Live discussion with Dr Bryony Sheaves - 14th December 2016

Dr Sheaves will be hosting a live online discussion here on Wednesday 14th December, 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.

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Posted 8 Dec 2016 at 3:35 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm pleased to hear that the SR has been helpful for sleep but sorry to hear that it is leaving you feeling unenthusiastic. Many people say that it is a difficult technique. In the short term it can leave people feeling fatigued. In the longer term, studies have shown that it is helpful as a stand alone strategy for improving sleep and as the sleep window gradually increases the negative effects also subside.

    That said, if anyone is concerned that SR is having a negative impact on any aspect of health, we would recommend sticking to consistent sleep times, but not restricting the sleep window to the same degree as it is currently. All the other techniques are more accessible (e.g. the 15 minute rule) and have been tested in groups who experiences mental health difficulties so these are still available.

    Well done on the gains you have made to date with your sleep – I'm sure it's taken lots of effort.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I see you are on session 2 so reasonably early on in the course. There will be many techniques which are designed to help with this anxiety.

    Next week you will get to sleep restriction which is one of the more powerful techniques in helping to get a more regular amount of sleep across nights.

    When people describe feeling anxious in the evening period, one of the earlier things we usually recommend is relaxation audios. These can particularly be a helpful replacement for alcohol which can in fact decrease sleep quality. There are relaxation audios which can be downloaded from Sleepio. Have you seen them?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Well done for working at the sleep restriction, it is indeed a tough technique in the short term, but can be very helpful for improving sleep in the long term.

    In terms of the question about 10 hours in bed, am I right in saying that you are sleeping for around 6 hours? It's common when people have sleep problems to spend much time in bed awake – and this is why sleep efficiency can be lower. However this decreases our bed=sleep connection and means that instead, bed is associated with wakefulness (and often anxiety or frustration). There are strategies to combat this, such as the 15 minute rule. Have you covered this yet in the course?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    For people who describe finding it very difficult to stay awake until bedtime, but then rise earlier we sometime recommend shifting the sleep window so that the bedtime (and rise time) are earlier. This may mean that the sleep window is more in line with the body clock (circadian rhythm). Here's an article on how:

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

    Whilst feeling fatigued is usual during sleep restriction if anyone is feeling dangerously tired, we'd recommend taking a short 20 min nap earlier in the day (ie. before 3pm).

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm sorry to hear that you are struggling with sleep. It sounds like there is quite a pressure on you to sleep as soon as you have time off.

    The Sleepio course can be helpful for improving difficulties with getting to sleep or staying asleep, so there may be some beneficial strategies. However it does also work best if there is an adequate opportunity for sleep, also allowing for a wind down time. If it is OK, I'll forward your concern to our team of experts to see what they think.

  • Sleepio Member

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    Expert

    Hi,

    The key with sleep medication is linking with the prescriber so that there is a plan for weaning off of them and knowing what to expect when the meds are reduced (in terms of potential side effects) . This boosts the chances of success. Some people like to start tapering meds from the start of the programme whilst others prefer to learn the strategies first, then reduce medication. It usually depends on the individual and their personal goals.

    Good luck!

  • Sleepio Member

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    Expert

    Hi,

    Great to hear that you've been trying the techniques. Have they helped at all?

    Firstly, are there any reasons for the waking at that time? E.g. a nightmare / using the bathroom / light coming in through the curtains / noise / sleep breathing problems or snoring? We'd usually consider these first.

    The other thing that I would usually bear in mind with night time waking is the timing of the sleep window. I've mentioned this in previous posts but it can be really helpful to align the sleep window with the natural body clock. If a morning person, it can be helpful to move the sleep window earlier to gain more sleep:

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

    Am mindful the session is about to end so I may not see a response to the above but do check in next week in the live session if helpful.

