Live discussion with Dr Bryony Sheaves - 10th May 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 10th May, 7.00 to 8.30pm British Standard Time or 2.00 to 3.30pm US Eastern Standard Time.

Dr Sheaves is a Research Clinical Psychologist working within the Sleep and Circadian Neuroscience Institute at the University of Oxford. Her work focuses on the association between sleep and mental health difficulties, particularly symptoms of psychosis.

Please do note that, as per our guidelines, Dr Sheaves won't be able to give personal medical advice. Her replies to questions will be made in such a way as to help as many people as possible who might have similar issues. 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.

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Posted 4 May 2017 at 12:55 PM
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  • Sleepio Member

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    Expert

    Hi,

    This is a common experience described by Sleepio users. There are many things that can help with this that will be covered in the course. Thinking about the timing and amount of sleep (in session 3) is particularly helpful for improving the quality of sleep. And the pre-sleep routine is also helpful for improving the sleep that follows.
    I see you're on session one which is all about setting the foundations for good sleep. Are there any ideas or strategies that have been helpful from that session?

  • Sleepio Member

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    Expert

    Hi,

    Good to hear you're receiving treatment for apnoea. Yes, using Sleepio alongside the CPAP treatment can still help with difficulties getting to sleep or staying asleep.

    When you say hyper insomnia are you referring to hypersomnia (i.e. sleeping for v long periods?). I see many people who have difficulty sleeping, but also have periods of oversleeping. Session 3 of the course aims to help the Sleepio user work out the right amount of sleep for them. This can initially be on the low side and then the amount of sleep is gradually increased. This is often one of the most helpful techniques for people who have a problem oversleeping but who also have difficulties getting to sleep / staying asleep.

    For some people, hypersomnia is related to narcolepsy (experiencing sleep attacks where it can feel impossible to remain awake). For this group, we would always recommend that this receives optimal treatment alongside running through the Sleepio course.

    If you have any other specific questions do log back in here and we'll be happy to work them.

  • Sleepio Member

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    Expert

    Hi,

    Thanks for your question. For questions like these I usually head back to guidelines for improving insomnia.
    The recommended treatment in these guidelines for night time waking (a symptom of insomnia) are cognitive behavioral strategies, which is what Sleepio offers. This involves working through each week and trying out new techniques.

    For those aged 55+, modified release melatonin can also be beneficial. A GP / primary care physician can provide specialist advice regarding medications (I'm a doctor of clinical psychology rather than medicine).

    In general we tend to think that trying one treatment at a time is most helpful. This means that if there is improvement then it is more clear what has caused it, and hence what to continue with.

    Good luck, I hope you find some benefit of the course for your night time wakings.

  • Sleepio Member

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    Expert

    Hi,

    I think finding the right wind down routine for each person is important. The key thing is how the activity leaves the person feeling (if relaxed, or even bored, this can be helpful. If alert, interested scared or excited, this can be unhelpful). If TV leaves someone feeling awake, I'd usually recommend scheduling TV time for daytime or early evening rather than just before bed. Are there any other activities that do leave you feeling sleepy? Other ideas: reading a relaxing book, knitting, mindfulness colouring in books, doing a puzzle. I'm sure the other Sleepio users will have lots of ideas if you're stuck, it may be worth posting a thread in the community.

    Good luck

  • Sleepio Member

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    Hi,

    Good question – have just answered another Sleepio user who asked the same thing – take a look a few posts earlier and you should see my reply

  • Sleepio Member

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    Hi,

    There are many things which can increase the amount of dreams we have, and these differ from person to person so it can be helpful to work out which are relevant to each person. Essentially, dreams happen in a particular stage of sleep called rapid eye movement (REM) sleep. So anything that affects REM can impact on how many dreams or nightmares we have. Here are a few:

    -Sleeping for a long time, which can happen when people have insomnia and want to catch up on lost hours of sleep. In fact if we sleep for a long time we get more REM 'dreaming' sleep (because we get more REM sleep the longer we sleep). So reducing the sleep window slightly can be helpful.
    -Some medications (can increase REM 'dreaming' sleep we get).
    -Alcohol use – initially suppresses REM sleep and then causes a kick back later in the night.
    -Daytime exercise can help to increase sleep quality, just not within a few hours of bedtime.
    -Mood – low mood is associated with more REM sleep and in fact there are studies that have shown that waking people up in REM sleep can boost mood. A more straight forward way of boosting mood (without needing to use special equipment to measure sleep!) is to increase the number of activities in the daytime which give a sense of pleasure or sense of achievement.

