My colleague hovered unsteadily near the office coffee pot. He appeared a bit more haggard than usual. I asked why and he said that he had stopped drinking sakau (Piper methysticum, Pacific island kava) for three nights and had developed a headache. Tylenol only briefly knocked down the headache, and the headache was interfering with his ability to sleep.
I know that headache. And the sleep issue is not due to the headache – they are both withdrawal symptoms that hit around the 48 to 72 hour mark post-sakau. Sakau alters some part of the brain’s chemistry. My hunch is that sakau either artificially supplies a needed brain chemical, or that sakau blocks uptake of a brain chemical resulting in a decrease in production of that brain chemical. Either way, out at around 72 hours, give or take 24, the effect of the sakau wears off and the brain is either short of a chemical or out of balance in some other way.
A dull, heavy, headache is a symptom with which I am all too familiar. The broken sleep is another pattern with which I am well acquainted. In the wake of some viciously strong Kosraean sakau January 2012, I developed insomnia. I drank on a Tuesday night, on Thursday night I was woken up by dark dreams, agitated, excited, high heart rate. I would battle that insomnia for two weeks in January, unable to get anything more than a couple hours of stage one sleep – no deep sleep, no REM sleep.
At that time I had not yet sussed out that the sakau was causative. Two years later I am certain. I tried Unisom and melatonin back in 2012 – but they only made things worse, echoing some of what I was reading on line about anxiety. Sleep aids not only do not work for the anxious, they sometimes make everything worse.
I went to our family doctor and he suggested I try a couple Xanax. I went home and looked up what Xanax was supposed to treat and the potential side effects. I tossed the Xanax out. The Xanax, however, led me to learn about generalized anxiety disorder and the difficulties those who suffer from anxiety experience. Material written by those suffering from anxiety was spot on in describing what I was experiencing. A recent article by Scott Stossel on Surviving Anxiety caught me off guard when he also used a term that I too had thought, “existential dread.” That pervasive and unshakeable fear that is an entity unto itself.
The key to my recovery was to take nothing including no sakau and to get back into a regular running routing. Even with no sakau and running, I would remain anxious for another week, unable to come down out of the “mode” I was in where sleep was not possible.
Since then I have been paying much closer attention to the link between sakau and my brain. I know now that for me, third night post sakau I will have dark dreams that give me broken sleep. If I drink too much, I could trigger a full blown insomnia cycle. The amount that triggers me is small. I can drink no more than a single cup of sakau. In other words, if I “get the feeling” then I will have broken sleep and possibly insomnia that will run from the third night to about the sixth night. So I have to avoid sakaula as the sense of death and darkness that comes with the “mode” on the third night is too awful.
Since I do not “crave” sakau the way a nicotine addict craves ciggies, I cannot say that sakau is addictive, just that it has a rough withdrawal.
I strongly suspect that because brain chemistry is involved as everyone has a different brain reaction to sakau. I also know that this is a result of long term use, possibly at times abuse, of sakau. I have been drinking for twenty years, typically once a week but at times every night. I had no problems for the first ten years of drinking. I am also keenly aware that there are aging brain effects that I cannot deconfound from my sakau consumption. I am a study with a sample size of one.
I have noted, however, that many veteran older drinkers throttle back their consumption or quit. No one talks about this as sakau consumption is tied into the concept of being an ohlen Pohnpei. A real man. And those who do drink regularly almost seem to be unconsciously and intuitively aware of the third night brain effects. Many drinkers drink on a Friday-Sunday-Wednesday schedule. Redoping the brain before the absence of the effect of sakau chemicals hit.
I drank without issues in the 1990s. Even every night binges of heavy drinking did not disturb my brain chemistry significantly. In hindsight, however, I now recognize brief spells of post-binge sleeplessness circa 2001 as a sign of developing brain chemistry issues.
I rarely drink now, and when I do, I throttle way back. I wanted to provided company to a colleague on a Friday night, so I drank a cup and a half. And a small cup at that. I barely sip from the ngarangar when it is presented that way, and I prefer the cup where I can better control my consumption rate. I also held to my holiday running binge of daily joggling. Still, Sunday night I woke up at three in the morning after some sort of dark dream and settled back to sleep only slowly. Could be all in my head, but two years of experimenting have me convinced that this is simply a withdrawal impact. The third night I will fall asleep without difficulty, but wake up suddenly from dreams filled with dread and foreboding.
I have been playing with the parameters over the past many months. If I drink x amount, what can be done to minimize the third night impact? I have not found a silver bullet. Exercise helps, but does not prevent the third night broken sleep. Flushing with fluids does not seem to help appreciably. Eating before sakau and attempting to buffer may help, but only insofar as it decreases the sensation of sakaula. Ultimately, if one is sakaula, then one is changing one’s brain chemistry.
I know that true generalized anxiety disorder sufferers who attempt to get off of a Xanax dependency can take up to six months for their brain to again produce sufficient levels of the brain chemicals that make one feel functional. The brain heals only slowly – the centers that produce the chemicals are slow to return to production in the wake of a loss of externally supplied brain chemical.
Sakau may have a similar effect even in moderate and irregular doses. There are not a lot of studies of people on high doses of kavalactones over multi-decadal periods. The work of Dr. Balick suggests that Pohnpeian sakau is unusually strong not because of the plant but because of the use of the polysaccharides found in the keleu.
I have been on a running binge this Christmas, trying to run every day. I put in a short and fast 24 minute round trip to Spanish wall on the most recent Friday I went to sakau. Saturday I ran for 40 minutes on a treadmill followed by 15 minutes in a sauna, Sunday I put in a one hour and 53 minute run and juggle under sunny skies. I wondered if the sauna might help sweat out the chemical issue.
Sunday night I did wake up at 03:14 in the wake of a night terror, but by using some of the thinking my reading on cognitive behavioral therapy taught me two year ago, I was able to calm my elevated heart rate and eventually go back to sleep. Generally speaking, if I can recalm on that third night I seem to avoid the hyper-vigilant, sleepless mode.
I still drink sakau, in part because sakau is intertwined with my social life. In part because I recognize that doing things that scare me is good for me and prevents the over development of a comfort zone. In part to continue to test the parameters that influence sakau withdrawal. Although sakau is not addictive in the craving sense, I have a hunch that some military vets with possible PTSD issues here use sakau to handle their anxiety, and then get locked into a nightly cycle when they find that they are sleepless without sakau. Sakau definitely knocks down the high arousal state of a sleeplessly anxious person for a good 24 hours. And with little to no hangover, sakau allows one to be a very highly functioning person.
The amounts of sakau I drink are pitifully small now and I drink only on a rare occasion.
Sakau should be studied in the treatment of anxiety – a lifetime on sakau is probably better than a lifetime on a mix of benzodiazepines. The side effects appear to be far less pronounced. That said, a mix of cognitive behavioral therapy and vigorous daily exercise are probably a better path to working on healing the anxious brain.