Creating a Self Administered Sleep Scale

INTRODUCTION
These last few weeks have been a symphony of horror when it comes to sleep. I thought I had this nailed down, but in getting back from Spain from the States my sleep quality and quantity has been all over the place. This negatively affects almost every other habit I have, and it's a problem I've had for a very long time.

There are many variables I'd like to test out. The biggest problem I've encountered is finding a good metric that I can test variables against. A quick search resulted in this great overview. It outlines several scales, including:

  • The Medical Outcomes Study (MOS) Sleep Scale
  • The Insomnia Severity (IS) Index
  • Pittsburgh Sleep Diary (PghSD)
  • Pittsburgh Sleep Quality Index (PSQI) Instrument

What I want is a simple self-administered scale (just like the SRHI for habit formation) that I can use as a base to deliberately test out behaviors to see what will affect my sleep. There is so much advice out there, but almost none of this is systematically tested. I've also had several friends who have gone in for sleep studies only to get vague advice in return, usually related to sleep apnea. 

EVALUATION OF SCALES
I found that the Pittsburgh Sleep Diary (PghSD) and the Pittsburgh Sleep Quality Index (PSQI) Instrument both include too much detail and contain behavioral questions that I want to test out personally (how much alcohol did you consume, etc). I found the Insomnia Severity (IS) Index more feeling-based and difficult to assess with any accuracy over stretches of time. I found the Medical Outcomes Study Sleep (MOS) Scale good if applied to a week rather than the 4 weeks time periods questions were based on. The best thing I found was one section of the PSQUI on Habitual Sleep Efficiency (HSE). HSE is a simple weekly percentage:

# hours slept/# hours in bed X 100

I find this very elegant, but it does not assess quality of sleep. 

QUALITY OF SLEEP
Several questions spread out across multiple scales addressed sleep quality, so I decided to just collect them all irrespective of scale. Some had to do with daytime dysfunction (naps, sleepiness, alertness, enthusiasm), sleep disturbances (how many times did you wake up), and sometimes data collected from sleeping partners. 

Many of these questions dealt with quality of sleep during a month. Personally, I believe that remembering a month of sleep is not only inefficient, but highly inaccurate - I have problems remembering what happen a few days ago. That being said, I believe that assessing variables based on on one week would speed things along. Under the Likert-type scale, answers are based on sliding strengths of opinion. The SRHI is a great example of this with it's 7 point answer system, though many of the sleep scales have a 5 option system.

COLLECTING QUESTIONS FOR SLEEP QUALITY
Here are some questions I collected. I include this to show examples of not only the types of scales but how to potentially create self administered scales in the future, as I find them highly useful in productivity and personal development.

(All of the time/most of the time/a good bit of the time/some of the time/a little of the time/none of the time = 1, 2, 3, 4, 5, 6)
How often during the last 4 weeks ...

...did you feel that your sleep was not quiet (moving restlessly, feeling tense, speaking, etc, while sleeping)? 
...did you feel that you got enough sleep to feel rested upon waking in the morning
...did you feel drowsy or sleepy during the day
...did you awaken during your sleep time and have trouble falling asleep again
...did you have trouble staying awake during the day
...did you take naps during the day
....did you get the amount of sleep you needed

  • From the IS Index:
    (0 = none, mild = 1, 2=moderate, 3 = severe, 4 = very severe)

-difficulty staying asleep
-how satisfied/dissatisfied are you with your current sleep pattern?
-how noticeable to others
-how worried/distressed are you about your current sleep problem
-to what extend do you think your sleep problems interfere with your daily functioning - fatigue, mood, ability to function at work daily chores, concentration, memory, mood

  • From the PghSD:
    (specific numbers/written descriptions)
    -how many naps?
    -how many times did you wake up during the night?
    -different types of waking up?
    -sleep quality - very bad, very good - whole scale between
    -mood on final awakening
    -alertness on final awakening
     
  • rom the PSQI:
    How many times do you...
    -wake up in the middle of the night or early morning
    -have to get up to use the bathroom
    -overall sleep quality
    -trouble staying awake while doing things during the day
    -enthusiasm to get things done 

NARROWING DOWN SLEEP ASSESSMENT QUESTIONS
I went through these and narrowed them down and modified them. There were several problems with this. First, I had to include multiple elements to the scale. The SRHI doesn't just include length of time with respect to habit formation. It includes length of time, automaticity, identity, etc.

Secondly,  the all had to be scored similarly. Some were on a 5 points scale, others were specific numbers (how many times did you get up during the night?). If there were differences, different types of questions would have greater or lesser weight. This seems really obvious, but I didn't think of it at first, and I think it's just something to remember in the future when creating metrics.