    There are quite a few ideas there, hope that some are helpful

  • Sleepio Member

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    Hi,

    An interesting question. I think heading to the research can be helpful. A v influential paper that was written by Charles Morin and Ruth Benca in the Lancet in 2012 reports that 70-80% of people achieve a therapeutic response to CBT (i.e they see a significant improvement) and 40% reach remission (i.e. no longer have insomnia).

    It is very common for people who see a substantial improvement in their sleep to have 'blips' every now and then. And in fact, even for the very best sleeper, blips are very normal.

    Hope that answers your question in some way. I'm really pleased to hear that you have seen improvement from using Sleepio!!

  • Sleepio Member

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    Expert

    Hi,

    This is a very common experience and one that the course is very well set up to help with. In the next session you'll cover relaxation which can be helpful for speeding up the return to sleep after waking n the middle of the night. In the session after you'll cover the sleep schedule and quarter of an hour rule which can be particularly effective for this.

    The way the course works is it breaks up the strategies into accessible chunks so that each week users can integrate new techniques into their routines.

    Good luck with the course, I hope you see some benefit

  • Sleepio Member

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    Hi,

    The way that sleep restriction works is by ensuring that sleep pressure is high each night. Sleep pressure increases as a function of time (the longer we're awake the more likely we are to fall asleep). So by waking up the same time each morning, it is an investment in the follow night of sleep.

    So in principle, the answer is yes. However that said, this can be tough v tough and if it is simply not possible to stay awake all day, or individuals feel dangerously tired, it can be beneficial to schedule in a short nap earlier on in the day (no longer than 20 mins and before 3pm). We tend to recommend trying to keep these to a minimum however, so that sleep pressure isn't effected.

    SR is challenging but is effective as a stand alone strategy. There is much support in the community from other people who have experience of doing it. Some people find it helpful to hear others' experiences.

  • Sleepio Member

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    Graduate

    The different relaxation strategies have worked well for me. Progressive Relaxation and Autogenic Training and putting my day to rest.

    Essentially, I am getting 6.5 hours of sleep on average a night at 85% SE. Before starting I was getting 6.5 hours of sleep a night with 75% SE. I am still tired through the day and don't wake up feeling rested. Ideally, I'd like to get 7 hours (or more) of sleep a night, but I wake up at the drop of a hat from any noise or light or movement from my partner. This includes using ear plugs every night. I sleep very restlessly and this shows from my FitBit's analysis of my sleep. Thanks for the response!

  • Sleepio Member

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    Expert

    Hi,

    This is such great progress – congrats!!

    Changing time zones can be a challenge for sleep, so a bit of short term disruption is entirely normal and not necessarily a sign of a backward turn in sleep.

    I posted earlier about changing time zones (hot topic tonight) so have copied the answer here, hope that's OK.

    Hope you enjoy your trip!

    This is such a common issue that there is a Sleepio guided dedicated to it:
    https://www.sleepio.com/articles/jetlag/

    This has some helpful tips. Broadly I tend to recommend a bit of planning. There are two key things which control our sleep, the first is our body clock (which can be out of sync if shifting time zones) and the second is sleep pressure. If we ensure our sleep pressure is as high as possible the night after we land in the new destination this will increase the chances of sleep, even when our body clock is out of sync. But this means planning when we sleep / nap. We want to allow enough time between waking up and when we next want to sleep.

    Lastly, it can be helpful to remember that it is v normal to have some sleep difficulties when adjusting to a new time zone so being patient – the sleep will fall back into a routine eventually. And the above sleep pressure concept will be really helpful at speeding that up.

  • Sleepio Member

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    Expert

    Hi,

    Pleased to hear you are getting treatment for this and hope you find an effective dose soon.

    CBT techniques as covered in Sleepio can be helpful for people who have restless legs and also have insomnia. It can improve the insomnia symptoms.

