The Absence Of Sleep

Well,  before we get heavily into this blog. I invite you to sit back and enjoy(?) a little bit of Mike Myers doing his Austin Powers/Dr. Evil schtick. The reason will become all too clear.

Sorry, if you found that painfully unfunny and I’ve robbed you of a couple of minutes of life you ain’t ever going to get back!

Somewhere around my mid 30s things (if they hadn’t already) were taking a drastic downturn. Of course, I was waking up 30 times a night; of course, I was endlessly worried if I was going to have a laryngospasm, and, of course, I was self-medicating with promethazine and alcohol. I started to develop (along with my facial tic) a real fear of having to talk to people, to be in the spotlight of their gaze. It was kind of OK in the classroom, where I could teach to a point just above the student’s heads, as if I was addressing a student just beyond the back row. I say OK, but on bad days I was getting very anxious before lessons began. My lessons were hyper-organised in a way only an OCD person can. Water was always on the table, in case any of the chalk irritated my throat. I was surviving. Just.

Talking to my peers was much worse. One on ones, leading professional development sessions and interviews were just impossible. I started to feel out of my body, like I was watching this nervous excuse for a man stammering, coughing and hyperventilating. Eye contact with other people was hard to maintain. Conversations were spent worrying whether I’d made enough eye contact and was I able to breathe and swallow OK. I would often not be listening to the other person, just thinking about how to get out of the conversation as quickly as possible, probably accepting some unwanted job/invitation in return.

I no longer answered the telephone or door. I found going into rooms difficult – as I would have to initiate a conversation. I would come home shaking. This couldn’t get worse, but hey, you know what…….

OK, Austin Powers time. I think we’ve all had that moment of noticing something, something perhaps slightly embarrassing, when having a conversation with someone, for example, a spot on the nose and we spend the entire interaction trying not to look at it. Well, I managed to develop a weird OCD based around that. 

I am not exactly sure how it started or why, but I think it had something to do with my inability to maintain eye contact but I would be having conversations with people and something about their appearance would catch me eye and from then on in I was trapped. It could be the aforementioned spot, a stain, nasal hair, cleavage, and yes, even a mole but once it had found it’s way into my eyesight I was forever drawn to it. The vicious circle now had another wicked element to it.

1. Maintain eye contact
2. Swallow
3. Breathe
4. Don’t look at it
5. You looked at it
6. Nervously readdress eye contact
7. Don’t look at it
8. You looked at it
9. Speak
10. Your airway is closing.
11. Return to step 1, unless able to runaway

Every interaction had become a living hell. It was like a weird form of Tourette’s. First of all, my eye was spasming to its heart’s content and, secondly, I was forever making social situations worse by doing things that are inappropriate for said social situations. After every conversation my back would be laced with sweat  – time for aluminium-based roll-on deodorant (great stuff, quite toxic, I would cover my whole back in the stuff – sweating is now impossible!!). 

I think this entry for the Blog is a heartfelt apology to all of those many, many people who had to endure conversations with me during this period. Sorry, if I ever came across as weird or strange! Sorry if I ever made you feel uncomfortable. I am so sorry……

I really wanted to withdraw from the world. I knew I was upsetting other people. I cannot begin to describe the anxiety I was feeling. I gave up my job. Became unemployed, hid myself away……

A short musical update for this week. I plan for next week’s ‘normal’ blog to be a big and difficult one….

Flicking round Youtube, like you do, you can suddenly find moments of your past staring right back at you. For example, I was in a band called Highrise for a very short time in the 90s. Manchester based, I joined the band in my mid to late 20s and left relatively soon after. I played a couple of gigs with them and recorded 2 songs…and, something that I had totally forgotten, made a video.

The memories start to come back. I felt so ill on this day, I think I had flu and that is the reason for my slightly wan appearance.

I left the band as Sian the singer was leaving and I couldn’t see the band replacing her.

Of course, I was wrong. They carried on just fine and rerecorded the song and remade the video. You can decide which you prefer. But please notice it took 2 guitarists to replace the mighty Hancox!!!

