How Poor Sleep Quality Ruined My Life (No, Really)

Last October, when I first sought professional help after getting my depression diagnosis, and it became clear that I was going to be unable to do my job for an extended period of time.

I made a quick blog post (titled Burned Out) to inform everyone that things were not going well, and that I was going to be inactive for a bit.

It wasn’t a long post, and I closed it like so:

I have sought professional help to ensure I can recover as soon as possible, but I’ve been told that it’s going to get worse before it’s going to get better. […] When I feel better, I plan on writing a long post on the very topic. […]

So, it’s time. This is that long post I promised. Before I begin my tale, however, two important things.

1. First, should note that this is a retelling of my personal medical experiences. Everyone is different. I am also not a medical doctor. While I do have some takeaways at the bottom of this post, I want to make it clear that this is only intended to be generally informative, not specific advice.

2. Second, if the idea of reading this rather lengthy blog post seems too daunting, I don’t mind if you skip to the bottom line, which includes a few key takeaways that I want almost everyone who’s reading this to think about.

Okay, with that out of the way, let’s begin this story.

Introduction

Over the last few months, I’ve undergone quite a medical journey, with both physical and mental factors. It has been a distressing and difficult ride, but not too long ago we finally got around to identifying what I personally believe to be the underlying medical issue.

This is something I’d been suffering from, over a long time, that led to my burnout with both physical and mental exhaustion. It may have also caused other issues in the past.

Additionally, I’ll explain what could have happened if I hadn’t been proactive and somewhat intelligent during my recovery. This last part is also pretty important and may prove to be eye-opening to you.

I don’t particularly mind sharing my experience, as I think I did the best things I could do, but even then, I learned many new things. I also figure that it might be useful to share my thoughts on everything that has happened.

Sabbatical

In February of 2024, my sabbatical finally began. This was a three-month period I had negotiated with my boss and had carved out for personal rest. I honestly believed that it was a good idea to get some rest, as I noted:

I have been working hard to improve my life over the last two years, after the end of a decade long relationship. For the most part, all I’ve done has worked reasonably well so far: I have found myself no longer withering away, and I like to think the worst part is now behind me.

I lamented how I was feeling, and my personal belief was that I could use a sabbatical to figure out where I was going to go next. I had some concern about potential burn-out symptoms, too, so I figured that a sabbatical might also help with that.

So, I took that unpaid leave. Understandably, without a clear medical reason, this seemed like the only valid approach:

I’ve already had to take a few unpaid days over the last couple of months for personal reasons. I don’t love that I had to do that to not feel overwhelmed or exhausted. A longer break will hopefully ensure I won’t need to resort to such measures again.

At the office, one of my most capable colleagues had lobbied my direct boss for a promotion and was effectively promoted to technology lead a week or two before my sabbatical began, which I felt was a great and well-deserved development. This colleague is an excellent programmer, and I would describe as driven and intelligent. Dedicated to his craft.

As I personally had no aspirations to lead a team or make big technical decisions at the time, I didn’t even feel envious. While we didn’t always see eye-to-eye when it came to various technical approaches, I respect the hell out of the man’s domain knowledge. And I always respect competency.

This new change would mean that he’d make the final technical decisions, which would avoid various discussions between the most senior developers (mainly the most senior three people, one of which was me) when no consensus was reached quickly.

Frankly, since the time “wasted” by some of these discussions had been a point of discussion in the past, I felt like, upon my return, things might improve for the better, once I had found some of my energy back.

Upon my return, I expected things to be more streamlined and positive.

Post-Sabbatical Blues

My three-month sabbatical quickly came and went, as these things tend to do, and wrote another post, where I expressed a certain uncertain sentiment:

I must admit that while I have gotten a lot of rest over the last three months, I don’t feel in a remarkably better mood than I did when my break started. I had hoped that things would shift dramatically, but sadly the dreadful weather has worked against me and as a result my overall mood has been middling at best.

I returned to work, but I was not as happy as I should have been after a three-month break.

Perhaps this would simply be a new and better phase at the company. Now, if you’ve followed me during this period, you can probably guess where this is going, because in July…

Shields Down

I wrote Shields Down, a blog post that informed the world that I would be searching for something new to do in 2025. I would be leaving the company I’d been employed at for the last ten years.

You can read that post if you want to know more about the circumstances of why I decided that it was time for a new challenge, as soon as possible.

I was now ready to start exploring new opportunities… is what I would have told you, but sadly, my health would soon not allow this to happen.

Slow Panic

Then, as the summer began, I was no longer working on key projects inside of DIVE, instead working on the smaller projects that also needed to be done. Two weeks after realizing I’d be searching for a new job, I’d started feeling a little unwell.

During work hours, at the office, I remember feeling nauseated all of a sudden. A distinctly familiar feeling crawled up on me: slow panic. Not a full-blown panic attack, but a slow feeling of distress was apparent, with various other bodily functions affected.

In particular, my stomach started twisting and turning, and I wasn’t sure what was happening. I was definitely worried about my work situation, but it had only been two weeks, and I was probably fine until at least December to figure things out.

When I got home, I scheduled a visit to the doctor. It was probably some sort of flu, I was told, and had to take a few days off.

