Live discussion with Dr Bryony Sheaves - 13th April 2016

Dr Sheaves will be hosting a live online discussion here on Wednesday 13th April, 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 7 Apr 2016 at 11:53 AM
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  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I never would have thought of applying paradoxical thinking to this situation. I guess if you expect you'll be returning to home-sweet-sofa before too long, then going back to bed could serve as an incentive. Thanks.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Katew,

    The thinking behind keeping activities other than sleep away from bed is to build up the bed=sleep connection. It's all about associative learning, so our minds associate bed with sleep and hence sleep comes more easily when one is in bed. If bed is associated with things other than sleep then the mind is less inclined to instinctly calm as soon as we head to bed.

    I wonder whether there are attributes of bed that could be replicated in the wind down time e.g. getting comfy, dimming the lights, sitting with a comfy blanket? If this is as relaxing as it would be in bed then we might hope that when one heads to bed sleep comes more quickly.

  • Sleepio Member

    • 9 comments
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    in reply to Sleepio Member
    Session 4

    Thank you for your very clear and helpful responses to my posts. I now have a much clearer sense of the logic and value behind the quarter hour protocol, as well as a better understanding of the difference between active and passive relaxation. With reference to colouring books, I used one last night in my “wind down” period, and, to my surprise, found it calming, something I would not have believed before.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Em75,

    With sleep restriction, if anyone feels dangerously tired we'd always recommend taking a short nap and consider whether it is safe to drive. A nap of around 20 minutes, and before 3pm would be best.

    Are you sleeping for 2 hours consistently across nights or does it vary at all?

    A few things that some find helpful to consider:

    Whether the sleep window is matched with ones' biological clock. So for an evening person we may recommend a later sleep window, as this is the time that they are most likely to sleep. And for a morning person they may prefer an earlier sleep window. We'd recommend keeping the length the same but the window can be shifted earlier or later by following these instructions:

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

    The other thing to consider is how the time is spent up until that point when sleep comes. Is the 15 minute rule helpful? Is one feeling anxious or frustrated throughout the night? Are there things from the course that may help (e.g. relaxation). Or is there a way to plan relaxing (or even boring) activities for this time until the sleepy-tired feeling comes?

    Just a few thoughts – I hope you see some improvement in your sleep soon.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi irena,

    I'm so sorry to hear that your sleep is difficult and well done for keeping going with the techniques. It sounds like you have had a few changes with a new job and coming off the sleeping pills, these will naturally affect your sleep. Some find it helpful to wait for things to settle and then take a step back and review where things are.

    You mentioned about going on and off the sleeping pills so i thought I'd respond to this part. Sleeping pills are recommended in guidelines for short term use and tapering the dose down slowly is usually the recommended approach (and always seeking advice from the prescriber). Some people describe coming off of sleeping pills but using them when they need (e.g. after a bad night). This can lead to a 'rebound' of insomnia when the dose is reduced, so the sleep is worse and then before the rebound has passed it is tempting to go back onto the sleeping pills again. A consistent approach, or devising a plan with the prescriber can be helpful.

    Here is an article that may be interesting:

    https://www.sleepio.com/library/article/sleep-aids/

    And there are other discussions on the community from other Sleepio users' perspectives.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I see you are on session 1 of the course so you have lots of session content to come which is good news. It sounds like you have already noticed some patterns in your sleep, particularly with regard to the naps and this will certainly be covered in later sessions so it's great that you have a head start.

    Reading can be a helpful technique to wind down. The course will help you to build on strategies like these, so for example thinking about when and where you read in order to optimise sleep.

    As a general approach we recommend seeing what you can take from each session, trying things out and then moving on to the next session with some tools on your belt. Is there anything that has been helpful from session 1?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi gracenk,

    Many Sleepio users take medication whilst using the programme but it can be helpful to share with your doctor / prescriber that you are also trying psychological techniques.

    Reading will be covered in the program, the thing to consider with iPads is that (as with any back lit screen) they emit blue light that can reduce sleep quality if close to bed time.

    Best of luck with the course!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Waking in the night is a common symptom of insomnia and the course is well placed to teach many techniques that are helpful for this. The course delivers many strategies over the sessions so I wont jump ahead but I hope you will come away with something useful by the end of the course. See if you can take something away from each week of the course, try it out so you can see it's effect and then you are in a good position to build on it in the following session. Hopefully we shall see your sleep efficiency increase.