This current experiment has been going on for about three
months now, so it’s about time that I evaluated the state of play. It started
when I decided to ignore the fact that neurobiochemistry is complicated and just
dove right in to test my theory. Which was that David is deficient in the
neurotransmitter GABA.

The symptoms are apparently:

anxiety; worry; fear; muscle tension, especially in
shoulders, neck and jaw; restlessness; insomnia; early-morning awakenings; short
temper; phobias; impulsiveness; disorganization; reflux; IBS;
diarrhoea; hypertension; tinnitus; chronic pain; migraines;
PMS; alcoholism/addictions; schizophrenia; depression; OCD; allergies;
frequent urination; flushing/blushing; sweating; salt cravings[1] 

I’ve crossed out the ones that didn’t apply and of the ones
that do, some are dubious. Tinnitus, for example: he’s a musician and when he
plays live or rehearses, it’s loud. Salt cravings? Who doesn’t love nachos and
beer?

Despite not ticking all the boxes, it was enough to satisfy
me. And before you can say gamma-aminobutyric acid, I’d bought the supplements.

The first thing to note is the fact that the supplements
shouldn’t work. The blood-brain barrier prevents GABA from reaching the receptors,
so all the anecdotal accounts claiming the amazing reduction in anxiety must be
down to:

• A leaky blood-brain barrier – presumably not a
  good thing…
• An effect on the GABA receptors in the gut – and
  more about that later
• A placebo effect

The second thing to bear in mind is that GABA uptake is apparently
helped by having other substances with them. So if you’re interested in trying
this out, it’s recommended to have L-theanine, vitamin B6 and magnesium
included with your supplement.

Results so far

1. A slight improvement in initial sleep duration – some nights he reports going to sleep at 10:30ish and waking about 1ish, rather than after only an hour’s kip. Otherwise, there was no real difference – after that, he still continues to have this skittish, on-high-alert light sleep for the rest of the night.
2. Definitely feels calmer during the day. Is this down to GABA or simply a result of having a slightly better sleep? Possibly a bit of both. Who knows?
3. A definitely, more relaxed gut and less reflux. David has always been one of those people whose nerves reflected in their intestines. Tentative, self-diagnoses of IBS; sage nodding that yes, indeed, his mother also suffers from a dicky tummy; random claims to be intolerant of oats—these have all been bandied around as explanations to his hyperactive bowels. Roll on GABA and suddenly we have a calm colon. The reduced reflux could also be down to GABA, but let’s face it – not drinking wine most evenings probably has something to do with it too.

Because the results were not so dramatic, I decided to have
a break, just to see if it was worth continuing with. Guts became wobblier again
and he said he was feeling more anxious in general. OK, that’s interesting, I
thought, and clearly the old placebo effect could be responsible for it but nevertheless,
we’ve restarted it. For now, it’s a semi-successful experiment. And, as far as
we can tell, there’s no negative effects, so it’s a win-win.

In the meantime too, the aim is to increase GABA naturally.
How, I hear you ask? Well, unsurprisingly diet features strongly here. So you
should be eating a varied diet packed full of whole grains, vegetables, nuts –
you get it. More specifically, green or oolong tea is supposed to help and yoga
has been shown to boost GABA levels. All in all, nothing that deviants from the
usual wellness advice, although it’s good to know that boosting GABA is probably
why it actually is the usual wellness
advice.

---

[1] https://www.ondietandhealth.com/gaba-deficiency-symptoms/

First off all, I just want to say how proud I am of that title – you can’t beat a schoolboy pun. Be thankful, I was going to call this one **ENT – Extreme Nose Terror, which was another great punk rock reference but I feel fairly in touch with my audience and your grasp of the East Anglian early 90s hardcore scene is somewhat nil…..

So, the sleep problems were now getting totally unbearable. I was constantly jerking awake with either a coughing fit or purely gasping for air, plus the regularity of hypnic jerks was increasing (you know, when you’re just dropping off to sleep and you feel you’ve either been struck by lightening or you’re falling). These were particularly annoying, especially as I would have several one after another. The cause….not enough sleep. The cure……sleeping. But I can’t sleep…. so the vicious circle continues. I was also starting to develop a twitch on the left side of my face. It started with my eye, which then spread to the whole of the left hand-side of my face. This has left me with an eye that is sometimes half-closed and a mouth that is no longer straight. I often think that I look like that I’ve had a stroke.