  • Sleepio Member

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    Graduate

    I find getting up after 15 mins awale difficult because I disturb the rest of the family, and also the house is cold

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi, this is usually when 90% sleep efficiency is reported on the sleep diary. Then the sleep window is gradually increased by 15 mins at a time

  • Sleepio Member

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    Expert

    Hi, the sleep window is usually increased when 90% sleep efficiency is reported on the sleep diary. Then the sleep window is gradually increased by 15 mins at a time.

    The key with achieving this is to aim for consistency across nights. We ideally want sleep pressure to be equally high every night that one goes to bed (at least until the sleep efficiency is increased). Then in the longer term, when sleep is back on track, some people chose to add in a bit more flexibility into sleep times.

  • Sleepio Member

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    Expert

    Hi, I think as a general rule, if we are aware that we are awake it may be helpful to note this as an awakening in the sleep diary

  • Sleepio Member

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    Expert

    Hi,

    Good question, relevant to many I'm sure. It will usually last for several weeks. Each person starts with a sleep window which is gradually extended when sleep efficiency is high. This can take several weeks. Some people prefer to take this on in the holiday when there isn't work, but for others it can be disruptive to other plans. Here is an article that may be helpful:

    https://www.sleepio.com/library/article/im-going-on-holiday-should-i-stop-the-sleepio-cour/

  • Sleepio Member

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    Expert

    Hi everyone, we've run over time so I'm afraid I'm going to have to stop there. I'm aware that it's been a very busy session tonight which means there are some posts which aren't answered. I will contact the team to work out how we can reply to the remaining posts and let you know by posting on here.

    Thanks for all your questions and sorry I don't have longer this evening to answer them.

    bryony

  • Sleepio Member

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    in reply to Sleepio Member
    Session 4

    I often feel like that

  • Sleepio Member

    • 7 comments
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    in reply to Sleepio Member
    Graduate

    Thanks Dr.Sheaves for your reassuring reply. Seems Sleepio techniques spread out through daytime thinking too, letting negative thoughts come and go as they please without causing too much havoc. Makes for a much more harmonious life. Thanks Sleepio for techniques that really work.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Yes, I've been trying the 15 minute rule but am finding it exhausting, getting up 4-6 times or so. This morning I finally fell asleep at 5.30am after 7 rises from bed following the 15 minute rule. It's only 11.30am in the morning now, I've been up 2 hours or so and I feel dreadful. My night-times feel physically so tiring with the SR method in place.

  • Sleepio Member

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    Graduate

    I feel very sorry for you. I am also doing SR and after a very good first night didn't do so well last night. I think you need to talk with the Prof. I wonder if the extra exercise involved in going up and down stairs 7 times is stopping you from sleeping.

  • Sleepio Member

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    Session 5

    Yes, that'd be okay. I'm usually able to “catch up” on Sundays, but I miss having a day to wind down and work on home improvement projects.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    As promised, just getting back to you.

    Having discussed with other experts, we wondered if our guide to shift work may be relevant. This includes adaptations to the course for people who work shift. This includes for example adapting the sleep diary:

    https://www.sleepio.com/articles/shiftwork

    The key thing when working shifts is thinking about the principles that Sleepio covers and then thinking about how they may be adapted.

    So for example early in the course the Prof talks through different things that can get in the way of sleep. One of these is light. For people who work shift this is a particularly important point, as trying to sleep in the daytime.

    As another example, in session 3 sleep restriction will be covered, the principle behind this is ensuring that sleep pressure has enough time to build up. If high enough it will increase the chances of sleeping at the desired time. A sleep window is usually suggested at the end of this session, but this is difficult to maintain every night if a shift worker, so here it would be sensible just to bear in mind the concept of sleep pressure and think about how it could work given the shift patterns.

    If this is all sounding a bit complicated, do check back in to these sessions to discuss.

    Good luck,

  • Sleepio Member

    • 843 comments
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    Expert

    Hi all,

    Just to say, sorry that I wasn't able to answer all of the questions in the live session last Wednesday. There has been a link posted now to a new live session with Dr Vicki Creanor this Wednesday. Do post your questions early to ensure it is answered as the sessions have been very busy recently.

    Best wishes

    Bryony

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