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This concern would always be there with questions of patient noncompliance, but this study design in particular lends itself to this type of error

Dietary modifications can significantly reduce gastrointestinal side effects that interfere with sleep: Eat smaller, more frequent meals rather than large portions Avoid heavy, fatty, or spicy foods in the evening Finish your last meal at least 23 hours before bedtime Stay well-hydrated throughout the day but limit fluids close to bedtime Identify and avoid personal trigger foods that worsen nausea or reflux Sleep hygiene practices remain fundamental for quality rest, as recommended by the NHS: Maintain a consistent sleep schedule, going to bed and waking at the same times Create a cool, dark, quiet sleeping environment Limit screen time for at least an hour before bed Avoid caffeine and alcohol in the evening Engage in relaxing activities before sleep, such as reading or gentle stretching Managing nausea specifically may involve eating plain crackers or ginger biscuits, sipping ginger tea, or using acupressure wristbands

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instead, it may reflect an early adaptive inflammatory phase within a broader reparative trajectory 50