Live discussion with Dr Bryony Sheaves - 14th March 2018

Dr Sheaves will be hosting a live online discussion here on Wednesday 14th March, 7.00 to 8.30pm British Standard Time or 3.00 to 4.30pm US EDT.

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 including that about medication. 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 8 Mar 2018 at 3:08 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Sorry to hear that you had a set back in your progress. It's common to have bumps in the road to sleep improvement, so this is a common problem share by Sleepio users. The good thing is that you have seen improvement in the past so have a good model of how things can improve, it's just a case of getting back there.

    If people come with a key goal of reducing sleep medication I always ensure we're linking with the prescriber as this increases the chances of success. Evidence shows that having a specific plan of slowly tapering down medication is more effective for sleep improvement than taking them as and when needed, so it's always good to devise this plan with the person who knows about the medication. It can also be helpful to learn what to expect when reducing meds as this can have an impact on sleep.

    Some people chose to reduce medications alongside CBT programmes like Sleepio, whilst others prefer to learn the techniques first and then aim to reduce meds once they have the tools. It depends what their goal is.

    I hope you see some benefit from the course techniques soon and can get your sleep back on track.

  • Sleepio Member

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    Expert

    Hi,

    Really sorry to hear this. It makes sense that when the external time changes it takes a while for the internal clock (circadian rhythm) to catch up. This is quite a common occurrence and more so for people with insomnia symptoms who may be more sensitive to changes in the sleep schedule.

    I see you are a graduate, are there techniques covered in the course that helped previously? Would it be helpful to think through sleep timings together for example? If so, and you feel able to, please do share your current sleep schedule.

  • Sleepio Member

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    Expert

    Hi,

    It is indeed possible to have had dreams, they are very common in the morning as this is the time when we tend to get more rapid eye movement sleep, which is where most dreams occur.

    There are also phenomenon called hypnopompic and hypnagogic hallucinations which are dream or hallucination like experiences on the transition between sleep and wakefulness.

    The boundaries between sleep and wakefulness can be quite blurred!

  • Sleepio Member

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    Graduate

    Well I started in January so this is my first time change.In the fall it did not do this ,I am guessing because when I am woken ( usually by the alarm clock my husband uses ) its so dark ,now I try to go back to sleep and sometimes I do most times I just do not and cannot .Any way its so dark that I just do not like trying to get up when it seems like its night time .So try to go to bed at 10 sometimes I go to sleep right away and now it takes a while and yes I am on prescription medicine .

  • Sleepio Member

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    Expert

    Hi,

    I'm sorry to hear that you have experienced chronic insomnia for a long time. And I'm guessing you find it frustrating that we aren't able to offer more insights into medications. I'm really sorry about that, I wish I had more info to share to be more helpful with meds as you're right it does pop up a lot on the live sessions.

    It sounds like you are trying to work out what is the underlying cause of insomnia. I can't answer this for you specifically, but I can share some info about a common path.

    Whilst some people have experienced insomnia all of their life, it most often starts after some trigger, for example a big life event or stressor. What then typically happens is after a while of having sleep difficulties people adjust their sleep pattern and find ways of coping. There are often thoughts which can leave people more anxious about their sleep (e.g. predicting that I wont get any sleep at all tonight).

    These new patterns of thinking and behaviour which are all aimed at managing the sleep problem can in fact keep the sleep problem going. For example, by keeping attention focused on sleep or sleeplessness through the night and day this can actually disrupt sleep. Or by going to bed early (to catch up on sleep) this reduces our chances of sleep because we aren't tired enough yet. And having anxious thoughts at night fuel stress hormones which stop us sleeping.

    The Sleepio course has been built on lots of knowledge about what keeps sleep problems going and aims to tackle each of the key ones. Many going through the course will have other health concerns such as feeling low, anxious or chronic pain for example. But evidence shows that courses like Sleepio can still be helpful for improving sleep in spite of others concerns (provided treatment for the other health problem is also optimised).

    That's a detailed reply but I hope helpful in some way. Good luck with the course.

  • Sleepio Member

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    Expert

    Hi,

    This does sound tricky. I guess in general it will take some time for the body clock to adjust so we usually would allow a buffer period. Whilst tough when it's dark and bed is a warm and comfy place I wonder if there is a way to make getting up more appealing (e.g. leaving some warm slippers and a dressing gown by the bed or a cosy blanket in the next room)? I say this because when the body clock is a bit out of sync boosting sleep drive by getting up can be quite helpful for sleep the subsequent night.

  • Sleepio Member

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    Expert

    Hi, really sorry to hear that you have had this for many years. The Sleepio course has been trialed and shown to help people with sleep maintenance insomnia so I hope you also find some benefit.

    Strategies will be introduced each week by the Prof and we tend to find that the key to success is to try each of them out and work out how they work for you and your routine. Then a week later there will be more strategies. One of them is sleep restriction, but we tend to find this works best when running alongside other techniques which boost feelings of calm and relaxation and also help to manage those times when unable to sleep.

    I hope you find some benefit and do log back in here if you come across any stumbling blocks along the way.

  • Sleepio Member

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    Expert

    Hi,

    Changeable shift patterns can be tricky for the sleep system. In general we'd recommend trying to keep the sleep window as consistent as possible across nights. But adjusting minimally when needed. E.g. if there is a window between mid-night and 5am when it's possible to sleep, no matter what the shift pattern, it can be helpful to aim for this each night and then add on time before or after as needed to make up the sleep window set by the course.