The sleep clinics had advised me to go to a surgeon and his decision was to have my deviated septum fixed. This led to the operation that I wrote about earlier, when they struggled to intubate me as I had a laryngeal spasm as the anaesthetic was administered. The days after the operation were spent with tampons stuck up my nose and a giant, gauze moustache, which was stuck on my face collecting the overflow blood. Obviously I couldn’t breathe through my nose and had endless panic that I would have another laryngeal problem. Eventually everything healed and one small infection later, I could breathe clearly through my nose for the first time in my life. 

So, problem solved? No, actually it made my snoring worse. I was now able to pull great swathes of air in through my nose over my oh-so-wobbly soft palate causing me to snore even better (i.e. louder).

Following several visits to various doctors, I now have had the pleasure of: an exploratory examination of my entire airway under general anaesthetic, advice to do tongue exercises, told to do regular prolonged gargling, a mouthguard designed to bring my chin forward, being told I have a lazy epiglottis, advice that I should have an operation to stitch said epiglottis to the back of my tongue (low % success rate, high mortality rate), have my jaw broken and brought forward (at least 6 months of not being able to open your mouth), options to have the uvula removed, the soft palate strengthened, told to sleep on a tennis ball or even wear a rucksack to bed and, best of all, Velumount!!

“What is Velumount?” I hear you cry. Well, it’s a small ring of plastic that is supposed to reduce snoring. You have to place it in your mouth and move it past your gag reflex so that it hooks around your uvula with the idea of stopping your soft palate from vibrating. This resulted in hundreds of attempts to get this damn thing in place. Getting it past the gag reflex, is hard enough (lots of retching) but then trying to hook it over the uvula is near impossible. It’s like one of the most twisted fairground games I have ever played. I think I paid a couple of hundred for this nonsense (along with 800 for the examination under anaesthetic and three hundred for the mouthguard, all not covered by insurance). When you add this up – especially with all the other nonsense I have bought/tried over the years – this not sleeping is an expensive hobby!!!

Of course, all of this was now heavily taking its toll on my mental health and I was about ready to break……..

**ENT stand for Ears, Nose and Throat in the British health care system

Yes, I admit it. This weeks blog is all about pulling at your heart strings so that you might click on a video, add us to your Spotify list and increase my vast wealth by a minuscule amount. Last year I earned €3 from music. Obviously, this was vastly defeated by my outgoings, but we don’t like to talk about that….

Anyway, Paul (from the mighty Kerosene) and I have knocked together some songs under the banner of Def Robot. This piece of art(?) is called ‘Makers Of Mountains’ and from next month will be available to stream on Spotify. But if you can’t wait you can have a listen on Bandcamp 

https://defrobot.bandcamp.com/album/makers-of-mountains

Paul has also knocked out two accompanying videos which are great examples of what can happen when someone buys themselves a green screen (Just joking, Paul, they’re great!).

One of my favourite questions and one that every vegetarian loves being asked. Maybe I should go around demanding that meat-eaters tell me where they get their fibre from in retaliation…?

Just as I like to rotate the COLOURS of what I’m eating, I also have a masterplan for protein. It’s not as strict as it sounds but I do try to get a balance between tofu, dairy and pulses—and not forgetting handfuls of nuts and seeds to be thrown in for good measure too. So, for example: lunch might be a carrot and walnut salad with tahini sauce and dinner, a goat’s cheese salad. The next day, we’d be eating peanut-coated tofu with broccoli.

It’ll probably come as no surprise to hear that I do have a calendar with all the meals written on, so that I can get that overview of both colours and protein and perhaps I should be feeling slightly embarrassed about it but TBH I’m not. I love my calendar! An added bonus is, that when you plan ahead, you can make sure that you have lunches too, instead of relying on whatever you can grab from work. Healthier, cheaper and, once you get into the swing of it, it becomes second nature to just cook a bit more of something and then shove the extras in a Tupperware. Now I come to think of it though; that is the downside. I need a small cupboard just to house all the Tupperware…..

