Monday, December 30, 2013

Things that get worse in the night

A few weeks ago, my perpetually runny-nosed three-year-old had an earache. A horrible earache. So terrible, in fact, that I found myself literally attached to his ear for the entire night.

Picture the scene: It's 10pm. Mother is peacefully climbing into bed after shutting down her work computer, laying out her clothes for the morning, and checking to be sure her alarm is set for 6am. Previously sleeping child wanders into parents' room, crawls into bed saying his ear burns, and requests ice. Dad gets the ice. Child positions himself to "share" his mother's pillow, an act that translates into a restless 37-inch body occupying at least three-thirds of the 26-inch pillow. And then for the rest of the night, this: exhausted-mama's-left-hand-holds-green-shamrock-sock-covering-ice-filled-baggy-placed-over-child's-right-ear.  Just about every time mother dozes off to sleep, mother's hand (and the ice) slip off the right ear, and the achy child wakes to plead for the ice again.

Torture. For all involved.

And, "Quel relief!" when the alarm finally does go off at 6am.

I suspect that many a fellow human has lived such a night. And putting aside the debate about whether and when to treat an ear infection with antibiotics (fodder for a future post) and whether co-sleeping is a good idea (another excellent topic), this particularly painful night prompted me to consider how much worse things feel at night.

For you too, right?
Have you ever been short of breath in the darkness? Or had middle-of-the-night back pain that you were certain was about to kill you? Or felt a panic at 3am that literally wouldn't get up off your chest? Or sat in the predawn with a vomitous friend worried she might lose her very soul with each recurrent heave? Have you ever begged for the sun to rise and the darkness to lift?

It's freaking scary.

I personally know the darkness from my own pregnancy-induced heartburn years ago, from long nights in the hospital with sick sick patients, from my toddler's battles with croup in the most unfortunate of locations, from listening to the the night-time tales of the physicians-in-training I teach in early morning sign-out, and, most recurring, from patients' midnight calls about non-emergencies.

At midnight, you know, everything feels like an emergency-- even slow bowels and itchy ears.

And doctors are not exempt. If you eavesdrop on a bunch of doctors taking call (you know, the voices on the other end of the line when you call because your kid has been crying uncontrollably since 2am or your mother's feeling dizzy and her blood pressure is through the roof), they will complain of one of two related occurrences: either 1) "I couldn't sleep, I was up all night worried about such-and-such patient" (yes, those same scary night-time fantasies that keep you up keep up us too) or 2) I couldn't sleep, the patients kept calling."

Are things actually worse at night? Or is it all in our heads?

Accessing my rational (daytime) mind, there is definite evidence that many illnesses (or at least symptoms) are worse at night. Some common examples include the following:
  • Over fifty percent of uncontrolled asthmatics report night-time cough and wheeze
  • Fevers tend to go up later in the day
  • Night sweats are some of the most disruptive and frustrating symptoms of menopause
  • Bronchitis coughs tend to be more bothersome at night
  • Carpal tunnel symptoms (irritating numbness in the fingers) often wake people in the middle of the night
  • People with bad gastroesophogeal reflux (aka heartburn) tend to have worse symptoms when lying down, which happens for most of us at night
  • The same is true for earaches too (This is probably why my little guy acted fine upright and as though he was going to die when lying down)

But it's the irrational (night time) mind that inevitably exacerbates the discomforts.

As I see it, night feeds illness, and illness brings along her good friend, vulnerability. Darkness feeds fear. With fear and vulnerability runs imagination. And the untetherable imagination inevitably breaks free precisely as the temperature and pain peak.

And so, the next time you are up in the middle of the night worried that the mole on your shoulder is a flesh-eating cancer or that your coughing child might stop breathing any second, consider the context. Turn on the light. Take a little walk around the house, maybe even have a snack. Make the scene feel a little bit more like day than like night. And then re-evaluate.
If after a few minutes of daytime glee it becomes clear your imagination has gone overboard, stay up a little longer, have a cup of chamomile tea and do the crossword puzzle. Then, go to sleep.

If it's something you're still worried about (and I mean really worried about), call your primary care provider. That way she can stay up and worry about you--perhaps long after you've dozed off again.

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