Sleep Update

Sleep Update

On May 5th, I had my first sleep consultation with the Cognitive Behavioral Therapy for Insomnia (CBTi) experts at Yale. Over the following 8 weeks or so, I met with them weekly to go over various strategies to improve my sleep. It’s now about 5 months later so let’s look at the data.

DISCLAIMER: I’m using fitbit data which is generally frowned upon by experts for being far too unscientific. To that I say Whatever. I think it still tells a story.

Before CBTi
Jan 1 – May 5: Average hours asleep = 6.1

During CBTi
May 5 – July 7: Average hours asleep = 6.4

After CBTi
July 7 – Oct 7: Average hours asleep = 6.7 (woo!)

Let’s take a look at the charts for the before and after:

What have I noticed? Perhaps even more significant than the general increase in my average sleep is the fact that my nights with horrific sleep are virtually gone. Those are the nights where I wake up in the middle of the night and can’t get back to sleep. You can see them as the big white gaps in my first set of data. I used to be nervous when it was time to go to bed. I would anxiously wonder if it was going to be a terrible night again; but that’s all gone. These days I go to bed every night and fall asleep within 10 minutes or so. Most nights I do wake up, but I calmly go back to sleep without an issue and then I wake up with my alarm or just prior. I have found that I’ve been waking up before my alarm more often than I’d like, but I’m not really worried about that sort of thing.

I still have bad night’s sleep once in awhile, though now it’s usually due to an extrinsic event. My work phone rings or I have a looming deadline or presentation that is making me nervous. But these can be easily explained and dealt with.

I’m really happy I finally pulled the trigger and sought help with my sleeping. It’s made a huge difference.

A FASTcinating Experiment

A FASTcinating Experiment

In a previous post I mentioned that I was interested in attempting a 72 hour water only autophagy fast. A few months back I completed a 24 hour fast without any issue and wanted to push it to three days. Ultimately, my goal is a 72 hour fast once a month. The plan would be to start each fast on or around the first of each month. I decided to make July 1st my first attempt. My last meal was dinner on June 30th. Did I succeed with 72 hours? No. I stopped at 45 hours. Here’s how it all went down.

Preparation: in advance to the fast my only specific goal was to reduce caffeine reduction so that I wouldn’t have to deal with headaches on top of the stomach woes. I cut my caffeine two days prior by half, and then half again. I think this worked pretty well though next time around I’ll extend the caffeine draw down by an extra two days.

I opted to take the three days off from work. I didn’t want to be driving in a weakened state and since this was my first attempt I thought it prudent to be as cautious as possible. In retrospect, this was probably a bad idea. I think in the future I’ll schedule it so that I always start my fast on a Thursday. That way I have the distraction of work to keep me from getting as hungry for the first and second day. At least, I think that’s how I will approach my next attempt. There was a constant behavioral draw to go get a snack. “Oh! I’m home and it’s afternoon, snack time!” that sort of thing. If I can avoid that through situational control that would be preferred.

My last meal on June 30th was simple and basic: seasoned chicken breast, couscous, roasted veggies and some plain yogurt with berries for dessert. I didn’t eat huge quantities, just simple and standard.

Day 1:
Day 1 was straightforward and not particularly challenging. I was hungry at times but not in great discomfort. With my fasting commitment established I had no issue avoiding the urge to eat. Anytime I got hungry I drank some water and felt fine. I had a LITTLE caffeine headache, but it definitely wasn’t as bad as it would have been if I’d cut coffee completely at the same time as cutting food.

Sleep: Sleep, however, was rough. My stomach felt like a deflated balloon. I wasn’t feeling hunger, just discomfort. The discomfort was mild, certainly less than a stomach ache. I would describe it as a sustained feeling of ugh. I woke up around 11:30 feeling very hot and couldn’t get back to sleep until 2:00ish.

Day 2:
Hard, but not impossible. Again, I was not hungry, though the discomfort remained and over the course of the day it was joined by weakness and sluggishness. I started the day as I always do: with meditation and exercise. You’re not suppose to stop exercising through a fast, but whoa nelly: My exercising was terrible. Actually, so too was the meditation. I was extremely distracted, felt overly hot, and couldn’t concentrate.

The second morning I felt weak and was worried about dizziness though it never really came about. We went on a small hike and I felt okay through that. By noontime I was thinking it wouldn’t be too tough to make it through the night into day 3.

But… then I got a sore throat. Suddenly drinking water tasted like drinking daggers. It was bizarre. It felt like strep and my mind immediately went to strep or covid.

A lot of things change when your body is in ketosis. One of these changes is that your immune system reduces in effectiveness during the fast. Your body consumes some of its white blood cells for energy, so you have fewer fighting in your corner in case you’re sick. Curiously, AFTER a longer fast, research tends to suggest that your immune system gets a reboot. But given that I knew I’d be entering into the lowest immune period of the fast, I got spooked with the sore throat and opted to stop.

Stopping: You’re not suppose to come off a fast with a buffet. You take it slow with small meals spread out over time. At 5:00pm on Wednesday I started with a 1/2 Cup of bone broth. An hour later I had half a hardboiled egg. An hour after that, a 1/3 of a chicken breast and a 1/3 of a cup of couscous, and then after that the remaining half of the hardboiled egg and a few almonds. This was a perfect eating restart schedule and I’ll repeat it.

Sleep: My sleep was again poor. But I’m not surprised, the sum of the fast breaking “meals” was only 450 calories, so my stomach still wasn’t back to normal. I woke up at 3:00, unable to get back to sleep.

