Live discussion with Dr Bryony Sheaves - 17th June

Dr Sheaves will be hosting a live online discussion here on Wednesday 17th June 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 11 Jun 2015 at 4:55 PM
  • 20 comments
  • 2 helped

Comments

  • Sleepio Member

    • 1 comments
    • 1 helped
    Graduate

    I get off to sleep easily but tend to wake around 4/4.30 most mornings..
    Is my body clock out and What do you recommend I do to sleep later into the morning please?
    Many thanks
    Karen

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    My sleeping problems recur whenever there are big changes in my life (e.g. moving out from my parents' place, getting married, etc.) and tend to go away after a certain period. Hence, I have somehow developed an 'insomnia-response' for such 'stressful' periods. It appears to me that the key is that I need to cope with anxiety issues in different ways. Can the sleepio-course help me along those lines?

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    I never had difficulty sleeping until I hit menopause. Since then, it's been an issue – sometimes on and off, sometimes for weeks at a time. Is there a link between menopause and insomnia? Thank you!

  • Sleepio Member

    • 3 comments
    • 1 helped
    Graduate

    Hi there, I wonder would it be an idea to chat on apnoea and insomnia? I was diagnosed last year with mild OSA and used a mandibular advancement device for a while, and lost some weight. My wife is a very sound sleep so can't really give me feedback on how I am doing! I got the diagnosis having had some seemingly long sleeps and being unrefreshed after.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Session 5

    Hi there, two questions for you. The first is similar to Frannie's. I get disrupted sleep patterns during PMS and it seems to be getting worse. Can sleepio help this hormonal insomnia, and are there any supplements or something I could take during this time to counteract whatever hormones are keeping me awake? The second is this … I seem to be stuck in a good night/ bad night pattern at the moment. After a really good night I find I am very wakeful and not sleepy in the evening which leads to anxiety at bedtime and this Is at least partly responsible for a bad night. What can I do to stop this rather wild swinging to and fro? I would prefer, say, 5 hours of sleep every day rather than 9 hours one night and 2 the next.

  • Sleepio Member

    • 5 comments
    • 1 helped
    Graduate

    I was prescribed mirtazapine back in April 2014 for what I now consider to be minor sleep issues – sleeping 4-5 hours a night for around a month.
    This medication improved my sleep a great deal but within a few months it had lost its effect. I started to taper gradually off the medication shortly after and I took my last dose over 7 weeks ago.

    Unfortunately, I have suffered severe withdrawal symptoms during the taper and since coming off the medication completely. The worst and most distressing being chronic insomnia with a very erratic sleep pattern

    I have implemented all of the sleep techniques from the course, including sleep restriction therapy. However at least 2 nights a week I will be hit with a completely sleepless night. It has become a case of sleeping between 6-6.5 hours or non at all, nothing in between.

    This has had a massive impact on my work and relationship and I feel completely helpless.

    I used to sleep 8-9 hours consistently every night. I don't go to bed anxious and I always go believing that I will sleep but these sleepless nights are so unpredictable. I find it hard to believe that after 7 weeks since my last tablet they would still haunt me with this sleep issue.

    If anyone has had any experience with mirtazapine or an erratic sleep pattern I would really appreciate hearing from you.

    Thanks in advance,

    Scott

  • Sleepio Member

    • 28 comments
    • 2 helped
    Graduate

    Am starting week 3 of SR and not having too much difficulty with it as I had adopted a lazy form of it after reading about it a couple of years ago. I very much appreciate the excellently constructed programme that Sleepio provides. However, as a chronic insomniac for so many years, can I hope to really improve on an incapacitating level of fatigue. My GP says, 'it's the way I am'! Sorry to moan. B

  • Sleepio Member

    • 522 comments
    • 95 helped
    Expert

    Evening everyone and welcome to this evenings live session. I'll be here for the next hour and a half to answer any questions you have about sleep or the Sleepio course. If you have any questions at all, however big or small, do post away!

    Just a little bit about me – I'm a clinical psychologist with a special interest in sleep. I'm therefore best placed to answer any questions about the psychological aspects of insomnia or the course. If you have very specific medical queries or medication questions, your GP/primary care physician may be better placed to answer these.

