Live discussion with Dr Bryony Sheaves - 11th May 2016

Dr Sheaves will be hosting a live online discussion here on Wednesday 11th May, 7.00 until 8.30pm BST.

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.

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Posted 6 May 2016 at 9:34 AM
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  • Sleepio Member

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    Session 4

    My question is live and I am so hoping you can throw light on adrenal fatigue and insomnia.

  • Sleepio Member

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    Expert

    Hi,
    Thanks for your comment re: stressful live events, insomnia and nightmares. I'm really sorry to hear that you have been having a difficult time.

    The first thing to note is that insomnia and nightmare are both very common when we are going through a more stressful time in our lives. So your question I'm sure will resonate with many logging in this evening. This is because when we are feeling stressed (or hyperaroused) and have stress hormones racing through out bodies, we are less likely to sleep. Or if we do sleep the architecture of sleep can be altered so we wake easily, or may be prone to nightmares.

    We would usually recommend prioritising the course techniques at this time, to maximise chances of falling asleep. Often if we sleep well, this can help us to manage the daytime stressors. Techniques like 'putting the day to rest' in session 5 can be helpful for processes difficult life events:

    https://www.sleepio.com/library/article/putting-the-day-to-rest/

    as well as any other techniques that aim to calm the mind and body (e.g. relaxation).

    You mention sleep restriction, this is one of the more challenging elements of the course, so understandable that it's difficult to put into practice when there are other pressures. The principle behind it is ensuring that sleep pressure is high when one goes to bed to increase chances of sleep, so it is one of the more powerful techniques. This can be helpful when sleep challenges are particular high, like when we are feeling more stressed.

    Nightmares and insomnia often come together. Nightmares will often pass as daytime stressors pass, and the sleep routine in regularised (ie. when the insomnia improves). Some of the course techniques that target night time hyperarousal will also be helpful here, as well as considering other factors that affect the amount of dreaming (REM) sleep we get (some medications, alcohol, caffeine).

    All the best with the rest of the course.

  • Sleepio Member

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    Expert

    Hi,

    Sorry I seem to have missed this one out.

    When getting an optimal amount of sleep some people still report feeling fatigued during the day. In these cases it is sensible to speak to a GP / primary care physician to rule out any underlying physiological cause. Something else to bear in mind is medication side effects as many medications can affect how awake and alert we feel.

    If there is no physiological reason for this, then there are a few things to consider. One is the quality of sleep that one gets, see here for an interesting article:

    https://www.sleepio.com/library/article/what-accounts-for-unrefreshing-sleep-/

    Lastly, daytime activity levels can be relevant to energy levels. We often think of our energy stores as a battery, that depletes across the day and hence think that we should 'reserve' our energy if we have sleep difficulties. In fact energy is more like an elastic band – the more we pull it the more it gives back (unless of course we overstretch it!). And if we are more active we tend to sleep better. I would usually consider this if an individual is particularly low in activity levels (ie. there isn't much happening in the day).

  • Sleepio Member

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    Expert

    Hi,

    I'm afraid I don't have an in depth knowledge of adrenal fatigue to offer specific advice. Has the clinician who is treating you for this offered any particular advice on sleep?

    CBT techniques (such as Sleepio) have been used, and shown to be beneficial when people have insomnia and also other physical (e.g. pain, cancer) and psychological (depression, anxiety) health problems. In these cases the course knows about these other difficulties by answers to questions in the initial sleep test at the start of the course. Based on this info the Sleepio course is less restrictive with the sleep window for the sleep restriction element. Other techniques continue as usual. However we would always recommend that individuals inform other members of their care team that they are completing the course.

  • Sleepio Member

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    Expert

    In some cases it can be helpful to shift the window for sleep (e.g. earlier in the night). In this case the window of time stays the same, but is moved. If this is helpful, then there is an article here with more info on how to do this:

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

  • Sleepio Member

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    Expert

    Evening,

    SR is a two step process. Step one is aimed at increasing the chances of going to sleep and staying asleep for the restricted window. The goal here is to re-establish the habit of getting to sleep and also getting a regular amount of sleep each night. Sleep efficiency is a good measure of this and it sounds like this phase has been going well for you. The second step is to gradually increase the sleep window, to an amount of time that is more desirable, and hence increase the total sleep time. In this section, we aim to increase the window very gradually and when the sleep efficiency is high over a period of days then we can increase again. This phase can take some time depending on how long it takes for the sleep efficiency to stabilise. The end result is a more regular sleep pattern (getting rid of the bad nights) and also usually increased total sleep.

