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azurelunatic: A pajama-clad small child uses a rainbow-striped cruciform parachute. From illustration of "Go the Fuck to Sleep". (insomnia)
So because not only do I have insomnia, I also suffer from it, the most-recent in the chain of moderately alarmed sleep-adjacent professionals (the neurologist at Deer Creek) referred me to the Improve Your Sleep! class, which has been eating my Monday evenings over the last month.

The main feature of this class, in the eyes of the neurologist and my counselor, has been the CBT aspect of it. Apparently the number one thing that cures insomnia is CBT. So everyone was hopeful. (I had specified to the neurologist that I would in fact be running anything suggested in the CBT past my Supervisor and my therapist. Which was a good call to have made.)

It turns out that when Guide Dog Aunt loaned me a book on sleep a few years ago, the one that pointed out that there was not in fact any moral value to any specific sleep schedule, and that instead of saying stuff like "I'm lazy because I sleep until noon", one should look at it in terms of "My most productive hours are in the evening, and I schedule my life in a way that suits my sleep schedule" -- that general tool of re-framing the guilt and fear around sleep is in fact the very CBT that this class relies on. So, unfortunately, the CBT that I had hoped would be new information was not, in fact, new information at all. The book specifically addressed Negative Sleep Thoughts. The class then expanded the concepts of re-framing runaway negative thought chains in a better light, which is also a Fishmum trick that I've been teaching my little fishies and my partner...

The other main leg of this class is meditation and the relaxation response. I believe that I can trace my habit of meditative breathing in particular to the summer when I read ... some Heinlein book or other ... and thought that taking up meditation would be a grand idea. The latest that could have been was 1996. Then I formally took up meditation (and learned all of the techniques discussed in the meditation unit of this class) in 2001-ish, when I went to DeVry to get a degree in Holistic Massage join a coven. So depending how you slice it, I've been familiar with, and practicing, meditation for anywhere from fifteen to twenty years.

The main new information I got out of the class, in fact, was that sleep-maintenance insomnia was recently discovered to be associated with a sleep-time body temperature that has not dropped as it ought to for that part of the night. And I do, in fact, routinely overheat while attempting to sleep. Which means that if I'm in bed and even slightly think that I might not get to sleep soonish, I should immediately go and get the ice pack, and not try to be a hero.

Also, low doses of sedating antidepressants are also used as sleep medications. The instructor was down on this practice, because antidepressants are only good for people with depression. FUNNY THING, THAT.

Pretty much all the rest of the class was review, and (due to my internets research) I was often in possession of more detailed information than the instructor. I came to feel that I could probably have taught the class myself, given the curriculum.

The first class was pleasant enough. I think there were about ten of us. One woman came in late, and borrowed a pen from me. We had a pleasant chat while she was waiting for her husband to pick her up. She's sleep-deprived to the point that she can't safely drive, and caretaking for her autistic son has done a number on her sleep schedule and ability to stay asleep.

I reviewed the materials in the packets for the four weeks. The second week, the cognitive re-framing, was going to be hard, since the materials blithely suggested that "most people" could get away with abbreviated amounts of sleep with nothing more terrible than a loss of creativity and a bad mood. Pro tip: when your patient reports very bad effects ) tied to as little as one night of abbreviated sleep while under stressful circumstances (and the current Republican administration is nothing if not stressful circumstances) telling the patient that everything is probably going to be okay if they blow sunshine up their own ass is life-threateningly bad advice. So I realized that I had better sit next to the door in case I had to step out of the room.

During the second class, the instructor was trying to impress upon us the way that a poorly timed nap can fuck up your sleep schedule pretty badly. My friend said that this was going to be a problem for her: you put her in the car (as a passenger) and she passes out pretty much instantly.

"It should be easy to stay awake in the car!" said the instructor.

"It's hard."

"Well, life is hard."

At this juncture, I decided that the most constructive action I could take was going to be going and sitting in the hall for a bit (and angrily texting my partner). I came back in after about five minutes.

Later in the evening, the instructor planned to lead us through more meditation/relaxation, to include the rest of the class period. I abruptly realized that I did not actually feel that making myself vulnerable to and in front of this instructor was a good idea, and grabbed my stuff and left the building.