I continued to work on my new projects, but I eventually asked my boss if I could take all of my vacation days in August, as other employees were doing the same.

I still wasn’t feeling well and I also wanted to take some time to do some research to look for a new job, so I asked if I could take the entire month of August off.

This would mean two weeks of paid leave, and two weeks unpaid. Again, in retrospect I made the stupid mistake of going for unpaid vacation time, but I figured at this point… what does another two weeks cost? If it gives me peace of mind, it might be worth it!

How foolish of me.

Unwell

More trouble began sometime in the middle of August. Some of the same symptoms I’d felt in July were popping up again. This time, more frequently.

I wisely decided to get basic full physical check-up, as I’d had moments of feeling unwell (spells of dizziness, an upset stomach, headaches, exhaustion, more stress than usual) and it had been rather sudden without an obvious cause.

No obvious cause besides the added stress of needing to find a new job, that is, but I did not believe that this was such a major contributor to feeling unwell.

So I got blood work done, and everything came back clean. In addition to blood work, I got some urine work done, same outcome. Stool samples, same outcome. I wanted to be sure, so I asked to get those tests done.

They all came back fine. I got the all clear. I was healthy. Or so it seemed.

I still wasn’t feeling well, and worse, digestive issues seemed to get worse. After consulting with my physician I got a referral for a gastroscopy and went to the hospital to get my stomach checked out.

After examination, my stomach, oesophagus and throat seemed to be fine. In fact, due to the weight loss I’d worked on for the last years, I was in better health than the last time I’d gone for a gastroscope about half a decade ago.

So, I was supposedly fine. Unfortunately, I felt anything but healthy. I felt horrible.

The neck pain and dizziness in particular were quite disorienting, and I recall there being a period in 2019 where I had similar health issues that lasted a couple of weeks. Those issues kept coming back every now and then, even during times of COVID.

Back then, the symptoms would eventually go away again after some time, but I had always assumed the issue had been my blood pressure at the time.

After a visit to the cardiologist in 2021 it was confirmed that I needed to be more active, and my blood pressure troubles would be resolved. (I did just that. If you want to read more about that, check out my blog post.)

Regardless, I thought that by 2022 the issue was gone. Even better, I considered myself in tip top shape in 2023. This is when I was at peak physical fitness again. So to be (suddenly) suffering from dizziness once again was quite concerning.

It clearly seemed to me that these recurring issues were unrelated to my physical fitness, then… or at least unrelated to my cardiovascular health, which was now certainly better than average. No, the problem was back, and this time it meant something else was going on.

I just hoped things would get better… But at this point, it was nearing the end of August, and I wasn’t keen on getting back to work like this. A commute to the office while dizzy could pose a problem for myself and other people on the road. It wouldn’t be very responsible.

Considering whether getting in the car is a good idea wasn’t a new concept to me: I had previously stopped driving my car for a period of time due to health concerns, and found my self-confidence on the road was getting affected by my health issues again. (Things weren’t that bad yet, but I knew last time things got really bad.)

So, I wasn’t willing to just keep feeling bad, or even see things get worse. So, I went back to the physician and mentioned that I thought my problem could’ve returned.

This time, though, my doctor noted that my blood pressure was fine. I had been right, clearly: something else was going on. He said it could also be another passing illness. I was told to wait it out, and come back if things didn’t improve.

Unfortunately, my sleep also progressively got worse, and so did my mood as a result.

When it was time to go back to work (when my doctor’s note was no longer valid), I instead notified my boss that I had to make another visit to the doctor’s office and sort this out for good, because frankly, it couldn’t go on like this.

The morning of that particular doctor’s visit, I won’t soon forget. I almost didn’t get a wink of sleep that night prior, and by the time it was the moment to leave, I was shaking and anxious. I called someone to take me to the doctor’s office, a family member who lives close by.

Did You Say “Burnout”?

Two-pronged approach

And look, I sure was happy that I didn’t need to drive myself.

Because here I was, at my usual physician who has known me all my life, and it was obvious that I was clearly distressed.

As I sat down on the chair at his desk, he said his usual thing. “Tell me,” he said. “What’s wrong?” Like all physicians, he always asks his patients to explain what’s going wrong.

I told him that the last few days had been really bad. Sleep had been horrible, and now I was starting to feel tight in my chest again, and I felt panicked. I explained my heart rate was spiking all the time, and that I was concerned I was having serious issues, despite the results of the previous labs.

I’ve had a history of panic attacks and high blood pressure in the past, but those issues were related to being overweight, or so I had assumed. You see, I wasn’t overweight any more. Hadn’t been for years! I had a great BMI, and normally my blood pressure and heart rate were basically perfect at this point, thanks to my workout routine.

(If you want to read about how I got there with hard work and habit management, you can read my blog post here. I think it’s still a great read, by the way.)

So, what was going on now? Clearly, as healthy as I looked, something was going wrong.

“Would it make sense to go to the hospital?” I asked. “No,” he replied, “I can tell you are actually hyperventilating. This is why you feel so bad right now. Don’t worry, we need to do something about that right now and then things will improve quickly.”

He took things very seriously and told me that I had likely pushed myself too hard, and was now dealing with serious anxiety issues.

