Live discussion with Dr Adrienne Heinz - 20th February 2019

Dr Heinz will be hosting a live online discussion here on Wednesday 20th February, from 7:00pm to 8:30pm BT or 3:00pm to 4:30pm US ET.

She will discuss as many topics as possible in the hour and a half and, as always, you are welcome to ask any questions at all about sleep or the Sleepio program. If there are a lot of questions, she may not be able to answer all in the time available, but will try to answer as many as she can.

Please do note that, as per our guidelines, Dr Heinz will not be able to give personal medical advice including those about medication. Her replies to questions will be made in such a way as to help as many people as possible who might have similar issues.

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Posted 14 Feb 2019 at 3:25 PM
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  • Sleepio Member

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    • 17 helped
    Graduate

    I'm finding that time asleep and SE improve when I stay in bed, rather than get up with middle of the night awakenings. When I find myself awake after 15min., instead of getting up I do imagery, progressive relation, or mindfulness. It increases my chances to get back to sleep. After doing these strategies, if they are unsuccessful I get up. My subjective night will likely be over. Is this breaking the rules?

  • Sleepio Member

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    Graduate

    Hi all, I am on my 17th day of the Sleepio programme. i would not day things are improving much, but I am more motivated to work on it and feel supported in this, which is also an achievement. My question is about physical exercise late in the evening and, more specifically, if a very relaxed form of yoga (yin yoga, also called restorative) followed by a meditation session can be considered a type of exercise that should be avoided? The lesson I go to runs from 19:45 to 21:00. Last week the class made me feel very relaxed and sleepy, but it was followed by a sleepless night!
    Thanks

  • Sleepio Member

    • 3 comments
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    Graduate

    What are connections between weight gain and sleep challenges?
    1. Does increased weight impact sleep?
    2. Or is it the other way around – lack of sleep drives weight gain?

  • Sleepio Member

    • 139 comments
    • 25 helped
    Graduate

    Greetings community! Dr. Adrienne Heinz here. I'm a clinical and research psychologist and I look forward to answering your questions over the next 90 minutes.

  • Sleepio Member

    • 139 comments
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    in reply to Sleepio Member
    Graduate

    Great question. Lack of sleep and weight gain can have a chicken and egg relationship. What we know from the science of sleep is that chronic poor sleep is associated with increased release of hormones that mediate the experience of hunger (leptin and ghrelin). In addition, obesity is a risk factor for sleep apnea which can negatively impact one’s ability to obtain restful, rejuvenating sleep.

    See these articles as well: https://www.sleepio.com/library/article/food-and-sleep/

    https://www.sleepio.com/library/article/what-is-sleep-apnoea/

  • Sleepio Member

    • 3 comments
    • 1 helped
    in reply to Sleepio Member
    Graduate

    Thank you very much for the response – I have all of the above problems (weight and apnea). It does seem that since my sleep has become problemattic that appetite has significantly increased. I am currently going to the Gym 3+ times a week to try to counter. But it is difficult.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    The impact of exercise on sleep differs among individuals. For those who struggle with sleep, even light exercise has the potential to be disruptive. If possible, it’s best to exercise several hours before bed and stick to a consistent wind-down routine.

    Check out this library article for more information. https://www.sleepio.com/library/article/exercise-and-sleep/

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    This question bears upon how do we implement evidence-based treatments “in the wild.” There is good science behind the 15 minute rule and for most, it tends to be the best practice. However, we also strive to practice flexibility within fidelity to a protocol. If you find this strategy is helpful for your specific case, then you might consider collecting your sleep data to determine what works best for you. If after looking at patterns in your sleep data, you observe decreases in SE, you would want to consider adhering to the out of bed 15 minute practice.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    absolutely understandable. It can be a feedback loop that is difficult to break. You might consider consulting your doctor or a nutritionist about how to manage appetite under these circumstances.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    A weighted blanket can help optimize the sleeping environment. You can look at the community board here for other feedback on this matter. https://www.sleepio.com/community/discussion/do-over-the-counter-sleep-remedies-or-alternatives/

    The research on this matter has largely been conducted among children with autism spectrum disorder and other sensory processing challenges. Weighted blankets are indicated for this population.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Sleep restriction is not recommended during acute illness as the body requires more sleep to recover. If you find yourself needing to rest throughout the day, consider doing so on the couch or other areas outside of the bedroom. This will help preserve the nighttime sleep – bed connection that Sleepio aims to strengthen.

