Live discussion with Dr Bryony Sheaves - 12th August

Dr Sheaves will be hosting a live online discussion here on Wednesday 12th August 7pm-8.30pm BST.

She will discuss as many topics as possible in the hour and a half and, as always, you’re welcome to ask any questions at all about sleep or the Sleepio program. Please do note however that, as per our guidelines, Dr Sheaves won’t be able to give highly specific medical advice. He will however try to help as best as she can!

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Posted 7 Aug 2015 at 1:43 PM
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  • Sleepio Member

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    Expert

    Hi ekeller and sleepdeprivedj!

    Will take a look through for your questions

  • Sleepio Member

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    Expert

    Hi ekeller

    I can see that there is a practical difficulty here in implementing the wind down and quarter of an hour techniques. This is quite common so it's great to hear that you have been trying to be creative about solving this.

    Ideally, what you are aiming for with the quarter of an hour rule is strengthening your bed-sleep connection. So you want to spend as much time as possible asleep in the bed that you would like to be sleeping in long term, rather than the sofa.

    Your attempts at using the small space adjacent to your bedroom sound like a good solution, if you can resolve the stressors waking your husband. I wonder if any of the other sleepio members have any suggestions here – I know this has come up many times before.

    A few thoughts – does your husband know the rationale for what you are doing and appreciate that it wont be forever? Is he reassured that if you get up, there's nothing to worry about, you're just doing your quarter of an hour technique?

    Also, from your perspective, could you make the room adjacent to your bedroom a calm space too? Learning from what works well from the living space. Ensure you have nice relaxing things to do when you head there.

    Ideally, as soon as you feel sleepy-tired again it would great to creep calmly back to your bed and sleep there.

    Good luck!

  • Sleepio Member

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    Expert

    Hi Blodwen,

    Waking in the night, or waking earlier than you'd like in the morning is a common symptom of insomnia and I can see that it is nice enjoying the comfort of bed when you wake early. However it sounds like this isn't providing you with restorative sleep after your initial wakening – just snippets of sleep.

    I am guessing in the long term that you would prefer to have a longer chunk of sleep (ie sleeping past 5), than these extra morning snippets. If this is the case the best strategy is to get up out of bed at your usual wake time (5am) regularly, each day. This should build your sleep pressure for the following night and the hope would be that you gradually sleep longer.

    Is there anything that you can do to help lure yourself from bed at that time (I know it can be tough!). Perhaps have a nice drink/snack… some good radio, opening the curtains to let the natural light in (which should help wake you) or taking a short walk to energise you for the day? Anything that works for you.

    Good luck with it.

  • Sleepio Member

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    Hi SleepDeprived J,

    I hope my answers to both flick and blodwen are helpful in some way for you too. Waking in the night is a common symptom of insomnia, but there can also be other reasons for waking (hence my extra questions to flick). Let me know if anything is unclear or you have extra questions.

  • Sleepio Member

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    Graduate

    Thank you for that Dr Sheaves. No problem getting up at 5.00. My real problem is non restorative sleep! I probably too late for another reponse so thanks anyway. B

  • Sleepio Member

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    Hi PanNarrans,

    Am I right in saying that the initial sleep problem was the apnoea and then afterwards you developed the anxiety around falling asleep? If so it sounds like the apnoea was the trigger for your insomnia. These two sleep problems commonly co-occur. Anything that increases anxiety around the time you are due to sleep will likely interfere with getting to or staying asleep (insomnia).

    In terms of causes of apnoea, there can be many reasons for onset, including particular medications, alcohol use, smoking, having an unusual inner neck structure, a family history or other medical difficulties. Your treatment provider for your CPAP should be able to tell you more.

    It's great to hear that your apnoea is being treated. And you have now started work on your insomnia too so you should see your sleep improve as you work through the course. The course has techniques which should help specifically with the anxiety you describe around sleep too. I'd recommend seeing what you can take away from each session and try things out before the next session.

    Do check back in here if you have any further questions and good luck with the course.

  • Sleepio Member

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    Graduate

    Hi Dr. Sheaves, Thank you for the information. In your response to Flick you asked whether they experienced vivid dreams. Similar to Peter123’s post, above, I’m also having vivid dreams that I can remember in some detail upon waking.

    I'm looking forward to your response to Peter123’s post. Thanks!

  • Sleepio Member

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    Expert

    Hi Blodwen,

    Sorry I think I mis-understood, good to hear that getting up isn't a difficulty!

    In terms of non-restorative sleep more generally, it can be a reflection of another underlying sleep disorder (e.g. limb movements, sleep-breathing disturbance), or an associated underlying medical illness like Fibromyalgia, Chronic fatigue or chronic pain. It might help to have other conditions ruled out by your GP. In these latter medical conditions, there has been published evidence of altered sleep macro and micro structure, as well as studies showing improvements in sleep through CBT-based methods. You may well have read this already from the library article.