My physician gave me meds to calm my central nervous system, but I was only allowed to take these for a few days. Three days, to be more precise. If that wasn’t enough, I had to return afterwards.

They certainly helped, and I was able to get a little bit of sleep, but after those few days, things didn’t get any better.

So, discouraged and still on edge, I returned to his office, and explained that I wasn’t sure what to do next. I felt very strongly that returning to work would be borderline impossible in this state, as I felt increasingly unable to even deal with the basic day-to-day tasks without panicking.

This had never happened before, and was extraordinarily frightening to me.

Up until a few weeks prior, there had been no sign of any issues. Yet here I was, at the physician’s, unable to function and it had all happened so quickly. Frightening indeed.

“Generally speaking,” he explained, “you have two options, and you can combine them. If you are not opposed to talk therapy, I’d recommend seeking a therapist and getting that set up. I can get you the contact details of someone who will be able to help you. Are you open to that?”

I remember saying: “Absolutely, whatever it takes. I’d been thinking about going to therapy at some point, so I definitely would like to try it.”

He then continued: “Alternatively, or in addition to talking to a therapist, we can try to see if a light dosage of anti-depressants has a positive effect. This will take a while, as it will take a month to start working, and there is an adjustment period. You can decide which way you’d like to proceed, but I can’t give you any other medication to help you, as your blood work and further tests seem to indicate there is no real other issue we can identify. You are physically fine.”

That, in a nutshell, was what he said. Those were not his exact words, but that was the gist of it. We discussed those both options, and I explained that I wanted to do everything I could to get better. So, I decided to go for the two-pronged approach.

My doctor then told me that I was going to need to take a long period away from work while I deal with this, and that I should not feel too bad because it happens to many people these days… but I should learn from the process so it doesn’t happen again.

On the piece of paper I had to submit to the mutuality, it said “depression” as the reason for illness. That wasn’t a word that my physician had used when we were discussing things, but I suppose that’s what was going on… I was now officially clinically depressed.

What is depression?

A mental health disorder characterised by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

Possible causes include a combination of biological, psychological and social sources of distress. Increasingly, research suggests that these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain.

The persistent feeling of sadness or loss of interest that characterises major depression can lead to a range of behavioural and physical symptoms. These may include changes in sleep, appetite, energy level, concentration, daily behaviour or self-esteem. Depression can also be associated with thoughts of suicide.

The mainstay of treatment is usually medication, talk therapy or a combination of the two. Increasingly, research suggests that these treatments may normalise brain changes associated with depression.

→ More on depression on the website of the WHO

Starting therapy

I called a psychotherapist the same day I returned from the doctor’s office, and, surprisingly, I had an appointment ready for the next day in no time.

During a brief intake conversation on the phone I explained my situation for a few minutes and the therapist said that upon hearing my explanation, it definitely sounds like a typical case of burnout.

Obviously we’d need to go into further detail during our first session the next day to truly make sure that’s what’s going on.

I couldn’t believe I would be able to go the next day, but it was a big relief to me. Most people find it really difficult to 1) find a therapist and 2) get an appointment anytime soon, so I am incredibly grateful to my physician for the recommendation.

Therapy proved to be quite interesting, so let me tell you a bit more about that in a later section. (I should note that one of the initial challenges to overcome is the guilt of not being able to work, even though you’re physically capable of doing work. Or maybe not, but you’ll still feel guilty, as was my case.)

Starting physiotherapy

One of the other major complaints was intense pain in my shoulders, neck and the back of my skull. This is typically a stress indicator, so my physician also recommended me to visit a physiotherapist.

I set up my first appointment quickly and later that week got some partial relief.

I’d eventually end up visiting the physiotherapist every week for the first few months, to manage my shoulder and neck pain while I was recovering. There’s a little more to this, too, but I’ll tell you a bit more about that later.

Starting anti-depressants

Because exhaustion and poor sleep were parts of my depressive episode, I had to take mirtazapine at the end of the day, and I would easily pass out and get some sleep because of them, as they are a sedative antidepressant.

You need about thirty days to get used to these, and initially you can suffer from a variety of side effects. In September, using these was the most difficult, as I suffered from many side-effects. In particular, I was very hungry and very tired most of the time.

Exhausted

Reading, Reading, Reading

During the first few weeks of my recovery process, I spent a lot of time simply exhausted on the couch, unable to do much besides read. I was grateful to have access to The Stormlight Archive, as it is fair to say it really helped me get though this initial, difficult period.

In particular, in Stormlight, the immortal words are spoken:

“Life before death,
Strength before weakness,
Journey before destination”

– The First Ideal of the Knights Radiant

Those Words resonated with me, and I was able to escape to Roshar for a couple of weeks as I continued to work my way through these lengthy books.

I started with The Way of Kings and finally finished Wind and Truth at the end of the year, and what a ride it was! It was also quite comforting to see Kaladin, deal with depression and trauma. It made the books feel very genuine as I was dealing with my own struggles.

Physical and Cognitive State

Let me explain how things felt, overall.

Physically, I felt extremely tired. I was someone who would run about 5 km every day, and obviously this was no longer possible in my current state.

