Saturday, 27 May 2023

What does being a Patient Expert entail?

Good question!

My previous blog dealt with whether I identified with being an "expert patient" and I think the answer was yes in principle, although there was more to it than that.

Over the years I have had my condition, which is now 10 years since diagnosis, I have learned many things. But the thing is, even after all this time, I'm still learning more new things about my condition. Even things I have already learned may have changed over time, so whilst they may have been true, they may not be any more. Which is why being an "expert" is tricky.

If I have (say) brain fog today, or extreme fatigue, then this absolutely could be a lack of Cortisol (as I talked about in my previous blog). My body also fails to make any Testosterone, a symptom of very low testo is, guess what, fatigue. I'm being deliberately contentious using fatigue as the example, because there are SO MANY causes of fatigue. How am I to know?

So being an expert patient is trying to understand the situation you find yourself in and comparing it to your previous experience - is it the same, is it different, think to yourself - are there any possible other causes. Speaking to someone else can help, my wife always knows when something is up with me, often before I do. Are you a member of a peer support group, can you ask their opinion, what is their experience. An expert patient isn't just an expert themselves, they know when and where to reach out to others who can help, both peers and professionals and give them support.

What is going on with your condition? If you are trying to track a cause to an issue, make notes, make a diary of what is going on. When are you taking your medication, how much medication, what are you eating/drinking, what have you been doing during the day, are you sleeping normally, are you under any extra stresses.....the list of questions goes on. But make a note of them because despite you being absolutely convinced you know what you did and when, in 24/48 hours it all becomes a bit blurred if you haven't written it down, well it does for me anyways!

So being an "expert" is about knowing you, and also about knowing when your expertise in you has run out and you need help. It isn't an easy balancing act, because sometimes we don't want to ask for help, or we fear what the answer might be if we do ask for help. But asking for help is sometimes the only way and it is nothing to be ashamed of.

Am I an expert patient?

I became more aware of the phrase "expert patient" recently. I have heard it before but it had kind of washed over me without really sinking in, what does it mean, do I identify with the phrase? It turns out, it created quite a debate in my head......

I think the short summary of the answer to that question is "sometimes", but I do feel that a person who proclaims to be the "expert patient" needs to temper that feeling with views from others, particularly medical professionals. The language used is complex and I think that is why it has washed over me previously because it is complex and not something easy to put my finger on.

The view of "I am the expert on my condition" is of course entirely correct in principle. However, today I may be absolutely convinced that, say, I have extreme fatigue and that is the fault of low Cortisol. The answer is, therefore, to take an extra dose of Hydrocortisone. Maybe this works, maybe it doesn't. Let's say it does and I feel better, then what about tomorrow when the same happens again. We have to be 'expert' enough to know when our expertise runs out and we need help. To sit in front of a medical professional and say I am an expert is one thing, but caring for my health is a team effort and I need to listen to the medical view as much as they need to listen to me. When this team is working properly, I am in the best hands. There can be so very many reasons for fatigue (using this example) other than just low Cortisol.

Then, am I a "patient" all the time, or am I only a patient when I'm seeing a medical professional (keeping that as a very broad term on purpose, basically anyone at a GP surgery/hospital/medical establishment). My view is really that I am only a patient when I'm seeing a medical professional, not all the time. 

On a day to day basis I'm just me, Carl, I happen to have a condition called Secondary Adrenal Insufficiency, or Hypopituitarism, or even Hypoadrenalism. I did say the language gets complicated! Just to explain:

Secondary Adrenal Insufficiency, or SAI. I have no production of Cortisol from my adrenal glands for a 'secondary' reason, i.e. my Pituitary gland has malfunctioned, but my adrenal glands still function, just not fully.

Hypopituitarism. Hypo, meaning "under" or "below normal" and obviously Pituitary-ism. In other words my Pituitary gland is under-performing. In fact it no longer produces the signals for my body to produce both Cortisol and Testosterone. 

Hypoadrenalism. I have seen my condition described in this way, the amalgamation of the two words probably need no further explanation.

Then that brings me onto other language, if I am not a patient all the time, then on a daily basis do I "suffer" from SAI or do I just "have" SAI. This applies to all conditions of course, it doesn't bother me that much but I know it does some....

So where does that leave me potentially being an "expert patient" then? Am I, do I want to be? I think the answer is yes I am an expert, although I might not express myself in this way. Do I want to be, hell no! Nobody wants to be.