My passion for pulses goes a long way. I have jars and jars of different beans and lentils and got really excited when I bought a pressure cooker (I know, I know—sad doesn’t even begin to describe it!) OK, you do have to plan a little bit ahead because most of them need soaking overnight but I tend to just look at the shelves think—I haven’t had kidney beans in a while—and boil up a load. They can sit in the fridge for a couple days and be added to most meals.

For example, last weekend, I prepped a pile of black beans and they got thrown into:

1. The goat’s cheese, macadamia nut, blackberry salad with griddled asparagus
2. A jackfruit chilli
3. Spicy beanburgers

And check it out:

Not the sexiest of photos, I know but there’s my cheap and cheerful (with a spicy kick!) beanburgers on a quinoa salad. Yes, that is a dollop of mayonnaise looking a bit worse for wear on top, but trust me, it was a tasty lunch. And all home-made.

And if you don’t fancy all the palaver of soaking and boiling—cans of beans are just as good, cheap and easy to use. Drain, rinse, away you go!

I love tofu and cheese too, but beans are just a really handy way of getting protein into the meal AND you get plenty of fibre to boot. And who doesn’t love having great bowel movements? Have I gone too far…?

Why this week’s title? Well, because my experience of sleep clinics resembles something that only Cleese and Chapman could have written. Picture the scene…

We’re in a hospital room. There are 2 beds, both occupied by patients. The patients are covered head to toe in cables. So much so that they can hardly move. The beds are surrounded by various machines with flashing lights that emit occasional beeps.

Doctor: Mr Hancox, unfortunately, we haven’t got any useable results from last night. It doesn’t appear that you slept at all.

Mr Hancox: I know, I have a sleeping problem. 

Doctor: Well, how are we supposed to fix your problem if you don’t provide us with some data.

Mr Hancox: I’m so sorry. I totally sympathise with your situation. I will try my very hardest to sleep a little tonight. Of course, it wasn’t helped by the fact the patient next to me is the loudest most prolonged snorer I have ever heard.

Doctor: Yes, he has a sleep problem but at least he provides us with lots of data……

I have been to four different sleep clinics, which amounts to 12 nights of being monitored in real terms. OK, I might have overdramatised the above scene a little, but I always feel that a visit to one of these places always seems to end in a bit of a farce. Each one is unique and has it’s own way to keep you awake at night. Be it the snoring patient, the rectal thermometer in place all night, nurses taking blood from your ear (yes, ear) during the wee hours, mosquitos, wearing breathing apparatus that you have to breathe in time with (or it’s no air for you!), trips to the bathroom that fifteen minutes of cable work and then there are the adhesives……..

Yes, the adhesives. You really have wires plastered all over your body. On your head, legs, chest -and what goes on must come off. Ripping those suckers (pun intended) off is a hell in itself. It’s a full-on waxing. And it really hurts!

In between the non-sleeping nights, there are the various blood tests, urine samples, allergy pin pricks, cameras down the throat, lung function tests and lots of sitting around wanting to fall asleep. You have to stay there all day, as if on a ward. There is nothing to do and the one thing you want to do, you’re not allowed to do and in my case, you can’t anyway!

At the end you get a brief consultation from a doctor and sent on your way.

Now, sorry if all of that sounded negative. These are decent professionals trying to do a decent job with a limited amount of resources. It’s just that as a patient, I’ve really not enjoyed the experience. 

Still, I have received some useful advice, on occasion. After my first visit to a sleep clinic I was told that I hadn’t slept very much but there were definite signs that I had obstructive sleep apnoea, so they advised to go and make an appointment with an Ears, Nose and Throat specialist. OK, a step further. I was going to be introduced to a whole new level of machines that go ping!!

Sorry for the title, but it’s not often I get to namecheck an album by an obscure Boston punk band!

So, I started my 30s working in an inner city school in the North of England. I was drinking, eating quite poorly and doing no exercise. Levels of stress had started to rise and I spent some days begging not to have to go to work. I was failing as a teacher. 

