Maybe Since SHE Said it He'll Listen?

Josh went to see the Nurse Practitioner yesterday and allowed me to go with him. He told her that he thought he needed to get back on Adderall, but gave her no other information about 'the state of affairs'.

So I did.

"Josh went off his Bipolar medication this summer and quickly returned to 'normal', but slowly he's begun to slide into the same patterns he was in last fall when he began slipping towards suicide and failed his classes. He sleeps all day and is up all night, as a result, he's missing classes and close to failing this semester. Basically, he's not functioning well at all, but I'm kind of concerned that taking Adderall might cause further sleep problems."

"Well actually, it might have the opposite effect, people generally sleep BETTER when on this type of medication. But Josh, you have GOT to force yourself back onto a normal sleep schedule. There are all kinds of ramifications to what you're doing. Our bodies respond to the light during the daytime hours and you're missing out on that. This throws off your circadian rhythms and actually effects your immune system and tons of other stuff. You need to establish a sleep routine where you go to bed each night at, say, 11, and then you get up everyday at 9 and the first thing you do is take your Adderall, that will jump start you.

You need to do what we call 'sleep hygiene', you monitor your caffeine intake, make sure you have nothing distracting you when you go to sleep, even the light emitted by your phone or an alarm clock can disturb your ability to get to sleep. You want total dark and quiet, nothing but maybe some white noise.

You've told me before that you don't want to be on 'brain meds', but if you're serious about that you need to get the sleep under control and also work on taking in a very healthy diet, and supplement that with vitamins just to be on the safe side, and exercise, I can't tell you how important daily exercise is for you if you want to avoid brain meds.

I have a friend who was terribly depressed and on medication and she became an avid runner and no longer needs any depression medication, exercise is THAT good."

"So," I said, "let me make sure I understand what you're saying here. You're basically saying that Josh needs to make important LIFE changes."

"Yes, and he's the only one who can do this. You can't do it for him, I can't do it for him. Josh, this is YOUR life and nothing that I'm talking about here is anything more than what we ALL should do to be healthy. Our bodies cannot function normally when we're not taking care of them."

She suggested that for the first few weeks, he take a dose of melatonin before bed, "It's something you can take forever, but I think it will be especially helpful during the first few weeks."

She wants to see him back in one month.

When we left, Josh said that while he was at work that night, he'd think about the best way to reset his clock. The NP had suggested that it might be easiest if he missed one night's sleep, so Josh was going to try to figure out how to work that into his work/school schedule.

We discussed the addition of Wellbutrin to his meds, but Josh would like to avoid that if possible. The NP told him that she felt if he REALLY addressed the things she'd discussed, he could probably avoid additional medications.

Now we'll see what the man/boy does.