Everyone with a complex condition or conditions needs to advocate for themselves or have someone who can do it for them (family/friends etc). One needs to do the research to understand your own condition, tell people close to you about it and hopefully involve them in your care. Then you have some facts, some lived-in experience and maybe even someone who can help you voice all that.

I've rambled on for long enough, but I'm brewing another blog post on what being an "expert patient" might actually entail. Watch out for that one....

Friday, 30 July 2021

July 2021 - Man vs Hedge - the return!

 As many of you who have been following my pituitary blog for some years will know, “man vs hedge” has been a theme from time to time. The basic tenet of the title was twofold, partly because it was a genuine challenge I was facing at the time….the hedge that is, and partly the struggle it gave me physically as a person with Adrenal Insufficiency (AI).

Back in 2013 prior to my diagnosis I remember being much more physically fit and able to tackle strenuous jobs in the garden and then subsequent to my recovery in later 2013 and early 2014 how much harder gardening was. This manifested itself most obviously when I set about cutting our 70 foot long 9-foot-high conifer hedge in our old garden. It exhausted me.

Therefore, I blogged about my struggles at that time and how I sought to overcome them. I feel another ‘Man vs Hedge’ blog coming on, even though we are 7 years down the line – but apart from the elapsed time, we are also now the owners of a brand-new set of hedges. I call them ‘set’ of hedges because they are very mixed. We have a hedge out the front of the house about 6 to 7 foot high and 20-25 foot long, a mix of ivy, hawthorn and various other. Then that morphs into a mainly bay laurel hedge which goes on for another 100 feet or so. The rest of that side of the garden is mainly trees as is the bottom of the garden, about 40 feet across. Then all along the other side of the garden is a privet hedge. The back garden has 6 foot fences all around, so the hedges only exist from 6 feet upwards! The privet is probably 12 feet at its highest, the other side varies up to about 8 feet. And I thought a 70 foot long 9 foot high conifer was difficult!

How is my AI depleted body going to cope with all this hedge cutting I wonder? Why on earth did we buy such a large garden with so many hedges!! (answers on a postcard....)

Part of the answer as to how I will cope, is using the correct tools. I have learned that when I used to cut the old hedge by hand with shears, I used to get a great finish on the hedge but realistically I’m just not able to do that any more. I need power tools and a good ladder, that’s my excuse anyway. So I have a good cordless long reach hedge trimmer and longarm pruner (the latter extends to about 4 metres tall). This means less time spent up a ladder wobbling about and less chance of me falling off said ladder because of being an idiot. Broken bones and AI are good partners so I understand......

But the part that is more pertinent to this blog, interesting as gardening is, is how to cope physically. That is the interesting part, and now comes an annoying admission. For years I have mentally been in a place where I was ADAMANT that I do not need to pace myself. I can just throw myself at the task in hand and everything will be fine. Sadly that is not the case, and to be honest that isn’t probably just the fault of the AI. I am not getting any younger and moving house really hit me hard mentally and physically. I got through it but I learned a lot about myself, principally the admission that I DO have to pace myself.

I’ve said before many times about my energy crashes and how they often happen late morning. Well, they continue to happen from time to time. I also had an escalating bad mood tendency with this low energy. It was because I was ignoring the signs and trying to push through it, rather than accept it was happening, take a break, and deal with it.

Added to all this learning, I stopped working in March 2021, so amongst everything else going on (you know, global pandemic), I had another change to have to deal with….yes of course it was a nice change, but a change nonetheless. 

The end result of all this pondering is that rather than think “I’ll do some gardening for the next 4 hours, might nearly faint but it’ll be fine” I go out with a different mindset. This revelation manifests itself as “I’m going to do some gardening for 90 minutes or so, then pop in and have a cup of tea and a biscuit and an early Hydrocortisone tablet and a sit down for 20 minutes, then go back outside for another 90 minutes. In other words, I don’t set out to have such a long gardening session and I break that session up with a rest. It pains me to say it, but of course it is pacing myself. You’ll never guess what though, it works! (most of the time) It doesn't come entirely naturally, because I've never snacked between meals.

It is of course blindingly obviously that it would work, but a combination of bloody-mindedness on my part and a lack of wanting to see the obvious did not help. 

I think it serves as a very good life lesson that you cannot blame everything on your condition, whatever it is. There are always other factors at play, not least my age….which I would rather not dwell on (I’m getting close to one of those ‘decade’ birthdays….), but it is a fact that I’m not getting any younger.

