Janet Coburn

@janet-coburn | contributor
I am a freelance writer and editor who has bipolar disorder, type 2, and anxiety disorder. I blog weekly at bipolarme.blog. I have two published books, Bipolar Me and Bipolar Us, which are available on Amazon, Barnes & Noble, and other outlets.
Janet Coburn

John Oliver Takes on Insurance Companies and the U.S. Mental Health Crisis

You’ve no doubt heard that the mental health care system in the U.S. is broken. You’ve probably experienced that for yourself. But have you heard what John Oliver had to say about it? On August 1, on Oliver’s “Last Week Tonight” program, the comedian/commentator devoted a full 25 minutes to examining the flaws that plague mental health care. During the broadcast, Oliver presented appalling statistics (some of which even I had never heard before) and clips of interviews with participants in the mental health system, including people who have been affected by it, practitioners, and insurance executives. With his trademark sardonic humor, exasperated outrage, and comic zingers, Oliver deftly skewered the insurance industry and remote mental health companies, among other targets. It was an enlightening and satisfying performance. Here are some of the highlights. Oliver started with a flashback from the 1950s of women entering a beauty parlor (!) to receive makeovers that were supposed to solve their mental problems. “I don’t know what’s more alarming there — nurses being forced to take on the skills of a Sephora brand ambassador or the fact that ‘can make-up cure sad?’” Then he tackled the PSA on mental illness stigma featuring Harrison Ford, which was designed to make discussions of mental health “cool and trendy” and dissed the gallbladder for some reason. Next, he went through some stats on why such a PSA was necessary – the lack of access to mental health care, particularly since “for every 10 clinicians entering work in mental health clinics there, 13 leave. And if we continue at that rate, one day, we’re going to wind up with negative therapists.” Oliver noted that nearly 85% of all psychologists are white, and ran an interview with a Black couple. The man said that he “couldn’t find a black man to save my life,” which Oliver said was “something you expect to hear about the crowd on January 6th, or all 10 seasons of “Friends.” He also played a video of another man who couldn’t find treatment. His friends said, “Everything will be fine tomorrow. Suck it up, buttercup,” a response that to him meant “a 12-pack of something or a bottle of something.” Oliver also reported on the fact that hospital ERs are overrun, with one interviewee experiencing a stay of 27 days there, and then receiving advice to go from the ER to a doctor. Oliver noted that 27 days in an ER is “not calming” and that seeking help is serious, that “you can’t just put off mental healthcare indefinitely. It’s not a check engine light.” Some of Oliver’s most biting comments were reserved for AI programs that claim to counsel users on mental health issues. One of the free services was Woebot – “Bot as in robot and ‘woe’ as in ‘Whoa, that’s a dumb name.'” Their mascot is a robot waving a wrench (“He’s going to fix my brain with that!”). And when questioned about anxiety and lack of sleep, which affect 18% of people, the AI responded, “I can’t wait to hop into my jammies later.” Oliver also reported that when Woebot was confronted by the BBC with a test case of a 12-year-old reporting sexual abuse, it replied with the comment that it “shows me how much you care about connection, and that’s really kind of beautiful.” He did note that teletherapy is valuable and it can fill some of the gaps in care. But Oliver also highlighted investigations of sites that were “pill mills,” one of which claimed that 95% percent of their users “should get a scrip.” Noting that it was not 100%, Oliver compared it to the saying, “It’s not arson if you only burn most of a building down.” Regarding lack of accessibility and insurance parity despite laws requiring it, the program noted that the issue was complicated by finding a provider who will take your insurance. The Labor Department has investigated only 74 claims against insurance companies in the past year (but closed only 12 of the complaints) and has issued fines only 13 times since 2017. And insurance payments are often based on their own opinions on when a treatment is “medically necessary.” Oliver likened it to an insurance company, saying, “Imagine an insurance company reversing their decision in the middle of any other serious treatment. ‘Hey, we love how this heart surgery is going, just popping in to say, it’s done. Yeah, it’s done now. Hit the showers, everyone, great job. Don’t bother closing anything up, that’s not medically necessary.’” California, Oliver noted, requires insurers to “base medical necessity determinations on current, generally accepted standards of mental health care, instead of just making up the criteria for themselves.” Insurance companies also have “ghost networks” that offer patients providers who aren’t taking new patients or even practitioners who have died. Phone numbers can be wrong too, some of them reaching “jewelry stores and boutiques,” which Oliver admitted that, “to be fair, if you’re a woman in the 1950s, a boutique and a jewelry store is apparently the only mental health care you need.” The segment ended with the statement and plea, “It can’t be the case that, when people ask for help, our only option is to tell them to ‘suck it up, buttercup.’” We can only hope that “Last Week Tonight’s” take on the U.S. mental health care system will reach its literally millions of viewers with the news that something needs to be done – and soon. You can see the whole segment here or on John Oliver’s official website. It’s definitely worth a visit.

