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!

95% Confidence Interval

95% Confidence Interval

Here’s a fun game! Grab a piece of paper and answer these 20 questions as a range with 95% confidence interval.

The questions are crazy out there and will require guessing on most. BUT, again, you’ve gotta guess so that you’re 95% confident that the answer is within your defined range. That means when you’re done you should have exactly 19 of 20 correct.

So if the question was something like:

How many states are there in the United States?

*Note: Pretend you don’t already know the answer.

You’d have to put a range as your answer. so let’s say you said…

12, 60

This means you’re 95% confident there are no fewer than 12 states, and no more than 60.

When it comes time to score, and you see the answer 50… good job! you got that question right! Don’t worry: the answers will be much more ridiculously difficult.

Once you take the test, post your actual % correct confidence interval in the comments.



I suffer from sleep maintenance insomnia. Or so I am lead to believe by my research into sleep habits. After many years of not realizing I had an issue, I came across a great interview in one of my favorite podcasts, The Drive with Peter Attia, with Matthew Walker sleep guru and writer of the book “Why We Sleep”.

He described in a very straight-forward means that sleep is way more important for our health and well-being than is communicated and the 6 hours or so that’s standard in the American lifestyle is far from sufficient.

How to fix it? Not likely medication but behavioral modifications. I started down this path, but I haven’t been successful enough.

Things I’ve explored:

  1. Darkening the room
  2. Glycine before bed
  3. Sugar and Caffeine reduction
  4. No reading or movies in bed
  5. Meditation
  6. Getting up instead of waiting for sleep

But still it’s been a little rough. However we can’t fix what we can’t measure. So for the past year I’ve been tracking my sleep with a fitbit. Here’s the data so far for 2020:

Not enough sleep

Our Y axis is hours of sleep. The X axis are dates. The blue line is the amount of sleep I got each night in hours. The orange is the total time I was in bed. So, if we look at that very first data point, I had just over 8 hours in bed, and I slept for about 6.5 of those hours.

The amount of time in bed is called your sleep opportunity. Having a sleep efficiency of 85% is pretty normal for someone around age 40. Note: It’s highly age dependent, as you get older your sleep efficiency drops.

Last week I made a major step forward in my quest for sleep – I contacted a sleep doctor. I have my first appointment on Wednesday.

I’m pretty excited. Right now my data shows an average of 6.2 hours of sleep for me per night with an abysmal standard deviation of 2.2 hours. I’m hoping I can adopt new habits that will bring me above 7 hours of sleep per night average. We’ll see how it goes!