owl.jpgI’ve written a lot lately about how well I’m doing on the new hepatitis C medications, a 24-week treatment of ribavirin and Harvoni. My medical cocktail is full of other yummy items that many of you are probably familiar with: tacrolimus, ursodiol, furosemide, nadolol, and more.

For me, this mix of daily ribavirin and Harvoni is surprisingly free of the predicted strong anemia or other physical effects, but adding them to my previous medications changes the overall chemical mix, and lately I have felt my first significant negative result, but it’s not anemia; it’s insomnia. 
My sleep now is restless at best, and sometimes I’m awake well into the early morning hours. For a while I would suffer through it, and try to sleep in a bit to at least get 4 to 5 hours of shuteye. Sometimes that works, sometimes it doesn’t. The final straw was when I was going to Boston to meet my son, a Northeastern University junior, to meet and have dinner with his new, and seemingly serious, girlfriend.
The night before, I fell asleep at 5:30 AM, and got up at 7:30, as I had a few things to do before making the three-hour drive to Boston. I did pretty well until the last part of dinner, when it was a struggle to keep my face out of my pasta, let alone be engaging or fun to be around. They didn’t seem to mind, but I was disappointed at the least to be so out of it on an important night.
I told my doctor I needed some help, and she prescribed Ambien, a low-level sleep aid.  I slept well, but after three weeks of taking it at bedtime, I started to worry about dependence. So, two weeks ago, I tried to back off. I took the Ambien only when I seemed to need it, not every night. By the time I took it later in the night, however, it was too late. I was awake, and I was going to stay awake.  
Behaviors I didn’t recognize attached themselves to my lack of sleep, particularly impatience and shortness with people close to me with whom I disagreed. My wife, and even my son, suffer somewhat from my defensive, argumentative ways. I live in co-housing, and at a community meeting this week I was pretty hard on someone whose point of view I found difficult to understand. Living in community feels good, but also takes patience at various levels, especially when sleep deprivation has a grip on me. 
More and more often, I was acting like a jerk. I don’t see myself as being that kind of person, but the reality was hard to ignore. I was not acting like the peace-seeking meditator I imagine myself to be.
The past seven weeks of treatment, I found it easy to notice my good physical energy, and was pleased that I could still enjoy a good mile swim, slow (but still sweaty) jogs, walks in the woods, and two or three hour stints in the garden. Without the honest feedback from my wife, it wasn’t as easy, and nearly impossible, for me to notice the more subtle changes in my patience. It was more of a feeling of “what’s wrong with them?” instead of “what’s wrong with how I am responding?”
But I see it now, and I hope it will be easier to divert my negative reactions as I progress through the treatment. I also talked to my doctor, and we decided that leaving ambien behind after the treatments will be possible, but for now, sleep is especially important.  We added lactulose to curtail low-grade ammonia build-up that leads to hepatic encephalopathy and an unclear mental process. Of course, doing all the things that help the transition from being awake to being asleep, like lighter, early dinners, being well hydrated all day, early evening gentle yoga and reading in bed rather than queuing up a Netflix show, and warm lemon water by the bed stand, all usually enough to help most people sleep. The medication mix and its contribution to insomnia make things more challenging.
I’ll take the Ambien too, though I resisted adding it to my cocktail for many weeks. But, if I’m being impatient with the people most important in my life, and feel fuzzy around the edges, then for me it’s just not worth it. For now, I’ll take the pill, and hopefully sleep through the night again.
Sweet dreams.