What?

A healthy mind in a healthy body

In the first three chapters of this course we have explained the neuroaffective basis of mental health. In doing so, we have discussed both emotional (affective) and somatic (neurology) aspects. In this chapter, we will zoom in on the latter aspect and see how physical health is an integral part of mental happiness. As the old adage says: "Mens sana in corpore sano" — a healthy mind in a healthy body...

For instance, it is a well-known fact that chronic stress can cause a whole host of physical ailments, which can and should serve as warning signs from our bodies that our mental health is threatened. Many people who are under a lot of stress suffer from headaches or migraine, neck or back pain, heartburn or bowel issues, skin issues or acne, and so on. Conversely, it is also very evident that taking care of our physical health, in the form of good sleep, quality nutrition and exercise, are immensely beneficial for mental health.

So while this chapter will focus on fatigue and sleep, we will also discuss aspects of physical health in general as they contribute to alertness and sleep and also (to a lesser extent) to mental well-being in general. Of course, we cannot deal with such complex issues as sleep or nutrition in an exhaustive way. So you should consider the information in this chapter as an invitation for further exploration and research.

Why?

Sleep

The archetypical image of a programmer is that of a night owl. "Someone who turns coffee into code", we sometimes say in jest. And I'm sure there are many developers who do the majority of their work and their best work in the evening or even at night.

However, with only a few exceptions, human beings are genetically wired to be active during the day — specifically when it's light outside — and to rest at night — when it's dark. In other words, the healthy pattern for us is to wake up in the morning, to be active and do our work during the day, and to rest and eventually sleep when darkness comes. This is essential to maintain a healthy circadian rhythm or so-called "biological clock", which helps regulate sleep, but also metabolism, immune response, cardiovascular health and so on. Still, many people seem to resist that pattern (also because of social reasons) only to find themselves struggling with fatigue during the day and/or falling and remaining asleep at night...

So if you do identify as a night owl, even as a programmer, think about whether this really serves you or not. In my experience, night owls are people who not only shift their waking and sleeping hours, but have a lower total number of sleeping hours in general, because they usually don't manage to catch up on their sleep. Moreover, being a night owl does not agree well with a professional life; meetings are often scheduled in the morning, people expect you to follow office hours, ...

The importance of good sleep cannot be overstated. Sleep is truly the foundation of mental and physical health. Conversely, for mental health it is also an excellent warning sign: if you're not sleeping well, there is always a psychological component to that as well.

Energy and emotions

This chapter is about fatigue, or lack of energy. However, it is crucial that we do not neglect the role of emotions either.

To start, the brain uses about 20% of our metabolic energy. This means that emotions — which are in fact processes of the brain — can eat away a lot of our energy. As we saw in the chapter on anger, this can often happen in an unconcious way. So it is vital we become aware of our emotions (fear, anger, grief) and deal with them, if we want to optimize our physical energy. If you spend your day full of anxiety, harbouring anger or guilt, or blocked by strong convictions, it is no wonder that there is little energy left for work, or indeed, your positive affective systems and happiness!

This can serve as an important disclaimer for the tools and protocols that follow. If you try to remedy fatigue or bad sleep with some tips and tricks, but without doing any emotional work, I expect very little to no improvement.

How?

Master sleep and wakefulness

The first thing you can do to deal with fatigue is to have a good look at your sleep. The quality of your sleep and of your wakefulness are really intertwined: having sufficient energy and alertness to function and do work during the day starts with a good night's sleep the day before, and, vice versa, the quality of our sleep is influenced by our daily activities. This happens largely through the balance and the proper timing of the release of epinephrine (adrenaline) and cortisol, which are the wakefulness hormones.

There are two episodes from the Huberman Lab podcast by neuroscientist Andrew Huberman, Ph.D., which really tell you everything you need to know about the neurobiology of sleep and wakefulness, and the actions you can take yourself to improve them. They are more or less interchangeable; the first being a bit more theoretical, and the second more actionable.

I would really advise to listen to one of these podcasts (or both) in full, but here follow five key takeaways.

1/ Light

The first is providing your body with healthy and consistent "light anchors" to set a proper circadian rhythm. Huberman points out the immense benefits of viewing direct, low-angle sunlight in the morning (of course, without hurting your eyes), within 30-60 minutes of waking, for the proper release (and timing of that release) of cortisol (the wakefulness hormone) and thyriod hormones. Do that again in the late afternoon, prior to sunset. Conversely, Huberman also warns against viewing too much light, in particular bright, overhead light, in the evening and particularly at night for proper levels of melatonine (the sleep hormone).

2/ Habits

Wake up at the same time each day and go to sleep when you first start to feel sleepy. Also limit daytime naps, or don't nap at all. Use your bedroom for sleeping only and keep it dark and cool (your body temperature needs to drop for sleep to set in).

3/ Caffeine

Caffeine, the drug of choice for many programmers, is fine for most people (although a few find it too agitating), provided it is used moderately. Avoid caffeine within 8-10 hours of bedtime. Huberman's tip to avoid the dreaded afternoon dip is to delay caffeine intake until a couple of hours after you wake up, so you can shift the moment its effect as an adenosine receptor antagonist (adenosine makes us sleepy), tends to wear off (typically shortly after noon) to a later moment in the day.