All I could manage was spend some time on the couch, reading. Even then, I still felt quite anxious, would shiver sometimes, and I had various issues with headaches, neck aches and shoulder pain. Most of the pain was caused by stress tension.

Cognitively, I felt incredibly overwhelmed. I had a hard time thinking, and even when sitting on the couch, at home, I suffered from panic attacks and felt overwhelmed when multiple senses were stimulated at the same time.

In particular, an example that comes to mind is this: when I was reading, I could not tolerate background noise from e.g. the radio or television. I was forced to turn that off, or become extremely irritated to the point of getting angry in no time.

It was a bit scary, to be honest, because I knew that I felt overstimulated in a way I had never experienced before.

Sleep was incredibly difficult, and the likeliest cause of my burnout truly kicking off. It only improved when I started taking mirtazapine, which helped a little with my sleep, but also left me extremely groggy. (It is a sedative antidepressant, after all.)

Anti-depressant Angle

In the middle of October, I had the obligation to attend as best man at a wedding of a good friend. Unfortunately, I was still taking mirtazapine at the time of the wedding, so I felt quite weak and anxious on the big day.

Fortunately, I was able to pull of my speech without issues, but I was very lucky that I didn’t need to speech until later in the afternoon, or I might have been too sedated, still.

My increased appetite also led me to feel extremely weak when not eating anything, and there was a long ride in a limousine that did not include food that left me feeling absolutely miserable. When I finally got my hands on a nice baguette I think I literally stopped shivering when the food entered my stomach. I’ve never experienced such an instant body response to food before.

I decided there and then that, while the mirtazapine was helping my sleep, it wasn’t nearly helping enough for this to be worth it. There were too many side effects.

In retrospect, it became obvious that I was not really depressed but really, really exhausted due to fragmented sleep and that explains why I did not benefit that much from these. Family members did tell me that I seemed a bit less depressed while taking these, but I personally felt so sedated that I suspect that’s mostly what they noticed.

I did not regret my personal decision to eventually quit these drugs after discussing this with my physician. I do believe that is important to try anti-depressants, you may find that in your case they might help.

Therapy Progress

After two sessions in September, therapy really properly started in October. As it usually takes some time to go over your own personal history, you may find therapy takes a bit to really get going. That certainly was the case for me, too.

Initially, therapy focused on two fronts: first, understanding and accepting that I needed to take some time to rest and recover, and second, understanding and highlighting the emotions related to the various things that had happened over the last few years in my personal and work life.

I must admit that it certainly is nice to be able to discuss sensitive topics with a therapist, because they are able to help you with certain techniques. Therapists are also trained to help you identify blind spots, and I found out a few of my own.

Because this period was extremely frustrating on a personal level, being able to vent and discuss methods of dealing with the reality of being depressed and burnt out was super valuable.

I remember thinking that therapy might be needed when a major relationship fell apart in 2021, and yes, I’m quite positive it might have helped at the time.

Better late than never, though I am glad that I was able to work through my post-breakup woes on my own. (Still, there is no weakness in admitting one needs help.)

Slow Progress

The next three months were effectively focused on physical and mental recovery. In particular, my mental health improved as I continued to visit my therapist and physio weekly and slowly got some more energy back.

However, my physical health did not improve quite as much. I was still mostly exhausted, and the situation did not seem to improve much. These were winter months here, so that meant that I spent much of my time inside, and the short days did not help. Every day seemed to blend into the next.

There was not much to celebrate at the end of the year, and I hoped that the new year would eventually bring clarity and healing.

My physician insisted that it would simply just take more time, but I still struggled with sleep. Sometimes, I’d jolt awake and gasp for air. I attributed this to GERD (acid reflux) and changing my food habits seemed to help a little, but not enough.

During this period, I would wake up every day with a headache, and a dry throat. By the end of the year, the feeling of being overwhelmed by sensory input slowly started to improve, and I was able to spend some time playing video games again, as long as I tried not to do so for too long at a time.

I also spent some time trying to code, but most of my sessions only lasted for fifteen minutes. After all, it was really tricky to remain concentrated and mentally map out the things I was working on. So, coding was something I’d try again later.

My favorite activity to relax my body and avoid muscle strain was still reading books. I’d do so on my e-reader, because I did not want to strain my eyes too much. Because of this, I found myself increasing the font size on the device, and taking off my glasses. This gave me fewer headaches. I also worked on a tweaked font and blogged about it.

Every month, I’d have a check-in with my physician to discuss progress. Initially, especially these first few months, I was hopeful, but also… disappointed.

It was obvious that my time away from work was going to need to be extended for a while longer.

Walks, Calls and Coding

Since I was finally doing better in January, I decided that it was time to make more time for social visits.

After all, I had done a really poor job of staying in touch with everyone, since I was just wasting away on the couch.

I used the little bit of energy I had to go to various required medical appointments, and I met up with friends to go for short walks. I also tried my best to call friends I hadn’t heard often over the last little while, and informed them about how things were going.

I now felt decent enough to start watching some video content and streams again, so that’s how I would now fill my evenings, if I wasn’t reading.

I also started playing games a little bit more frequently, but still in short sessions, and nothing that was too demanding. I’d get headaches so quickly if I tried to do anything complex.