The summary…it only took me moving house, a pandemic, leaving my job of 43.5 years, continual problems with physical exhaustion over 7 years… finally make me come to my senses. I need to pace myself in certain activities, mainly gardening. And we certainly have a lot of that to do in our new house, so it is a good thing I enjoy it!!

Other than that, things have not changed that much. My pituitary gland will never work correctly and means I still take Hydrocortisone and Testosterone. I have lost a stone in weight for some reason (even with additional snacks), I’m only just over 9.5 stone or 61kg, this seems to be fairly constant and my consultant has done some checks to make sure nothing sinister is afoot. It isn’t. 

A couple of photos:
Couldn't very well have a blog about a hedge, without a (Stihl) hedge trimmer pic! This was courtesy of my very lovely work colleagues who got me some garden vouchers as a leaving present. The trimmer is  battery operated and nearly 7ft long!!

Part of the hedge, this has gradually been reduced in height, but have to be careful as this is our neighbours hedge!

Hedge on the left is privet, fence is 6ft high, hedge varies but is 12ft high in places!

Sunday, 18 April 2021

April 2021 - One foot in front of the other

When I sit down to type out a blog, I don't think very much about it - I start typing and words come out, unfiltered. Process normally takes 30 minutes from the time of sitting down to publishing. I don't go back and change my fundamental story, only typos and any factual errors. What you see is what you get and today, you're getting a bit of a grumpy blog post!

This weekend has been 2 days that were very different. One good and one not so good.

I've heard so many times about Adrenal Insufficiency, "oh you have to pace yourself" and "there are days when you have to surrender and just take it easy". I am not one to take it easy on the behest of my condition nor do I wish to pace myself because I am forced to. Perhaps that isn't the best way of looking at things, but it is how I feel.

Saturday was a good day. Got up early (Deb was at work doing admin for a Covid-19 vaccination clinic) so off out early for a 2 mile dog walk. Then steam mopped the downstairs and the bathrooms, and then cleaned my car all by lunchtime. In the afternoon, popped to a couple of local shops and did some weeding outside in the garden. Big relax from about 5pm along with a pizza and a film. All in all, a very good day.

Sunday, it seems like there was some payback. Slept well Saturday/Sunday, had about 9 hours and my sleep tracker suggested 2.5 hours of that was deep sleep. Had a bit of a lay in, but I knew as soon as I got up that this wasn't going to be a good day. Ready to go out with Deb and the dogs by about 10:45 so I pre-empted that 'dragging' feeling in my body with an early 5mg of Hydrocortisone plus a couple of bits of chocolate. Took the dogs out with Deb and walked about 2.5 miles.

Now here's the rub. Clearly if I was really not up to the walk then I wouldn't have been able to go at all, there are plenty of people a lot worse off than me at this point and wouldn't have gone at all. But that is kind of not the point, and I'm here to have a bit of a moan :-)  So off we went, and I dragged myself around the walk, it was a beautiful day nice and warm and blue skies. It was to all intents and purposes a brilliant place to be, in our local forest. But for me, it was 'project drag my butt around a dog walk' and it was not very enjoyable at all. Deb knew what was going on all too well, I shut down and hardly speak and I lag behind. But through sheer bloody-mindedness I make it around the dog walk, shattered.

Then having got home, I sit down and we have a bite to eat. Sometimes at this point I will recover, but not today. We had decided we wanted to go to a local garden centre, it doesn't open all winter and this is the first opportunity we've had to go since they reopened. So off we go, another drag myself around time and I didn't really take in all the lovely plants they had. But I made it. Back home about 4pm, time for another early Hydrocortisone dose and a sit down and more food. Finally this time, I can feel myself 'coming around'.

By 5pm I'm feeling a lot more human and I'm up for the dogs final walk of the day which is only a 25 minute quick around the block job. This was the best I've felt all day and by the time I've come home, I'm back on the ball. A quick vacuum of a couple of rooms and I'm ready for a roast chicken dinner that Deb has been lovingly preparing. I'm sitting here now wondering why I couldn't have felt like this all day. Normally my Hydrocortisone intake is:

7:30am 15mg - 13:00 5mg - 6pm 5mg

But today:

8:00 am 15mg - 10:45 5mg - 4pm 5mg

I haven't taken any extra Hydrocortisone today, I just didn't think it would be worth it. I have done on previous occasions and it doesn't always work.....sometimes it does, sometimes it does not. Quite how I can burn through 15mg in 2 hours 45 minutes I don't know. Having taken my 8am dose today, I was feeling vague by probably 09:30, so I don't really see how extra Hydro was going to help.

