What jumps out at me is your osteoarthritis. It is well known that Vit D3 facilitates absorbtion of calcium into the bones and prevents or relieves osteoporosis and arthritis...along with a wheat free/gluten free/sugar free diet....which apparently you have dialed in...judging by your lipid profile. Congratulations.

I also know that Vit D3 supplementation can alleviate aches and pains fibromyalgia.

I do recall I saw somewhere that fruit intake seems to be corolated with arthritis because of the fructose.

I am surprised that you have not seen any improvement in your arthritis by the elimination of wheat & sugar products. Be sure you are not consuming any psuedo sugars ala aspertame or any of the other chemical sweetners. Our bodies recognize these as sugar and mess with our blood sugar levels.

For post menopausal, I would be surprised if you really need to get your BF less than 16.5.

As you have identified, sleep deprevation certainly can lead to attention-learning problems. What helped me somewhat is doing tabata wind sprints...going all out running for 20sec and then rest for 10sec and then repeating 8 times. Total workout time 4 min. Do you have that much time in your day? Just three days a week. Such high intensity short duration activity tends to alleviate cortisol problems...which can cause sleep problems.

Also, are you sure you do not have sleep apnea. I used to think that only overweight people had sleep apnea because of lots of fat in and around the airways. But I know one relatively thin healthy person with sleep apnea. Getting diagnosed and getting a CPAP probably saved his life. Sleep apnea starves the body of needed oxygen and weakens the heart muscle and can lead to a coronary heart event.

You have done a great job so far. Keep the n=1 experiment going in your journey to good health.

Have you tried eliminating nightshades? Some people report problems with those.

I would not try to lose any more weight. At 16.5 percent body fat, you are in the lower range of healthy for a woman. If anything, I would try to build more muscle to take some of the impact off of your joints.

Also, you mentioned you're keto-adapted. Have you tried adding some starch in? Potatoes, sweet potatoes, or white rice might be good to play around with to see if it makes a difference.

Keep playing around with your sleep. I'm sure you know the importance of getting enough, especially for dealing with injuries and chronic conditions.

Good luck! And report back if you find any solutions.

I'd say forget about the weight, and either buy Esther Gokale's posture/movement book, or go to one of her workshops.

You're not obese, and the modicum of extra weight is not intimately tied to pain signals that persist. In other words, weight is a proximal indicator of deteriorating joints, but the causes of joint pain rarely lie there except in upper BMI echelons.

The poor learning, attention and concentration sounds like me when I was iodine deficient. Iodine deficiency also caused me to have muscle weakness and stiffness, too. You might want to try Epsom salts baths, too, for the sulfur and magnesium they contain. Put 2 or 3 cups of Epsom salts into a tub of water that is as hot as you can stand it and soak for at least 20 mins. Magnesium is a miracle when it comes to muscle stiffness and tension and sulfur is good for cartilege.

Your diet sounds good. Not sure what your caffeine intake is like, but I would consider that in regard to your sleep problems. Diet is not a panacea. Sounds like you have some wear and tear on your body. Agree with the Gokhale recommendations above, her class is well worth taking if it comes to your area. Structural integration or Rolfing is expensive but might be useful as well. Pilates, movement or yoga instruction from a teacher that focuses on your biomechanics rather than getting you into a specific position or movement pattern. Most of all, I would consider strengthening the muscles around your arthritic joints using a safe, measurable approach like the one in Body by Science. If you have a facility near you, Med-X makes a highly specialized spine strengthening machine that might help with your back. Lastly, pain is mulitfactorial and there are social and psychological inputs into many people's chronic pain. Consider cognitive behavioral therapy if you think it might be indicated. Opioids for long term pain is often a recipe for disaster, due to tolerance, hyperalgesia and other brain based changes. Good luck!