Physical Ceiling

In February, as my mental health improved, I decided to try using ChatGPT and build a little calorie tracking app for iOS. Because you see, here’s what happened: I’d been using a calorie tracking app for a long time, but my subscription had lapsed and the price had increased.

I usually do very basic calorie logging without a database or such, so I decided it would be nice to cobble together a quick app that would let me avoid needing to pay for this expensive subscription. I haven’t really written about it, but being sick can be sort of expensive.

And so, Calodin was born. It was fun to do some programming, but I still found it wildly exhausting, so I haven’t done any further work on the app beyond the initial 1.0 release that is currently on the App Store.

But before I launched the app, something happened that caused me quite a bit of worry.

I had been tinkering on the app one late night, when I was suddenly contacted by a neighbour with some bad news. Worrying news. It turns out, on a Friday evening in the beginning of February (or was it the end of January?), my dad had gotten in a serious accident and needed some assistance, so it was up to me to step up and sort some stuff out.

Apparently, my father had been hit by a car at a dangerous crossing when he was on his bike, late at night… when that happens, you immediately worry about the worst case scenario. From what I initially heard, he’d been taken to the hospital, but it had been a bad incident. He’d been flung though the air, and while conscious, was in quite the pain.

I quickly called the hospital, and they informed me he’d been seriously injured, and had broken many ribs, and that he was now undergoing further tests to assess internal organ damage. Fortunately, it turned out that his ribs had taken on most of the force of the collision, and he only had some minor bruising on the inside of one of his lungs, something that would heal in time and wasn’t too serious.

He remained up in the hospital for about two weeks. The doctors told me he’d been very, very lucky. Despite that, his recovery was rather swift over the next two months considering the injuries, but he’d initially needed surgery and lots of painkillers, and it was quite stressful the first night when he was being kept in the ICU while I was being briefed on the damage.

The whole event really stressed me out. He could have died that day. It was a quick reminder that in life, things can happen really, really quickly. I tensed up for the next three weeks, to the point that my visits to the physiotherapist had to be upped again in order to manage my neck and shoulder issues.

Thankfully, therapy also helped me during this difficult period. That helped ease my mind, but I can’t say that I was feeling any less exhausted in my day-to-day life (doing mostly nothing). Sure, I was doing a little bit better mentally, but unfortunately… my next visit at my physician’s wasn’t that positive.

Chronic Fatigue Syndrome

Okay, at this point you might be wondering: what bad news did you get? Well, you probably read the chapter title, so…

During my monthly visit with my physician this month, the words chronic fatigue syndrome were uttered. This was a surprise, but my physician said that signs were pointing in that direction.

ME isn’t a fun diagnosis, and the symptoms certainly lined up with my symptoms. You see, there isn’t any real cure for ME/CFS, you simply “manage” the condition and try to relieve the symptoms (with therapy, energy management, and such).

Ultimately, it sort of feels as though when doctors diagnose you with CFS, it effectively means “we don’t precisely know what’s wrong, but there’s a bunch of things that can cause this”.

Still, I strongly felt that there must still be some physical explanation for all of this, and I figured that my poor sleep quality must be involved somehow.

The few days prior, I had been reading about sleep apnea at the time after being concerned about my Apple Watch sleep stage results, and stumbled upon a bunch of Reddit posts of concerned folks asking why they were waking up so often at night, and what that meant.

Here and here are such example. Some folks explained that it’s normal to wake up without remembering it often:

I had a sleep study done once and learnt that all of us wake up many, many times a night but we don’t know it. It is normal. That’s not to say that waking up tired is normal. I’m just saying it is not abnormal to be waking up (without knowing it) many times a night. I think the technical term of this kind of waking up is “arousal”.

Other redditors chimed in with messages encouraging a visit to the doctor, with many noting that if you woke up exhausted or tired it could indicate your sleep quality is poor:

Mine looks like this. I was diagnosed with severe sleep apnea. I feel sleep deprived most of the time. I’m working on getting it corrected. I hope you went to see a doctor about it.

Sleep apnea is a suspect. I have a cold and can’t breath through my nose, last nights sleep looked a lot like this.

The consensus online seemed to be that a visit to a hospital for a sleep lab would be recommended if your sleep phases look similar, and you know what? Looking at these screenshots, I recognized these results: lots of orange “awake” moments, often quickly after the start of a REM or deep sleep cycle.

My respiratory rate also seemed to drop below the normal range during sleep, according to my watch. A drop in respiratory rate is often associated with sleep apnea, especially if there’s a dip, followed by an increase in heart rate and an awakening.

As an aside: a low respiratory rate with sufficient O2 levels (>95%) means your heart works efficiently and this could also be an indicator of proper physical fitness, mind you. A low heart rate at night is usually an indicator of being healthy.

And this is what I sort of saw? Now, these watches aren’t always super accurate, but Apple Watch apparently does relatively well compared to other sleep tracking devices.

So, I asked my doctor if it was possible that my symptoms could also be explained by sleep apnea, and he said that it was unlikely for someone of my age and weight, but certainly not impossible. I had already been prescribed some melatonin for my sleep, but I hadn’t seen any improvement in my sleep quality.