    Lastly, another reason why people find that their sleep is unrefreshing is because they are sleeping for the right amount, but at the wrong time. Would you say that you have always been more of a morning person? If so you may well find it easier to get more sleep at the start of your sleep window (ie. heading to bed slightly earlier), than sleeping past 5am. You can google 'morningness-eveningness questionnaire' which (as long as it has the scoring on the end) will let you know your sleep time preferences.

    I hope that's helpful in some way Blodwen.

  • Sleepio Member

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    Expert

    Hi wayneio,

    And welcome to the sleepio course! Yes complete the sleep diary even when you take sleeping tablets.

    There are further instructions on completing the sleep diary here:

    https://www.sleepio.com/library/article/how-to-fill-in-your-sleep-diary/

    Hope that's helpful and do log back into the live session if you have further questions.

  • Sleepio Member

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    Graduate

    Thanks much for you advice Dr Sheaves.

    Yes, my husband is aware and supportive of the program and very glad that I'm tackling this issue that has been plaguing me and in turn affecting him increasingly over 20y.

    That said, it's a big difference talking about the program when we are both awake vs. experiencing sudden and multiple awakenings by me at night.

    My husband (undisturbed) will fall asleep instantly and sleep through the night. But he is easily awakened by my rustling, getting in and out, heading for the loo, etc.
    His reactions differ, I guess depending on factors such as how many times a night this happens, where he is in his sleep at that moment, what time at night it happens.

    As I am rather cranky myself when someone wakes me in the middle of my sleep, I can appreciate that the wake-ups don't earn me smiley-points and feel sorry to take away from his well-deserved sleep.

    Luckily we can laugh about it the next day, but still, during the night when it happens, it's annoying/sleep-depriving for him and added stress for me in winding down as I constantly need to try to be as quiet as possible.

    We improved a lot by switching to 2 separate beds with non-touching frames, but not sure what else could be done. (maybe a less rustling blanket now that I think about it….)

    I have been thinking about making improvement to the little room… will discuss and pursue based on your advice. I will also “clear” the path so that I don't bump into things when I'm groggy to minimize awakenings. There are practical limitations, but worth giving it a shot.

    Thanks again very much for your help!

  • Sleepio Member

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    Expert

    Hi rubytuesday,

    Many people who come to the course are taking medication to help them sleep so you are not alone here. In terms of timing, this is down to you (and your prescriber). Some people prefer to start learning the techniques first, see their sleep improve and know that they have the skills in place to manage when they come off the medication. For others, particularly if they have been on medication a while they prefer to reduce medication at the earliest opportunity. It's really down to what you will manage best and what your prescriber thinks.

    It's really important to have a plan in place for reducing medications – usually tapering off them gradually. So do speak to the person who prescribes you the zopiclone to find out the right increments for reducing the dose.

    You will likely find that when you reduce the medication you have some extra difficulties with sleeping until your body gets used to the reduction. This is called rebound insomnia. It can be helpful to expect this rather than be surprised.

    Here are some discussions that you might find helpful to read from other sleepio users:

    Community discussion about weaning off medication:
    https://www.sleepio.com/community/discussion/zopilcone-depedance---how-to-ween-off-/

    Community discussion about taking medication while doing the program:

    https://www.sleepio.com/community/discussion/using-medication-while-doing-the-sleepio-course/

    Good luck with the course and do check back here if you have further questions.

  • Sleepio Member

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    Expert

    Hi Peter123,

    I wonder if you noticed any particular trigger when you started to have sleep problems? Either life stressors or any other medical problems that started around this time? If you are concerned about a possible physical cause of your sleep problem I'd advise speaking to your primary care physician / GP.

    The course should certainly be able to help with the difficulties waking in the night and waking too early. Try to work through each session in turn and try things out in between to find out which techniques work best for you.

    In terms of the vivid dreams, the course doesn't cover these, so here is some extra info and things to consider:

    -Are you taking any medication that might impact on dreams. Some meds can impact on sleep architecture so it might be worth speaking to your prescriber or taking a careful look through side effects.

    -Similarly alcohol can impact on dreams. You could use the compare sleep tags tool in the sleep diary to see if this is having an impact for you.

    -Relaxation can be helpful to get off to a restful sleep. You can download relaxation MP's when you cover this aspect of the course.

    Best of luck with the course and do log back in here for any further advice.

  • Sleepio Member

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    Graduate

    Thanks for the comment. Can't think of any stresses that would have caused my insomnia, which is why I wondered about physical causes, although I'm generally pretty fit. Its not the dreams themselves that concern me, but rather, whether this means that I am only ever in a light sleep phase and not getting any deep sleep.

  • Sleepio Member

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    Expert

    Dear scotty,

    You are right that sleep does naturally change as we get older. The architecture of sleep changes with age so that people report waking feeling unrefreshed, difficulties getting to or staying asleep and a tendency to nap during the day. The good news is that cognitive behavioural techniques, such as those used in sleepio can also be used to good effect for older adults and even with other physical or psychological health conditions.

    There is some evidence that melatonin medication can also be helpful for older adults. Though it might be worth working through the sleepio course first and then speaking to your doctor afterwards if applicable so you can learn which tips from the course are of most benefit to you and also whether melatonin is of added benefit.