Thirdly, I had to figure out what time frame the questionnaire would be based on. Most of the exams I pilfered questions from were for a month. I don't think this is very accurate - I certainly don't remember my sleep patterns after a few days. So I'm going with a daily assessment with a weekly average in order to test out variables for a week. 

A MODIFIED SLEEP QUALITY INDEX

  1. [Sleep quality at night] How severe was the restlessness of your sleep?
    0=Very Severe, 1=Severe, 2=Moderate, 3=Mild, 4=None
  2. [Morning] How well rested do you feel in the morning?
    0=Exhausted, 1=Not Rested, 2=Moderately Rested, 3=Rested, 4=Energized
  3. [Rested, next day] How often do you feel drowsy or sleepy during the day?
    0=Incredibly drowsy, 1=Quite Drowsy, 2=Somewhat Drowsy, 3=A little drowsy, 4=Not at all
  4. [Sleep quality] How often do you awaken during your sleep and have trouble falling asleep again?
    0=Every Day, 1=Several Days, 2=A Few Times, 3=Once This Week, 4=Never
  5. [aps] How often do you take naps during the day this week?
    0=Every Day, 1=Several Days, 2=A few days, 3=Once a Week, 4=Never
  6. [General] How often this week did you get the amount of sleep you need?
    0=Never, 1=Once, 2=A Few Times, 3=Almost Every Day, 4=Every Day
  7. [Functioning] To what extend do you think your sleep problems currently interfere with your daily functioning?
    0=Every Single Day, 1=Almost Every Day, 2=A Few Times a Week, 3=Once, 4=Never

CONCLUSION + FIRST TEST
Right now, I see my sleep scale to be comprised of both the Habitual Sleep Efficiency (HSE) and the above modified sleep quality index. My intention is to take both every day to be averaged for the week. I'll be doing a controlled test this week, just to see how it works and the ins and outs of taking it. I'll check to see if some elements need to be modified.

Yesterday just happened to be a day that I had a particularly bad night's sleep. Since I already have a habit of sleep recording, it was pretty easy to figure out my HSE.

HSE = Total Hours Slept  (6) / Total Hours in Bed (11) X 100 = 54.5%

Sounds about right.

My, for lack of a better label, "Sukumaran Sleep Quality Index" was a little more difficult. Here were my results:
1. 0
2. 0
3. 0
4. I got up once
5. I took one nap
6. 0
7. 0

Numbers 1-3 were simple. Questions 6 and 7 could be modified to read "Did you get the amount of sleep you needed today?" and "To what extent did your sleep interfere with your functioning today?" respectively. Questions 4 and 5 were weird because though getting up once might be considered a medium response on the Likert scale, repeatedly having to get up over a week might result in a worse score. For question number 5, for a daily question my answer would most likely be binary - either I took a nap or I didn't. Added up for the week would result in a number that means something. So it's really difficult to take the scale accurately for a day.

It might just be best to keep all of this information, plus side notes - like the number of times I feel drowsy during the day (yesterday's total count was 32, tracked with my handy hand tally counter) - in a specified document, or appended to my daily log.


 

Towards A Master Writing Program

The last few weeks I’ve been under a lot of strain in terms of writing. It’s given me some additional clarity.

NaNoWriMo has honed my ability to bust out a first draft in record time. But that’s not enough. I see writing mastery as a linear game.

Level 1 - Draft Writing
Level 2 - Rewrite 1 - order, transitions
Level 3 - Research
Level 4 - Rewrite 2 - Word choice, how things are said, scamping
Level 5 - Proofing.

Various websites, including THIS one, divide the process into revision, editing, and proofreading, but I’ve seen it described in other ways as well.

This relates to an article I know how to do. This would change depending on the essay’s purpose. For example, writing a story is different than writing a pitch. A story may not need research per se, but may need more depth in regards to character development or world building. So this order might be altered in different scenarios, but generally the conception seems useful so far.

This NaNoWriMo I was under a huge time constraint and writing a draft was particularly painful. I found that in doing 20 (rather than standard 25) minute Pomodoros, I was able to consistently output 1,000 words per session for 3 sessions, after which I needed a break. I feel pretty damn good about that.

I found that in a more recent article, the pain period arose with the rewrite rather than the draft. And the same exact emotional problems arose: the need to do it all at once and the need for it to be perfect. In my mind at the time Levels 2 through 4 were jammed together. James Patterson’s Master Class sneak peak got me past that.

