Q. I'm a 37 y/o wife/mother of three small children. For the past 18 months I have experienced rather severe autonomic symptoms which in part include rapidly alternating high/low BP, bowel incontinence, urinary hesitancy/urgency, extreme nervousness, extreme agitation with any external stimuli to the point of making my BP spike as high as 200/140. Recent tilt table test confirmed worsening autonomic neuropathy with rather severe orthostatic hypotension. I have had several periods of being up and down over the course of this time, with as long as 2 wks to 2 months of feeling better, then I'll crash for a couple of weeks to a couple of months again. During my "up" times, I need very little sleep, run myself into the ground physically, emotionally and am very irritable with my kids over very petty things. Over the last three weeks, I have slept less than 3 hours/night every night and rarely take a nap during the day. However, now I am so exhausted that I can barely stand up or keep my eyes open. I have just been started on Depakote and Klonopin for sleep. I hope it works as I feel about to the end of my endurance, and yet my mind keeps on thinking up things that I need to do and I do them until I literally fall over with exhaustion. I have never had anything like this before the autonomic stuff hit 18 months ago.

My question is: Can bipolar disorder cause autonomic dysfunction, or vice versa? I have been in a wheelchair and used a walker and been to a rehab center to get back on my feet. I have recent positive Babinski signs in both feet and hyperactive reflexes in my knees. I scream in my sleep at night when I do manage to sleep 2 hours at a time. I haven't slept the night through in 18 months.

Is there hope for me? I've been on a roller coaster ride that I feel unable to get off of. I've never been suicidal, just wanted to get out of my body for awhile and come back and find it well, or at least sleep for 2 weeks without interruption. I rarely cry, but some days it really gets to me and then I get hysterical and have to call a friend who is very understanding and just listens. I feel very badly for my husband and children and just want to be able to take care of my family on an even keel again like I used to.

  A. I am not aware of any types of autonomic dysfunction like you describe from the medications or the illness. It might be worth getting a good medical examination to see if something else is going on. Those are some very high blood pressures, and they need to be stabilized quickly. There could be a number of causes for the autonomic symptoms, and the physical causes that are treatable need to be investigated.