Live discussion with Dr Bryony Sheaves - 12th April 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 12th April, 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 6 Apr 2017 at 12:09 PM
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  • Sleepio Member

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    Graduate

    Hi Dr Sheaves
    my sleep window was set based on my sleep diary, which I had some technical issues with at the start. I guess my question is really does this sleep window have to be considerably restricted in order for the program to work? I am assuming the sleep deprivation helps reprogram your body clock/sleeping patterns – and also guess that the more restricted it is the more effective it is. Is this correct and should I shorten mine a bit. I am averaging 6 hours sleep each day and have a sleep window of 7.5hours. Thanks JCS

  • Sleepio Member

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    Expert

    Hi,

    I'm really sorry that your sleep has gotten worse. If you were finding your RLS medication helpful I'm sure that it's really tough having that stopped.

    From what you have described in your post, your thoughts are focused on sleep at night and wondering how much sleep you will get. Many people describe that when they are worried about sleep, this can decrease the chances of getting to sleep, which is quite frustrating, and just the type of difficulty the course is well placed to help with.

    For example finding ways to wind down effectively before heading to bed, changing the window of sleep to increase the chances of sleep each night and checking out pre-sleep thoughts so that they don't get in the way of sleep. Each week the Prof introduced new strategies to try out which are all aimed at maximising the chances of sleep. After trying this over the week, a new strategy will be introduced the following week. I'm wondering whether there has been anything that has been helpful so far? You still have most of the key techniques still to come, but sessions 1 and 2 can set the foundations for the rest of the strategies later.

    If you consider that RLS is also an issue, there is an article here that may be of interest, you may have to copy and paste this into your browser:

    https://www.sleepio.com/library/article/what-is-restless-legs-syndrome-rls/

    I hope there are strategies which are helpful for your sleep and best of luck with the rest of the course.

  • Sleepio Member

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    Expert

    Hi,

    Good question.

    Sleep restriction works by increasing sleep pressure, and the higher the sleep pressure at night, the higher the chances of sleep. So a smaller sleep window can increase the chances of sleep.

    However the sleep window needs to be tolerable and safe:
    -If a very reduced window significantly increases pre-sleep anxiety (which reduces chances of sleep) then sticking to a slightly longer one may be helpful.
    -If there are health issues which may be exacerbated with sleep deprivation, the course does not restrict the sleep window as severely.
    -If the person is feeling dangerously tired in the daytime (e.g. if operating machinery or driving) a less restricted window may be advised.

    There have also been studies where the sleep window hasn't been as severely restricted (particularly where there are other health issues) and the other techniques, alongside a consistent sleep window each night, can also lead to significant improvements in insomnia.

    I hope the above provides enough info to help inform your decision

  • Sleepio Member

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    Expert

    Hi, is this a new problem or longstanding?

  • Sleepio Member

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    Graduate

    It's slightly new, it's been happening over the last couple months.

  • Sleepio Member

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    Expert

    Hi

    Sorry I just say your live post, here's a reply:

    You have mentioned a few factors which may decrease the chances of sleep. And I imagine that the impact of each of these may be different across different days.

    -Sleep difficulties can be more common in athletes, particularly if they have less control over training / competition times. Exercise increases arousal and it can take the body time for this to steadily decrease before sleep. As you've mentioned, timing of exercise for earlier in the day, to cue the body for wakefulness can be helpful for sleep. But avoiding exercise in the hours before sleep can be helpful.

    -Intake of food is important. If we are hungry when we go to sleep, or haven't had enough calories in the day to match our need this can disrupt sleep (it makes evolutionary sense that we shouldn't sleep if we need fuel). Obviously eating a balanced diet is important and some people find that adding in a snack prior to sleep can stave off any night time hunger until morning.

    You mentioned your weight loss, were expecting this weight loss or has it come as a surprise? If anyone is concerned about about another issue we always recommend speaking to GP / Primary Care Physician.

    -Low mood and anxiety can also impact on sleep and it can be helpful to ensure treatment for this is also optimised alongside working on the sleep.

    The course will involve working through many strategies to wind down at night (which many people who feel anxious can find particularly helpful), working out the right sleep window to increase the chances of sleep as well as considering lifestyle factors and how to manage on nights when sleep doesn't come straight away.

    I hope you find the strategies useful and do check back in here if we can help with any sleep questions!

  • Sleepio Member

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    Expert

    Have there been any other changes in this time? I'm wondering whether it's possible to identify any potential triggers as these can be individual to each person.

    Sorry for the slow responses – I can't see new ones when I'm putting together another post.

  • Sleepio Member

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    Graduate

    It's not problem, I understand.

    Nothing major has changed in my life. My diet has remained the same and that's really heathy. I write stories but I've been doing that for a while as well. Nothing stands out at all. I'm sorry I'm such an odd case.

  • Sleepio Member

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    Expert

    Hi, and welcome to Sleepio (I see you've just started the course). The racing mind is a very common problem for people who have sleep difficulties, so much so that the course has developed strategies particularly for this issue. Most of the strategies come up in session 5.

