Sleep Diary

As I focus on getting better sleep, not for its own sake but as a path to being more functional when I'm not asleep, some experts recommend a sleep diary.  Some are available in cyberspace to capture and print out, which I did.  Most follow a similar format though vary by detail.  Entries are made shortly after wakening and before retiring for the night.  Mine covered a week, some extend for two, but it doesn't take long for a pattern to emerge.  Changing the pattern may prove difficult, as there are probably some fundamental biological realities that create it.  My diary showed predictability within a few days, but it also showed areas of uncertainty.

My Evening Log confirmed two or three caffeinated beverages, all consumed before 5PM.  They did not ask about chocolate, which I do eat after 5PM but not a lot on any day.  Alcohol is one serving on a typical day, never  more. They left the cutoff time at 5PM which can bridge Happy Hour for those who build that into their schedule, but for me it is sherry or port shortly before that or about half a bottle of beer with supper, occasionally the whole bottle.  Exercise is always done before 9PM, on a calendar schedule with rare lapses. Each session lasts 30 minutes.  

My medicines are constant, five chemicals swallowed at suppertime.  This can be an important wild card, as common medicines affect sleep.  Statins are best taken at night based on how they work.  The PPI seems to do better taken at night.  My antihypertensives offer flexibility, taken at night because taking all medicine one time per day enhances the likelihood that they will be taken.  I could try moving the SSRI.  However, I have given myself an extended drug holiday from this with little effect on early awakening.

Naps are more problematic.  Basically I have stopped intentional napping and have not returned to my bed outside of scheduled sleep times.  I did doze off three times this week, the longest estimated at 45 minutes.  While I do not return to bed once up, I will lie down on the living room couch and often take advantage of a reclining chair that keeps me at about 45 degrees tilt. Whether this affects sleep or not is uncertain.  I have tried to avoid the couch, or anything else horizontal, but it's a habit that requires more focus to undo.

My daytime assessment recorded as favorable five of seven days, tired one, morning stiffness and achiness one.  The pre-sleep ritual seems to be taking shape, watching the shows I recorded on the big screen TV in My Space or reading in bed for a short time before lights out.  One day I donated platelets, which pre-empts my scheduled exercise that day.

The Evening Log has more uncertainty.  I fixed the lights out and arise time, adhering to both with little flexibility, the key advice of any Sleep Hygiene initiative.  I fall asleep promptly, or at least I think I do. Most nights I awake twice, some nights once but for the rest of the night, I think.  I am unable to estimate if and when I return to sleep or how long I am awake.  My iTouch watch records sleep time, but it is really in bed time.  I don't have a good way of timing my actual sleep. I have tried a cell phone app to do this, and it captured my wakening better than it captured my sleep.  Identifiable sleep interrupters are invariably nocturia once the majority of nights.  I am sometimes awakened, sometimes already up.  The time at which I need to get up varies a bit.  I seem to be able to return to bed and relax if not resume some level of actual sleep. For two nights, some back and hip discomfort occurred.  I took naproxen once, more to be able to exercise on the treadmill the following day than to restore sleep.  One night I skipped two medicines with no effect.  I bought a new pillow which greatly enhanced comfort going to bed, though little impact on early awakening.  I took diphenhydramine one night which left me dragged the next morning without a material effect on the fundamental sleep pattern.  My self assessment of how I think I slept was mostly mediocre, never wretched, never optimal.  Yet except for the morning after the sleep aid I felt reasonably well each morning.

Making adjustments depends largely on what I want to achieve.  If my goal is optimal function through the day, I'm not doing badly despite the early awakening, which seems largely ingrained into my cycles.  What I have not done, largely via adverse experience, is get up when restless and use the time.  I find myself resetting to awake and wanting to catch up on the lost time in bed the following day.  It has been counterproductive, I think.  A sleep lab might be premature, though it would be nice to know when I am really asleep and for how long.  My environment is now largely ideal.  The schedule seems the right one.  I can still move the antihypertensives and ssri to the morning.  But as long as I feel good when I need to, which is largely true now, estimating my sleep as mediocre does not seem to detract from what I push myself to accomplish.