Community Voices

What was the defining moment or incident that made you seek treatment for bipolar disorder?

<p>What was the defining moment or incident that made you seek treatment for <a href="https://themighty.com/topic/bipolar-disorder/?label=bipolar" class="tm-embed-link  tm-autolink health-map" data-id="5b23ce6600553f33fe98e465" data-name="bipolar" title="bipolar" target="_blank">bipolar</a> disorder?</p>
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Janet Coburn

What Life With Bipolar II Disorder Is Like

I have bipolar II disorder. This is my story. First, some background. Bipolar disorder used to be called manic-depressive illness, and many people still know and refer to it that way. The term “bipolar” reflects the concept that there are two extremes to the continuum of mood disorders, and some people swing dramatically from one to the other. According to this definition, clinical depression by itself is “unipolar,” occupying only one end of the spectrum. Depression is to sadness as a broken leg is to a splinter. Depression sucks the life from a person, mutes all emotions except misery, denies any possibility of joy or even contentment and makes life seem meaningless or impossible. This is hell. Mania is to ordinary happiness as diving off a cliff is to diving off a diving board. Mania brings exhilaration, ambition, confidence, abandon and invincibility, with no brakes. It is hell on wheels. Oscillating between the two extremes, that’s bipolar disorder, type 1. It is a serious illness. Left untreated, it can cause destruction of families, careers and more. It can lead to psychosis or suicide. The treatments for it are no picnic either. A severe case of bipolar disorder often requires hospitalization. If the symptoms can be controlled with medication, then the patients must have frequent blood tests to assure that the drug is present in the right quantity. When I was (incorrectly) diagnosed with unipolar depression, I used to wish that I were bipolar, on the theory that at least then I could accomplish something. Boy, was I wrong about that. Plans made in mania never come to fruition. They are started, rethought, abandoned, exchanged for something grander and ultimately fizzle out when the mania wears off. My diagnosis actually made some sense at the time, as I never experienced anything like the manic highs. All I got were depressive lows. This leads us at last to bipolar II disorder. The mood swings are not as extreme, the lows less debilitating and the highs less overwhelming. The person with bipolar II stays closer to a baseline of normal mood, but still experiences swings back and forth. Technically, the mini-lows are called dysthymia and the mini-highs are called hypomania. In my case, the lows were just as low as in unipolar depression, but I never got the mini-jags of buoyancy that accompany hypomania. Instead, these feelings, came out sideways, as anxiety. My brain was still racing with little control, but in a different direction. Instead of elation and purpose, I was beset by in worries, fears and catastrophizing. One of the difficulties with treating bipolar disorder (of either type) is trying to find a medication or a combination of medications that will level out the person’s moods. Usually this requires more than one drug, and finding the right mix or cocktail of chemicals usually requires more than one drug. It takes a great deal of trial and error. In the meantime, the mood swings continue. At this point, my bipolar II is fairly well-controlled on medication. I still have spells of depression. Now, they last at most a week and sometimes just a day or two. Untreated, they could last months or years. I still have anxiety too. However, I have the medication I take for that so I don’t feel like I’m about to jump out of my own skin. Most of the time, I’m fairly high-functioning. I can write, work and earn a living. I have a great marriage and a number of friends, including some who are closer than family to me. I have never been hospitalized, nor have I had electroshock (though that was a near thing). Before I got my proper diagnosis and treatment, I would have not believed this to be possible. My goal in life was simply to stay out of a psychiatric hospital as long as I could or at least until I qualified for Social Security Disability. I’m sharing these experiences with you today because I believe mental disorders should not be hidden or viewed with shame and horror as they have been in the past and sometimes the present. It’s undeniable that there is a stigma associated with having mental illness. Going public with it entails a risk. I’ve seen the fixed “smile and back away slowly” reaction. I’ve seen sudden turnarounds in my work performance evaluations, but I’ve also seen the, “Me too!” response. There is strength in numbers. As more of us who live with psychiatric conditions talk about it and share our stories, the more we build understanding. Perhaps, we also encourage those who are “roller-coastering” to seek treatment. So that’s the nuts and bolts of it: Bipolar II disorder is a mental illness. I have it and live with it every day. I do not go around threatening the safety of other people or my own. I take medication for it. I know I will likely have to for the rest of my life, and I’m OK with that. I hope that eventually the rest of the world will be, too. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741. We want to hear your story. Become a Mighty contributor here. Image via Thinkstock.