    If alternatively you think that the need to pee is problematic and gets in the way of using techniques you may want to speak to your GP / Primary Care Physician for specific advice.

    Good luck with the course!

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    Hi sharonyau – good question. I'm going to seek specific advice from other experts on this if that's ok.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi scruffy,

    I cant offer specific tips on this but generally it's best to devise a plan with the person who prescribes the medication. Sleeping meds tend to need to be tapered down slowly so best to have a plan in place to increase chances of success.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi Elizabeth,

    We usually recommend relaxation (or anything other than sleep) outside of the bed. I've posted some earlier comments outlining the rationale for bed=sleep so these may be worth reading.

    With the sleep diary, we fully appreciate that it can be really tricky knowing sleep times. An approximation is ok for this, so don't feel too concerned if it isn't exact.

  • Sleepio Member

    • 478 comments
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    In reply to a deleted comment
    Expert

    Hi sharonyau,

    The Sleepio course is well placed to work on night time awakening. Look out for session 3 which is about sleep restriction and the quarter of an hour rule. Do check back in if you have any difficulties.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    I'm sorry that you are having continued difficulty with your sleep. I'm going to check in with some of the other experts re: very frequent night time awakenings to see if they have any particular thoughts if that's ok. If in the meantime you could offer more detail (e.g. how long you are sleeping in one block, is there any pattern to your awakenings) that would be really helpful.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    I think the sleep diary can certainly take a bit of getting used to. An estimation of times and number of awakenings is completely fine for the purpose of the sleep diary so don't worry about watching the clock as this is unlikely to be helpful for sleep.

    Good luck with the course.

  • Sleepio Member

    • 44 comments
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    in reply to Sleepio Member
    Graduate

    Regarding blue light, the latest iOS (9.3.1) has a feature called Night Shift that filters blue light in iPhones and iPads. Once installed, it does not turn on automatically; you have to select an icon.

  • Sleepio Member

    • 44 comments
    • 4 helped
    in reply to Sleepio Member
    Graduate

    Regarding blue light, the latest iOS (9.3.1) has a feature called Night Shift that filters blue light in iPhones and iPads. Once installed, it does not turn on automatically; you have to select an icon.

  • Sleepio Member

    • 478 comments
    • 81 helped
    Expert

    Hi all,

    That's all for tonight! Sorry we have run over a bit but I hope you all find a reply. There are a few posts that I am going to speak to our other experts about but I will get back to you when I hear a response.

    Many thanks for so many interesting questions this evening and best of luck with the sleep techniques this evening.

  • Sleepio Member

    • 2 comments
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    in reply to Sleepio Member
    Session 2

    Yes. Just having to write my journal made me accountable for leaving media by 11PM to get a 7 hour sleep.

    What are your thoughts on afternoon naps?

  • Sleepio Member

    • 478 comments
    • 81 helped
    In reply to a deleted comment
    Expert

    Hi,

    I'm just responding re: your live session comment. I've spoken to the other experts who have advised me that the Sleepio program is not ordinarily advised for those who are pregnant. This is owing to the increased need for sleep during pregnancy. I believe this is stated in the terms of use. The element of the course which this impacts upon is sleep restriction, which is coming up for you in session 3. The options here are to continue with the course but not use the sleep restriction element (relaxation and wind down routine and stimulus control for example should all be ok) or to contact the team and we will refund you (contact hello@sleepio.com). I will also contact them in advance so they are also aware. There is also a booklet on sleep during pregnancy which you can read here in case it is helpful: https://www.sleepio.com/articles/pregnancy/

    Apologies that you have got this far without being aware of this recommendation.

    Best wishes,

    Bryony

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    Just following up from the live session as I've been in touch with the other experts for further consultation re: your night time awakenings (given the number of them). There are many things that can cause night time awakenings, these include obstructive sleep apnea, pain, very high caffeine / stimulant use, pregnancy and sleep movement disorders. With the information that we have it is not possible for us to consider which, if any may be relevant.

    Risks for sleep apnea (a sleep breathing disorder) include having a large neck circumference, male, heavy snoring, waking up choking or gasping for air and waking up with a dry mouth or headache.

    When it is possible that other problems may cause, or exacerbate insomnia we would advice speaking to a GP or Primary Care Physician.

    I hope this is of some help, the next live session is next Wednesday if you would value posting further details re: the night time awakenings.

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