    For some people who are early morning risers it can be helpful to think about the natural body clock when considering the timing of the sleep window (or difficulties with making progress in the second phase I mentioned above). For 'morning people' they may have the best chance of sleeping earlier in the night as they naturally rise early) and for evening people they may find it easier to have their window later in the night.

    If this is relevant then there is more info here:

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

  • Sleepio Member

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    Expert

    Hi,

    Hyperarousal is thought to underpin both anxiety and insomnia. The good news is that the course covers techniques for this, look out for things like 'putting the day to rest', the 'thought checker', relaxation audios which you can download. All of these should be helpful to target this element.

    Also just to note that it's very common to find that worries can feel worse at night. If we aren't asleep then this is a time when worrying thoughts can take hold with no distraction and therefore leave us feeling very anxious (and less likely to sleep). The Sleepio techniques are all aimed at improving sleep, which should also reduce the time that these anxious night time thoughts have.

    Good luck with the rest of the course.

  • Sleepio Member

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    Expert

    Hi,

    Indeed this is quite normal (and actually normal for even the very best sleepers to have night time awakenings!).

    It can take a while for sleep to stabilise, particularly if it has been a difficulty for some time. With regular night time awakenings it can be helpful to rule out whether there is anything obvious waking at that time, e.g. light is a common factor in the UK at this time of year. Practical strategies can be helpful for this (e.g. eye mask / good quality curtains).

    Very pleased to hear that you have seen improvement in your sleep – thank you for sharing.

  • Sleepio Member

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    Expert

    Hi,

    From what you are saying you are having difficulties getting to sleep and also then difficulties staying asleep. These are very common experience at the start of the course. The good news is the course is well placed to improve both of these. Each week the course will run through some new techniques. Users are encouraged to see what they can take away from each week, give it a go and see how things change with the sleep (using the sleep diary). Good luck with it and I hope you see some improvements.

  • Sleepio Member

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    Expert

    Hi,

    It sounds like you have put lots of work into trying to improve your sleep – well done for this.

    Some people say that when they put a lot of thought and attention on sleep this can actually reduce the chances of sleep because it puts a lot of pressure on when heading to bed (and that tends to be unhelpful for sleep). There are two strategies that can be helpful in this scenario and both relate to giving up the sleep effort. The first is acceptance that actually all of us may not fall asleep when we head to bed. But what we do have up our sleeve is other techniques (e.g. the 15 minute rule) to manage OK if we don't. The other technique is paradoxical intention, actually trying to stay awake (shifting focus from sleep to wakefulness):

    https://www.sleepio.com/library/topic/paradoxical-thinking/

    Just a few ideas, and each supplements the key techniques: sleep restriction and improving the bed=sleep connection.

  • Sleepio Member

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    Expert

    Hi Orlando,

    Sorry to hear that it has been difficult and do take a look at my other reply re: the sleep efficiency and other ideas. Whilst it sounds like your sleep isn't where you'd like it to be it sounds like there has been some improvement in the time it takes you to fall asleep and your sleep quality. This is excellent news and a step in the right direction. Sleep habits can take some time to improve, particularly if the difficulty sleeping has been happening for some time.

    Re: the regular night time awakening, is there anything that may be waking you at that regular time? E.g. light / bad dreams? Also, as mentioned in previous posts, some people with persistent early morning waking find it helpful to shift the sleep window earlier (if they are 'morning people') to work with the body natural body clock.

  • Sleepio Member

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    Expert

    Hi,

    I'm sure many people relate to the difficulty getting up in the morning so well done for managing it! Taking time to wake is quite normal, referred to as 'sleep intertia'. One of the most helpful things for helping us to wake is natural sunlight so opening the curtains can be very helpful. Other ideas include playing up beat music, speaking to someone (planning a phone call, depending on time), taking a shower.

    I wonder if the other Sleepio members in the community would have other ideas?