Janet Coburn

How Remote Work Can Help People With Mental Illness

Nowadays, it seems like many workplaces have a toxic culture or at least a dysfunctional one. They demand — not just expect — more from their employees than any human being should have to, or be willing to, give. Sixty-hour weeks. Twelve-hour days. Giving up weekends and holidays. They treat employees as fungible things that can be easily replaced, and regularly are, especially if they don’t live up to the brutal “standards” that are supposedly required by the free market. Toxic workplaces also tend to be full of toxic people. Bullying of employees and coworkers is common. Gaslighting even happens, more regularly than we’d like to admit. Required conformity and enforced corporate “team-building” parties and picnics suck the meaning out of workplace enjoyment, in my opinion. Exhortations that the workplace is a “family” and then behaving in ways that belie this are rampant, false, harmful, and destructive. Corporate practices often aren’t human-friendly, much less family-friendly. In some companies, flexible working hours, job-sharing, onsite childcare, remote work, part-time work, and extended sick and other types of leave are largely reserved for only the highest echelons or never even considered for any workers. Health and disability insurance are often nonexistent or ultra-expensive for workers because of the monetary costs to the company. In my experience, discussions about the stress caused by work end in suggestions to try yoga. Employee Assistance Programs (EAPs), if they exist, provide some therapy, but only with a provider of the company’s choosing and usually only for six weeks or so. Then along comes the COVID-19 pandemic. Suddenly, corporations and other, smaller businesses were faced with the difficulties of staffing during lockdowns and quarantines. All of a sudden, workers weren’t so available or so desperate. Owners had to scramble to hire enough workers to keep the wheels turning. Some businesses were forced to raise wages. Others had to rethink corporate travel to cut costs. And some turned to remote work. Not all could, of course. Some jobs simply can’t be done from home. Construction workers, wait staff, airline attendants, and countless others were simply let go or put on furlough, many of them without even partial pay. But many jobs, particularly office jobs, were the sorts that could be done from home, on the phone or via computer. And that seemed beneficial both for the affected companies and for the mental health of their workers. Bosses suddenly realized that work-from-home can improve their bottom line, reducing overhead. It soon became clear that many home-workers were able to be as or even more productive when not being constantly interrupted by mandatory meetings and other useless exercises. How did telecommuting affect workers’ mental health? First, remote workers were spared from many aspects of toxic workplaces. Micromanaging became largely unfeasible. This certainly helped improve their working conditions and stress. So did getting respectably dressed only from the waist up, especially for those of us with limited spoons. Being able to step away from the computer for a half-hour or more to do something about chores or even hobbies provided a welcome break. Lunches could now be taken whenever you were hungry and last more than 30 minutes. Even spending more time with pets reduced stress and provided emotional support that’s next to impossible in most workplaces. Many of the stresses that so exacerbate mental health conditions were at least lessened. Many people were more comfortable in their own homes, with comfort objects and self-care items more readily available. Those with a greater need for alone time suddenly had more of it. If they found that they could work better or more productively part-time at home, it was a benefit for the companies as well. Of course, not all bosses took to this new way of working. Once they figured out that employees could be more productive when working at home, some of them upped output requirements. They could insist that employees remain logged in during standard working hours, making flex-time less doable. Or they started requiring more output from those telecommuting, or scheduling Skype meetings that cut into employees’ time. I work at home, remotely, and have for a number of years. I do so because I have been fortunate enough to find jobs that pay (though not a lot), jobs that match my skill set, jobs that aren’t 9-5, and jobs that are conducive to working around my days of depression and hypomania. I’ve considered going back to work in an office from time to time when funds were low, but not enough to actively pursue it. Truth to tell, I don’t think I’ll ever be able to do that again, and not just because I like working in my pajamas. (For those who are curious, I’m doing transcription and ghostwriting at the moment. They provide a supplement to Social Security and allow me time to work on my blogs.) Did toxic work environments cause mental illness? Probably not, though they have pushed some people closer to the edge and others past the breaking point. It’s hard to work in corporate culture with any kind of mental disorder. For these people, remote working is a blessing. COVID has been devastating, but one of its side effects has been to improve working conditions for millions of people — and especially those living with mental illnesses.