It is also worth noting this doesn't happen 'this bad' very often, probably a couple of times a month. Another couple of times in a month it happens, but is less pronounced. I suppose what I'm saying is about once a week I'll feel a bit sub-optimal.

Having just re-read what I've written so far, the story does sound a bit 'whingey', I still did quite a bit today because I forced myself to do so. The morning dog walk was a real slog and I could have easily just stayed behind and sat on the couch. But then Deb wouldn't have felt safe to do that walk on her own as it is through remote forest, so it would have ruined her morning as well as my own. I wanted to go to the garden centre, as did Deb, so I wanted to make that happen. I really-really DON'T want to give into the enforced rest - in hindsight that is probably totally flippin' ridiculous. But I can't see me changing my feelings about that any time soon. I should probably just feel lucky that I am able to force myself to walk 2.5 miles, a lot of people don't have that luxury.

Anyway, there it is, grumpy blog. A purpose of this blog has always been to get things off my chest, which this is a good way of doing. Whether this particular post actually helps anyone or resonates I don't know. But as the saying goes (and I quite dislike it....) "it is what it is"!!

Monday, 12 October 2020

October 2020 - Something is going on!

Hello again, time for my 2nd post of 2020, not exactly prolific but I've got a little bit to report.

It has been on and off for a while, I've had these episodes of feeling a bit exhausted but nothing a sit down and an early dose of Hydrocortisone hasn't sorted out....maybe the odd extra dose of Hydro. If you remember a while back my daily dose was slightly raised by 5mg per day from 20mg to 25mg per day - 15mg at breakfast, 5mg at lunch and 5mg with dinner. As reported in my August 2020 update a pretty major event has happened, moving house.

I reported last time that I had lost 3kg and my BMI was 23, well I've now lost 5kg and my BMI is down to 22. So I decided that enough was enough, and I thought I'd better contact a doctor to check everything was ok. I 'ummed' and 'ahhhed' as to which doctor to go for, whether it be my GP or the Endocrinologist who looks after me and after a bit of thinking I decided to go for the latter. It isn't uncommon if you've got a pituitary condition for another hormone to go a bit out of kilter, so that was my first choice. Having emailed and then chatted on the phone, some blood tests were ordered. The blood form came through the post and I made an appointment and had them done.

The report that came back was that my Testosterone was high, because I hadn't long had my 12 weekly injection of that, but my Thyroid was at the 'low end of normal'. I looked up symptoms of low thyroid on the NHS website:

Tiredness - definitely got this

Being sensitive to cold - got this too

Weight gain - quite the opposite of this!

Constipation - thankfully not!

Depression - nope!

Slow movements and thoughts - yes, although I can also attribute this to low Cortisol (or low Hydrocortisone in my case)

Muscle aches and weakness - definitely, although again, I could attribute this to much higher activity levels and moving house

Muscle cramps - yes definitely, particularly in my hands

Dry and scaly skin - yes, getting worse over the last couple of weeks

Brittle hair and nails - well, at my age my hair is going to be on the run, one of my nails has split, which is quite unusual for me

Pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome) - Nope

Later symptoms of an underactive thyroid include:

A low-pitched and hoarse voice - this can definitely be me at times!

A puffy-looking face - definitely not, I'm thinner in the face than I was.

Thinned or partly missing eyebrows - haven't really looked at this!

A slow heart rate - I've always had quite a slow heart rate of 50-60bpm, but I have a graph on this in a minute.

Hearing loss - if you ask my wife, she will tell you I never listen to her, is this the same thing?!

Anaemia - don't know.

So it isn't a slam-dunk 'I've got everything on the list', but I do have a fair few (the weight gain symptom versus my weight loss being the most obvious clash). But of course this is where hormones catch you out, because probably if I listed several other conditions created by the pituitary, I'd probably match quite a few of them too.

The answer for the moment is to have another blood test in a month or so, to see if my Thyroid level is stable or worse and then take it from there. If it is lower then I can start Thyroxine tablets to see if this helps, or if the Thyroid levels are stable or better then we need to look at something else, don't ask me what!

How about some data? Why am I losing weight and what about my heart rate. Like many people I wear a fitness tracker, so I downloaded some stats into Excel (other spreadsheet applications are available), and here is what I found.

Weight loss. The obvious reason for losing weight is because I've gone on a diet, but I haven't. I haven't changed my food intake much at all for years, I eat a mixture of fairly healthy with lovely puddings and pizza on a Saturday night. Have I increased my activity level, well I would have said "no", but my fitness tracker says otherwise. Of course in the lead up to the house move and a couple of weeks after, activity levels surged. But they haven't gone back to normal despite me not doing anything radical (July was the house move):

As you can see, I've gone from a number of steps averaging 6,000-7,000 to well over 9,000 and into the 10,000 range, quite incredible. My work schedule hasn't changed, I still walk the dogs as much as I ever did. However, all the little jobs around the house, the fact the garden is bigger than it used to, the house is slightly all adds up. So my activity level HAS gone up and it has stayed up!

Heart rate, it said above in the symptoms that your heart rate could go down if you have low Thyroid. I don't have my fitness tracker set to constantly monitor my heart rate, however having downloaded the data off of it, it turns out that it does monitor it every 2 minutes at night and I'm assuming it does that in part to track 'light sleep' and 'deep sleep'. So I've analysed that data too:

Well what do you know! I'm no doctor so I don't really know whether averaging 53bpm overnight down to around 50bpm overnight is really a big deal. However the data doesn't lie and it is showing a downward trend in my overnight heart rate. They say your heart rate lowers if you are very fit I think? What with me walking many miles a day now, perhaps that is it!!

If nothing else, it fills up a blog post. I'm not sure what the data tells me other than I really am doing more physical activity which can't be a bad thing. But perhaps I'm burning way more calories than I'm taking onboard, after all that is what a weight-loss diet aims to achieve! Break out the biscuits..... :-)

I could certainly do without feeling bouts of exhaustion/tiredness because they are extremely inconvenient. In fact they hark back to pre-2013 when I was first diagnosed, I had bouts of extreme tiredness back then plus quite a few of those other symptoms like cramp and muscle aches and weakness. I could certainly do with an answer that's for sure.

I'll give you an update as soon as I have one!

Sunday, 2 August 2020

August 2020

Wow, nearly a year since my last post. A lot has happened since then, most of it in the last few weeks.

The pituitary update element of this post is that all is well. I've had the usual bloods done which all came back normal, the eye checkup which was fine showing no further degradation of my optic nerve and an MRI scan which confirms that he tumour is still not re-growing. So a good set of results which means that I continue down the line of being monitored but nothing to worry about. Which is great news!

In terms of day to day pituitary life, things are relatively normal. 2020 has thrown a lot at us so far, mainly in the form of COVID-19. The stresses this has brought have not really affected me as I am lucky enough to be able to work from home, so this switch has been easy. Pituitary patients fall into the clinically vulnerable group which meant I had to maintain stricter social distancing, but not full shielding. Life continued pretty much as normal, at least as normal as it ever could be under such conditions.

The thing that really did affect me is the decision to buy a new house. One day back in April 2019, Deb walked the dogs past a house locally that had been renovated and remarked how nice it looked. We had been looking at houses for quite some time, but not that seriously. So in early May 2019 we decided to view the house and fell in love with it. But we didn't have our house on the market at that point and our 'dream' house sold quickly, and that was that. Or so we thought....

The estate agent called us back in November 2019 wondering if we were still interested, as the sale fell through. We were, but now things were getting serious, because it meant getting our house on the market. This happened fairly quickly and in early 2020 our house sold, our offer was accepted on the new house and everything seemed to be going smoothly. We would be moved in by Easter. However, lockdown happened......

To cut a long story short, following the end of the lockdown it took an age to get the move done for various reasons. We finally moved in near the end of July 2020. It really is a fantastic house and very much a dream house for us. It was a 1955 bungalow which was extensively converted into a very modern chalet bungalow. We are very lucky....but what does this have to do with a pituitary blog. Well dear readers, stress.

When you updose Hydrocortisone it is referred to as 'stress dosing'. I don't think I had really appreciated this term until the last couple of weeks. I frequently refer in this blog to my occasional crashes, well when you are moving house, the stress of that plus the unusually high physical and mental activity really exposed how clever the human body is and how reliant it is on Cortisol, or Hydrocortisone in my case. To say I was flagging a bit most days is an understatement. I am just at the end of 2 weeks off, the first week was leading up to the move and the second week was following the move. Up and down to our old loft, packing boxes, lifting boxes and constantly thinking about something. Getting up early and going to bed late. Then moving in and cleaning and unpacking and lots more brain activity. My body was just burning through Hydrocortisone like no-ones business. I took an extra 5mg most days and a little bit more than that some days.

I have lost 3kg in weight due to a combination of the physical and mental strains. I also found myself really needing extra food. A stupid thing to say really, because if you are working hard, you burn the calories and need to fuel up, but I'm just not used to it. My body aches and to be honest, anyones would....of course it would. It is just another stabbing reminder that I rely so much on the Hydrocortisone to keep me going. I can confirm that on the day of the move the one thing that wasn't packed and was very much with me was a stash of pills and my Hydrocortisone injection. We were only moving around the corner, but that is plenty far enough to get into real trouble if my medication wasn't to hand.

Hopefully, I will put the weight back on as my BMI is around 23 which is fine, but I was happier with another couple of Kg on me. Not doing 10,000 - 15,000 steps daily will probably sort that out, my normal daily is around 8,000. The day of the move I did nearly 25,000.

Moral of the story, don't be afraid to updose if there is good reason. I'm back at work tomorrow, so on a much more 'normal' schedule for me, let's see how that goes!

Photo is me and the dogs relaxing after mowing the lawn today

Thursday, 15 August 2019

August 2019

Hello there.

A quick update, and a conundrum. I went for my Endo checkup recently and all is well, I had the normal raft of blood tests done beforehand plus a few extra and all of them came out within normal ranges. Even my growth hormone, but more on that later....

Over the last few months, as I've reported in the blog before, I have had more instances of Cortisol crashes for no obvious reason. I had explained this in a previous Endo appointment and the doctor suggested upping my morning dose from 10mg to 15mg, which I did. It definitely did help and it appears I am one of those people who burns more Cortisol (Hydrocortisone in my case) in the morning, as I stuck to my normal 5mg lunchtime and 5mg teatime dosage. So largely the problem was fixed, but still those annoying crashes would appear.

I knew already, but I was reminded at my recent Endo appointment, that replacing Cortisol with Hydrocortisone is never going to be perfect. I can never know exactly how much Cortisol my body will need and when, and although I try and mimic the correct dosing I am going to get it wrong from time to time. Coming back to that growth hormone subject though, this is monitored regularly because GH is a hormone that can tail off in time with some people with Adrenal Insufficiency and cause similar symptoms to a lack of Cortisol. However, it appears that my growth hormone is in the upper zone of the normal range.

So I got to thinking what else could be at play, and I had an idea. This is the part where I need an expert to chime in, because the idea is a bit 'out there'. Like many people I wear a fitness tracker, an 'Amazfit Bip'. The Bip tracks steps, heart rate, sleep patterns and has GPS know, all the regular fitness tracker stuff. I have had it since last March and I have been very pleased with it, in fact it has hardly ever been off my wrist since. It is the sleep tracking in particular I noticed, it tracks total sleep per night and the amount of that sleep that is 'light sleep' and 'deep sleep'. Now, I don't honestly know how it determines 'deep sleep', I can only assume that it is a combination of movement (or lack of it) and my heart rate that makes it determine how deep my sleep is. It seems I go in and out of deep sleep during the night. I've done a graph below of my averages per month since I've had the tracker.

You can see that I am one of the lucky people that gets between 7.5 to 8 hours sleep per night, and the orange line shows the percentage of this sleep that is deep sleep. The deep sleep peaked in June to August 2018 and has been steadily coming down ever since. But then in July this year, I noticed my deep sleep shot up, some nights it was up to 40 to 50 percent of my total sleep per night. It has tailed off a bit this month as you can see.

My Cortisol crashes had been on the increase throughout 2018 and into 2019. But in the last 6 weeks, I don't think I have had one crash, not one! This coincides with me getting a lot more "deep sleep", is this a coincidence, is there any science that would correlate here??

My lifestyle is pretty constant throughout this period, a job on the same days doing the same thing, some days out at dog shows being very active and on my feet, walking the dog, same diet etc. No real change in what I'm up to to suddenly make me get more deep sleep.

Because I can't find anything on the Amazfit website that specifically states how the gadget measures "deep sleep", I can't really hand on heart say that this may be the cause, can I? Not unless my deep sleep tails off and the crashes start again. If this is in any way related, am I just in fact bog-standard knackered due to a lack of deep sleep, nothing whatsoever to do with my Hydrocortisone/Cortisol hilarious would that be!!

But anyway, there is my theory for what it is worth, I'll leave it with you!

One thing I can say for sure, is that I am very much enjoying my lack of crashes.