#58 Points of YES return

I’m currently researching a podcast episode on sleep deprivation and have read three great articles to prepare for my conversation (see below for citations). One of the ideas that caught my attention was mentioned by Waters et al (2018): the “turning point” one experiences at five days of wakefulness, in other words, without any sleep. This point in one’s sleep deprived state is a clear indicator, according to the authors, that one has departed from the sane world of sleepers to the sleep deprived-induced insane world of psychotics. They say that the fifth day of sleeplessness, this turning point, is “characterized by a sudden deterioration of participants’ mental health and the demonstration of acute psychotic symptoms with persistent hallucinations, delusions, and aggression. By that stage, delusions are elaborated and firmly held” (Waters et al, 2018, 7).

When I read about this turning point, I immediately thought of the expression, “point of no return.” According to Merriam-Webster dictionary, this point signifies a critical point when turning back is impossible, for example, when an aircraft has used more than half of its fuel to make the return journey; if one goes past that point, they must continue the journey, or I suppose, they could turn back and crash land near their original takeoff point. In one sense, crash landing near one’s embarkation point is not too bad of an idea because although you’re not returning exactly from where you departed, at least you’re getting pretty close. Or, you just keep an eye on that fuel gauge and make sure to not go past the halfway marker. Even so, you’ll likely want more than half of your fuel just in case you have to take a detour or maneuver through hostile territory or weather.

The turning point to which Waters et al refer is about sleep deprivation and the hallucinatory states this phenomenon can produce in otherwise healthy subjects. They found little effect of sleeplessness during the first 24 hours and mild perceptual anomalies, anxiety, and irritability at 24 hours of sleeplessness; distortions, illusions, and hallucinations after 48 hours; visual, somatosensory, and auditory perceptual changes, including a change in stance from questioning their experience to full acceptance of their condition after 3 days; and a “turning point” after 5 days, which includes acute psychotic symptoms such as thought disorder, delusions, toxic delirium (Waters et al, 2018, 9). For me, what Waters et al discovered through their historical analysis of studying 21 previous studies on sleep deprivation ranging from 1 to 11 days without sleep in healthy participants is that this 5-day turning point is an important marker that indicates a sleep deprived person will likely exhibit states of psychotic thinking and behaving.

We might say this halfway point of fuel in one’s airplane is equivalent to stable cognition or energy reserves during psychedelic states of consciousness. The first point of no return for psychedelic users is the moment of ingestion. For example, some substances cannot be vomited out of the body before they start to have an effect. Eating a handful of mushrooms and then vomiting them out ten minutes later will probably not produce a full-blown psilocybin experience because you didn’t give enough time to the body to digest and thus absorb the psychoactive chemicals. LSD, with its microgram action (that is, one millionth of a gram), is already on its way to the blood—brain barrier once put in the body. Colloquially speaking, you’re already fucked, not in the sense of being immediately intoxicated, but rather the psychoactive chemicals are traveling to the receptors in your brain for which it has affinity, and so, you cannot reverse the process at this point unlike other psychedelics upon immediately vomiting them out before they have the chance to be digested.

The second point of no return is reaching peak experience; once you’re at the peak, down is the only way to go. Know that the worst, or rather the most intense part of the trip, is done and it’s usually smooth sailing down to baseline consciousness. Other points of no return exist such as vomiting, as is common during ayahuasca and iboga experiences; paying a non-refundable sizeable sum of money to partake in a weekend experience; traveling to another country to partake in an experience, that is to say, once you get on the departing airplane you’ll likely go through with the plan because you don’t want to waste time and money and you already set your intention likely weeks and months before, so why not just go through with it; other people have changed their plans to be with you for a period of time, either to take care of you or be there as support while shamans or guides take care of you.

On some of my iboga experiences, I notice the turning point happening around the third night of sleep deprivation and post ingestion. There comes a point where, as Waters et al clearly state, albeit at the fifth day, I begin to not question my altered mental state and the visionary phenomena I experience but begin to believe in the hallucinatory narratives and scenarios. It takes a couple of times to be fooled by these visions and the information communicated to me by them to be all the wiser on subsequent experiences. As the saying goes, “Fool me once, shame on you; fool me twice, shame on me.” I couldn’t agree more. Personal experience and some academic knowledge of this turning point among other expectations of hallucinatory and sleep deprived states soon act as one’s cognitive armor against being duped by very convincing visionary phenomena.

Some psychedelic turning points are not points of no return. For example, if the psychedelic experience is combined with long bouts of sleep deprivation, Waters et al (2018, 7) remind readers about the concept of “recovery sleep” that says: “Participants required approximately 50% of the total time they had been awake to recover from the deprivation period (e.g. 50 h of sleep to recover from 100 h of sleep deprivation).” If sleep deprivation is not part of your psychedelic experience, then know that the psychedelic will eventually metabolize, and you will return to baseline. Unless you are predisposed to psychosis, for example you know for certain you have schizophrenic tendencies or it runs in your family, there is a very small chance of you staying permanently in the altered state. One of my friends writes in pen the time of ingestion on his arm, expected peak experience below that, and likely time when the experience will be over below that. In this way, when he experiences time distortion or slowed down time, he can look at his arm and compare it to clock time and know that he’ll be alright and come through in one piece.

The most difficult thing to come to grips with, in my opinion, is simply knowing that there are turning points during psychedelic experiences, ranging from not being able to vomit out a substance last minute to sleep deprived acute psychosis, like how iboga keeps one awake. The next best thing you can do is come up with ways to mitigate or navigate such points. For example, if sleep deprivation correlates to your substance, think of some ways to get to sleep, such as taking some melatonin or other natural food supplements that induce sleepiness. Think of ways to manage these intense turning points. Being prepared both conceptually but also practically can give you more confidence that everything will be alright and ways to enact such procedures.

González, J., Prieto, J. P., Rodríguez, P., Cavelli, M., Benedetto, L., Mondino, A., Pazos, M., Seoane, G., Carrera, I., Scorza, C., & Torterolo, P. (2018). Ibogaine Acute Administration in Rats Promotes Wakefulness, Long-Lasting REM Sleep Suppression, and a Distinctive Motor Profile. Frontiers in Pharmacology, 9, 374.

Göder, R., Bares, S., Vogel, C., Böttcher, H., Drews, H. J., Lechinger, J., Jauch-Chara, K., & Weinhold, S. (2020). Psychotic-like experiences in patients with insomnia or sleep apnea: Associations with sleep parameters. Sleep Medicine [Pre-proof], https://doi.org/10.1016/j.sleep.2020.04.015.

Waters, F., Chiu, V., Atkinson, A., & Blom, J. D. (2018). Severe Sleep Deprivation Causes Hallucinations and a Gradual Progression Toward Psychosis With Increasing Time Awake. Frontiers in Psychiatry, 9, 303.

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