tinnitus Mental health and severe insomnia

[euphonix8]

Hello everyone, 

I wasn't sure where to post this exactly so please let me know if I need to put it somewhere else. I am currently service connected at 70% combined with 50% for dysthymic disorder, GAD, and adjustment disorder. 30% IBS, and 10% tinnitus. My insomnia has been getting much worse where I am only sleeping 2-3 hours per night with medication. My VA phsciatrist has tried ambien, trazodone, silenor. All with little effect. The ambien used to work but I was taking it since 2007 and it started to loose its effectiveness. I am also taking wellbutrin, and some kind of anxiety medication that I can't remember the name of. For the anti depressants we have also tried several different types because of side effects and ineffectiveness. I have just started a new job at the VA and have used up all of my sick time and annual leave for doctors appointments and sleeping during the day since I fall asleep an hour before I need to get up to go to work. When I do go in I am so tired I can't focus on anything. Being that I am still in the probation period I am afraid they will let me go. I am also afraid to ask for an increase of my rating because I haven't been fired and knowing the VA they would probably end up lowering it just because they can. What should I do? I'm a nervous wreck, constantly exhausted. I can't focus at work, i'm missing work, my family life is a wreck because of the anxiety, and irritability. Any advise is appreciated.

[ADodge]

SO Has your medical team looked at your sleep issue from the other side?  As in have you had the usual MSLT and the Overnight Sleep tests done?  To see it there is an issue with your sleep?  I have what is called Idiopathic hypersomnia A sleep condition that is also known as excessive day time sleepiness. For some reason my brain just decides that it is time for sleep.  And that is what begins to happen.  If you google this condition I am sure you will find many sites that will give many reason why this happens.  This condition is a lot like Narcolepsy except for the fact that with this condition you don't have the lose of muscle function or what is called Catalepsy.  The major symptoms of this condition are as follows; 

• Daytime naps that do not relieve drowsiness
• Difficulty waking from a long sleep -- may feel confused or disoriented
• Increased need for sleep during the day -- even while at work, or during a meal or conversation
• Increased sleep time -- up to 14 to 18 hours per day
• Anxiety
• Feeling irritated
• Loss of appetite
• Low energy
• Restlessness
• Slow thinking or speech
• Trouble remembering                             

I struggled with this condition for a majority of my life thinking I was never getting to bed on time or enough sleep. I was also being treated for ADHD which years ago the drug treatment for this condition was the same as it was for ADHD. But in 1999 they released a drug called Provigil and I started taking that and let me tell you.  If you have this condition you will know it once you start taking that medicine.  It was like a fog was lifted from my life.  I take Nuvigil now a better form of Provigil.  But my advice to you is go see a sleep specialist and have a MSLT done then the overnight test done.  Those test can pretty much tell if this is what the problem is.   (MSLT +  Multiple Sleep Latency Test) 

I hope this helps you!  

 

[euphonix8]

Thanks for the reply, I will talk to my primary care doctor about referral to a sleep specialist. So far they have just assumed that it is all related to mental health and have not done any sleep studies or anything.

[Berta]

Dysthymic disorder can go hand in hand with insomnia.

If VA was fully aware of your disabilities, to include the insomnia, when they hired you, they have to make reasonable accommodation for your disabilties.

I feel you would have a strong ADA EEOC case if they canned you for any behavior that stemmed from your insomnia.

If they should fire you , you should apply for TDIU and also SSDI. But I dont think they will fire you.

 

Are you part of FERS yet?

Reason I ask...decades ago the supervisor of a VAMC  dept here in NY was relentless with the PTSD vets they had working in this department.He felt, since he was a Vietnam combat vet like they were, then they should not have PTSD because he didnt have it . He was very tough on my husband  and kept calling him up here after VA ER gave him 3 days off for a "sinus infection" to get him back on the VA job. He was abusive and hostile to all the other Vietnam vets.

