I have a hard day, for whatever reason. Maybe it’s the weather (between 2 to 13°C and rainy/damp), maybe I had a long commute back from Toronto on a bus or train, or a long drive back from anywhere, or I played soccer, or any of a hundred other ways I can end up with too high a proportion of vertical in my day. Too much vertical means increased pain.
If I can’t get the pain under control before lying down, it’s very hard to get to sleep. No position is comfortable for very long, pain sweat makes my pillow all warm and icky****, and when the pain is bad it’s hard to still my mind towards sleep, hard to focus.
Remember that every hour I don’t sleep, I’m also lowering my pain tolerance for the next day. If, as last night, I can’t get to sleep until 3:30, and wake repeatedly before my next set of meds kick in, I maybe get two hours, maybe three.
So when I get up the next day (for some value of “up”), I’m already in a deficit. I’m short of sleep because of the pain, and I’m unable to take the pain as well because I’m short of sleep.
If I can’t intervene and break this cycle, it can get so bad…well, I don’t really know how to describe it, I’m sorry. One of the ways I can intervene is to take a day of horizontal. Necessarily, this means that if I’m working outside the home, that day is a write-off. If I’m working for myself, and I can get the pain low enough while lying down, I can dictate notes for me to work on later about the thing I’m working on (translation, or thesis, or whatever). Often, even at home, it ends up being a writeoff anyway.
Where it becomes a bigger problem is when one day won’t do it. Or when people don’t understand (usually bosses and/or clients) that yes, I was able to work eleven hours yesterday on your project, but because I did that, I will now need at least two or three days to recover, most of which will be spent horizontal in some manner as seems appropriate.
Speaking of which, it’s time to get more horizontal in my presentation to the world. I believe I shall use my bed for this. See you after my (hoped-for) nap.
** I won’t rehash that here, but if you want me to talk about it, drop a note on any post and I’ll put it on my list.
*** And I’m going to, so it’s not like complaining is going to help.
**** Pro tip for others who have this problem. Use two pillows. Between the pillows, at about the spot your head would rest if you flipped the top pillow toward you, put the most solid, long-lasting ice pack you have, wrapped in something fairly water-absorbent if possible. Continually flip the pillow toward you as you try and get the pain down to a level where you won’t be dripping and sweaty for no fun reason. I use an icepack used for shipping refrigerated medical supplies, because it easily stays at leas half-frozen for several hours when held between two nice insulating pillows.