Community Voices

My Mental Health Goals

Part 1 of 2 When I was a teen to early college age, my main #MentalHealth goal was staying out of an inpatient department of a hospital or #OtherMentalHealth facility. I knew, though I wasn’t yet diagnosed, that there was something wrong with me – that I had some kind of #MentalHealth problem based on my aberrant behavior and how people reacted to me. That fear has never completely left me, though as I’ve grown and learned more about my diagnosis of #BipolarDisorder with #Anxiety , I’ve come to think it is less and less likely. Yet I know that #BipolarDisorder can sometimes lead to #Psychosis and necessitate hospitalization. That’s not as likely to happen to me as a person with #Bipolar2Disorder , but it still crosses my troubled mind.

Later in life, it became my goal to find a therapist and a psychiatrist who could help me. I tried various ones, including ones through EAPs, therapy groups, and couples counseling. Some seemed to help, but others were spectacular failures. Some positively shredded me, leaving me worse off than when I came in. Others misdiagnosed me (which I can’t really fault them for, as #Bipolar2Disorder was a rare or even nonexistent diagnosis when I started looking for help). Among other things, I learned that group therapy was not for me. And I learned that Prozac did help, at least to some extent.

At that point, my main #MentalHealth goal was to find someone who could tell me what was happening to me and to figure out what could help. I no longer remember how I found him, but eventually I came to Dr. R. He was the one who finally gave me the correct diagnosis. Then my #MentalHealth goal became finding a medication that would help me with this new diagnosis better than Prozac did.

Dr. R. was patient with his patient. He and I began a journey that lasted for several years, trying one medication after another and then combinations of medications, in hopes of finding a “cocktail” of drugs that worked for me. That became my new #MentalHealth goal – along with enduring the years of failures as just the right combination eluded us.

One of my other (it seemed irrational) fears and #MentalHealth goals was to avoid being subjected to electro convulsive therapy (ECT). But that became a real possibility when my case proved so resistant to medication that Dr. R. recommended it. I freaked out. It seemed that my fears were about to become reality. I eventually agreed with him that it might be necessary and began to prepare myself for what had seemed to me like an ultimate horror, right up there with being hospitalized.

Fortunately, however, Dr. R. had one more medication in his arsenal and it proved so effective that the ECT was deemed unnecessary. We achieved that effective cocktail of medications that would stabilize me.

Then Dr. R. retired. Immediately, my new #MentalHealth goal was to find a new psychiatrist who could prescribe for me and a therapist who could help me with the day-to-day difficulties of living with #Bipolar2Disorder . It took a while to find a psychiatrist who had an opening – though with a wait of about six months. (My primary care physician continued writing prescriptions for me while I waited.) Eventually, I found Dr. G., who said that, as I was fairly well stabilized on my assorted medications, he needed to see me only four times a year for maintenance and to tweak my meds if I encountered any further difficulties.

It was also time to choose a therapist, and my goal became finding one that I meshed with. (I had learned this was necessary from all the bad experiences that I had had in the past.) I started “interviewing” therapists. I tried to find one that had dealt with #MoodDisorders in the past, wasn’t a Freudian, and could come at things from a feminist perspective. I found Dr. B. I wasn’t exactly typical of her patients. She dealt mostly with college students. (Her practice was in a clinic within the Student Union building at a university that was, fortuitously, right down the road from me.) I have been with her and Dr. G. ever since.

My current #MentalHealth goal is to maintain – the medications I’m stabilized on and the sessions with Dr. B. to help me navigate through the difficulties such as #Anxiety that

Community Voices

My Mental Health Goals

Part 2 of 2 still pop up from time to time.

It’s a whole lot better than having that goal to stay out of a mental hospital.

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Community Voices

Why Do We Need Boundaries?

