This is not a new experience for me at all but today it feels like the worst thing ever even though it's not even close to the worst I've been. But I am so, so tired.

I have bipolar I with mixed episodes and rapid cycling and have been hard to treat from the beginning. I've done better with high dose Seroquel XR, Emsam, klonopin and a couple of drugs that do less (gabapentin, topamax, both at low doses), for quite a while. Because Emsam is activating when I've been most agitated over the last several years I've used valium at a low dose and it has always worked well at getting me to sleep but not over-sedating me. Sleeping pills are completely ineffective for me so having that valium working when needed has been important but I didn't even realize how much until it hasn't been working.

Since January I've had this episode brewing and the last month has been bad. Sleep has been very difficult and if I use the Emsam at full dose I don't sleep but I can't cut it down much because I'm also depressed and need it. Sunday night I think my body finally hit rock bottom and I slept for 7 hours. Since I woke up 35 hours ago I've slept one hour. I did see my psychiatrist yesterday and we figured out a way to reduce my Emsam dose a bit and since valium has either done nothing or has knocked me out so long that it affected the next day I'm going to try liquid valium to see if I can get my sensitive body to accept some specific amount. That had to be ordered of course so I have to wait for tomorrow to start it. My Emsam patch has been off since yesterday night and I'm going to leave it off until tomorrow when I have the valium that hopefully will help.

I've had a lot of hypothyroid symptoms and was hoping that was going to have some answers but the labs came back and apparently I'm just tired; my thyroid was fine. I've been exercising every day that I've had some sleep. I am recovering from ankle reconstruction surgery and just now am able to do more with my ankle after a year of either being injured or recovering from surgery so I can't just go for 3 or 4 mile walks like I have done in the past when this manic; my body tolerates 1-2 miles and then my ankle is about done although it is getting stronger. I've only been out of a brace for about a month and my surgery was in June so I have a long way to go to be in shape again (and several more months of healing. I need to go back to PT but there is no way I can do that while going through this episode).

I really just need to hear that I'll sleep again sometime. I know my body is tired and yet I'm not the least bit sleepy even though I was too manic to even lay still by 4 AM and I didn't lay down until 3. And even though I've done this many, many times the present one always feels bad enough when it is happening, no matter how much worse I know it has been. I'm beginning to be afraid this will lead to the hospital and I hate the hospital when I'm agitated. I don't love it ever but it feels like special torture when agitated.

I don't even have much of a point, I just needed to say this to people who understand.

Thank you.