Sleep was getting more and more unsettled—I was waking up constantly and needing the toilet at least once a night. It was also around this time that OCD (Obsessive Compulsive Disorder) and social anxiety started to impact on my life. It started subtly. The first signs were: not only did I alphabetise my CDs but also could only listen to them in the given alphabetical order; I arranged all my clothing and had to wear them in a definite order – no matter what the weather AND I started to avoid answering the phone or making appointments (‘Can we do it online?’). 

On the other hand, my favourite part of OCD was buying wine. Each day a new bottle, the next one along the shelf at the supermarket. An order for reds, an order for whites. Wine was our treat. The Wife was also a teacher now and there was nothing better than getting home, cracking open the wine and ripping in to a pizza….

As well as our waistlines, our middle class habits were expanding: white collar jobs, a car, a house in the Peak District and holidays on the continent. What comes next? A family? At this point we cried stop! We were full of a desire to escape; to not have to conform, but more importantly, not to have to deal with other people. We became teachers in international schools, working in Germany, Portugal and then Germany again. I suddenly found out that I was a reasonable teacher after all. I loved being in the classroom and got on really well with my students—it was just fellow adults that were the problem. We’d get invited out but would just make our excuses and go home for one, maybe two bottles of wine. Sleeping got worse. The Wife started to complain that my snoring was keeping her awake. I didn’t even knew I snored, but soon enough, I was snoring myself awake or waking up coughing and choking on a regular basis. 

Around this time I started taking promethazine. In Britain it’s known as Phenergen and is meant to be used for hay fever but many people have got wise to its sleep-inducing properties. Step by step I was becoming more dependent on it. This wonder drug would keep me under for longer, or if I woke up, I was so ‘blissed’ out that I didn’t care and would fall back asleep. I’d still need the bathroom during the night—walking in a straight line on promethazine was always interesting— and OK, I would be a zombie with a headache the next day but who cares, I got some sleep and there was always wine and chocolate at the end of the day to make me feel better.

On the days I didn’t take pills, sleep was an even bigger problem. I was now waking up 20-30 times a night and was getting really, really tired. 

I was prescribed a tricyclic acid derivative for a while to help with sleep and my rising social anxiety. It didn’t do anything. I was then sent to a lung specialist, who couldn’t find anything wrong, so he forwarded me to a Schlaf Labor (a sleep clinic). 

At last! Things were going to get better now. Sing a song a six pack!!!

Sometimes, you just got to stop those overwhelming negative thoughts and appreciate the things you have, the things that you often take for granted. Music is a real constant in my life and when I’m playing and I’m totally in the zone (or some other poorly acquired sport terminology), I forget about everything else – it is my meditation. 

I am particularly lucky to have fell in with a bunch of people that go under the band name MOTO. It is hard to describe how much support, structure and sense of purpose I get from playing with them. We rehearse once a week. I turn up, every Thursday, in my normal zombie fashion, sometimes so nervous I can barely speak, but after a couple of rock ’n’roll tunes, I’ve woken up, ready to fill the room with my ‘Allo ‘Allo style German.

We play gigs throughout the year (for any German readers we are playing in Wandlitz this month) and it’s always good fun. Friends will often remark then when I am on stage I actually look awake for a change!! Adrenalin is a powerful hormone!!

We play surf, beat and ye ye music.Ye Ye music? This was totally new genre for me. It’s quirky French pop from the 60s for all you music aficionados out there.

It took me a little while to get used to playing in a band with Germans. They are much more music savvy than us Brits – ‘You are playing a dominant 3rd instead of a flattened fifth in bar 82’…….

Plus, for a long time , I was certain that the Germans had managed to develop a secret extra note ‘H’. Yes, really, they have an extra note ‘H’ – this might explain Schlagermusik! But after careful research I found out that they don’t actually have an extra note, just very poor alphabetical order skills.

I’ve attached a couple of videos. One is a video that the band did before I joined (which is probably why it’s so good). The other is a clip of using playing live. Oh, and if you can’t tell which one is me, I’m the arrogant one…….

That is indeed the question but before I answer it, I better paint the scene for you.