Part 1 of 2 What are boundaries and why is it important to have them?

Boundaries are limits in a #Relationships that your friends, partners (and relatives) need to observe. They can be simple or complicated. They can address different aspects of a #Relationships – social, emotional, or physical, for example. And there can be different levels of boundaries that you set.

In the kink community, boundaries are set before a consensual #Relationships starts. The different levels are “hard no,” “yes,” and “maybe.” It’s easy to understand what hard no and yes mean – that the person simply will not perform certain acts or gives voluntary consent to them. The maybe category is a bit trickier. These are acts that the person is willing to consider or try, but hasn’t definitely either agreed to or ruled out. That’s why partners have “safe words” or other signals that indicate when a maybe isn’t working for them and they need to slow down or stop.

Boundaries are useful in nonsexual #Relationships too, and again have categories like hard no, maybe, and yes. For example, in romantic #Relationships I have a hard no against physical #Abuse , and I communicate that to all my partners. If one of them hits, slaps, or otherwise gets physically violent with me, that’s the end of the #Relationships . No explanations, no excuses, no second chances. I’m out of there. I’ve made my husband aware of this boundary and he respects it. He’s never crossed that boundary.

Unfortunately, at the time I established that boundary about physical #Abuse , I didn’t know about the concepts of verbal #Abuse and emotional #Abuse . In one significant #Relationships , I put up with these for quite some time. Verbal #Abuse and emotional #Abuse are two of the tactics of gaslighting. I put up with those for far too long before I was able to say, “I’m out of here.”

Dan once described boundaries to me using the metaphor of cookies. Suppose someone offers you a cookie and says, “Here’s a delicious chocolate chip cookie I made just for you. Yum, yum. Try it.” Only when you do try it do you discover that the cookie isn’t a chocolate chip cookie at all. Instead, it’s a shit cookie – something you definitely don’t want to eat. You set up a boundary about shit cookies. Just because someone offers you a shit cookie, you don’t have to eat it. And you really don’t have to say, “Yum, yum. This is delicious!”

What kinds of shit cookies are you likely to encounter? They can be insults. You don’t have to believe them. They can be other kinds of distressing – talking about you behind your back, for instance. You don’t have to respond or explain. Or they can be actions such as the aforementioned gaslighting, sandbagging, or saying one thing and then undercutting it with actions. You don’t have to put up with those. Refuse to eat the shit cookies. They are all bad for your #MentalHealth .

There are less drastic boundaries that you may have to set as well. If you have a friend who always calls you and vents at length about their problems but never listens to your problems or your advice regarding their problems, you might set a boundary: “You can call me with problems, just not after 9:00 p.m.” or you could set an unspoken limit that you will only listen to the friend for half an hour at a time. After that, you end the conversation and get off the phone. Perhaps you establish a signal that you have reached your limit: “My eyes just glazed over.” Your friend may even pick up on the signal: “Your eyes just glazed over, didn’t they?”

Or you might have a partner that has unreasonable expectations. Such a limit might be that you will be involved in disciplining the children, but you won’t do it all yourself. It could even be a seemingly silly one. I refused to iron my husband’s shirts because I felt resentful when he treated me like a laundress. He came to understand what I meant. And we worked out a solution: wash-and-wear shirts. Those I would gladly purchase. Problem solved.

Sometimes, however, there are people in your life who go beyond simple boundary breaking. They refuse to acknowledge any boundaries that you may have. People who hurt another family member, for instance, or who expect you to solve all

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Community Voices

Why Do We Need Boundaries?

Part 2 of 2 their problems – not just asks for help, but insists on it and gets offended when you try to establish that boundary. It’s best to cut toxic people out of your life entirely.

But what if it’s a member of your own family who’s toxic? That makes the situation more difficult. You might cut off contact with the person, but have to see them at family reunions or holiday occasions. The toxic person might go behind your back and tell their side of the story to the rest of the family.

The only thing you can do in those circumstances is not to eat the shit cookies. Establish your boundaries and remain firm with them

.You’ll get a lot of pushback from other family members and even your friends. “But they’re family!” they’ll cry. “Family comes first, before everything else.” But that’s a trap. Family may be very important to you, but at some point you have to establish that ultimate boundary in order to protect yourself and your mental and emotional health.