  • Sleepio Member

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    Expert

    Hi,

    A regular sleep window is helpful for the body to aim for each night and preferable to a changeable pattern but the other techniques, and particularly increasing the bed=sleep connection are usually more helpful in these situations.

  • Sleepio Member

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    Expert

    Hi,

    Yes I think if there is a reason that one may need more sleep, E.g. illness then take the sleep needed and return to the window after recovery.

  • Sleepio Member

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    Expert

    Hi,

    I'm sorry that it sounds like the sleep is difficult. In this scenario the first thing I'd check is whether one is feeling sleepy-tired when heading to bed. This can be different to feeling fatigued and tends to include things like yawning, scratchy or stinging eyes, aching muscles, tendency to nod off. These are usually indicators that it is a good time to head to bed. The other thing I would check out is what's running through ones mind when heading to bed, are there sleep related thoughts that could benefit from the sleep checker, mindfulness or some imagery exercises (see session 5 for a recap in the library)?

    Or if the wakenings are a new problem and not improved it can be helpful to have a medical to rule out other potential causes.

  • Sleepio Member

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    Expert

    Hi,

    Sorry it has taken some time to get to your questions, it's been a very busy night online tonight. I'll answer each of your questions together if that's ok.

    The first is about adaptations to the stimulus control (bed=sleep) technique. I'm pleased you've asked this as I think it is very relevant to many Sleepio users. In an ideal world the bed would not be used for anything other than sleep and intimacy but we know this can be a challenge in particular living situations. One solution is creating 'zones' in the room, so maybe having a bean bag to get out of bed onto at night and also for other activities (e.g. TV). If this is impractical (e.g for space reasons), then the thing we are absolutely trying to avoid is staying lying in bed when unable to sleep, so another adaptation is sitting up in bed, swinging the legs round and sitting at the other end of the bed when unable to sleep. Anything to distinguish between what happens when you are sleeping (lying down, head on pillow) and when not asleep (some other position).

    The second question was about nightmares. These are common for people who experience insomnia. They are also (just like insomnia) driven by hyperarousal so some of the techniques that reduce this (e.g. the wind down routine, relaxation) can also benefit nightmares. For treatment of nightmares we also consider what one puts into the body (medications, alcohol, substances, caffeine) as many of these impact of REM (dreaming) sleep which can increase the chances of nightmares. There is also a psychological therapy called Imagery Rehearsal Training which particularly targets nightmares. In my clinical experience this is particularly helpful for recurrent nightmares. It essentially involves using the power of the imagination to rewrite the script of the recurrent nightmare and rehearse this new, more positive ending.

    The last question was about thought blocking. The technique used can depend somewhat on the thoughts and the response to the thoughts. E.g. if one tries very hard to block out a thought, this can (counterintuitively) lead them to pop back in again (because we're trying so hard not to think of it). In this scenario mindfully accepting the thoughts that come to mind at night can be helpful. The 'the' technique can be helpful for interrupting the chatter of negative thoughts, but if one has given it a good test and it hasn't been helpful then there are other options. Lastly, if there are clear negative thoughts that can be challenged then the thought checker may be a helpful approach. In the library there is a recap of the key techniques for thoughts at night (see sessions 2,4 and 5) and videos that accompany.

    I hope that's helpful and best of luck with the rest of the course.

  • Sleepio Member

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    Expert

    Sorry I've run over this evening, I wanted to try and answer each of the questions as I value the thought and efforts you have put into your posts.

    Good night all, wishing you all best of luck with the sleep tonight.

  • Sleepio Member

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    Graduate

    Dear Dr. Sheaves, thank you very much for your reply. I very often hear on Sleepio that “it takes some time” for the sleep to restructure…I understand that, and also I understand that and I also understand it is indivdual, but when one is struggling with tiredness for weeks, a timeframe would be very helpful to “endure”. As is known, SRT does not help everyone, so I would just like to know when I should quit if it does not help. After 6 weeks of SRT, after 2 or 3 months? Thanks!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks for the answer :)

  • Sleepio Member

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    Graduate

    Thank you for your reply Dr Sheaves, I hadn't thought of opening windows until now and as it is getting sunnier early it may help a lot.

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