Case study 5: John's disrupted sleep
John is a 50-year-old retired engineer who recently started his fitness coaching practice. His struggles with obesity and related health issues are what motivated him to become a fitness coach.
After implementing a rigorous diet and exercise routine, John lost over 20 kilos and gained confidence in himself. He is now passionate about helping others achieve their fitness goals.
However, John has been under a lot of stress lately: his daughter is going through a divorce, and his wife is struggling with her health issues (right when his coaching business is starting to thrive).
Despite his progress, John has noticed that he has started to gain weight again around his midsection. In an attempt to address the weight gain (which makes him feel a little self-conscious in his new coaching role), he has started incorporating some new weight-loss strategies into his coaching, including high-intensity interval training.
John has come to me because he is now having trouble sleeping.
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What did I do?
Well, first I needed to investigate the underlying causes of John's sleep troubles and address any potential lifestyle factors that may be impacting his sleep quality.
Step 1: Assess
I used with him my Functional Medicine Sleep Questionnaire to gain more information about the specifics of his disrupted sleep.
Analysis of the stressors
Due to the additional stressors in John’s life, such as issues with his children, financial difficulties, the start of a new business, and his age, there may be added pressure on the functioning of his key stress hormones that could be impacting his sleep. These hormones include cortisol, DHEA, and the fight or flight duo: epinephrine and norepinephrine.
Although intermittent fasting would be acceptable under ideal circumstances, it may not be beneficial in John’s present situation. The reason for this is that intermittent fasting in an already stressful environment can cause a rise in cortisol levels. Increased cortisol levels during certain times of the day, such as during the mid-afternoon slump John experiences, can be highly beneficial as they keep us alert and full of energy.
However, in the middle of the night when John is experiencing a 2 am wake-up time, this surge in cortisol is both the cause of his awakening and the stimulant that is keeping him awake.
There are a couple of significant factors that can raise cortisol levels, and one of them is bright light. That is why we should unplug and avoid light exposure at our nighttime. This is one important piece of this puzzle, and it puts us in a sympathetic versus parasympathetic state when we should be resting.
Step 2: Recommend
Before he did any lab tests, He left my consultation with the following recommendations based on his situation:
I recommended that John covers his alarm clock with a towel or washcloth to prevent disturbance of his wife's neurohormone production while still allowing him to hear the bell he likes to wake up to.
As John wakes up in the night to use the bathroom, I advised him to move through the house without turning on any lights, as exposure to bright light can elevate cortisol levels and disrupt his sleep.
I advised him to adjust his bedtime by an hour and do it gradually. He was also advised to stick to the same bedtime and wake up every day.
While I recognize that John is currently taking a magnesium supplement that works well for him, I suggest adding other herbs and nutrients to his supplement protocol. My assessment has led me to recommend 3 drops of passionflower vine extract and some liposomal GABA to promote relaxation and gentle hormone support.
Finally, I advised John to abandon his intermittent fasting efforts and instead consume a small amount of food right before bed to support blood sugar regulation and adrenal balance through the night. We recommend a nighttime nugget containing pumpkin seed butter, coconut oil, cacao butter, sea salt and stevia to provide him with sustained blood sugar level until morning.
Step 3: Tracking
I reviewed John's serum labs, using my Lab partners, and found that he had a consistent decrease in liver enzymes. This suggested that his liver and protein digestion could use some support. To address these concerns, I recommended adding an enzyme complex, P5P (B6) supplement to his nighttime regimen and incorporating fermented apple cider vinegar in water before meals.
Furthermore, I suggested that John starts using my “Food-Mood-Poop-Blood Sugar Tracker” to monitor his eating pattern and overall health. This tool has helped him understand the relationship between his food choices, mood, digestion, and blood sugar levels.
John has followed my nutrition and lifestyle changes, and his sleep quality has improved a lot. He lost weight, started feeling more energy again, and was able to deal better with stress.