Sleep, perception and reality

When I was in the rehab facility in the UK, I began to get annoyed at how often my sleep was being disturbed. At the time, I was a falling risk, which included the possibility that I might fall out of bed and be unable to get up off the floor. Never mind that I hadn't fallen out of bed for over thirty years, or that I knew how to get up, with great difficulty, but I could do it; I was a falling risk, so a carer came and checked on me every hour.

Normally, this wouldn't have been a problem, since they would open the door quietly, check that I was still snoozing, and begone. My left eye, however, didn't close properly, and still doesn't: the lower lid doesn't work yet. So the carer could be as quiet as you like, but the room would suddenly brighten for a moment. My brain would perceive the light, and wake me up, just as the carer closed the door and went on their merry way, oblivious to having woken me up.

Eventually, I managed to get them to leave me alone, and then moved down to Dorset where my room was quiet and dark all night, but I discovered that I was sleeping less than I had before the stroke. This is sufficiently unusual post-stroke that I was surprised, and initially skeptical but it seemed that, independently of how tired I got, I actually slept less.

I suspected that how grumpy I felt after a 'bad' night's sleep did not necessarily correlate with the actual quality of rest, or whether I slept enough. Being a fan of science (or a giant nerd, take your pick), I decided to test this using "Sleep as Android" to provide a third party opinion on how soundly I slumbered. The app had the added benefit of recording any noise made, so I would also find out if losing weight meant that I snored less, and whether I talked in my sleep, which would be an exciting new brain damage development.

The data demonstrate, to my satisfaction, that it's possible to get a good night's sleep, but have such a strong memory of being awake, that I feel as though I slept poorly, and am grouchy. The converse is not true: I never think that I slept well, when I did not. Also, the snoring and accompanying apnoea are gone (yay!), and I am not a chatty napper (boo?).

At the same time as I formulated my hypothesis, the notion of a "second sleep" was doing the rounds. For all I know, it's been debunked, but it coincided with my discovery that I tend to zonk out completely for 3-4 hours, wake up for a bit, then go back to sleep more or less soundly. If I try to sleep more when I wake up, it doesn't work, and I end up sleeping less on balance. If, instead, I get up, go to the bathroom, read a bit, check email, and go back to bed, all within about half an hour, no more than an hour, then I sleep well for my second sleep.

TL;DR: My sleep patterns are weird, but not as weird as mischaracterizing sleep that was good as being bad on the basis of short-term memory. If you're grouchy from bad sleep, make sure you're actually sleeping poorly with a cunning machine. Also, I don't snore, boys.

Perchance To Dream

One of the most common effects of stroke is that you sleep more. At least that's the received wisdom. And for a while after I first had the stroke, I certainly did, as some of the wonderful visitors I had can attest: At least one person shlepped up to Mt. Sinai to find me slumbering beatifically (I assume), and went away again without me waking for an hour or more. Kudos to them.

However, as I progressed through rehab, my sleep was disturbed. Part of the problem is that my left eye (still) won't rest closed. If I jam my face into the pillow just right then it closes properly, but while in the pleasantly dark in-patient rehab facility, I was considered at risk of falling, which apparently included falling out of bed, so someone would poke their head around the door softly to check that I wasn't flailing about on the floor. No matter how quiet they were (which was variable), they admitted light to the room, and my brain, receiving the light from the open eye, would wake me up. Usually after the offending dutiful carers were gone, making shouted remonstrations impractical as well as ill-mannered.

This contributed to what I now think of as "my bad week" when I was tired, irascible, depressed, reluctant to do exercises and generally unpleasant. Or even more unpleasant than usual depending on how well you know me, and your perspective. 

As time has progressed, however, I haven't had any external factors to blame for interrupted sleep, and I realise that unlike every other stroke sufferer I've met or read about, I sleep less than I did before. Or at least I think I sleep less, but maybe the reality is that I sleep about the same, but became hyper-aware of being awake for the brief moments I was awake.

Over a few weeks it became clear that, although I was aware of being awake for short periods, this seemed to have no bearing on how tired I actually felt,how much I could do in the gym, or anything else except my mood. The very idea that I had slept poorly made me grouchy. I decided to relax a bit about being awake whenever I was awake, and remember that I was getting several chunks of good sleep anyway, and made the 'problem' just go away by thinking about it differently.

Now, I don't stress out when I'm awake in the middle of the night, I just turn on the light and read for an hour or two, then go back to sleep. The timely article about historical second sleeps helped me not care about being awake, too.

Recently I found a way to be a bit more empirical about how long I'm actually sleeping, using the Sleep Cycle alarm clock app. Its daily graph of when I was awake or asleep (using the iPhone's accelerometer and how much I move about) is not enormously accurate, or particularly scientific, but it works well enough for me. It's confirmed that I'm sleeping less than I used to, but also that I'm getting more sleep than my awareness of being awake would lead me to believe. 

TL;DR: My brain (and brain injury) are weird, I sleep less than before my stroke, but more than I think.