Practical Guidance for Using Medications for Sleep and Pain

Practical Guidance for Using Medications for Sleep and Pain - GBF BlogUntil I was fifty, I never used prescription medication. I was proud that I was being “natural” in the way that I had cared for myself. It seemed stronger, independent, and organic to be able to let my body take care of itself.  

In my 20s, it felt like ingesting prescribed medication was only for serious medical or psychological issues. It almost seemed like I didn’t have any issues with using medication when I thought it was necessary. After all, I used to set up psychiatric appointments for my clients and patients who needed medical help, either for serious depression, extreme anxiety, or schizophrenia. However, a few years later, it became clear that this was an idealistic, naïve view and that there were many reasons that medications could create benefits that I had been unaware of.

Why we need psychological reforms when considering medication

 A huge turning point was when I had my kidney transplant at 50. I had an unusual reaction to my transplant medication — for the first six months after the operation, I only slept an average of an hour a night. I was in a state of near-perpetual exhaustion and a continuous sense of being driven. This also left me in a state of heightened anxiety and depression from the lack of sleep. In addition to all this, the medication also had a direct agitating effect on my nervous system. 

I tried everything I knew to lessen the severity — meditation, prayer, communication, therapy, friendship — none of it scratched the surface of my state of sleeplessness or these energetic side effects.  

After the first couple of months, in a bid to get some sleep again, I began experimenting with the standard safe sleeping alternatives. When none of them helped, I turned to out-of-the-box alternatives, including an array of low-dose anti-depressants with strong sedating side effects before bedtime. But, again, nothing made a significant difference.

It was clear that the speedy sensation I had running through my whole body would require something to slow it down. This meant I had to try using medication that would be in a class of medicines considered potentially addictive. 

I started off using ½ a milligram of Clonazepam (through a psychiatrist friend’s suggestion). I began with such a low dose as there is a huge bias against using any benzodiazepines — so much so that the psychiatrist I was seeing didn’t suggest their use. Of course, I knew that whatever I chose to use, I might very well need for the rest of my life unless I could find something better, as I needed to continuously take the transplant medication to stop my immune system from rejecting the kidney.

Immediately the first night I took the Clonazepam, I changed from my then-average one hour to 3 and a half hours of sleep, which was a relative home run. This was the beginning of approximately 350 chemical experiments over the last 23 years when you count dosage changes and the multiple medication regimes I’ve ultimately needed. 

Over the last decade and a half, I’ve experimented with several combinations of medications because it’s clear that no one type of pill would allow me to sleep through the night and still be healthy both physically and psychologically.

My personal experience with medication and using it to relieve my suffering made me think quite a bit about the way we consider the use of medication in our lives. For most of our lives, doctors, hospitals, hospices, and other healthcare professionals have informed and warned patients to use the medication in very restricted doses due to the fear of addiction and resistance. In fact, the threat of serious addiction and overdose due to misuse is so strong that many of us only turn to these potentially addictive drugs as a very last resort or, sometimes, not at all. 

One of the things that both my partner at The Global Bridge Foundation — Dave — and I have done is helped people get through all forms of medical maladies with various medical needs. For example, it was clear to us that so many of our friends and family were suffering from pain or poor sleep. Learning this brought us right to the heart of the dilemma. There’s a need to help those with these issues, but also a need to be careful with the quantity and frequency of use of these medicines.

After all of these years of personal use, and guiding others to persuade their doctors to consider various alternatives, it became clear that there are psychological patterns and attitudes of patients, doctors, and hospice caregivers that needed to be deeply understood to support both safety and quality of life.

To better explain these psychological patterns and attitudes, let’s identify the three categories of personalities when it comes to needing medications. 

2. Addictive 

 This is the easiest form of personality to identify. Almost all of us have been exposed to someone with an addictive personality, as many of them are in our immediate circles alone. These individuals may have had experiences with excessive drug use, been in alcohol addiction treatments or life-threatening situations due to overdoses, etc. 