  • Sleepio Member

    • 139 comments
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    in reply to Sleepio Member
    Graduate

    Sleep restriction is by far one of the more difficult behavioral health interventions to implement. Your question regarding risks of sleep deprivation is best answered by considering long and short term consequences. In the short-term, one should refrain from driving, operating heavy machinery, and other related activities when heavily sleep deprived. Long-term sleep deprivation has extremely serious and negative health and well-being consequences. Accordingly, a short term intervention to reduce the negative impact of long-term sleep deprivation is the recommended best practice.

  • Sleepio Member

    • 139 comments
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    in reply to Sleepio Member
    Graduate

    Its great to have insight into the factors that originally contributed to experiencing insomnia in the first place. How is your sleep during this 11pm-5:15am window? If it's acceptable, it suggests that the sleep restriction is working as it should. If you are still having struggles remaining asleep, especially as you begin to expand your sleep window, consider changing your morning routine to a more pleasant activity. This could include reading the newspaper, playing a game – but staying off emails and other activities that might induce stress and urgency. If you are having early morning wakings and cannot return to sleep after 15 mins – again, consider engaging in a low arousal activity that is not work related (outside of the kitchen where you previously worked).

  • Sleepio Member

    • 139 comments
    • 25 helped
    in reply to Sleepio Member
    Graduate

    Yes – there is! You can record that noise and listen to it throughout the day. Eventually our brain starts to habituate.

    Here are some additional resources. https://www.sleepio.com/library/article/dealing-with-noise/

    and a community discussion board on this matter
    https://www.sleepio.com/community/discussion/coping-with-noise/

  • Sleepio Member

    • 38 comments
    • 18 helped
    in reply to Sleepio Member
    Graduate

    “How is your sleep during this 11pm-5:15am window?”: I'm now waking up ~2-3 times in this window, each time relatively briefly. I vaguely remember some half-awake periods, so I think light/disturbed sleep is still possible, but I have no idea how to measure that.

    I still feel pretty terrible, but I imagine that's normal even with 'good' sleep, with such a short window?

  • Sleepio Member

    • 139 comments
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    in reply to Sleepio Member
    Graduate

    Tricky situation you describe here. If you are experiencing sleep of any kind during those 15 mins after waking, then the QHR is not indicated even if the sleep is not perceived as restful.

    There are multiple reasons for unrefreshing sleep – see here for more information https://www.sleepio.com/library/article/what-accounts-for-unrefreshing-sleep-/

  • Sleepio Member

    • 139 comments
    • 25 helped
    in reply to Sleepio Member
    Graduate

    Regarding your question about your particular sleep window and it's relation to hormones that optimize sleep – it's true that chronic sleep deprivation can dysregulate hormonal balance. See here for more information https://www.sleepio.com/library/article/hormones-and-sleep-a-two-way-street/

    In addition, night-time stress, pre-sleep, has also been found to be associated with reduced slow-wave sleep (deep sleep) once asleep. Indeed, the expression of slow wave sleep is associated with low levels of the stress hormone cortisol, as well as reductions in sympathetic nervous system activity and increased parasympathetic nervous system activity.

    Given that individuals living with insomnia already experience these challenges, the sleep restriction intervention is intended to “recalibrate” these systems that mediate sleep processes.

    Regarding free-running sleep, once your sleep has returned to a healthy and consistent pattern, one is welcome to conduct “experiments” with new techniques and collect data with the sleep diary to determine effectiveness.

  • Sleepio Member

    • 38 comments
    • 18 helped
    Graduate

    Thanks for all your help. A quick Q if you have time: I've rigged up my phone to beep 10 minutes after I tap on the screen, whenever I wake up.

    I don't feel like I slept that well.. but I also don't remember hearing any beeps. This would suggest that I'm getting back to sleep in < 10 minutes.

    Is this conclusive, or could there be some other complicating factors in play here? Half-awake states where hearing (or memory!) is unreliable, or something?

  • Sleepio Member

    • 139 comments
    • 25 helped
    in reply to Sleepio Member
    Graduate

    hmmmm – this might have some helpful information https://www.sleepio.com/library/article/can-you-think-youre-awake-when-actually-youre-asle/

  • Sleepio Member

    • 139 comments
    • 25 helped
    Graduate

    Thanks everyone for all your questions! You can catch us here every Wednesday for the live expert session. Sleep well!

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