Toxicity can eat away at your soul. It can destroy whatever good or even tolerable #Relationships you had with that person. It’s not worth it to try to understand a toxic person or to give them fourth and fifth and fifteenth and fiftieth chances to change. At some point, you have to draw the line and recognize that nothing you say or do will ever change that person. It’s not reasonable to expect you to change your feelings or your actions to accommodate them.

Setting boundaries and sticking to them – sometimes it’s the only way you can live with others or, more importantly, with yourself, at least in terms of your #MentalHealth . It takes practice and determination. But in the end, you’ll be mentally healthier. And you won’t experience the lingering taste of shit cookies.

Janet Coburn

Can Sleep Apnea Affect Your Mental Health?

My husband and I both have sleep apnea. We also both have depression, or at least he does, and I have bipolar disorder with a pretty hefty depressive bent. Sleep apnea is a medical condition in which a person stops breathing multiple times a night. The body responds to this by resuming breathing after a second or two, but sleep disruption has already occurred. For my husband, this occurs up to 60 times a night, while it happens to me more like six times. Technically, my version is called “hypopnea” (hypo+pnea – low+breath; apnea, a+pnea – no+breath.) The body depends on breathing, of course, for oxygen, but it also depends on sleep – which is disrupted in sleep apnea – for proper functioning. REM sleep, for example, is vital for dreaming, which has multiple beneficial effects on the body and mind. REM sleep has been known to be altered in depression, and studies have suggested that it is involved in modulating mood symptoms, including psychological distress in general. One of the more observable symptoms of sleep apnea is loud and prolonged snoring, which both my husband and I have experienced. While I was traveling with my mother, she even requested that I let her go to sleep first since my snoring kept her awake. But what does sleep apnea actually do to the brain? Surely lack of oxygen to the brain has some effect. Indeed it does. According to research conducted at UCLA, “gasping during the night that characterizes obstructive sleep apnea can damage the brain in ways that lead to high blood pressure, depression, memory loss, and anxiety.” Sleep apnea has been associated with difficulty concentrating, memory problems, poor decision-making, depression, and stress. A study published in Sleep Health found that untreated sleep apnea increases the chance of anxiety by over three and a half times; depression, by more than three times; severe psychological distress, by not quite three times; and suicidal thoughts, by more than two and a half times. Sleep apnea has also been associated with PTSD. The Journal of Clinical Sleep Medicine recommends that “in individuals with [obstructive sleep apnea] and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes.” Studies suggest that sleep apnea is linked with changes in at least two neurotransmitters in the brain (GABA and glutamate) that combine and coordinate signals that help regulate emotions, thinking, and some physical functions. Researchers plan to investigate whether treatments for sleep apnea will help these brain chemical levels return to normal. SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine and sertraline (Prozac and Zoloft) are thought to be valuable in treating sleep apnea. One study indicated that SSRIs may be a good treatment option for [sleep apnea], particularly for those [patients] with epilepsy. Another study showed a link between “having sleep apnea and increased odds of having a mental health issue” or symptoms such as anxiety or thoughts of suicide. Treatments for sleep apnea include dental appliances to be worn while sleeping, lifestyle changes, and even surgeries. These treatments sometimes address snoring directly, but not the underlying mechanism. The more effective treatment is “positive air pressure,” delivered by CPAP machines. CPAPs use positive air pressure to keep the sleeper’s airway from collapsing, which is what impedes their breathing and jolts their brains into resuming it. They consist of a unit that generates air pressure, a hose and mask to deliver it, and assorted straps to keep the hose in place throughout the night. The masks can be ones that cover the entire nose and mouth or cannulas that are simply placed in the nostrils. There are also cushions on the masks or available separately that reduce discomfort as well as waking up with “mask face.” Many people find the masks uncomfortable to wear all night, but others use them not only at night but also for naps. Unlike a ventilator, the CPAP doesn’t breathe for a person. It allows them to breathe more effectively on their own. Diagnosing sleep apnea requires a “sleep study” ordered by a doctor. Assorted leads are attached to the subject, who then spends all night sleeping (or trying to). Breathing rate, heart rate, oxygen saturation, and other parameters are measured and a record is kept of the number of times the subject stops breathing during the night. This is sent to the doctor, who can then prescribe a CPAP unit and mask. Dan and I both use CPAP machines. They are a bit inconvenient, especially when we travel and have to take power cords so we both can use them at the same time (and power converters when we travel abroad). When it comes to packing, the machines are a bit bulky and somewhat heavy. Still, we take them with us religiously. Has sleep apnea treatment improved our mental health? It’s hard to tell, especially since we’re both taking SSRIs anyway. I know correlation isn’t causation, but our depression and bipolar have certainly eased up since we started getting treatment and our sleep cycles have become more regular. But if all it does is stop the snoring, that’s still a win for us. So, if you snore a lot and have a mental health condition, you might want to be tested for sleep apnea and treated if you do. Like chicken soup, it can’t hurt and might help.

