Naps and graphs

[Click on any graph to enlarge]

For the past 4 Remicade cycles, I tracked how many hours I napped per day. Though I know I didn’t manage to record 100% of all naps, my records are reasonably accurate. I dumped them into Excel and thought the results would follow a pattern like this:

Example of linear increase

or like this:

Example of exponential increase

because I had the general impression for years that I get more and more tired, and can do less and less work, as my Remicade wears off. While my abilities to concentrate on work definitely do follow this pattern, I was surprised to see that my pattern of napping is, well, not what I expected:

Very messy graph with error bars from hell

The error bars on this and all subsequent graphs are standard error measurements.

Of course, the variation here is huge because there were only 4 Remicade cycles in the data set, so each point on the graph represents the average of only 4 days. But, still, the crazy fluctuation during weeks 4 and 5 (days 21-35) threw me. Then I remembered that in one Remicade cycle, I’d had bronchitis. I removed the 3 days of sleeping off the bronchitis from the data, and the resulting graph is slightly less weird:

Slightly less messy graph with error bars from hell

Then I got the brainwave that I tend to sleep more on the weekends than on weekdays. I know that I’ve introduced a certain amount of error in my data tracking here because I did not count sleeping in as nap time, even though the number of hours I sleep per day on weekends tends — I think! — to be higher than the number of hours I sleep per day during the week. When I was counting naps, I only counted the number of hours I slept after I had already woken up, gotten dressed, eaten breakfast, etc.

Anyway, taking all that into consideration, here’s the same graph as the one above, but with the weekends marked. Note that I always get Remicade on a Thursday — shown as day 0 on all graphs — so weekends fall in the middle of the treatment cycle “weeks”:

I wasn’t sure if there was an obvious pattern, so I compared the average hours I spent napping during each week with the average hours I spent napping on the weekends:

This graph shows a massive overlap in the number of hours I spend napping on the weekdays and weekends in every week of the Remicade cycle. Also, rather strangely, it shows that the week that I tend to sleep the least is one of the weeks in which I feel most tired: week 6.

So what does this all mean?

I think what’s going on is that:

  1. the naps on the two days immediately after the Remicade infusion are related to steroid withdrawal;
  2. I’m generally pretty active in weeks 1, 2, and 3 after treatment (days 3-21 on most of the graphs) and have more control over when I nap, so I’m napping, but it’s not interfering with work too much;
  3. all of that activity in weeks 1-3 tends to catch up with me by week 4 (days 22-27 on the graph), and by week 5, I start getting multiple Crohn’s symptoms, including mouth ulcers and rashes and arthritis. I tend to decrease my activity levels in week 5 to prevent the fatigue from getting too bad, but I end up having to nap anyway;
  4. in weeks 6 and 7 (days 35-49), I’m generally too tired to be active. I tend to sit around a lot during week 6, which helps me avoid getting so tired that I need to nap, but by week 7, I’m napping a lot despite my low activity levels. I also get overwhelmingly tired more suddenly and have less control over when I fall asleep.

Messy graph with comments (explained in text)

Unfortunately, I tracked only the time I spent napping, so these graphs don’t take into account the modifications I make to my activity levels to balance my obligations with my degree of fatigue or the loss of control I experience over nap times as my Remicade wears off.

The take-home message from this Excel blowout is that I need to track my activity levels as well in order to show that my interpretation of my napping patterns makes as much sense as I think it does!

Maybe I should borrow or buy one of those quantified self wristband things . . .

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