Tuesday, February 27, 2007

Sleepless in Salt Lake City

I was concerned back in January after talking to one of Bevin’s caretakers in Salt Lake City. She told me that Bevin had been having trouble sleeping. She got up in the night and wandered through the home, slamming doors, stashing things in closets. One night she had even managed to go outside and set off the alarm. I had always thought of Bevin as a girl with an infinite capacity to sleep, so this development surprised me, alarmed me. To me it was a sign of Bevin’s underlying anxiety. And also probably related to the fact that she was always in a group situation, really didn’t have down time. The caretaker told me that she had never seen her in “veg” mode--resting with a blanket over her head. This is often what Bev does when she’s in group situations and gets overwhelmed. That made me think that she really didn’t have a chance to be in quiet places or alone where she was living. I wondered whether her increasing anxiety, that had to be the cause of her sleeplessness, was related to this.

I heard from Pam, her stepmom, that East Side had put Bevin on something to help her sleep. When I picked her up in Salt Lake City last week, I was given a bottle of her “sleeping” medication. I decided to give her the pills--until I figured out more about what is going on with her. I can’t remember whether I gave her the medication the first night, but I know that I did the other evenings until Saturday night. I decided not to give her the pill but gave her a Benadryl instead. I only had four or five pills left, so I thought I would just stop giving them to her and see whether she could sleep without them.

Bevin’s behavior can be alarming when she has what I think of as an anxiety fit. For some reason, sometimes related to something that has happened but often pretty mysterious as to origin. her emotions run out of control. She begins running around, slamming doors, throwing things off surfaces, flushing the toilet, and making a peculiar “puffing” face. It’s amazing how quickly she can move and how little she responds to any verbal cautions. When she was smaller, she could be restrained when she acted out. But now that she’s older, that’s harder to do. Often I take her walking or driving in the car to help her calm down. Because that’s what needs to happen, she has to somehow get out of the rage of anxiety and back to quieter, calmer place. Bevin’s “normal” self is cheerful and rather cooperative.

Over the past six months or so when I’ve spent time with Bevin, her anxiety fits have been the exception rather than the rule. Occasionally they happen when she is getting ready for bed. She is most vulnerable to losing her cool at times of transition or at those moments of chaos that happen from time to time in a group or family situation.

Bevin woke up last Sunday morning, after her night without the “sleep” medication in a vulnerable mood. She lost her calm by the time she got out of the bathtub--usually a relaxing experience for her. I had a difficult time getting clothes on her. I let her go out and get in the car without getting shoes on her. I was just glad she wasn’t naked. We drove around for a little while, and then I brought her back and gave her breakfast. But I could tell she was still anxious. So I spent the day driving. We drove from 10:00 or so until 5:00. She is always pretty calm when we drive. She loves to drive, and I do too. So we’re a great pair. We drove to Whitbey Island via La conner, took the ferry to Port Townsend, drove back via the Tacoma Narrows. I could tell when we got back she was still on the edge. And she lost it when I tried to get her ready for bed. She started running around, pretty much naked, and I couldn’t calm her down. I also wasn’t inclined to go driving again. I knew that I had to get her calmed down in the house. I herded her downstairs where there were fewer things to throw and clear from surfaces. I finally cleared out the bathroom and blocked the door until she sat down. Finally she let me sing to her, rug her back, and finally put her nightgown on. Eventually I coaxed her into bed.

I had given her the “sleeping” pill before I tried to get her ready for bed, beginning to wonder whether the behavior was related to not taking the pill.

She woke up the next morning a different person. She was cheerful, funny, cooperative. And remained so for the whole day. We drove a little, but mostly we worked around the house, went for a walk. And she watched Barney, an old favorite from childhood, on the TV. I gave her the pill again last night, and she’s been Bevin the charmer all day again today.

Obviously I also began researching her “sleeping” medicine--trazodone. It turns out that it’s an anti-depressant, in particular used for anxiety and prescribed some times for sleep problems. It is one of the drugs that has been noted as problematic in teens--causing sometimes thoughts of suicide etc. Obviously taking her off the medicine quickly is a problem at this point. I’m left wondering about next steps here. Maybe this is just the thing to help her manage anxiety. But I also wonder how much of the anxiety is biological and how much contextual. I’m thinking that I somehow need to get to ground zero with Bevin, to figure out where she is, before I can begin making good decisions about her future. I can’t imagine putting her into another group situation until I have a sense of just what her emotional, physical situation is.

I did refill the medicine and found a doctor to see her this Friday. I want to begin working on a plan to figure out who and how Bevin is at this point in her life. That has to be the first step here.

Will she also be sleepless in Seattle? Or can she find her way to a calmer self? I just don’t know.

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