By the way, unlike coffeee, alcohol may help some to fall asleep, but it is greatly detrimental to the quality of our sleep. By the way, whether you do or do not drink alcohol at all, is something for you to decide. Personally, I don't — not only because it affects sleep, but also because it poses many other risks for your body, brain and health.

4/ NSDR

Another great piece of advice is the use of NSDR or "non-sleep deep-rest" in the form of, for instance, yoga nidra or meditation. Especially yoga nidra which means "sleep yoga" is a great tool for both resting during the day (e.g. to compensate for lack of sleep during the night) and to better fall asleep in the evening. I really like the yoga nidra scripts by Ally Boothroyd, for instance:

5/ Supplementation

Finally, there's certain supplementation you could consider taking, preferrably only after you try the above techniques and discuss them with your doctor first. These include magnesium threonate or thianine, but beware of melatonine as commercial dosages tend to be unreliable (much less or, worse, much more than indicated) and melatonine can influence the functioning of our sex hormones. You might also want to look into ashwaganda which helps lower cortisol.

Nutrition

It is fairly obvious that what we consume will have a direct influence on our wakefulness. Most people will know from experience that large helpings of starchy carbohydrates make you drowsy. On the other hand, the data supports that a light meal that is rich in proteine, is probably ideal for alertness and focus.

Intermittent fasting

Intermittent fasting is an increasingly popular diet whereby you delay eating for a certain period of time. For instance, many people eat in a 8/16 hour split, e.g. only eating from noon till 6 p.m., and fasting the rest of the time. Consuming beverages, including those with caffeine, is allowed during the fast. Some advocate more moderate (12/12) or extreme (4/20) splits, but the benefits of intermittent fasting seem relatively unrelated to the number of hours you fast.

What matters is that intermittent fasting is a good tool for increasing focus (along with a number of other benefits), provided you can practice it in a sustainable way. It is not uncommon to feel a little weak when first starting intermittent fasting, but if you find this persists, or if you find you're having trouble keeping your weight stable, I would advise against it, or at least to consult your doctor before continuing!

Intuitive eating

The danger with something like intermittent fasting, and with many other health protocols, is that for control-minded people like IT professionals, they can become a goal by themselves, instead of a means towards an end.

While fasting has benefits, it is still important to listen to your body and acknowledge its varying needs. This is why it is also interesting to look at the approach of intuitive eating, whereby you simply listen to the body's cues of hunger and satisfaction and foster a positive relationship with food.

Eating when you're hungry and stopping when you're satiated seems like a simple protocol, but in reality many people will find it challenging. This in itself is a valuable therapeutic tool. Reflecting on when, how much and which food you eat, will help you uncover emotions of fear and anger that probably stand in the way of more than your physical health or energy. Indeed, coping with your emotions without food is one of the guidelines of intuitive eating.

Exercise

We all know that regular exercise is beneficial for our health, our energy levels and the quality of our sleep. Moreover, there are many studies that link exercise with improved mental health. The phrase "sitting is the new smoking" may seem dramatic, but the research really does show that people with sedentary professions, like IT workers, are at risk for a number of health issues such as obesity, diabetes, cardiovascular diseases or orthopaedic disorders. Perfect programmer posture has literally become a meme...

Apart from sitting breaks, trying a treadmill or standing desk, regular exercise is a key factor in avoiding the risks of this sedentary behaviour. However, as with nutrition, I would also warn against taking things to the extreme and putting too much strain on your body. Strength training like weightlifting, for instance, is often praised as an excellent type of exercise, with not only benefits for general health and fitness, but also improved focus, immunity and hormonal health. On the other hand, I know from experience that intense weightlifting can be hard to recover from for your nervous system and raises your cortisol levels, which may lead to feeling stressed and cause trouble falling asleep. Moreover, beware of the dangers of perfectionism than can be triggered by the progressive overload that strength training includes.

This is why I think that low to mid-intensity aerobic exercise is better suited to offset sedentary behaviour than anaerobic strength training. Things like hiking, jogging, softball, tennis or padel are excellent examples — especially those that also include an aspect of competition and playfulness! As with nutrition, it is also important to find a type of exercise that is not only good for you, but you also enjoy and can integrate consistently in your schedule.

Cold exposure

Deliberate cold exposure, often done through cold showers or ice baths, can positively affect brain and body. In the morning, they can help you time your daily cortisol release and studies have also shown significant and prolonged (i.e. continuing after the exposure) release of dopamine, which helps with motivation, and (nor)epinephrine, which increases energy and focus.

If you want to try cold exposure yourself, here's a few guidelines:

never get into a dangerous body of water
start slow to avoid cold shock
temperature does not really matter, as long as it's "uncomfortably" cold
start with short bouts of 1-5 minutes
keep still (physically) and calm (mentally) while in the cold

Breathing

In the chapter on stress we have already discussed the power of breathing for stress relief. This is especially true for nasal breathing, which stimulates the vagus nerve, a key regulator of heart rate and autonomic balance. This activation promotes a state of calmness and relaxation.

