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Selah R, M.S. LPC
Selah R, M.S. LPC, Therapist
Category: Mental Health
Satisfied Customers: 582
Experience:  Licensed Professional Counselor; over 13+ yrs exp working with adults, teens, & families/couples.
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im bipolar, ptsd, anxiety, multiple personality, depressed,

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im bipolar, ptsd, anxiety, multiple personality, depressed, borderline personality. spent mid jan to mid april in psych hospital for depression and suicide plans. no psychiatrist nor on any psych meds. past six weeks went 89.5 hours straight no sleep, had three days of about five to six hours. next few weeks it was 74, 72, 72 hours no sleep before getting 5 and 6 hours a night for a few days in betwee. last week was up 99 hours straight, slept three hours then up another 35. at this point got a prescription of ambien from pcp. took ambien that night slept 12 straight hours uninterrupted sleep. but since that night even with taking the ambien i dropped to 5 hours next night, then to two then an hour this morning. i am soooooo overtired it is not funny. i do not know how i am funtioning. body aches, headache, nausceous and vomiting. last thursday collapsed to the floor from pure exhaustion. my counselor, my dmh worker, my daughter all say i am manic and have been over these weeks. when pcp gave me ambien she said if still dont sleep get psych eval. dont feel i need that because im manic and not sleeping. lot on my mind but not suicidal. i am an injurer spent friday night cutting and scraping a name tattoo off my leg. counselor made me show her. she diddnt hospitalize me she is used to the cutting but is insisting i go to pcp tomorrow to get it checked. i feel i dont need to. therapist says if i dont get it checked by pcp by next appt on wed dont bother coming anymore. i know there are laws about the cutting. are there any to protect me from this
Submitted: 5 years ago.
Category: Mental Health
Expert:  Selah R, M.S. LPC replied 5 years ago.
Thank you for trusting JustAnswer with your important question.

You have a lot going on, and the lack of sleep can be from more than one source (anxiety, mania, triggered parts who don't want to allow sleep because they are afraid of nightmares/memories, and burned out adrenal glands from all the stress!). Seeing your doctor to rule out any other medical issues (like hormones, and thyroid) and to check your body to make sure this serious lack of sleep isn't causing physical damage (increased heart rate, increased blood pressure, changes in organ function like kidney and liver tests) are worth considering.

You may need a different medication to help you sleep. Ability and Seroquel are both used to treat mania, and I have seen both used to help with sleep disturbance (most commonly is Seroquel, which I've seen used for racing thoughts, nighttime anxiety, and even treatment resistant depression that can disrupt sleep). The Ambien may not be targeting the right brain chemicals to help you get your body to go to sleep.

As far as the cutting, your therapist has a legal and ethical obligation to keep you from being a harm to yourself or others. When we work with a client with self-injury habits, we look for potential lethality, increased suicidal ideation, and increased severity of impairment (lack of sleep, overwhelming depression, unbearable anxiety, feelings of hopeless or helpless, etc) to help judge when inpatient treatment may be needed. If you are willing to try medications, and try to reduce your self-injury tendencies, your therapist will probably not have to force you inpatient. But if they fear that you no longer have the emotional resources, medication compliance, or external support system to stay safe from potentially lethal self-injury, then they may attempt to force you to go to a hospital for observation (23-72 hours depending on your state laws and severity of symptoms).

Talk to your therapist about your concerns, and what kind of contract you can make with her to avoid inpatient treatment so you know exactly what her boundaries are and exactly what would make her attempt an admittance for observation or treatment. She may ethically and legally just want the security of having you see another professional who also deems you safe enough not to need hospitalization. And she may want you to try medication to help therapy be more productive. It's hard to do therapy when you are manic, sleep deprived, or otherwise in an extended mental and physical crisis.

Best wishes,
Customer: replied 5 years ago.
while in the hospital and for long time prior my psych meds were seroquel 1200mg, depakote 2500mg, lithium 2000mg, klonopin 2mg, vistril 100mg, and trazadone 200mg. i also took 9 mg of melatonin on top of it. this was my meds for along time with doses and different meds sometimes changing. my psychiatrist at time no matter what combos or dosages could help with sleep. she just couldnt figure it out. just dont know what to do anymore. feel unfixable. the psychiatrist said those meds should be knocking me out that i was on high dosages. havent seen a psychatrist since getting out of psych hospital april 13. the psychiatrist i was working with suddenly felt my mental illnesses were to much of a liability all of a sudden when she knew everything including the injuring from the beginning and i found out via computer she wouldnt see me anymore. her name was tattooed on my leg and i tried to cut it out so now my counselor says that is worse then me stapling myself. to me injuring is all the same. my dmh worker finally got me to agree to get another psychiatrist but i really have no interest in one. feel it is time to just help myself. but i know 6 straight weeks of major sleep deprivation is not helping the self destruct in me. im afraid if i go to my pcp to get checked she will hospitalize me and i dont want that. my counselor already called and left a message that i needed to be seen and she wanted the pcp to call her before wednesday because that is when i am suppossed to see my therapist again. therapist says if i dont go to dr and dr dont call her she will not see me. dont think that is fair. was hoping you knew of a law that i could get out of this. i really dont think i need medical attention. therapist is really concerned because i am diabetic she thinks im gonna get gangrene and lose my leg. ive been injuring for 26 years and never got so much as an infection i feel she is blowing it all out of proportion.
Expert:  Selah R, M.S. LPC replied 5 years ago.
There is no law to prevent her from being able to send you to a hospital. The only thing you can do is be calm and centered enough that no one at the hospital thinks you are a danger to yourself or others. Then they will not keep you there. if you see your PCP let them know the basics. "I have a history of self-injury, I am not suicidal, but my therapist wanted me to have my wound looked at because of my diabetes.". Once the doctor knows you're under the care of someone for self-injury they are less likely to panic and try to force hospitalization. Most well-trained doctors understand now that self-injury is not the same as suicidal behaviors, and many hospitals won't even admit people for only self-injury unless there are other significant symptoms or impairments in ability to function are taking place.

I have heard some clients getting relief from mania and chronic insomnia by going to a trained therapist in EMDR. The trauma and dissociation may be causing a great deal of your insomnia, and the medications are not treating either of those. EMDR may help your brain stop being stuck in stressed out mode. Maybe your therapist or insurance company can help you find a certified practioner in your area. is also a place to find EMDR trained counselors.

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