(Unfortunately, sleep quality is also impacted by stress, and it’s common for doctors to simply assume that it’s stress causing these issues.)

I’d had this gut feeling that I was on the right track when I went through the list of side effects of sleep apnea, and asked my physician for a referral. He gave me one, and I called the sleep lab department at a local hospital for the next possible appointment where I had the biggest chance of getting checked out the fastest.

Mind you, it was the start of the month, and I was extremely fortunate. You see, fortunate enough to get an appointment only 5 weeks later.

(I later found out that the next possible appointment was likely in… wait for it… October! Now I had my appointment in April. I had called at the right time as a cancellation had caused an opening to appear.)

This could very well be another dead end, but I had a feeling that this might at least explain my horrible sleep. In the meantime, I read up a ton on understanding sleep, sleep quality, understanding sleep apnea, and more.

It was very enlightening, and I certainly won’t pretend to be a doctor, but I am way more informed now than I ever was before.

I also seriously underestimated the importance of a good night’s sleep, to be honest.

While I waited for my sleep study, I threw myself into a new (temporary) obsession: further customizing fonts for my e-reader. I’d been working on looking for new fun fonts ever since I tweaked EB Garamond and turned it into NV Garamond. That was a fun process, and it made a lot of sense as I’d been reading a ton.

Eventually, I even wrote another blog post about it. (I mean, I even created a dedicated page on my website to distribute all these customized fonts. I also put them on GitHub. I figured sharing them might be a fun thing to do! And it looks like people are slowly finding the repository, so that’s nice.)

Sleep Study & Report

During the first week of April, a few days before my birthday, it was time for me to head to the hospital and get the sleep study done. I was excited to find out more about my sleep quality. I was, however, quite stressed for the whole thing.

A sleep study involves a bunch of different steps, and you basically arrive at the hospital at 6 PM, where the nurses record an electrocardiogram to determine that there are no obvious heart issues that could be causing trouble, and then you are left alone for an hour or two, before they wire you up to many, many sensors.

(They also connect some electrodes to your head for the EEG. Nurses told me that it’s actually really quite helpful to be bald for this sort of stuff, because removal of these conductive blobs that they put on your head can be rather tricky when you have long hair.)

In the end, muscle tension near your arms, legs, chest, breathing patterns, EEG, heart rate, oxygen saturation and more are monitored. An infrared camera is also used, probably to determine your sleeping position (supine, left or right) and to check overall heat distribution and temperatures during the night.

Before you head to bed, you inform the nurses, and then you just try to get some sleep. They need to register you in bed for at least 8 hours, but they don’t expect you to be asleep for the entire duration.

I asked the nurse about the waiting list and she informed me that, actually, I’d been quite lucky because at the time (in April) the next free slots were only in October, which would mean that I’d need to wait another six months or so before getting my final results.

I say six months because you need to wait another four weeks before you can see a pneumologist who will do additional lung tests and then discuss your sleep test with you.

As they set me up, some fifteen minutes later the nurse came over to visit me to tell me that it was already obvious that my breating was a bit shallow. They did some adjustments to better track my breathing, and I was told to do some more breath work when I got home, as this could also affect my sleep quality.

I then slept, had a poor night’s sleep and dragged myself out of bed the next morning. I got up, took a shower, and returned home, feeling worse than ever. A bed I wasn’t used to, and poor sleep with all these wires and things on your body… not exactly excellent and fun conditions for a great night’s sleep.

In the meantime, I examined yoga breathing exercises online and focused on getting my breathing under control, i.e. breathing “via the stomach” (the right way) as opposed to breathing “via the chest” (the wrong way). Initially this was pretty frustrating, because you feel like you’re not getting enough air in when you’re breathing the right way.

This incorrect breathing had probably manifested as a consequence of anxiety and nasal congestion. Mouth-breathing isn’t necessarily bad per se, but when it becomes a common occurrence, there can be an impact to the unconscious way one breathes, as was clearly the case in my situation here.

A week and a half after the sleep study, my report was available online, and I went through the entire report. It was a huge PDF of about 15 pages, with a conclusion at the end.

The conclusion notes stated:

Increased REM latency. Reduced N3 and REM. Absence of snoring. Arousals mostly paired with obstructive hypopneas, rarely PLM.

I had suspected sleep apnea was in play, and it turns out I was sort of right. In case you’re curious PLM means “periodic limb movement”, and that can be when you’re moving your legs during your sleep and that causes you to wake up.

The good news is that hypopneas are not quite as bad as apneas, in the sense that apneas are truly dangerous because your O2 saturation goes down the toilet and this has a cardiovascular impact. Hypopnea means there’s a partial obstruction, whereas with apneas your breathing stops, full stop. The latter is more dangerous than the former, but both are equally destructive in terms of sleep disruption.

With a mild case such as mine, you’re also unlikely to need any additional medical equipment to help with the condition such as the CPAP machine (or the more common, modern version, APAP, which can dynamically adjust pressure as needed).

I obviously consulted my friendly neighbourhood ChatGPT and various other LLMs to tell me more about sleep deprivation, sleep disruption and explained my own situation and asked for some tentative information. Obviously I was still going to visit the specialist in a few weeks, but I wanted my answers now.