However, there are more benefits to correct breathing than just stress relief. Nasal breathing allows for efficient oxygenation of the body. Unlike the more shallow and rapid mouth breathing, breathing through the nose facilitates a slower, deeper breath. This creates better oxygenation, which enhances mental clarity and focus, and can improve memory, attention span, and information processing abilities.

This is why engaging in a simple routine, like practicing regular, deliberate, mindful nose breathing for a few minutes every day, can enhance our ability to concentrate, think critically, and maintain mental acuity.

Digital balance

A final topic to discuss when it comes to fatigue and general (mental) health is the way we consume digital media. Of course, for IT professionals are spending a substantial part of their day using digital devices. For many, this is not only true for their work day, but also for their time off, when they pursue hobby projects or maybe engage in activities like gaming or watch movies and such.

We have already mentioned in the chapter about stress that such behaviour is not well-suited for primary stress relief. Here we can also add that when it comes to managing fatigue, you should definitely also take into account the energy you spend on pet projects. Even if you enjoy such work a lot, it is still work that actively engages our prefrontal cortex and the dopamine pathways (dopamine is the metabolic precursor of adrenaline). So it is probably not a good idea to engage in these thought- and attention-provoking activities immediately before or close to going to bed, when we should ideally activate our rest- and digest system.

The same goes for using social media, which actively takes advantage of the fact that negative content elicits more user engagement than positive ( doomscrolling). In this way, it is a subtle cause of stress and anxiety that many people are unaware of, and should be avoided close to bedtime. Stress releases cortisol and cortisol blocks melatonine, which we need to fall asleep.

The best thing is to shut off all devices and put away your phone at least one hour before bedtime. Even during the day you can ask yourself whether you really need to be checking work e-mails, Trello, Slack or Jira on your phone. You might object that you need to be standbye in case there is a problem, but if you have to use your phone (during your commute, at lunch, ...) instead of your computer, are you really in the best position to do something about the issue? Maintaining a health work-life balance can start with something a simple as not using your private phone for work...

Beware of the rules!

As a final piece of advice I would warn you against thinking about the above protocols as rules you need to follow. Rules are the stuff of control and perfectionism, which are avoidance strategies and take us away from self-love. Whether it is intermittent fasting, cold exposure or exercise, the moment these practices become a burden or an obligation they actually do more harm than good for your mental health, and physical health! That's right: the same thing that can be good for mood, focus, energy and immunity, can have the adverse effect once you start dreading what you are doing or lose motivation.

This is because the cortisol that all of these induce can cross the blood-brain barrier and therefore feed stress and anxiety (in the brain), rather than optimizing alertness or immunity (in the body). Adrenaline cannot cross this barrier (we call adrenaline in the brain epinephrine). This means that it is perfectly possible, biologically speaking, for you body to feel excited (adrenaline) but your mind to be calm, whereas it is quite challenging for your body to be stressed (cortisol) while keeping your mind happy!

Exercise

For this week's exercise, I want you to schedule two doctor's appointments — preferrably with your own general practitioner. If you do not have a general practitioner or another health care professional who sees you regularly, now might be a good time to get one so you can start building a relation of trust with someone who will keep track of your medical history.

Now you might think "I don't feel sick, why would I need two doctor's appointments?". The thing is that, if you are taking a course on mental health and thinking about things like fatigue and energy, this is really something your doctor should know. There will be a particular reason you became interested in this course; perhaps you feel overly stressed or have trouble sleeping? Maybe you're wondering if you're experiencing depression or burnout. These are things your doctor should know. Moreover, talking to a health care professional about them, will help you take these warning signs seriously.

First appointment

Use your first appointment to inform your doctor about your current state of mind and about any physical complaints you might have. As we have seen, chances are that both are in some way or another related. Ask for a full physical examination (blood pressure, weight, heart sounds, ...) — some practices allow you to book a "long" consultation, so you have enough time to raise your concerns.

If possible, you should also ask to get blood work done. This is always indicator of what is going on in your body at the moment and it can warn you about deficiencies or other anomalies. If you feel the need, now is also a good time to talk about changes in your exercise, nutrition or supplementation routine.

Don't forget to talk about your mental well-being either. Do you sometimes worry about your mental health? Do you feel depressed or burned out? Do you have questions about therapy or need a referral? Now is the time to raise these issues and a chance to get professional advice!

Second appointment

The second appointment is perhaps even more important than the first. You can choose to book it close to the first, so you can discuss the results of the blood work. If possible, however, I would try to get the results over the phone and book the second appointment a couple of months after the first. The idea of this follow-up appointment is mainly to monitor your improvement and this takes some time. Ask you doctor to help you reflect on what has changed in your mental and physical state since the time of the first visit. Are you still experiencing as much stress as before? Has your sleep improved? Have you succesfully integrated an exercise routine in your week? And so on.

Inspiration

This chapter, even more than the others, is only a brief introduction to some very large topics like sleep, energy, focus, nutrition, exercise and so on. These are all issues that you can spend a lifetime educating yourself on. The following resources can help you direct your further explorations: