Friday Q&A: sleep tracking apps; chronic pain; appetite suppression from GLP1s; & baby aspirin

Keep the questions coming 👏

ICYMI 👉

• What Does a "Good Death" Actually Look Like?

• Are You Getting Enough Rest?

• The Downsides of Ozempic are Real

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Can I trust the “sleep quality” measurement from my sleep tracking app?

• What are some options for chronic pain besides just adding more medications?

• How much can I trust signals from my body when I’m taking GLP-1s?

• Is daily aspirin worth the bleeding risk for someone like me with family history of heart disease?

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Photo by Solen Feyissa on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: ACCURACY OF SLEEP TRACKING APPS

I've been using a sleep app from my smart watch that says I'm only getting 20 minutes of deep sleep per night. I wake up tired most mornings even though I'm in bed for 8 hours. I'm 49 and wondering if I should do a sleep study, or if these apps are just making me anxious about normal sleep.

-Jennifer

Hi Jennifer,

You're asking exactly the right questions. Consumer sleep apps and wearables are notoriously inaccurate when it comes to measuring sleep stages, especially deep sleep. These devices use movement and sometimes heart rate to estimate sleep phases, but they can't actually measure the brain waves that define true deep sleep. That requires specialized equipment used in sleep labs. I've had patients develop real insomnia from obsessing over their sleep scores!

The more important question is why you're waking up tired despite eight hours in bed. At 49, hormonal changes from perimenopause could absolutely be disrupting your sleep quality. Other common culprits include sleep apnea, medication side effects, caffeine later in the day, or even stress that doesn't let your mind truly settle.

A sleep study might be worth considering if you have signs of sleep apnea—like loud snoring, gasping during sleep, or morning headaches. It's also reasonable if you've addressed other factors like cutting caffeine after 2 PM, creating a cooler bedroom environment, and managing evening screen time without improvement.

In general I suggest focusing less on what the app says and more on how your body feels—then discuss this with your doctor. Sometimes the most helpful thing is to step back from the technology and tune into what your body is actually telling you.

QUESTION #2: MANAGING CHRONIC PAIN

I've been dealing with chronic pain for two years since a car accident. My doctors keep offering more medications, but I don't want to become dependent. What other options should I be exploring?

-Michelle

Hey there Michelle,

Your concern about medication dependency is completely valid and reflects thoughtful self-advocacy. Two years of chronic pain after a car accident has likely changed your nervous system in ways that go far beyond the original injury, and simply adding stronger medications often isn't the most effective long-term solution.

Chronic pain that persists beyond a few months can become its own neurobiological condition, affecting sleep, mood, stress hormones, and inflammation throughout your body—which means it can become complex condition that responds best to multi-pronged approaches beyond just medications.

Of course for specific advice you should talk with your doctor. But you might consider pain rehabilitation programs that combine physical therapy designed specifically for chronic pain patients, cognitive behavioral therapy to address the psychological dimensions of pain, and gradual activity pacing to rebuild strength without triggering flares. Many patients also benefit from approaches like mindfulness-based stress reduction, acupuncture, or massage therapy. Sometimes medication optimization actually means reducing certain prescriptions rather than adding more. I hope that helps!

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QUESTION #3: INTERPRETING BODY SIGNALS ON GLP-1 MEDS

I've been on Wegovy for 8 months and lost 35 pounds, which is great. But lately I've been feeling kind of depressed and my appetite is so suppressed that I sometimes forget to eat until dinner. My doctor says to just 'listen to my body' but my body seems to be saying 'don't eat.' Is this normal or concerning?

-Rachel

Hello Rachel,

Your concerns are absolutely valid. While Wegovy can be a powerful tool for weight loss and metabolic health (as it has been for you!), your symptoms suggest it may be time to taper down the dose.

GLP-1 medications like Wegovy work by affecting dopamine receptors in your brain and slowing digestion to help regulate appetite. For many patients, this creates a healthier relationship with food—they eat when hungry, stop when satisfied, and aren't constantly thinking about food. But forgetting to eat entirely until dinner isn't the goal, and depression as a side effect needs attention.

Your body still needs regular nourishment throughout the day, even if you don't feel hungry. When we don't eat adequate meals, our blood sugar spikes from stress hormones trying to compensate, and by evening our insulin resistance worsens. This feast-or-famine pattern can actually work against your health goals and contribute to mood problems. Maybe you don't need an antidepressant—maybe you just need lunch!

Talk to your doctor about adjusting your dosage. You could also start setting phone alarms for regular meals, focusing on protein-rich foods to stabilize your mood and energy. The medication should help you have a healthier relationship with food, not eliminate your relationship with food entirely. Thanks for this important question!

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QUESTION #4: RISKS & BENEFITS OF BABY ASPIRIN

My cardiologist recommended baby aspirin for heart protection - I'm 62 with mildly elevated cholesterol. But a friend had serious bleeding issues from aspirin and now I'm nervous. My father had a heart attack at 68, so I'm really torn. How risky is this daily aspirin for someone like me?

-Robert

Greetings Robert,

This is exactly the kind of medical decision where both the benefits and risks are real and need careful consideration. Your friend's bleeding experience isn’t uncommon—aspirin increases the risk for bleeding, particularly in the stomach and brain. But for someone with your risk profile, the question becomes whether the cardiovascular benefits outweigh these bleeding risks.

Your family history of heart attack at 68 is significant and factors into this equation. Combined with your mildly elevated cholesterol at age 62, you're not in the lowest-risk category where aspirin's benefits might be minimal. The evidence shows that for people with your risk factors, daily low-dose aspirin can reduce heart attack and stroke risk by about 10-15%. That sounds modest, but it represents real protection.

The bleeding risk is typically around 2-3 additional serious bleeding events per 1,000 people taking aspirin annually. Most are gastrointestinal bleeds that, while serious, are generally more treatable than heart attacks. The risk is higher if you have a history of ulcers, take other blood-thinning medications, or have H. pylori infection.

Here's what I'd suggest: have an honest conversation with your cardiologist about your specific bleeding risks. Ask about whether you've been tested for H. pylori, discuss your other medications, and consider whether you're taking NSAIDs regularly. Some people at higher bleeding risk might benefit from a stomach-protecting medication if they take aspirin.

This decision ultimately comes down to your personal risk tolerance—what feels acceptable to you. Some patients in your situation readily accept the small bleeding risk to protect against heart attack, while others prefer to focus on aggressive cholesterol management and lifestyle approaches. Both are reasonable choices when made with full information.

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

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ICYMI, check out my recent Q&As on:

• Statins and dementia; too much protein?; when to have joint replacement surgery; & timing of blood pressure meds

• Managing blood sugar and cholesterol; heart health for women; when to get a DEXA scan; & fueling adequately on a vegetarian diet

• Starting a statin; improving balance; cardiac calcium scan necessity; & side effects of osteoporosis drugs