I also found that the pain of editing was very high. I noticed a pattern, that for every 20 minute Pomodoro editing session I paused at 12 or 13 minutes. That pause would break my concentration, and the remaining 7 minutes would be incredibly draining. It really reminded me of what I’d read about Flow states - that keeping in them requires constant positive and progressive stimulation. I appeared to go into mini flow states while working, but jump out of it at  around 13 minute mark.

At this point I didn’t seriously think anything of it. But I decided to experiment to see if anything changed if I instead did 13 minute Pomodoros. The results were quite staggering.

I was able to easily do 6 or 7 sets. I was able to more readily bypass the pain and work forward. I could go longer at a higher level of concentration, even if I didn’t pause after the alarm in order to take a break. It really reminds me of my breakthrough with waking up early - it’s not the alarm that wakes me up since I usually wake up close to an hour before it. It’s the act of setting the alarm and recording my sets that makes a mark on my mind.

I was also eager to squeeze in a Pomodoro even when I didn’t have much time, because, hell, it’s only 13 minutes, right? That is an incredible difference from constantly putting off the work. My failure to start issues evaporated.

It makes me feel, perhaps prematurely, that I’ve nailed the next level of writing. In the last few weeks it caused me to take more assignments than I thought I’d be able to do (what with jet lag and travel), and complete them successfully on a deadline.

There are a few other questions and points going forward.

I’m curious how this affects other levels. Research is the next lull I experience in my writing, and it’s something that I believe requires a strict cut off point, which is slightly different than simply recording 13 minute Pomodoros.

Other techniques, like scamping and a thesaurus at the ready with sentence wording and rubber duck decoding for proofing should be a default. For more complex articles, I’m also having problems with keeping transitions and open loops all in my head, and am testing out an idea that involves a distilled symbolic logic notation - like a programming language - to concisely summarize prose. That way I can easily see the global progression of an article complete with themes and specific transitions. It has still has a lot of kinks, but I hope it will really come in handy for the revision level.

Metrics really help with all this - knowing I can do 3,000 words in a rough draft per hour is relieving in its predictability. I don’t really have that with the other levels involved in completing a piece - yet. It’s something I should perhaps measure. I’m beginning to think I should keep a writing master log so I can better assess this.

This master plan also does not address skill pushes for other types of writing. I believe this is where classes come into play, replacing the role challenges play in other habits (or NaNoWriMo did for me with the draft level). Luckily there are plenty of resources -  I am taking a Gotham class on querying next month, and I’ve already bought the full James Patterson course for Lydia that I’d like to go through as well. The same goes for the specific Holly Lisle courses.

The point of all of this is that often enough knowing where you’re going takes so much of the stress out of endeavors. I often feel totally lost with writing, and have a sneaking suspicion that there really should be a more efficient way to progress in the skill - when I’m not drowning in panic. I think this is the beginning of such an efficient progression.

Seeing the Forest: The Importance of Metrics in Preventing Blindness in Self Improvement

I’m approaching almost 2 years of recording my habits with the SRHI.

One thing I’ve noticed is that it’s really difficult to see how much I have improved when I’m constantly working on these tasks. In the midst of all this detailed tracking, it’s easy to lose track of the larger growth. You can’t see the forest for the trees.

When you can’t see the big picture, you feel like you’re in a never ending slog, where no matter how hard you try, you cannot prevail. And that can cast a long shadow on the entire endeavor. And that shadow is a really bad thing because the emotional equilibrium is a huge part of long term habit formation.

The truth is that every foot gained is a success. And that’s where good metrics come in. A metric allows you to actually consistently prove to yourself that you are making progress. And it is something I feel we are all horrendously bad at.

I know that the best metric tool for meditation is a stop watch. Yet it took me forever to actually obtain one. I know that the best metric for fat loss is regular measurements of my body. But I constantly avoid doing it.

I’ve talked to several people about this and it seems to be a constant problem when people start a new behavior. I mentioned this in a previous post (Day 651 & The Little Details Make all the Difference - Metrics and Implementation Intention) where I extract a maxim:

Tools and data pertaining to metrics are invaluable to self improvement, but are almost always forgotten

But it’s more than that. I just talked to Lydia and she described how she decided this week to start using a stop watch to counteract stalled progress in meditation. Instead she just hasn’t meditated this week.

There’s something in us that doesn’t just overlook metrics - we go out of our way to deliberately NOT do it.

Counteracting this strong subconscious protocol requires us to bounce back hard.

I remember when I first started this project it was so difficult to keep track of my habits - I had to force myself to record them, and that one habit managed to make a world of difference. Perhaps a similar protocol is required for metrics.

My reworked maxim for metrics is now:

Tools and data pertaining to metrics are invaluable to self improvement, but are almost always willfully omitted.