There are also a number of other addictive personality types that are a bit under the radar. They are the kind to use more than the suggested amount of pills their doctor prescribed and have difficulty staying within the limits of sensible chemistry balance or treatment. If they can’t sleep or are still in significant pain, they will, on their own accord, take doses that exceed the amount prescribed, allow the medication to be used for a longer duration that creates risks and also run short of their typical monthly supply. 

2. Phobic

This second ground is a lot more subtle in its attitudes and is largely ignored by both the medical profession, and by most of us. Even those of us that are in this large group. They are what could accurately be referred to as “phobic,”  which is almost always unconscious. This means that they have heard enough about the addictive tendencies of others and are afraid of being that way themselves — a fear that is deeply exaggerated. 

Phobic people, therefore, would rather tolerate not sleeping or being in significant pain rather than really come to a deeper understanding of what would be best practices from the point of view of living the best quality of life possible and still being safe medically. As a result, they have a prejudice (usually unconscious) that it is better not to use medications when at all possible, even though they are compromising not only their quality of life but also often their physical health.  

Some common responses from this group that I’ve heard range from:

  • “I don’t believe in using medications unless it is after surgery or something close to life-threatening.”
  • “I just don’t believe in using medications.”
  • “I’d rather just suffer through it.”
  • And sometimes, there’s often a subtle (and occasionally not-so-subtle) pride when they say, “I only take very little, or I don’t need medication.”
  • This can be very common in spiritual or religious communities — it’s often considered natural to rely on spiritual practice or on God’s help to get through the pain.  

This is incredibly unfortunate, especially if one holds this point of view for their whole life. It most frequently starts with a very sensible caution, because we are talking about medication that can have a negative impact if misused.

This needs to be emphasized as this is where the overwhelming phobia comes in. These medications are only dangerous if they are misused. If you are “phobic,” it leads you to a life of extra suffering that isn’t necessary at all. In my practice, friendships, and family, this elucidation has changed hundreds of people’s quality of life by giving them a keener insight to recognize if they’re phobic.  

A phobic person can be almost as hard to support as an addictive one. If this is you, I am intentionally attempting to get your attention that your devotion to what you see as caution may very well be a phobia that will really injure your potential for the best quality of life. This is much more common than realized.  

Your self-assurance that you are being prudent is misguided by a relatively innocent initial instinct, one that doctors themselves all too frequently reinforce, to avoid the dangers of lawsuits and creating injury. 

There needs to be a comprehensive evaluative guide that requires thorough questioning to determine your background, thoughts, life experience, fears, and medical intelligence, which will help the experts and phobics guide themselves in a more balanced and prudent way.

3. Balanced

The third group is the balanced. This is most commonly an outcome of having to face real-life circumstances where medications are a must not to compromise their quality of life. In addition, they didn’t have a pre-existing tendency toward addiction. This allows for trial and error to see if any given medication can be used to support you with your challenges.  

It presumes that you will naturally have consistent communication with your medical professional and that you will gain the expertise to be able to seek a medical professional who also holds a balanced perspective and outlook toward medication. 

This is not an attempt to criticize any medical professionals but an effort to support seeing that frequently the decisions that they make are cautious or overly cautious that you might be an addictive personality or become one. Unfortunately, they aren’t always trained to discern the difference unless they have that skill from their life experience or have the ability to ask enough questions about your background and do their homework about your history to take this into consideration.

A balanced person understands very well when I say that the body is composed of chemistry and that when we don’t receive or have the right balance of chemicals for whatever we are dealing with, we learn to see medication as being as innocent and sensible as taking the vitamins we need. 

Socio-cultural reasons for our phobic reaction toward medication

For those of you that are informed about the incredible tragedies highlighted by the use of oxycodone and have seen the series Dopesick, it is clear that we need a strategy that is going to have extensive safeguards set up nationally to lessen the dangers of addiction greatly.  

I highly recommend watching Dopesick to see how deeply a combination of greed, naivete, and addiction flooded our country. This was when the regulations and national safeguards were not in place. This was when there was so much addiction, death, and neglect that it led to the creation of a national policy that would start to best serve the needs of all of us.

What I’m about to write about is a controversial perception that I’ve seen with friends, clients, and myself regarding a significant backlash and over-correction since the tragedy of the oxycodone epidemic. This highlighted the two extremes of addiction and phobia.  

Through a psychological lens, it is well understood that, as human beings, we tend to go from one extreme to the other, especially when dealing with significant challenges or trauma. Whether that is from being raised in a restrictive environment to becoming excessively loose with drugs, sex, alcohol, food, or money, it all reveals the human tendency to go from one end of the spectrum to the other. We so frequently miss the healthy midpoint. This is seen in politics, emotional reactivity in love relationships, and many of our original families.

I believe that this kind of backlash against the dangers of addiction is occurring today. It’s resulted in millions of people who can’t get the pain and sleeping medications that could be safe only if the proper guard rails were established nationally. The guardrails are slowly being built, as the DEA is in the beginning phases of monitoring controlled substances and having all pharmacies report to a central oversight body to protect against abuse.  

There is what appears to be one national reporting requirement for all pharmacies with all controlled substances. There is significant evidence that this is underway, but it has a ways to go to be completely inclusive. The DEA needs to receive all of this information, and, perhaps with the help of artificial intelligence, automatically give a warning when any individual is in danger of abuse that preferably would be programmed to consider history. 

This would also need to lead to mental health warnings to the prescribers to communicate with their patients. Ideally, there would also be communication between the DEA and medical professionals to optimize understanding of unique circumstances.

In the rest of this article, I will presume this crucial safeguard is in place. This is to find the healing midpoint where addiction is being monitored closely, and those needing help to sleep or deal with their pain are all being taken care of as much as possible. But, unfortunately, there is not sufficient understanding of either phobic reactions to medication or addiction, which is a central key to finding balance for all of our benefits.

An overabundance of caution could spell a lifetime of pain

One of the keys to understanding addiction is to see that there is a common misunderstanding of what addiction really is. Many people see it as having to take a sleeping medication for the rest of their lives or the same for various maladies, including pain. Some medications have side effects when you take them for a prolonged period of time, but there are many without any life-changing side effects.  

It is vital that we learn what the truth is for each medication based on science and real-life experience. This becomes particularly important when we reach our middle or later years as there are many medications that, if we take them for the rest of our lives, are purely sensible and not at all an addiction.  

When we take medication that is more than what is prescribed or for longer than is suggested — that’s addiction. When side effects are listed, it is vital to see the percentage of times that these side effects will occur, as it can be a decision of being in pain or not sleeping well for the rest of our lives or a less than 1% chance of having some side effect.  

These are common questions investigated by those who have learned through life experience how to become balanced. Many times, we need to become our own doctors, which doesn’t mean that we ignore our doctor’s advice. However, it can often lead to the need to go to a different doctor that isn’t consciously or unconsciously protecting themselves from being sued.

One of the parallels that I picked up on in my middle twenties was when I visited St. Christopher’s Hospice in 1970 and saw cancer patients being given pain medication before they were in pain. This resulted in the patients needing the same or less medication because it eliminated the fear of pain, which invariably added to the pain and increased the need for medication. It was used in a remarkable way with patients that were in the final stages of dying being able to stay alert and dominantly pain-free until the end of their lives.  

However, in the United States, this was never adopted like it was there by hospices, as there was an absurd fear of dying patients being addicted to pain medication even though they were likely to die within a few months. This demonstrated the balance we’re talking about that American doctors didn’t embrace. This was phobia in action.

Today, 23 years after my transplant and taking all the accompanying medications, I’m now sleeping regularly (7-8 hours a night) with 5 sleeping medications, each working on a different part of my brain. I took the time to pay attention to my body and found that another medication I took during a root canal, in small dosages, allows me to be balanced throughout the day. If I had followed strict guidance, I wouldn’t ever have come close to the quality of life I have been in for the last seven years. 

This lesson and suggestion for you to inquire into your own pattern could be invaluable. In my observation, more than half of the people I know are phobics in this way and are unnecessarily and unwittingly enduring more pain, less sleep, and a variety of other forms of suffering that absolutely isn’t necessary.  

If this is true for you, I hope you’ll take the time to reform your attitude about medications and find a doctor that is in accord with your new understanding.

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