Recovery day: The following day I continued spreading out meals. Breakfast took place over four hours and consisted of a cup of coffee, 6 almonds, two hardboiled eggs, 1 serving of plain oatmeal, and a 1/2 cup of cooked spinach. At 10, I had some BadaBeanBadaBooms (delicious nutricious) and an hour later a banana and two servings of peanuts.

When you spread that list of food out over the course of 4 hours it doesn’t sound like a lot, but the banana&peanuts crushed my stomach. Next time I’ll split that last snack in two and extend it out over additional hours. For lunch I had more small portions and was back to full meal volume that night. NOTE: My nutritionist recommended keeping meals trim and frequent for TWO days, not one. Next time I’ll try to be more careful. I think I was a little reckless with my dinner on July 3rd. (it was bbq burgers and they were soooo delicious)

Conclusion:

Interesting. Educational. Hard, but not impossible. The bizarre sore throat went away within 24 hours of restarting food. I wonder if it might have been some sort of heightened reaction to seasonal allergies due to lack of food? I don’t know. I’m curious to see if I get the same horrific sore throat next time. If so, I’ll likely cut the fast short again – I acknowledge being cautious as I start down this path is prudent.

Also, maybe it seems semantic, but moving forward I’ll refer to these attempts for what they are: 70 hour fasts. I ended my food at 7:00pm on June 30th with the intent of starting back up at 5:00pm on July 3rd. I plan to keep that same goal moving forward.

The Year of Health

The Year of Health

Fittingly, for New Years I decided to make 2020 a year of health initiatives and health goals. Of course with the pandemic, health has been front and center in everyone’s mind, but either way it was a good goal.

As we approach halfway through the year, I have to say I’m pleased with my progress.

Successes

  1. I have maintained a weight training exercise habit
  2. I haven’t missed a single day of flossing and morning teeth care is now part of the routine
  3. I have given up discretionary sugar (no dessert or brown sugar on my oatmeal, but I’ll still eat a slice of banana bread)
  4. I am following a prescribed sleep program
  5. I have maintained a meditation practice

Not Yet Successes

  1. I built a solid cardio routine at the company gym, but this dropped with Covid. I have to bring cardio back
  2. I have tried a preliminary autophagy fast (24hrs), but I want to make higher level fasting (72 hrs) part of a monthly program
  3. I’d like to get a more scientific grasp of my eating. Starting a food log and seeing a nutritionist are on the list
  4. My exercise routine is self-developed. Perhaps enlisting the help of a physical therapist or personal trainer would be wise, especially as it relates to the annoyance that is my Thoracic Outlet Syndrome
  5. Water consumption has been good, but I’d like to be more deliberate. Right now I drink 2-3 liters a day, more definition is needed

Has anyone out there executed some unique healthy habits that they care to share? I’m eager to optimize!

Sleep Consultation

Sleep Consultation

Two weeks ago I had my initial sleep consult, with a follow up happening the following Monday. My hope was to be recommended for Cognitive Behavioral Therapy for Insomnia (CBT-I) and I’m pleased to report that this turned out to be the prescribed path.

CBT-I is sleep training for adults. If you have enjoyed life as a new parent, you likely spent money on books explaining how to train your kid to sleep better by employing tricks like: maintain a strict sleeping schedule for the baby, don’t feed immediately before setting to bed, wake them up with lights and excitement to encourage them into the day, etc. There are so many books because the tricks tend to help. It’s pretty logical that the same would work for adults. Aside: I find it amusing that we are generally poor at enforcing good sleep practices for ourselves.

My first meeting with the sleep clinic went as expected. The doctor asked basic questions like:

  1. What time do you go to bed at night and wake up in the morning?
  2. Do you drink caffeine, and if so when?
  3. What does your insomnia look like?
  4. Did the origins of your sleeping problems coincide with any sort of life event like a physical trauma or an illness?

The general purpose of these questions was to get a basic understanding of my lifestyle and to see if there might be a medical reason I was having problems. After 15 minutes of questions, the doctor pointed me towards a Psychologist for CBT-I. Woo!

Scene II: The second doctor televisit

My second visit was a more lengthy one. I met with the doctor and went into a far more detailed series of questions that related to my day to day sleep schedule and how I dealt with sleep related issues. Questions like:

  1. When you wake up at night, what do you do?
  2. Do you ever snack in the middle of the night?
  3. What time do you eat dinner?
  4. Do you ever nap to recover your sleep?
  5. Have you ever fallen asleep or found yourself nodding off at the wheel?

It was an exciting line of questions. They said I was doing a lot of things right, but the biggest area that I could improve on was my wake up time.

I used to set two alarms: one for 5 am and another for 6:20. If it was a good night sleep, I’d get up early and exercise etc. But, if I was awake suffering from insomnia from, say, 1am til 4am, I’d turn off that early alarm and skip the exercise that day. Same thing with weekends: no need to get up at 5, if I don’t have work.

“Stick to a standard wake up time,” they implored. They made the point like this: imagine sleep is a pendulum. One night might be bad, but then the next night swings into the good and then it goes bad and back and forth and back and forth. If you can’t make a bad night better, the best way to stabilize the pendulum might be (sadly) to kill the upswing. Suffer in the short term to improve in the long term.

So that’s what I’ve done. I have been a rock with getting up at 5:00am even if I’m up during the night. I’ve also removed all electronics from my middle of the night waking episodes. CBT-I has a 70-80% success rate and tends to work within a six week time frame. I’m just about two weeks into the practice, so hopefully we shall see results soon.

The doctor also advised I keep track of my sleep with an app: CBT-i coach. It’s free, so if you’re curious about your own sleep – give it a shot.

I’ve got another appointment next Monday. I think the goal of this next session will be to review the data I’ve collected and then prescribe a more detailed sleep program for me. Exciting!