I go through weeks or months-long periods where I feel exhausted throughout the day and it’s been getting worse over the past few years. I thought it might be sleep apnea—my dad has it bad and for him getting tested and hooked up to a Darth Vader mask changed his life—so I did a sleep study at the beginning of March. It was super easy—of course you first have to go into your primary care physician and be like “I feel tired”, and she refers you to a sleep doctor, and you go to them and you say “I feel tired”, and then they send you home and you come back in two weeks to pick up the device (and then they want you to schedule a follow-up appointment to discuss results! 4 visits overall for one sleep study. My sleep doctor was cool and said she could just summarize the results over MyChart, which she did, so I got out of this with just 3 visits. And if I’d really tried, I could have probably gone to her directly, without talking to my PCP first, although some insurance designs force you to go tell a PCP “I am tired” before you are allowed to visit a specialist, which is a great insurance design if you want to waste everybody’s time).
But the actual study was easy. You just tie a strap around your torso and stick some tubes to your nostrils and go to sleep. (The device is the shoddiest-looking thing you’ve ever seen in your life, and on the paper you sign when you rent it, it says they’ll charge you 3 grand if you lose it. I would have guessed this number would be $100.)
The raw study results are a good time—I think there is a special doctor who sits in a tiny basement room and just summarizes the results of sleep studies all day, in his alien sleep-doctor dialect—this dialect of his is why they don’t let him out of the basement. From him I learned my clustered central events may represent occult obstruction, which I think means the girl from The Exorcist is sneaking into my room at night and blocking my airway. My RIP index is 100%, which is appropriate, because reading his report made me feel like killing myself. But I asked the sleep doctor I’d talked to to summarize these 5 pages of GPT-2 and she said I had scored a 5.3 on the apnea scale, where numbers from 5-15 indicate apnea, i.e. I basically don’t have it. Also I don’t snore. So that’s out.
My theory for a while has been that I have some extremely snotty circadian algorithm going on, where if I don’t sleep and wake up at exactly the right times, my body decides that from 9am to 4pm, it is actually 5am, and depresses my system accordingly. I’d taken melatonin for a while a year ago at 5pm and it helped, but stopped working after a while, so I stopped. Then I had a sore throat in January and suspected Omicron and read some papers theorizing that melatonin might help, so I took 3mg melatonin at 7pm. I was out like a light by 10p, woke up at 6am, and felt the best I had in months. I got a COVID test that day and it came back positive and this day I tested positive for the fucking plague was literally the most energized and awake and alive with potential I had felt since November. So I went back on 2mg melatonin daily and that sort of helped but it was nothing like that COVID day. So maybe my circadian system is set up to only work properly when lab-invented pathogens are streaming through my ACE-2 receptors.
I bought a big bright light and started staring directly into it in the mornings, and I’m not sure if it helped, because it’s so incredibly boring to sit and stare into a lamp that I couldn’t keep it up. An online recommendation I read said to do it for half an hour every morning! Can you imagine? I should try it again—maybe I will.
I got so sick of this I tried staying up all night a few Saturdays ago to wack my rhythm back into shape—like how we used to slap our televisions when the picture got static-y. It didn’t work in the long term, but I had a fantastic night playing playstation for 8 hours and took a 2 hour nap in the morning and felt great and ended up taking a 9-mile walk around where I live and discovered a closed disaster of an old grain mill—common in Minneapolis—grafitti’d to shit, out back behind a brewery. I listened to Gleick’s biography of Isaac Newton the whole time and learned he invented a lot of the calculus he used during the bubonic plague lockdown, just sitting alone by himself in the country for a year or two. It was a great day! I expected to feel like trash on Monday, but I slept for like 9 hours overnight and felt just fine. So I might start caring less about getting enough sleep—I slept like garbage the past two nights and feel motivated enough today to write this craven money-grabbing Goodhart post (which you should absolutely upvote right now if you liked even a single sentence). I’ve had many 6 or 7-hour sleep days where I feel bright and alive, and plenty of 9-hour sleep days where I feel like one of those old dogs that spend 16 hours a day in their dog bed every day, that I’ve given up on sleep consistency as a route toward feeling awake.
I also never actually can sleep when I feel un-awake like this—there’s no daytime can’t-stay-awakeness going on—it’s probably better to call all this “low energy levels”. My most recent episode, mostly resolved now, happened when I decided to lose some weight for the summer and started restricting myself to 1500-2000 calories a day. I did this a few years ago when cutting weight for boxing and trained and ran most days while being at these low-calorie levels and felt alive and had a great time, but this time, it totally floored me, and I was dead in the water. The Daylight Savings switch happened around the same time, and the worst of it began the Monday after the time change, so that’s a suspect, but Jesus, it’s just an hour difference! How could that do this much?
I tried changing my diet up to random things, and eating a spoonful of honey before bed, but I don’t see differences, so I’m back to eating hamburger and cajun fries every day (so good!).