    It is also common to describe feeling more alert during sleep, or being semi-alert to what is happening around you. There have been research studies showing that when people with insomnia are asleep (assessed by brain activity and other physiological measures) they are more aware of what is happening.

    The course is designed to help with this issue by thinking about preparing for sleep well before heading to bed, ensuring that the sleep window increases the chance of sleep and strategies to manage thoughts and mental activity in bed. Each week a new strategy will be introduced which works towards better sleep and the most fruitful approach can be to try out the strategy before the next one is introduced in a later session.

    I hope you find some helpful techniques and do check back in here if you have further questions

  • Sleepio Member

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    Expert

    Hi,

    I'm sorry I haven't been more help so far.

    Another factor that can be related is current mood.
    If low mood is an issue, there is some evidence that people can experience more REM (dreaming sleep).
    Reducing the sleep window can be helpful here.

    I'm wondering what your usual sleep timings are at the moment? Are you happy with them or is there scope to increase / decrease?

  • Sleepio Member

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    Graduate

    I'm a pretty happy person and I would be up for trying to decrease my sleep if that would help. My current window is in bed by 12 and out by 9. Do you think changing that would help?

  • Sleepio Member

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    Expert

    Hi,

    Of course the priority that sleep has in our lives can change, particularly if there are other important things to manage. As a general principle consistency is helpful for sleep so if there are some strategies that are easier to continue with this may be helpful for keeping sleep on track. Of course if this isn't possible the techniques will still be there afterwards when things have returned to usual. And if sleep has been knocked a little (as it can be when there are other big life events) it can be helpful to remember that there are tools designed to help get things back on track.

  • Sleepio Member

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    Graduate

    Thank you for the helpful comments, I'll definitely try the pre-bed snack idea. The weight comment was more to say that I don't think I have a significant calorie deficit contributing to the hunger/poor sleep, but perhaps it doesn't take much of a deficit to feel the effects.

    If you have time for a follow-up question/comment, I suppose what I am finding confusing about the exercise -> arousal -> poor sleep theory is that I feel very tired and get off to sleep easily – the problem is I'm waking intermittently (but briefly) through the night and then getting up several hours earlier than I normally would. So my sleep efficiency is pretty good because I don't spend much time awake for long periods in the middle of the night. I'm a bit worried about how the sleep restriction is going to work and how it will impact my training/recovery- but I'm probably getting ahead of myself!

  • Sleepio Member

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    Expert

    What we know is that both short and long sleep can be associated with feeling tired in the day. For long sleepers this is often because dreaming sleep is tiring and the longer we sleep the more dreaming sleep we have.

    Working out the right amount of sleep for each individual can take a bit of trial and error. Some people find experimenting with the sleep window helpful, e.g. keeping it the same for a week and logging daytime fatigue and then for reducing it for a week and logging daytime fatigue to see if there has been any impact.

    Good luck, hope you do find a resolution.

  • Sleepio Member

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    Graduate

    Thanks! I really appreciate your help! Hope you have a wonderful day! :)

  • Sleepio Member

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    Expert

    Hi, just briefly – sleep restriction is matched to the sleep diary data so if sleep efficiency is looking pretty good, the window will be less restricted. It can be very effective for reducing brief night time awakenings. It's also temporary, ie. the window is gradually increased again to aim for the goal sleep duration. So in the longer term, it's v helpful for improving sleep

  • Sleepio Member

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    Expert

    Hi

    If anyone feels dangerously tired (especially if driving) we recommend a short 20 min nap, but earlier in the day so that sleep pressure can rebuild. In general, it is more helpful to save sleep for the night time to give the body clear cues about when it's time to sleep and when it's time to be awake.

    Often people find a bit of gentle exercise (e.g. a walk) and getting some exposure to sunlight can help at times when naps are most likely.

  • Sleepio Member

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    Expert

    Hi

    Fitness trackers can be v helpful for taking the focus off sleep (by not completing the sleep diaries). However that's only helpful if their gauge on sleep is broadly accurate and that can depend on how well they fit, the data they use and the algorithms they use to decide if someone is awake or asleep. I tend to prioritise what the individual tells me about their sleep, and how they are feeling in the daytime over a tracker, though as I said they can be a helpful addition.

  • Sleepio Member

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    Expert

    Hi

    As you mention there are a few different approaches. And it would also depend on flight length (e.g. is it possible to sleep on the flight?) and whether changing time zones.

    If changing time zones it can be helpful to plan sleep as closely as possible to the new time zone. And in general, one would be aiming for a high sleep pressure the first night in the new destination. So if sleeping before the flight in the day will avoid a nap in the daytime at the new destination, this may be helpful.

    But of course, it may not be possible to sleep before the flight (before usual bedtime)and that is quite normal as our bodies aren't usually ready for sleep in the daytime.

    It may take a little adjustment to get the sleep back in place but that is completely usual in a situation like what you are describing.

  • Sleepio Member

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    Expert

    We'll finish there. Thanks v much for all your posts tonight and best of luck with the sleep later.

    best wishes

    Bryony

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