Janet Coburn

What's the Difference and Similarities Between Anxiety and Mania?

“Ha,” you say. That’s an easy one. I know the answer to that. It’s like the difference between walking on pins and needles and walking on eggshells. For me, anxiety is the pins and needles, while mania produces the eggshells. Pins and needles hurt more, but eggshells are easier to break. Anxiety causes me more pain, but mania has me treading carefully on a fragile edge. I know more about anxiety than mania. My diagnosis is actually bipolar disorder type 2 with an anxiety disorder. As such, I never really experience true mania. Hypomania is about as far as I get. And believe me, that’s enough. First, let’s start by admitting that anxiety and mania have a lot in common. At least, they do in my life. Both of them make me frantic. Both of them make me obsessed with money. Both disrupt my eating habits. And both of them make me very, very twitchy. 1. Frantic. Both anxiety and hypomania make me feel frantic, like there is something I need to be doing to alleviate them. I know this isn’t true, that they are out of my control, but it feels that way. I get all revved up inside, a nagging, prickly feeling that jangles my nerves and irritates my brain. I try desperately to think what it might be that would calm the feeling, but there is nothing this side of an anti- anxiety pill, which might or might not help. 2. Obsessed with money. With anxiety, I obsess about the bills and how I am going to pay them. With mania, I obsess about what money I do have and how I can best spend it. Since this is, after all, hypomania , I tend not to go on wild spending sprees, but I have been known to buy myself or my husband presents, telling myself the costs are comparatively reasonable and that at least I have limited myself to a non-extravagant amount. (Which may be the anxiety and the hypomania arguing with each other.) With anxiety, I try to anticipate all possible bills and juggle their amounts, due dates and relative necessity (like power cut off or trash removal cut off). I take on extra work, not because I think I have the wherewithal to do it, but because I want the extra money, no matter what it costs me in terms of physical and emotional energy. 3. Eating habits. Both anxiety and hypomania make me eat more than usual. With anxiety, no doubt I am trying to fill an existential hole or find something to distract me from my worries. With hypomania, I crave the relatively safe sensations of rum raisin ice cream, cinnamon danish, or salted, buttery popcorn. 4. Twitchy. Both anxiety and hypomania can cause the shakes, tremors in my hands and arms and legs. Alas, not for me; I don’t get the euphoria of true mania, but the inherent sensation that I’m doing something wrong at some level. I can’t even enjoy hypomania without guilt. There are differences, however. Anxiety leaves me immobilized, in a way that hypomania just doesn’t. You’d think with all that nervous energy vibrating around my body and brain, I would hyper myself into a frenzy. Instead, all the jitters cancel each other out, leaving me with no place I can go to escape. My fears leave me frozen. The money worries leave me unable to decide what bill to pay first. I can’t decide whether it’s better to stay awake and try to read (if I have enough ability to concentrate), or take that anti- anxiety pill and try to rest, if not sleep. Mania can make me productive, in a way that anxiety can’t. When I’m hypomanic, I can write, or at least put words on the screen. (Whether they’re any good or not is anybody’s guess.) But at least I have the illusion of motion, the impetus to create. That extra energy seems more focused, at least in comparison with anxiety. When I hit a hypomanic jag, I sometimes try to get ahead on my blogs, or at least jot down titles and ideas that I hope I can decipher and develop later. Neither state of mind is preferable. Anxiety is the more painful and hypomania the more fragile. Anxiety is more familiar to me and hypomania more rare and even exciting. But I can’t choose. I can’t say I like hypomania more than anxiety, although it does seem to have more benefits. But I know it can be destructive and futile, promising things it can’t fulfill. Given the choice, I’d rather not walk on pins and needles or on eggshells. Level ground is fine with me.