I also had another important thought: my sleep was often bad because of my allergies and nasal congestion. Obstructive sleep apnea as a general category (and hypopneas are part of that category) can be caused by various factors, including the position of the tongue, but also by nasal issues, GERD, and more. Given that my nose was still causing me trouble on a daily basis, I decided that enough was enough.

If my congested nose was potentially one of the reasons I was dealing with sleep disruption, it was time to do something about it. I figured it was time to see the ENT and discuss my options.

You see, I’d already made an appointment some time prior, because I wanted to work on sleep and breathing at the same time. Unsurprisingly, both were connected, which I had also suspected.

(Making those appointments with specialists in parallel would later turn out to have been a good decision, because I was able to take a two-track approach to getting this problem resolved. It probably sped up the process of getting help by a couple of weeks, for sure.)

So, in the middle of April I was able to visit the ENT and get my nose checked out. I brought a report from my previous visit with an ENT a few years prior, who had recommended surgery but had explained that there was no medical urgency. (The issue being a deviated septum, which meant that airflow was decreased through my left nostril.)

The previous ENT had emphasised that recovery would be brutal, and this was right before COVID became a thing. I had decided to postpone surgery, and when COVID happened and other health concerns became more of an issue, optional nose surgery had not really been a priority. But now, things were different.

I explained the situation to the ENT, and the ENT decided to do a test to determine how impaired my breathing was through my left nostril. Sure enough, impaired enough to recommend surgery, especially given the current complaints. The appropriate surgery to straighten the septum is called a septoplasty (not to be confused with rhinoplasty).

I told the ENT that I wanted to get this surgery done as quickly as possible, so that I could recover as quickly as possible and hopefully enjoy a somewhat okay summer to continue my burnout recovery. The date of surgery was set for the 26th of May, and it would be a few frustrating weeks to recover, but the whole thing would be considered “minor surgery”.

In the end, I’d get a septoconchaplasty which would straighten the septum, but also do some additional work to shrink turbinates where necessary and remove any polyps when necessary.

The date was set, and I returned home with a feeling of dread. I wasn’t looking forward to this surgery, but I was looking forward to being able to breathe properly for the first time in my life. (You see, due to the deviated septum and allergies my left nasal passage was almost always partially if not completely obstructed.)

Specialist Visits & Surgery

I was to visit the hospital again to get a consultation with the pneumologist in May, after needing to wait for a few weeks. In the meantime, I had been doing some more sleep tracking with my Apple Watch which kept confirming that I was waking up often during my sleep, and my nasal congestion was getting worse, too.

I was happy that it wouldn’t be too long before I could get surgery, but hated the idea of that first week of recovery, even though I was very positive about the eventual outcome and results.

So, when I went to see the pneumologist they did some basic tests to verify that the issue was not related to my lungs; they did routine lung capacity tests, and a little after that I was able to sit down with the specialist, who told me many things that I’d already personally researched, so I was happy to get a confirmation from a specialist that I’d done my due diligence. The pneumologist also said it was a good thing that surgery for my nose was planned, as that should definitely also help. “Stress management,” she said, “Is also going to help, but I suspect your nose is going to make a big difference.”

The ENT had told me that there was a possibility that the sleep hypopneas were not connected to the sleep disturbances, but there was no doubt that improved breathing would likely also have a positive effect on my general sleep quality, which would impact stress levels, anxiety, and this would also further affect my sleep.

I went home feeling hopeful that, perhaps soon, the problem would be resolved. Now it was just time to wait for surgery.

Fortunately, I didn’t have to wait long.

Some two weeks later, the day of surgery arrived, which was a Monday. I was brought to the hospital for my overnight stay. I arrived in the morning at 11, and surgery was planned for 4 in the afternoon. The waiting was honestly the most frustrating part.

I was taken to the prep room at 4 in the afternoon, so there was a slight delay, I think it was 4:30 when I was in the OR. Surgery wasn’t going to take long, this is usually a 30-45 minute procedure. After going through a brief checklist with the anthesiologist I was put under, and the next thing I remember is waking up at 5:30 with no ability to breathe except through my mouth.

I was destined to be a mouth breather for the next five days. This was the part that I’d been dreading: as part of the surgery they’d put nasal packing in and it needed to remain in until that Friday.

My nose hurt, I was on antibiotics and painkillers, and a little later my nose started bleeding consistently. They put a “mustache” on you to ensure that all of the blood doesn’t end up in your mouth. The bleeding was being monitored and eventually slowed down over the next twelve hours.

Initially, I was also super tingly because the sedatives and anesthesia still needed to completely wear off. I was sharp mentally, but my body was still a bit sluggish. Every few hours the nurses would come to replace the “mustache” and also take blood pressure, replace the IV, and then I tried to get some sleep when it got late.

Unfortunately, I didn’t really get a lot of sleep that night.

The next morning, the specialist visited and explained everything had gone well, and that I was free to go home around noon. On Friday, I’d have to return to the hospital to have the nasal packing removed, but until then I was told to simply “endure” the annoying situation as it was.