In the third class, I sat by the door. (My friend did not show up for this class, or the following week.) When the meditation/relaxation section arrived, I popped both headphones in and proceeded to listen to podcasts, and only emerged when that bit was done. At the end of class, I asked the instructor about the bits in the next one, saying without explanation that I would not be taking part in the relaxation exercise, and would likely leave the room. He said when the long one would be, and there would be another short one later.

In the fourth class (tonight), I sat by the door, and took a chair with me when I popped out for the duration of the exercise. The instructor came and fetched me when it was done. And I did other things for the short one.

I did ask, this time, what he recommended to keep you awake when the sleep pressure is high but it's a bad time for a nap. And if there were resources on being a millennial and not having a whole house to work with in terms of keeping stress out of your bedroom. (Do something loud. And, probably, somewhere.) I asked about next steps. He recommended the meditation class, or the anxiety class. "That really doesn't seem to be a recommendation geared for someone who has been practicing meditation for fifteen years," I said, smiling aggressively.

He recommended tai chi.

"That's really rather along the same lines," I said, still smiling.

There was a class evaluation form, which asked about how much we learned from the class, and how helpful it was. It was ... not.

So I'll be asking my GP, my counselor, and my psychiatrist about next steps, then. Now that I've taken this miserable class so they'll take me seriously.
azurelunatic: Teddybear that contains ethernet switch.  (teddyborg)
So yesterday's medical woe was all down to Kaiser (insurance company) shenanigans with Apria (CPAP provider). The name Kaiser transmitted is different from the name on my ID. Because I am heartily tired of being called *Miss* $WALLETNAME, I have asked Kaiser to stop calling me that, and start calling me Reverend. I didn't get ordained for nothing. Because Kaiser's computer system has no place for honorific, the way they treat it when it's causing the patient distress is to shove it in front of the first name. Therefore, I get prescriptions written to Rev $WALLETFIRSTNAME $WALLETLASTNAME. Clusterfuck.

Hopefully my new insurance card will be in the new name, for less confusion, when I hand it to people. My Top has grumbled about the insurance company making their Sub cry. My Top would like the insurance company to be better equipped to handle people with particular honorifics and atypical genders, please.

I would really like an iOS Dreamwidth client, one that was offline friendly, so I could compose while offline and waiting somewhere, and it would post automatically when I connected.

The morning started with some leisurely chatting with my partner, then progressed to Skype the instant it was helpful to do so. The connection was crappy, but sufficient, and I am coming to know my partner's face and body well enough that I can reconstruct the general visual from even a pixellated blur. (A misspent youth that didn't include enough anime to get *quite* that good...) Upon heading off for errands, we swapped over to phone as soon as I got out of the signal-eating garage. There we stayed, with a few intermissions, until their ex's arrival was imminent.

No two introverts can talk that long uninterrupted. Fortunately, that's not what we were doing. They were enjoying some well-earned video game time. I was doing various housework and re-arrangement of the bedside ecosystem to accommodate the new machinery and its power hookups. In addition to the CPAP I also now have a daylight lamp, one of the sorts that turns itself on at whatever hour you tell it to simulate dawn.

I am honestly not expecting the CPAP to rock my world and change my life. I know it must be doing some good, because after the first night I was even remotely willing to put the thing up my face again. The week I had the loaner did have some improvement in sleep, but it also had a steep drop in outdoor temperature. Post-surgery, I've been getting hot flashes; overheating was already a major cause of bad sleep, and hot flashes have not helped that. Previously I was able to make do with a fan pointed at me. Prior to the temperature drop, I've had to snuggle ice packs. There were a few other things that changed. I also have a very mild case (enough that the insurance does not cover the equipment, although I still got their rate in purchasing it). So I don't expect that this will change my life or rock my world.

I do expect that if I *still* have terrible sleep with great CPAP compliance data, they might take me seriously. Also, the lack of CPAP kept me from going home after surgery that could (technically) have been outpatient. The surgeon said that with a CPAP he'd have been okay with letting me go home once I was okay enough, but without that, he wanted to keep an eye on me and make sure I got enough oxygen and didn't stop breathing.

(My medication change last September did in fact change my life and rock my world; prior to that I was falling asleep in meetings and similar, regularly.)