    The sleep schedules account for other underlying vulnerabilities that you have by using information from your sleep test that you completed at the start. But, when you get to sleep restriction, if you have a particular physical or psychological difficulty that you think may require a less restricted sleep window do ask us for specific advice.

    Good luck with the rest of the course scotty!

  • Sleepio Member

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    Expert

    Hi Kathrync,

    There is some evidence that hormones that control appetite are also associated with reduced sleep duration. Some people with insomnia also report that due to feeling fatigued, they tend to eat different foods, e.g. sugary foods, in an effort to boost energy levels. Of course do keep in mind that you are doing a course designed to help with sleep(!), so if it is playing some role, hopefully it will be improved soon. Good luck with the rest of the course.

  • Sleepio Member

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    Graduate

    Interesting! I am certainly a morning person. Will explore the Questionaire. Many thanks B

  • Sleepio Member

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    Expert

    hi t1
    I'm sorry that you are not seeing the gains that you hoped for – have you seen any improvement at all in that time?

    Here are a few thoughts. Are there other aspects of the course that would be helpful when you are exhausted and unable to sleep. E.g. the quarter of an hour rule, checking out your thoughts with the thought tracker or alleviating anxiety with relaxation?

    It's also always worth us checking out whether you are managing the sleep window. Are you able to stay up until the start of the window and avoid the odd oversleep? If you are having difficulties with keeping to a consistent schedule this can slow improvement.


    Lastly, if you are feeling dangerously tired, avoid driving and do take a short nap if required, but earlier in the day so that your sleep pressure has time to build again.

  • Sleepio Member

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    Expert

    Hi interfaceleader

    You are not alone in noticing this and there are indeed links between hormonal changes and sleep. In terms of the course I wouldn't recommend any specific changes, other than keeping all the techniques that you find helpful up your sleeve for those times of the month. E.g. if you found sleep restriction helpful, you could go to bed slightly later at that time, or if relaxation was your thing make sure that is a priority each night at that time.

    Overall, sleep likes consistency, so trying to avoid big changes in your sleep window across your cycle (as you have successfully been doing through the course) will be helpful.

    It might be worth posting in the community discussion to other sleepio members as there have been questions in these sessions in the past and I wonder if there is anything that others' have found particularly helpful?

  • Sleepio Member

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    Expert

    Hi everyone,

    I hope I have answered everyone's initial questions and apologies if I haven't responded to later comments – I've run over quite a bit and need to wrap up now. It's been a busy night on here tonight with many interesting questions so thank you so much for your posts and to those logging in live!

    Good luck to those still working through the course.

    Best wishes

    Bryony

  • Sleepio Member

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    Graduate

    Hello Dr. Sheaves,

    I am sorry to get home too late from my first job to log on live! I will write in to next week's expert session for more help, but your excellent questions have sparked some useful thoughts.

    To reply to the questions posed in case anyone is wondering:
    -The recurrent waking is new, and just began a few months back -- and after I'd thought my insomnia was fading away! The insomnia itself began about a year ago for no apparent reason.
    -I've had vivid, easily-remembered dreams all of my life, so this is not new as I will be 53 next week.
    -I'm not breathless when I wake and my husband reports that I do not snore and do not show signs of sleep apnea.

    My current sleep window is 10:15 pm to 6:00 am, which I shorten to 10:30 pm to 5:00 am despite the Prof's urgings to extend it! This should be an adequate SW but because I wake up so much and am typically awake for good by 5:00 am, I don't ever feel rested. In the old days I was able to sleep and feel “normal” on a solid 9 hours of sleep a night! But now I'm lucky to get 6 hours, broken up into little fragments. (Can't complain too much though, as when I started here I was getting 2 to 3 hours of sleep a night!) My natural SW before insomnia began was 11:00 pm to 8:00 am but I must be up by 6:00 am for work so I would sleep from 10 pm to 6 am during the week and 10 pm to 8 am on the weekends to catch up. It was bliss!

    Come to think of it, the recurrent awakening that begins within the first hour of my falling asleep started when I began having severe nighttime lower leg and foot spasms after recovering from pneumonia and reactive airway disease with bronchospasm in April and May of this year -- the antibiotics (and 2 kinds of inhalers, one of them steroidal) I had to take seemed to have washed out my body's potassium and magnesium, but it took me many weeks to figure this out. The spasms would begin within minutes of my lying down and would always wake me up again within the first hour of my falling asleep, and repeatedly on through the night. The spasms were so strong and persistent that I had to immediately and urgently stand up and walk around weight bearing and prancing my legs for at least 10 minutes to get them to settle, and I learned never to stretch my legs down in bed or let my toes point down as this was an immediate trigger for the spasms. Now I take a magnesium supplement and eat a banana a day so I rarely have the leg cramps and spasms anymore but the apparently learned response of waking up early and often has remained with me.

    Thank you for your time and insight … now I just have to figure out how to retrain my brain (again!) so I am not anticipating waking up to lower extremity spasms.

    Flick
    xoxo

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