Sleep, Cognition, and So On

I’ve been waiting on an order for Xanax and Gabapentin, so that I can 1) sleep at night and 2) be in a bit less pain during the day, but both, for some reason, are long in coming. My pharmacist ordered both early last week, and they have still not arrived. Therefore, I’ve not been doing much sleeping, and last night I had to break down and buy the expensive option for Gabapentin at the large commercial pharmacy. I can’t get Xanax from the large pharmacy because it can only be gotten 1) with a prescription or 2) from a local pharmacist who has become a friend.

Surprisingly, however, I slept like a baby last night, all the way through the night, and woke up at 8:30 rather than the customary 6:30 in the morning. Go figure. I guess I was tiredJ I was in significant pain when I went to bed, and woke up with the same pain in the morning. Just like being married.

So I formulated my plan for the day over a breakfast which consisted of a chocolate-marshmallow cookie. The plan was to 1) take my laundry to the cleaner, 2) stop by the Circle K store for cigarettes and 3) go to Starbucks to do some writing and reading and chatting.

Ah, but my best laid plans, like those of all mice and men, do often go awry. Arriving at the laundry place, I noted that I had forgotten my laptop. Retrieving the laptop from the house and heading for the Circle K, I noted that I had forgotten my helmet. Retrieving my helmet, I head for Starbucks, and noted, upon arrival there, that I had forgotten to buy the cigarettes.

This, actually, is a fairly normal course of events and may be put down to the strange phenomenon of cognitive difficulties associated with MS. In a similar way, the other day, while driving home from the mall, I suddenly had the panicky impression that I had forgotten my laptop. It was not in its usual place by my feet on the front of the bike. Where could it be? I must have left it at the mall! Making a U-turn, I headed swiftly back toward the mall, only to realize just as suddenly that Oh, the laptop is in the backpack on my back! Whew.

Cognitive changes are certainly a very weird part of MS. The National MS Society describes the condition as follows:

Cognitive” means of or relating to “cognition” — which refers to a range of high-level brain functions including the ability to learn and remember information, organize, plan and problem-solve, focus, maintain and shift attention, understand and use language, accurately perceive the environment, and perform calculations.

Cognitive changes are a common symptom of MS — more than half of all people with MS will develop problems with cognition. For some, it may even be the first symptom of MS. Certain functions are more likely to be affected than others:

• Information processing (dealing with information gathered by the five senses)
• Memory (acquiring, retaining and retrieving new information)
• Attention and concentration (particularly divided attention)
• Executive functions (planning and prioritizing)
• Visuospatial functions (visual perception and constructional abilities)
• Verbal fluency (word-finding)

A person may experience difficulties in only one or two areas of cognitive functioning or in several. Certain functions including general intellect, long-term (remote) memory, conversational skill and reading comprehension are likely to remain intact.

Most people who experience changes in cognitive function can use compensatory strategies and tools to help them function effectively. However, cognitive dysfunction is one of the major causes of early departure from the workforce. In very rare instances, cognitive dysfunction may become so severe that the person can no longer function independently.

So, in other words, ‘bummer’, right?

Some of this can be overcome through intention—purposing, that is, to remember that you have probably forgotten something. You take extra time before leaving the house. You take an inventory of what you have with you and what might be missing. You don’t just ‘get up and go’. It’s something one has to practice, because that part of one’s brain that is not really functioning, really thinks that it is functioning, and confidently tells you so. I’ve got it all together, it says. Let’s go!

So, it’s that habit of saying ‘No, you don’t,’ that is difficult to learn—because of course the part of the brain that is failing to function does not remember that it is failing to function.