(The sinus infection ,I proved, was a heart attack that was the initial misdiagnosis VA made that caused/contributed to his untimely death FTCA/1151)

A few years ago this same supervisor called me up and apologized for the way he had treated Rod and the other combat vets who worked under him. He knew I had been a vet center volunteer and told me the VA had just put him on a FERS disability  leave, and diagnosed him with PTSD from combat.

We had a long talk. He told me he never associated what happened in Vietnam with his own behavior and had almost lost his wife due to his violent outbursts at home and knew he had a drinking problem too. He said he had many stressors but didnt want to even consider that  he had PTSD and now he knew he had been in denial for years.

 

My point is, he told me he  was suddenly afraid of everything ,even the VA where he had worked for years, but the fact is the VA did a good thing for him....because this man did need their help and maybe the diagnosis would save his marriage, with a good treatment program...and even save his life.

FERs disability requires SSDI application at some point and I told him to apply for TDIU as well.

And my real point is that I dont think the VA would fire you....but might feel you should ,at some point , be on FERs disability.....if your SCs interfere with your ability to work.

But A Dodge make the best point of all.....there might be a way the insomnia can be treated better by a specialist and it would not interfere at all with your ability to work.

That would be great!    Are you able to drive safely to work?

 

 

 

[USMC_VET]

having been a federal employee i will say that even during the probationary period it is very difficult to be fired except for in cases of total negligence or criminal activity.  Especially in your case i can guarantee you with 99% certainty if they hired you under the VEOA hiring authority and as a 10 point compensable veteran (30% rating or more) they cannot claim to not know you had disabilities etc. 

Reasonable accomadations have to be made for disabilities.

You can also request leave donations through the voluntary leave transfer program, talk to HR about that.

I second the sleep study, get that done.  You have a good case for getting a higher rating or even maybe TDIU if it keeps affecting your work performance.

[euphonix8]

For driving it depends on the day. Some days for example if I don't fall asleep until an hour before I need to get up to go to work I just call in because I am useless. Other days if I feel that I will be unsafe I have my wife drive me in. For a sleep study do I need do get that set up through my primary care doctor, or my psychiatrist? I am a part of FERS as far as contributions go. I have thought about TDIU, however having a family I can't quit and wait for however long it takes for the VA to make a decision. You have to be unemployed to apply for TDIU right?

[USMC_VET]

PCP or psych can order it, however i would go through PCP.

Talk to your PCP and tell them all the symptoms, snoring, wife says you stop breathing.  You are fatigued the next day, its dangerous to drive, etc.

Actually do this...

Write a message on SECURE MESSAGING to your PCP requesting a visit regarding sleep issues. 

Write a lengthy and detailed email regarding ALL your symptoms. and request that a sleep consult be put in. 

Dont request a sleep study because they cant do that, they can request a consult with a sleep specialist and that specialist will or will not request a sleep study.

By secure messaging them it becomes part of your record and in your C-file for review.  i always secure message my PCP with ALL my symptoms for an issue i want to see them for.  this way no matter what THEY write as your REPORTED symptoms this message is part of the record as WHAT YOU REPORTED AS SYMPTOMS.  see how that works?

This way as well they know they are on record for you asking for a consult and have concerns about this issue.  if you just go in and they "dont feel like you need one" they will write up the notes however they want to point to that conclusion, if you secure message them its in the record and if you take actions later they know they are on the hook for it.  I find that when i do this they act more in accordance with what I THE PATIENT want and less what they want.

Sleep specialists are in short supply so dont expect it quickly, a few weeks or a month to see them and probably a month or so for a sleep study.  at least in my subjective experience.

for FERS you  can file for disability retirement from the federal system. I would consult some of the FERS disability blogs on how to do that.  so this way you can retire on disability from them and then file for TDIU maybe? im speaking out my butt a bit on this since i have never researched it myself.

You might also want to do a fiscal fast for a while, save up a nest egg to live on, maybe sell the house and get something smaller and less expensive, or if renting find something smaller and less expensive while this process goes on. 

i know there are folks on here who have done this so take what i said in regards to FERS and the TDIU route with a grain of salt.  wait for the experts to speak.