I went home, visited the pharmacy to get the necessary painkillers, antibiotics and also extra fabric so I could replace the “mustache” for the next 24-48 hours. I also got some nasal spray that I’d need to start using on Saturday, the day after the packing was removed.

The next few days weren’t fun, but I worked my way through. On Friday, in the evening, I was the last person to visit the specialist that day. It was an unpleasant few seconds as the packing was removed, but there were no real issues. “Just some minor bleeding at the back,” I was told, “but you don’t need to worry, it’ll pass.”

I couldn’t exactly breathe through both nostrils yet, as everything was sore and the necessary mucuous membrane needed some more time to heal, but this was infinitely better than having both nostrils completely blocked.

Broken Nose Recovery

At this point, when week two of my recovery started, it was the beginning of June.

My nose is healing, and it will take many weeks before a complete recovery. At this point, I could already tell that my nasal congestion was less of an issue.

As far as my recovery is concerned, things are going well. My nose will still need to heal for the next couple of weeks and I am noticing that my mental acuity has improved significantly.

At the time of posting, August has arrived and things are so much better. It’s truly remarkable how big of a difference being able to breathe makes, and how much better my sleep quality seems to be.

Lessons Learned

• Poor sleep quality led to mental health concerns (anxiety, panic attacks) and this has likely been the case for years. There seems to have been flare-ups every few years.
• Being around dust and various other causes of allergic reactions (e.g. animals, outdoor during hayfever season) on my part probably exacerbated the issues above.
• Besides worrying about diet and exercise (which I’ve been doing for years now) I’m integrating good sleep hygiene into my routine.
• Improved airflow & breathing technique has led to improved stress levels, which impacts sleep, and should now let me properly recover from my depression and burnout. Progress is being made.
• I had no idea how badly the bad sleep quality had been affecting me until I truly hit rock bottom mentally. The cognitive decline was rather substantive, now that I can compare how I feel today and how I felt back then.

What you should take away from this

• Sleep quality is very important, as it impacts your day-to-day life: it impacts your energy levels, your ability to think, your ability to react, and more.
  • If you wake up and feel exhausted, have headaches and/or find yourself falling asleep during daytime activities, it may be necessary to evaluate your sleep schedule and/or sleep health.
  • You will find many people disagree on how much sleep is needed, but aiming for at least 7 hours of decent sleep is not a luxury, it is something that will profoundly impact your life.
  • Being relaxed, being able to breathe, not being randomly woken by environmental factors all play a key part to restful sleep.
  • If you find yourself emotionally under pressure, stressed out, worried or otherwise tense (sometimes literally: are you tensing up your muscles?) you will need to do something about that because your sleep quality will suffer.
  • Sleep is required if you wish to be better equipped to deal with mental stress. In particular, REM sleep is very important for proper recovery.
  • Deep sleep and/or REM sleep may be affected if you suffer from any form of sleep apnea.
  • Good sleep also has a profound psychological impact: you are far less likely to suffer from depression when well-rested.
• Sleep apnea, either mild or severe, can be extremely disruptive to sleep and potentially life-threatening.
  • Obstructive sleep apnea is actually very harmful to your cardiovascular system, especially if you stop breathing for extended periods of time.
  • Mild sleep apnea can be enough to cause you to wake up often at night, which can be very disruptive. This may prevent you from getting enough REM and deep sleep, which can be quite serious and lead to fragmented sleep.
• Try to get some good sleep tonight. Seriously.
  • If your sleep has been really crap, go see a physician. Don’t let things remain this way. Don’t be like me and let things get progressively worse!
  • You may not be aware of how bad the decline has been, if you are sleeping poorly. So, consider carefully if your sleep quality may have been affected.

Closing thoughts

Wow, this all really fucking sucked, and the suck isn’t entirely over yet, but I am hopeful for the future as things seem to be improving. The scary bit is that I am totally in the dark about how long I’ve been impacted by this.

I have felt more rigid and inflexible when it comes to my energy levels for at least the last decade, and I wonder: how much were my personal relationships and career choices impacted by a mentality directly impacted by poor sleep?

I may never have the answer, but I suspect my life may have turned out profoundly different had I been in a different state of mind, less tired and more sharp. Over the last weeks, I’ve found myself more willing to take chances, more optimistic, more willing to change my life than ever before.

If you’re constantly tired, your thinking is affected in various ways. In retrospect, I can definitely feel that I wasn’t doing my best work at work because I was physically and mentally held back by poor sleep.

I was lucky to be curious and determined to determine what was causing all of these problems, because if I had not advocated for myself in this way, I probably would still be where I was before, taking anti-depressants and going to therapy, while continuing to struggle with poor sleep and poor breathing form.

During therapy sessions, I was able to communicate my dissatisfaction with myself and the industry I have been working in for the last ten years. I don’t think I’m meant to be a programmer for that many hours on end, day after day, as this was also clearly having an impact on my life.

I’m confident the direction I’m going now is positively impacted by the decisions I’ve made over the last twelve months. Not all of those decisions have been easy, but I do believe they have been the right ones.

In the coming months, I suspect many things will change. However, I am excited about the future for the first time in a long while. I’m sure I will have more to share in September, but until then, stay tuned!