Case study: insomnia through a Functional Lens, part 2
BY: Andrea Nakayama
DATE: 2019-03-19
Last week you met our Functional Nutrition Alliance Clinic client named Shelly. (You can read more about Shelly’s case here.)
Before I bring you back to Shelly’s story, I have a confession to make…a confession about me and case studies. If you’re a reader, like I am, you probably often see case studies written up in side-bars or in little isolated boxes on the page.
They’re written through the lens of: problem → remedy → solution.
Yet I don’t believe cases are that simple (and I trust you recognize this as well.)
In fact, these case studies always leave me with more questions than answers!
A case is a human being sitting before us with a unique story, set of physiological impacts, life habits, patterns, situations and efforts, that all add up to the point that brings them to us for support today.
And to study is to examine, analyze, contemplate and learn. In order to study, we need to get curious.
Based on this thinking, a case study is more like a novel! Or a hero’s journey. It’s not a sidebar.
What that means for Shelly’s case is that we’re with her on her journey to learn more about her body. We want to assess her physiological influences and burdens, as well as understand her emotional state, so that we can make the appropriate recommendations.
We also want to work with her to educate and elucidatewhat’s going on inside of her biological ecosystem so that she can shift her mindset from the desire for the quick-fix that may be promised by someone’s blog or a Facebook ad (those things outside of our own experience that yank at our collective yearning for the often elusive results we want), and move towards the “I” or the internal.
In other words: What is true for Shelly (based on what we know today)?
Functional Nutrition Approach to Insomnia
In our Nutrition Counseling, there were factors we were able to address with Shelly from the very first session which led to results. Again, you can review the initial details of her case here.
You’ll see those factors (yes, a washcloth over the alarm clock!) may not be sexy, but they work!
In fact, Shelly is doing much better in just a few short weeks with the changes we made. She’s waking up less often and even feels more energy through the day. That said, the belly fat she’s concerned about hasn’t yet budged. Fortunately, Shelly is not fixated on it because the renewed energy and improved sleep are giving her more impetus to get to her Barre class.
As you may recall from my previous post about Shelly’s case, the first two steps to a Functional Nutrition approach are 1) Assess and 2) Recommend.
Step 3: Track
Using our Functional Nutrition Alliance tracking tools, Shelly has tracked her progress throughout our work together. Here are the updates after one additional session with Shelly following the initial recommendations:
Shelly moved her bedtime to 10:30pm. She notices that she sleeps more soundly through the night when going to bed at 10:30 instead of 11:00, and she’s willing to experiment with getting to bed even earlier.
Shelly has trialed a few nighttime snacks. She notices that a small “fat bomb” the size of a donut hole (something with a good combo of fat, fiber and protein), works best for her. She’s doesn’t feel full and is sleeping more solidly through the night.
Shelly brought in the two new nighttime nutrients (one at a time to start) and is enjoying the results of them both. She now fondly refers to them as her nighttime cocktail! We started with just 3 drops of the Passionflower Vine extract (start low and go slow) and she’s found that 6 drops works best for her.
And there is no more glowing light in her bedroom room. Shelly’s husband has agreed to cover the alarm clock and, if Shelly does wake in the night (which is only happening about once a week now, for reasons we’ve been able to identify), she avoids turning on any lights or checking her phone.
Fortunately Shelly knows how important sleep is for all of her other health goals and concerns! (As a retired RN and Health Coach, she’s a highly educated client, so she’s not looking to bypass this key step in healing.)
But we have to remember that the Non Negotiables include a Trifecta—sleep, poop, and blood sugar balance. Of course the aspects of the Trifecta are intricately intertwined. As we learned with Shelly’s intermittent fasting efforts during a time of added stress, blood sugar dysregulation can lead to sleep issues, and sleep issues can lead to elimination issues. Imbalances in each area can become a catch-22, leading to challenges in the others.
So while we continue to work on sleep (like asking Shelly to push her bedtime back that extra 30 minutes to 10:00pm), we also take the next steps in Tracking.
We review Shelly’s serum labs, using our Lab Tracker. Due to a consistent increase in her liver enzymes that suggests her liver and protein digestion could use some support, we introduce a P5P (B6) supplement to her nighttime “cocktail” and bring in some fermented apple cider vinegar in water before meals. (These help with both the concerns, respectively.)
We also ask Shelly to introduce our
The tracker has an area to loosely monitor sleep as well, so we’ll have all the data we need in one place.
You see, the fact that Shelly’s belly fat isn’t budging tells us there is more information to uncover and assess. (We Assess, Recommend, Track, and Repeat.)
While we suspect we may want to do some urinary hormone testing, we decide to hold off on that for now. There’s still plenty we can do and regulate before we take on that added expense. (We have to remember that Shelly’s husband recently lost his job, and funds are a little tighter than usual. We’re thinking through the lens of Empathy here, and Shelly is grateful for this understanding!)
Several days of Blood Sugar Tracking will tell us quite a bit about where to go next.
Therapeutic Partnership
And here’s the thing to note: Shelly is so grateful to have someone who is really in it with her as she navigates this sometimes tricky and emotional terrain.
She is getting the support she needs while being under stress, and also getting the education that helps her understand her body better. As a side benefit, both the education and support she’s receiving for her own issues help her to be a better coach with her clients! Win-win.
And with all the support she’s receiving—dietary and lifestyle recommendations, as well as the emotional support of knowing someone is in the details with her, helping her to determine what is needed—Shelly is able to tap into her innate resilience. She notices that, in addition to experiencing relief from her primary complaints, her body and mind are feeling the positive side benefits of her work. She’s happier, has fewer mid-afternoon slumps, more overall energy, and less arguments with her husband.
Plus, she notices that the long-lost sparkle is back in her eyes.
But it doesn’t end here. We will continue to work with Shelly…because that’s how we do a case study. We remain curious.
What sets Functional Nutrition Counselors apart is that we’re not just looking for a quick fix. (If there is one, we’ll take it. But we also know how to recognize when that isn’t an option.) Instead…
We take the time to build a .
We have a depth of assessment tools that are unparalleled.
We make recommendations that are feasible to the client in her current life situation rather than requiring a large and expensive battery of tests and supplements.
We continually track changes so that our recommendations follow the scientific method.
We continually look through the lens of the 3 Tiers to Nutrition Mastery, ensuring that we’re not bypassing key Non-Negotiables and Deficiencies in search of the Dysfunction isolated from those factors (because it’s not isolated!)
And we don’t give up. Because there is always something you can do to help your client feel better.
Working Functionally means we’re not just going for remedy. We’re going for resolution.
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Case study: insomnia through a Functional Lens, part 1
By: Andrea Nakayama, FxNA Founder & Functional Medicine Nutritionist
Functional Nutrition Alliance provides the comprehensive online Functional Nutrition training in the Science & Art of the Functional Nutrition practice. Learn to address the roots of your clients’ suffering with client education, diet & lifestyle modifications.