    Having a buffer zone for winding down is usually also helpful to prioritise. If trying to sleep earlier than the night previously sleep drive may be lower, so increasing emphasis on a long and relaxing wind down routine can be helpful.

    I hope that's helpful in some way.

  • Sleepio Member

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    Session 4

    Hi there!

    Just wondering about your thoughts on gadgets like Fitbit and whether you think they do an okay job at tracking sleep.

    Also, I seem to sleep in 1.5 hour chunks at night time, I might be up from 10 min – 1 hour and then I go back to bed. This happens about 3 times a night. I am not particularly anxious when this happens except that I worry that this might be an unhealthy habit. Thanks :)

  • Sleepio Member

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    Expert

    Hi,
    That sounds like a very difficult thing to hear and I'm sure not helpful for the anxiety about sleep. In fact the amount of sleep that people need varies and 6 hours is very common.

    Anxiety about sleep is a very common part of insomnia. The anxiety unfortunately gets in the way of the usual sleep processes working their magic each night. The good news however is that because of this the course is very well set up to help manage sleep related anxiety and will cover a range of techniques. The Prof will cover these in the forthcoming weeks but if you have any specific questions when they do come up please do get in touch in one of the live sessions.

  • Sleepio Member

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    Graduate

    That’s the first time I’ve heard of “stress hormones”. When life is governed by unpredictable sleep it’s so hard not to focus on it as it causes such an impact. I’ve had a good day today due to getting some sleep last night. All I can hope is that Sleepio & my antidepressants (of 4 weeks) can get my mind off thinking of “will I sleep tonight”. I envy people who say “as soon as my head hits the pillow I’m off”. What makes them so different. Thanks for being there.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Gadgets vary in their ability to track sleep. In general I recommend taking the persons own perspective on sleep first, and if the person I'm working with thinks that the gadget got the sleep wrong, work out why. Commonly people say that the gadget over-estimates sleep and this is usually because they are lying very still for example.

    The wakenings you mention in the night are very common. In fact awakenings after around 90 mins of sleep are usual, but we aren't aware that they've happened because they are usually very brief. The course can help to squeeze out these awakenings. Session 3 in particular can be helpful for this.

    Good luck with the course!

  • Sleepio Member

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    Expert

    A frustrating bunch aren't they?! I'm so pleased to hear that you had a good sleep last night. It may well mean that the sleep drive / pressure is slightly lower tonight, and it takes longer to sleep tonight, but that's OK (and normal), there is always the 15 minute rule and wind down routine which help sleep to come more quickly. And if you do get to sleep the same as last night, fantastic, celebrate it!!

    Good luck

  • Sleepio Member

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    Expert

    Hi,

    Being sleep deprived is a known trigger for low mood, and may well work alongside hormonal changes to trigger post partum depression. Are you currently waking up with this frequency due to your baby or are you speaking historically? It is very tricky to be working on insomnia when there are external factors impacting on sleep. My usual advice for new parents is to sleep when it's possible, seek support and see if there are opportunities to share some of the night feeds (by expressing milk) and to liaise (as you have done already) with a doctor if mood drops. There's no doubt this is a very tough time for sleep.

    Working through a CBT course like Sleepio is usually better placed for when the child is settled into a sleep routine themselves and it's possible to give the course the time and commitment it requires. If you are a new parent it may be worth considering whether this is the best time for the course and contact hello@sleepio.com to discuss.

  • Sleepio Member

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    Expert

    Hi, this sounds like you've been managing insomnia for a long time. The course will cover many techniques to foster relaxation and these can be used in the middle of the night too, which can be additionally helpful for taking attention away from the anxiety provoking clock! There will be audios to download to help with this. There are also be a range of other techniques which will help get things back on track. Each week sessions will be unlocked and the Prof will talk through the techniques in detail but do log back in here if you find you have more questions. Good luck!

  • Sleepio Member

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    Expert

    Hi,

    If people describe unrefreshing sleep and waking with a jolt I'd often consider whether there are sleep breathing difficulties, such as sleep apnea. There is a brief screen here: http://www.stopbang.ca/osa/screening.php
    but for anyone concerned about this we would always recommend speaking to a medical doctor.

    It could also be as you say that after one night of good sleep the sleep drive is lower and there is less 'need for sleep', which triggers an awakening. If this is the case the course will be helpful for evening out sleep across nights.

  • Sleepio Member

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    Expert

    Hi,

    I did a search for published research articles and couldn't find anything helpful on this I'm afraid. It certainly hasn't made it into the UK / US treatment guidelines for insomnia. Sorry not to be of more help!

  • Sleepio Member

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    Expert

    That's all for this evening folks. As mentioned this is my last Sleepio session so I wont be back next month. But there are other fantastic experts who will be running sessions each wednesday as usual.

    Good luck with the sleep tonight!

    Best wishes,

    Bryony

  • Sleepio Member

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    Graduate

    Thank you again. I’m really trying to be cool and calm as the hours before bed approach. Yes indeed, I will celebrate if I get another good night!

  • Sleepio Member

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    Session 4

    I prefer to learn the tools and then slowly slowly reduce them. Even thought because i am going through a difficult times my doc gave me a new additional medication. Lets see what happens

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