Nocturne

I'm a little concerned about my nocturnal eating habits. I'm not a good sleeper, never have been--and sometimes I wake up hungry. I've been lectured about eating during the night--one doctor went so far as to assert, "You're not hungry, it's just a bad habit". Of course, if it were up to doctors, no fat people would never eat anything ever again until their ribs could be counted (she snarked, peevishly).

Back when I was on Ambien, I was binge eating during the night with no memory of doing so--we would find the evidence in the morning. That was a legitimate problem. This isn't binge eating and I'm conscious for all of it. I'm awake, my stomach growls, I go and get a snack. They are gastric-bypass-friendly snacks, like sugar-free Jell-O or string cheese or a South Beach cereal bar. Sometimes I take a Muscle Milk back to bed with me, sip on it and finish it in the morning.

I eat so little now, I wonder if this is even a problem. If I could reliably sleep through the night, maybe I wouldn't want to eat. Sometimes I do sleep through the night, and usually the first thing I do in the morning is eat because I'm hungry.

I know in an ideal world, sleep isn't interrupted for food. I'm debating whether to even discuss this with the nutritionist or one of my doctors--I don't want to make more of it than it is. I'd be more worried if I wasn't losing weight, or if I was finding mystery crumbs and packaging in the morning.

Official denial letter arrives amidst Ambien CR withdrawal

My official hard copy of the denial letter arrived from insurance today. Basically, I meet all of their medical necessity criteria, except the six months of supervised diet and exercise, which I knew--and apparently, that is their sticking point.

Their criteria for deeming bariatric surgery medically necessary is as follows:

Age 18 years or older;

Body mass index (BMI) of 40 or greater or a BMI of 35-39.9 with at least one co-morbidity including but not limited to cardiovascular disease, type II diabetes, hypertension, coronary artery disease, or pulmonary hypertension;

Active participation within last two years in one physician-supervised weight-management program for a minimum of six months without significant gaps that includes monthly documentation of the following: weight; current dietary program; exercise program.

Recent evaluation by a multidisciplinary team including all of the following:

A recommendation for surgery for treatment of morbid obesity by a bariatric surgeon;

A separate medical evaluation recommending bariatric surgery;

Clearance for surgery by a mental health provider;

Nutritional evaluation by a physician or registered dietician.

I assume these criteria are typical requirements for any health insurance that actually covers bariatric surgery.

The letter wasn't alarming in and of itself, but did include a passage that stated no services denied as medically necessary would be covered per their contract. I am hoping that doesn't mean all the preliminary appointments listed above that have already been completed, because I will fight tooth and nail if they try to deny those things--I only did them because insurance required them, after all. Since the providers call before every appointment to see if it is covered--and since they have said "yes" every time--I doubt the charges could be denied for any of this stuff. Given my past experiences with this insurance, however, I notice they have to be called and reminded someone is reading their policies, statements, and correspondence in order for them to actually fork over the dough.

***

It's been a weird few days--this is the first time in about ten years (save a day or two here and there) that I haven't taken any kind of sleeping pill. I am glad to be getting this stuff out of my system, because if the way withdrawal feels is any indication, I doubt it was doing anything good in there. I couldn't sleep at all for the first three days, then I crashed for about 12 hours. The past couple of days I have been sleeping in long blocks of time--today I could barely rouse myself at all. I've had cottonmouth and tingling hands, and the dreams I've had have been really vivid and intense, like being in the middle of 2 or 3 movies mashed together.

Going off Ambien CR

I decided this evening that I am just going to quit taking Ambien. I forgot to bring any with me when I went to visit my friends out of town last night, just toughed it out and tried to doze a bit with the Ipod on my special insomnia/quiet playlist. I didn't sleep all night.

When I got home today, I thought: why am I taking this stuff? I've been taking it for years, and it's not helping me much. I'm eating in the middle of the night, and I definitely don't need THAT. (I can imagine the complications that could cause over and above potential weight gain, particularly post-op when some foods are going to make me sick--I'm going to want to remember what they are so I don't eat them again.)

So, I'm awake for the second night in a row. I'd rather just stop taking Ambien and have a bad day or two, not have it in my body, and not pay for it--even with insurance, it is not cheap. I was also reading online tonight about some of the side effects others have had with it, both while taking it and while trying to discontinue its use. I have escaped unscathed compared to many of these folks.

I just hope I will be able to sleep at some point before too much longer.

Sleep or lack thereof

My sleep has been really, really bad lately. It has never been good, not since I can remember. I'm a lifetime insomniac, since I was a young teenager anyway; I also have PTSD (post-traumatic stress disorder). The PTSD has improved drastically over the years, since I am no longer attacked while sleeping or awakened to the sound of violence and haven't been for decades. I've also been taking medication to help me sleep for the last ten years. My current fears involve possible intrusions from the outside world, and I do have them sometimes to an irrational degree. ("Did you lock the door? Are you sure? Well, I'm going to go look.") Unfortunately, I don't think this will never leave me completely, but I do the best I can. I would feel better with more locks on the doors (like about ten) and a really large, protective dog that loves me best. A razor-wire electric fence around my house and an armed guard might be nice, too. (I wish I was kidding.) A doctor looked at me once and said, "You have sleep apnea AND insomnia?" and I could tell he was thinking, Well, you're screwed.

Part of the problem with waking up often during the night--at least while I've been on Ambien/Ambien CR--is nocturnal eating. I've found wrappers and crumbs in different places in the house the next day and had no memory of eating anything or even being there. I have tried and rejected several sleep drugs over the years, and am about to try a new one. The only one that worked for me was Remeron, which provided the loveliest, most restful sleep of my life. I gained fifty pounds on it (one of the side effects is increased appetite), so I had to discontinue its use. (I managed to lose half of the fifty pounds I gained and keep it off, but at this point, who's counting?)

The other I wrote something weird in my food journal when I had a middle-of-the-night snack. Of course, I didn't remember eating or writing. That assignment was to write down why I was eating, what, what time, whether it was need-based or for some other reason. I wrote was "3:00 AM, 2 cookies. Want or love?" It creeped me out, and, taken literally, probably revealed more than I wanted it to--even to myself.

I have also been having nightmares, which isn't unusual for me, but some are easier to shake off than others. Like any nightmares, it feels as if my subconscious took a laxative and what comes out comes out. Last night's involved having to watch a dog be burned alive as part of some twisted ritual I wasn't part of but couldn't escape. The night before that, it was about being in the hospital with my mind alert, but unable to communicate with anyone, and being wheeled around on a gurney. I could feel the wheels wobbling under me.

These two examples are upsetting to me, but actually quite mild as my nightmares go. My dreams in general tend to be vivid and involved, like movies, with people I don't know taking part and plot twists aplenty. In the past, have had PTSD flashbacks manifest themselves as dreams, and we've all had those anxiety-based "naked in high school" dreams. I know a lot of dreams are symbolic, but I try not to spend a lot of time analyzing them, just chalking them up to the aforementioned laxative of the subconscious processing everyday life.

People are asking me lately if I am scared about having this surgery. The answer is, of course I am. But I've had several surgeries in the past few years, and this one is a lot less invasive than most of them. This one also has the capacity to really be a tool to help me improve my life. Yes, I could die, but anyone can die from any surgery. If my number is up, I have no control over that, so I don't see the point in fussing about that aspect of it. I'm more focused on the ways my life has to change and determined to make the most of what this could do for me.