So now I’m wondering if it’s ADHD or something—I read some symptoms and then remembered of, how everyone I’ve ever worked with, I go the craziest when forced to sit in an hour-long meeting to which I have nothing to contribute. Also, like, I’m in the tech-worker cluster of person, and so are a lot of the people I know, so when I asked around about other people’s experience with this stuff, it turns out most of them have or suspect they have ADHD? I’ve been amazed by my friend John’s productivity for years and wondered how I could be like him—turns out he takes prescription Adderall every day. Asked another friend—also prescribed. Asked another friend—she thinks she has it, and her brother is diagnosed. Asked another friend, and she’s never considered it but also has fugue states worse than mine, the most recent of hers lasting for months of bare-minimum productivity. So, uh, like, everyone. (I should say—because I’ve linked my LessWrong blog on my resume & LinkedIn, which seemed like a good idea before writing this post—that even at my worst I’ve never had a full week where I couldn’t work, and usually am decently productive even in my bad states, even if it’s through a haze of pallid exhaustion—and that most weeks I have great days of productivity—please believe me! it’s true!).
Luckily, I have a good case for diagnosis, and not for seeming like a pill-seeker—I dealt with this for years, I went the responsible route of getting a sleep study done first, and so on. It turns out the doctors I’ve talked to do not care one little tiny bit about this. I talked to one on a virtual provider app—specializes in ADHD! - who I waited a week to see and by minute 8 of our 45-minute appointment had declined to test me, declined to give me any therapy, and said he could only refer me to other doctors. In his mind, this was helping me, for the “some insurances require you to have a referral before you receive actual specialist care” reason, but in my mind, it, uh, didn’t help. Appointments for this kind of testing are so booked-up that one health system I called said they couldn’t schedule me, because open appointments were so far in the future (June?) that no providers had entered their availability for appointments that far ahead. Lots of ads online say they’ll test me virtually, but they all seem ripe with scam potential, and I’m not sure whether bringing a printed PDF of adhdonline.com’s diagnosis of me to a prescribing provider would get me laughed out of the clinic. Another local testing center said they were unfortunately out of network, so it would cost me $300 or so per visit, but they could get me an appointment in… September!
Even though I was inspired to write this in an hour, without any editing, for craven upvote-begging financial reasons, I had a good time, and everything in it is true. If you enjoyed this post, and it’s still April 1st 2022, you should upvote it. Consider a strong upvote—what does it cost you? Nobody has to know.
Towards trying to feel consistently energized
I go through weeks or months-long periods where I feel exhausted throughout the day and it’s been getting worse over the past few years. I thought it might be sleep apnea—my dad has it bad and for him getting tested and hooked up to a Darth Vader mask changed his life—so I did a sleep study at the beginning of March. It was super easy—of course you first have to go into your primary care physician and be like “I feel tired”, and she refers you to a sleep doctor, and you go to them and you say “I feel tired”, and then they send you home and you come back in two weeks to pick up the device (and then they want you to schedule a follow-up appointment to discuss results! 4 visits overall for one sleep study. My sleep doctor was cool and said she could just summarize the results over MyChart, which she did, so I got out of this with just 3 visits. And if I’d really tried, I could have probably gone to her directly, without talking to my PCP first, although some insurance designs force you to go tell a PCP “I am tired” before you are allowed to visit a specialist, which is a great insurance design if you want to waste everybody’s time).
But the actual study was easy. You just tie a strap around your torso and stick some tubes to your nostrils and go to sleep. (The device is the shoddiest-looking thing you’ve ever seen in your life, and on the paper you sign when you rent it, it says they’ll charge you 3 grand if you lose it. I would have guessed this number would be $100.)
The raw study results are a good time—I think there is a special doctor who sits in a tiny basement room and just summarizes the results of sleep studies all day, in his alien sleep-doctor dialect—this dialect of his is why they don’t let him out of the basement. From him I learned my clustered central events may represent occult obstruction, which I think means the girl from The Exorcist is sneaking into my room at night and blocking my airway. My RIP index is 100%, which is appropriate, because reading his report made me feel like killing myself. But I asked the sleep doctor I’d talked to to summarize these 5 pages of GPT-2 and she said I had scored a 5.3 on the apnea scale, where numbers from 5-15 indicate apnea, i.e. I basically don’t have it. Also I don’t snore. So that’s out.
My theory for a while has been that I have some extremely snotty circadian algorithm going on, where if I don’t sleep and wake up at exactly the right times, my body decides that from 9am to 4pm, it is actually 5am, and depresses my system accordingly. I’d taken melatonin for a while a year ago at 5pm and it helped, but stopped working after a while, so I stopped. Then I had a sore throat in January and suspected Omicron and read some papers theorizing that melatonin might help, so I took 3mg melatonin at 7pm. I was out like a light by 10p, woke up at 6am, and felt the best I had in months. I got a COVID test that day and it came back positive and this day I tested positive for the fucking plague was literally the most energized and awake and alive with potential I had felt since November. So I went back on 2mg melatonin daily and that sort of helped but it was nothing like that COVID day. So maybe my circadian system is set up to only work properly when lab-invented pathogens are streaming through my ACE-2 receptors.