Ev went back to New York today, which gets her out of range of her terrible mother. Though not before her mother imposed home cooking on her, with the expectation that she would take it back with her and eat it. This is one of the perils of being the American child of immigrants: if your parent is a *terrible* cook of their original culture, it's at least doubly terrible on account of the part where that perhaps isn't even food in the American paradigm. Her mother is a terrible cook. I gave her permission to throw it out. (Also, it delights me that she's got to the point where she often knows the best course of action on her own, and merely needs my validation to go ahead and proceed with that action.)

I will remember her stay here for weeks, if only by the fact that her hair has gotten all over everything. I know it's hers because it's pink. Mine is blue.
azurelunatic: a modification of the Oxidizer hazard label reading 'Caution Flaming Asshole'  (flaming)
So my healthcare provider attempts to provide world-class service. They try.

... They are trying, yes.

Now, I'm one of those people whose ability to take incoming calls from unknown/untrusted parties is significantly variable, but never great. I'm generally completely unable to take calls before I've properly awakened. If something needs to be communicated with complete clarity and without error, telephone is the worst way to do it. Text is far preferable. That's without even counting in the PTSD... (two terrible phone jobs and one ex-friend having an extended breakdown culminating in serious self-harm. do not recommend.) My sleep schedule is terrible, and there's no guarantee that I'll be coherent before noon, even if I'm awake, without a different medication setup than the one I'm currently on.

They have a website where you can ostensibly manage various parts of the information that is distributed to all of the departments which interact with you. You would think that you'd be able to update your name, honorific, and telephone preferences there...

... and you would think wrong.

99% of the departments who interact with me start their relationship by ignoring the note that says NEVER CALL THIS PATIENT, and ignoring the note that says THIS PATIENT'S NAME IS [INITIALS], and calling me at 9am or shortly thereafter, with a cheerful "Hi [wallet first name, mispronounced]!"

So I put in a request that maybe there should be some place on their fucking website where I could manage preferences for things like DON'T FUCKING CALL ME, EVER.


At 4:50 pm on Monday, more or less, my phone rang. It was Member Services, who had some questions, like, who exactly was it who was calling me? EVERY DEPARTMENT EVER. But Member Services and Marketing didn't call me? MY DOCTORS, EVEN WITH THE BIG NOTE ABOUT NOT CALLING ME. EACH SEPARATE MEDICAL DEPARTMENT. But not Member Services? Because this got sent to Member Services. LOOK I WAS JUST TRYING TO SEND A SUGGESTION ABOUT HOW YOU COULD IMPROVE THINGS, WHY THE FUCK COULDN'T YOU EMAIL ME. But email's not secure? YOUR DOCTORS HAVE THIS NIFTY THING WHERE THEY EMAIL OUT A NOTICE AND I LOG IN TO THE WEBSITE AND READ THE MESSAGE. IT WORKS JUST FINE. Oh. We don't have that. WELL MAYBE THEY SHOULD GIVE IT TO YOU.

Apparently eventually I answered all the questions.

... Except then Tuesday, right while I was waiting for an optometrist, THE PHONE RINGS. IT'S THEM AGAIN. WHY ARE YOU CALLING ME; THIS IS IN FACT A BAD TIME; PLEASE EMAIL IT, WHATEVER IT IS.

... And naturally, dealing with the phone call then? Made me actually incapable of dealing sensibly with the optometrist. WHICH IS WHY YOU MOTHERFUCKERS NEED TO STOP FUCKING CALLING ME.


... seriously. When someone has submitted a grievance about PEOPLE CALLING WHEN THE NOTE SAYS NOT TO CALL, who the *fuck* thinks "Oh, I don't understand this ... I should call them to clarify!"????????
azurelunatic: Ryoko's gloved hand dripping with her own blood. (bleeding)
Since I was 16 in the summer of 1996, I have had the bad body-habit of suddenly and for no real reason developing nasty cases of swimmer's ear for no particular reason, especially when I'm under stress. The case that summer was in both ears, and caused so much swelling that I was unable to fully close my jaw, which was bad and led to me still having problems with my jaw now.

At 4-ish last night, I noticed that my ear was starting to hurt in that distinctive way, and it was coming on fast.

I woke up about a half-hour ago in pain, and it's already difficult for me to force my jaw closed on that side because it hurts to close the jaw. Touching anywhere near the ear on that side of my face (right side, but it varies each time I get it) hurts. Turning my head hurts. It hurts when it's not disturbed either, but disturbing it hurts it worse.

Fuck. Ow.

I grab breakfast and go, before I'm completely incoherent.

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