Our drinking normally looks like a bottle of wine shared over dinner, and that happens 3-4 times a week. I say, normally. There can be weeks where it is practically every day – all it takes is for one of us to murmur: ‘Do you fancy a bottle…?’

Our drinking is of the ‘wind-down-after-work’ variety; the ‘you-deserve-a-treat’ type. If you tote up the units, it’s really not that bad but that was more to do with good luck than good management. The last time we pushed the boat out and opened a second bottle, I spent the entire next day hanging over the toilet. You can look at that as a positive aspect of getting older…

The thing was, we spent such a lot of energy in thinking about drinking. Planning when the ‘drinking days’ were going to be and feeling slightly resentful when it was a non-drinking day. That made you look at the whole thing and say: ‘You know what – I don’t think this is too healthy.’

But we had such a laugh. There was none of the negatives like black-outs, injuries and embarrassing regrets. Just relaxing and having a laugh together and that was why, despite all the warnings linking alcohol and poor mental health, we didn’t stop.

Last year, we did Dry January, February and March but then decided that life was simply too grey and boring without wine to cheer us up. The other major factor was that David didn’t really feel any better – sleep didn’t improve and his mood got worse. So, what the hell, we thought.

Looking back, I’d say that the most significant impact on that particular experiment was the fact that he was still working as a teacher. This year, however, he wasn’t.

Dry January 2019 rolled into February, March, April and now, May. In fact, it’s been *squints at app* 124 days sober. Which apparently is: 408 units not drunk (thank-you says the Liver); £638 not spent and 27,500 calories not consumed. All-round winner, or what?

But other than these stats, is it worth it from an anxiety and depression perspective?

Well, the data seems to apply to heavier drinkers but who knows? Some people could be more easily affected than others.

Here’s the facts in terms of brain biochemistry:

• Alcohol inhibits the release of glutamate and, as glutamate is an excitory neurotransmitter, this is why you feel relaxed and sleepy after a drink.
• Alcohol also increases the effect of GABA – the ‘calm down’ neurotransmitter. Even if you feel you’re a ’happy’ drunk, alcohol will still act as depressant in the way that your reaction times are slowed, your voice becomes slurred and you stumble around.
• Alcohol is a dopamine-agonist which means that it enhances the effect of the ‘pleasure/reward’ neurotransmitter, so you feel that everything is just great and everyone is your best mate. Sounds good, so far. So what’s the problem?

Well firstly, following a drinking session when you’re chilled and flooded with GABA, the brain goes: ‘Hang on, this isn’t right!’ and tries to correct the imbalance by producing more of the opposite neurotransmitter, glutamate. This heightened excited mode is why people can feel more anxious the next day.

Secondly, continuing to drink over a longer period will start to desensitise the GABA receptors. You might have enough GABA around but if the receptors don’t pick it up, it can’t make an effect. This means that the relaxed feeling is not achieved, so stress and anxiety build up – your brain is simply not able to calm down as it used to.

Thirdly, alcohol is known to reduce the amount of serotonin, so this can contribute to depression and, last but not least, we’ve probably all experienced the disturbed sleep after drinking. It’s not just the bed-spinning sensation after a marathon session; with just a couple of glasses of wine, I would wake up at 1 or 2 in the morning and just feel like my mind was firing randomly. The next day, you’re dealing with sleep deprivation. Plainly, this is not good for someone with chronic insomnia.

It would seem an obvious thing to do, given all the issues, but going tee-total was way down on the list of ‘experiments-to-try’. Still, we’ve done it now and 124 days in, what results are we seeing?

• I’m sleeping better; David – no change.
• Weight loss and better skin? Well, no-one has commented on how youthful and fantastic we’re looking, so probably not.
• Depression and anxiety? No obvious direct connection but let’s be honest, it’s far too complex a thing to pin one factor on it. However, there is….
• More time and motivation to do other things than just lying on the sofa watching box-sets, and this gives a sense of purpose, it’s a distraction and can just be about enjoying life. And that has to be a good thing for anyone dealing with depression and anxiety.

So on balance, it’s a win for being tee-total and for now, we’re definitely sticking with the herbal teas. Bottoms up!