I bought a big bright light and started staring directly into it in the mornings, and I’m not sure if it helped, because it’s so incredibly boring to sit and stare into a lamp that I couldn’t keep it up. An online recommendation I read said to do it for half an hour every morning! Can you imagine? I should try it again—maybe I will.
I got so sick of this I tried staying up all night a few Saturdays ago to wack my rhythm back into shape—like how we used to slap our televisions when the picture got static-y. It didn’t work in the long term, but I had a fantastic night playing playstation for 8 hours and took a 2 hour nap in the morning and felt great and ended up taking a 9-mile walk around where I live and discovered a closed disaster of an old grain mill—common in Minneapolis—grafitti’d to shit, out back behind a brewery. I listened to Gleick’s biography of Isaac Newton the whole time and learned he invented a lot of the calculus he used during the bubonic plague lockdown, just sitting alone by himself in the country for a year or two. It was a great day! I expected to feel like trash on Monday, but I slept for like 9 hours overnight and felt just fine. So I might start caring less about getting enough sleep—I slept like garbage the past two nights and feel motivated enough today to write this craven money-grabbing Goodhart post (which you should absolutely upvote right now if you liked even a single sentence). I’ve had many 6 or 7-hour sleep days where I feel bright and alive, and plenty of 9-hour sleep days where I feel like one of those old dogs that spend 16 hours a day in their dog bed every day, that I’ve given up on sleep consistency as a route toward feeling awake.
I also never actually can sleep when I feel un-awake like this—there’s no daytime can’t-stay-awakeness going on—it’s probably better to call all this “low energy levels”. My most recent episode, mostly resolved now, happened when I decided to lose some weight for the summer and started restricting myself to 1500-2000 calories a day. I did this a few years ago when cutting weight for boxing and trained and ran most days while being at these low-calorie levels and felt alive and had a great time, but this time, it totally floored me, and I was dead in the water. The Daylight Savings switch happened around the same time, and the worst of it began the Monday after the time change, so that’s a suspect, but Jesus, it’s just an hour difference! How could that do this much?
I tried changing my diet up to random things, and eating a spoonful of honey before bed, but I don’t see differences, so I’m back to eating hamburger and cajun fries every day (so good!).
So now I’m wondering if it’s ADHD or something—I read some symptoms and then remembered of, how everyone I’ve ever worked with, I go the craziest when forced to sit in an hour-long meeting to which I have nothing to contribute. Also, like, I’m in the tech-worker cluster of person, and so are a lot of the people I know, so when I asked around about other people’s experience with this stuff, it turns out most of them have or suspect they have ADHD? I’ve been amazed by my friend John’s productivity for years and wondered how I could be like him—turns out he takes prescription Adderall every day. Asked another friend—also prescribed. Asked another friend—she thinks she has it, and her brother is diagnosed. Asked another friend, and she’s never considered it but also has fugue states worse than mine, the most recent of hers lasting for months of bare-minimum productivity. So, uh, like, everyone. (I should say—because I’ve linked my LessWrong blog on my resume & LinkedIn, which seemed like a good idea before writing this post—that even at my worst I’ve never had a full week where I couldn’t work, and usually am decently productive even in my bad states, even if it’s through a haze of pallid exhaustion—and that most weeks I have great days of productivity—please believe me! it’s true!).
Luckily, I have a good case for diagnosis, and not for seeming like a pill-seeker—I dealt with this for years, I went the responsible route of getting a sleep study done first, and so on. It turns out the doctors I’ve talked to do not care one little tiny bit about this. I talked to one on a virtual provider app—specializes in ADHD! - who I waited a week to see and by minute 8 of our 45-minute appointment had declined to test me, declined to give me any therapy, and said he could only refer me to other doctors. In his mind, this was helping me, for the “some insurances require you to have a referral before you receive actual specialist care” reason, but in my mind, it, uh, didn’t help. Appointments for this kind of testing are so booked-up that one health system I called said they couldn’t schedule me, because open appointments were so far in the future (June?) that no providers had entered their availability for appointments that far ahead. Lots of ads online say they’ll test me virtually, but they all seem ripe with scam potential, and I’m not sure whether bringing a printed PDF of adhdonline.com’s diagnosis of me to a prescribing provider would get me laughed out of the clinic. Another local testing center said they were unfortunately out of network, so it would cost me $300 or so per visit, but they could get me an appointment in… September!
Even though I was inspired to write this in an hour, without any editing, for craven upvote-begging financial reasons, I had a good time, and everything in it is true. If you enjoyed this post, and it’s still April 1st 2022, you should upvote it. Consider a strong upvote—what does it cost you? Nobody has to know.