    One consideration is that there is some literature indicating that sleep restriction ( a component of session 3) can worsen restless legs in the very short term because people are slightly sleep deprived (this is a means to an end for improving sleep and is usually a very powerful techniques for improving insomnia). The sleep window that the Prof suggests is based on the sleep test at the start of the course. If a very restricted window is suggested, some people may chose to have a less restricted sleep window. There are many other more accessible techniques that the course runs through and these can also result in big improvements in sleep so it is still possible to use the course.

    Some people chose to try one thing at a time, e.g. access the help for RLS first and then the help for insomnia, or vice versa. If that is the case you could try emailing hello@sleepio.com to check out what this means for your access (presume you have a long time left with Sleepio but just in case).

  • Sleepio Member

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    Expert

    Hi,

    Pleased to hear that your SE has improved but I see the frustration with the sleep duration. A few thoughts:

    -Is the timing of the sleep window best matched to the body clock? For a morning person, it can be more helpful to add time on at the start of the night, or even shift the whole window a bit earlier so it is in line with the body's natural circadian rhythm (body clock). I've pasted a link below on how to shift the sleep window. To help with this, prioritising a long wind down (like the relaxation) will help give the body cues for sleep earlier.
    -The second thought, is I wonder how long you've been experiencing insomnia? The reason I ask is because CBT techniques can take a while to work and particularly if insomnia has been part of someones life for a long time. Some see improvements quickly and for others it can be a more gradual process which requires some patience (and being kind to oneself in the meantime). It can take a while for our body to get used to the new schedule and adapt to the new strategies.

    It sounds like you've been working hard to improve your sleep, and it can be frustrating to not be where you'd like to be. I really hope you continue to see further improvements and get to the 7 hours – you're not too far away.

    Link to shifting sleep window:
    https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/

  • Sleepio Member

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    Expert

    We'll finish there for tonight. Thanks for your interesting questions and 'see' you all soon!

  • Sleepio Member

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    Graduate

    I am not a morning person, but with a 3 year old, I have resigned myself to waking at 6 AM and moving my bed time earlier as I achieve 90% SE, but maybe I should look at it the other way and add time in the morning and go to bed at the same time.

    I have been having these troubles for over a decade, so it is good to know that this can take a long time. I know it isn't a quick fix, I just like to have a concept of how long I should be trying this before trying something else. Thanks again for your response.

  • Sleepio Member

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    Graduate

    Thank you for your comments. I did mean hypersomnia. :) My doctor thinks is is related to narcolepsy without cataplexy in my case. I will continue on and hopefully pick up some great information along the way.

  • Sleepio Member

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    Graduate

    Hi Dr. Sheaves,
    The cognitive shuffle is a “new (2013) super somnolent mentation theory of sleep induction proposed by Luc P. Beaudoin.” The theory was published in an open access paper on March 31, 2013 at Simon Fraser University ( Burnaby, B.C., Canada where Luc Beaudoin is an adjunct professor.
    The link to the description of this theory and practical application is ishttps://mysleepbutton.com/support/the-cognitive-science/
    My understanding is that you imagine different things or think of different words to distract yourself as you are trying to fall asleep. There is a free app for it. There have been several articles written about it in the New York Times and in Forbes magazine and Popular Science. I have been trying the DIY version and it seems to help me with falling asleep.

  • Sleepio Member

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    Graduate

    Hi skiersue

    Just writing a quick message to say thank you very much for posting this link. I just had a read through and it sounds really interesting.

    I hope you're progressing well with Sleepio. I took the course, experienced a real improvement in my sleep, graduated, and am now going through a post-graduate 'blip' phase, so still on the lookout for new techniques to try alongside SR, PR, QHR etc etc.

  • Sleepio Member

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    Graduate

    My wake up time is 6am but most mornings for some reason I wake up between 5 & 5.30. I usually fall back asleep. Should I just get up? It's not a big problem but annoying to keep waking up 45 minutes before I need to.

  • Sleepio Member

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    Graduate

    Sorry, I asked about the use of melatonin ( in my case i've tried 3-4 times and it helps me a little to fall sleep) is it advisable to take it? for how long can we take it? is it a more natural system than pills?
    I couldn't see the answer you gave another participant
    thanks

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