    I tend to work through the posts in order, though if you are posting live do let me know and I can prioritise your post.

    For anyone who is new to the session – welcome!

    Let's get started….

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi Karen,

    My first thought in reading this is are you from the UK, and if so, is this coinciding with sunrise? Natural light is the most important input to our body clock and will wake us, or prevent us from getting to sleep, so as a basis, it can be helpful to ensure you have good black out blinds or thick curtains.

    Early morning rising is also a common symptom of insomnia. I'd encourage you to keep trying out the techniques offered as part of the course as they are often very helpful for this problem.

    Some people can experience a disrupted body clock (circadian rhythm disorder) – this is where the person is an extreme morning person, or evening person, or has an erratic rhythm. You can look online for the morningness eveningness questionnaire which can help you think about your body's sleep preferences:

    http://www.cet-hosting.com/limesurvey/index.php?sid=61524&lang=en

    If you think after completing this that you are much more of a morning person you might want to bear this in mind when you get to the sleep restriction element of the course as it can be helpful to match your sleep window to your sleep preferences. Do feedback here if this is the case and we can help.

    Best of luck with the rest of the course!

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi ukobischi,

    The course can indeed help you with this. Insomnia is often caused by hyperarousal, which can also result from stress. So it is really normal to have difficulty sleeping when you are experiencing a big life change.

    This article from the library might be of interest:

    https://www.sleepio.com/library/article/stressful-life-events-and-sleep-disturbance/

    The course should certainly be able to help you break the link between anxiety and insomnia.

    In particular you probably want to work on your pre-sleep routine. Have you tried the MP3s that you can download after session 2? Eg. a progressive muscle relaxation? Through the course you will also work on 'the racing mind' which can be a common experience during big life changes.

    By the end of the course you should have many techniques up your sleeve to help you manage your sleep during life's challenges. Good luck and do check back in if you have further questions.

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi Frannie,

    With age sleep tends to become more fragmented and insomnia is common. But you are right, a time when many women see changes in sleep is the menopause. Here is an article from the library that you might find interesting:

    https://www.sleepio.com/library/article/hormones-and-sleep-a-two-way-street/

    The most recent research literature recommends usual treatments for insomnia. Cognitive behavioural techniques (ie. those used in sleepio) are the first line recommended treatment in the UK so do keep going with the course. If there are particular differences that you notice, or wonder if adaptions to the strategies might be helpful for you, feel free to post here again and we can try to help.

    Given how common this is, it's very likely that you aren't alone in this so you might want to post in the community to find out other peoples' experiences.

    Good luck with the course.

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi SeamusSweeney (interesting name!)

    This is a very good suggestion. Insomnia and sleep apnea commonly co-occur.

    For those that aren't aware, apnea is when your airway becomes relaxed during sleep and therefore narrows, making it difficult to breath. People might find that they wake up gasping for air or their bed partner notices interruptions in breathing during sleep. Risk factors include being male, having a large neck circumference and being a heavy snorer.

    The usual treatment is continuous positive airway pressure – a mask worn over the nose and mouth during sleep. You may well have been offered this? Or perhaps weight loss and the mouth device you wear are helping?

    The course can help with difficulties getting to or staying asleep but it's great that you have highlighted this as treatment for apnea should be used alongside.

    How have you found the strategies from the course?

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi Roberta42,

    Hormonal changes can indeed impact on sleep. You might have seen the article that I posted earlier from the library:

    https://www.sleepio.com/library/article/hormones-and-sleep-a-two-way-street/

    You might also want to speak to your GP / primary care physician about this as they would be best placed to answer any queries regarding supplements. You can mention that you are taking a course of online cbt for insomnia so that they are aware that you are receiving help for the sleep complaint.

    The sleep restriction element of the course should really help with the erratic sleep pattern you describe. This will aim to even out your sleep, just as you say! I think you might be just starting this part of the course now. Whilst it is one of the most powerful tools to help with sleep it can be challenging to undertake so do seek support from the community if this would be helpful.

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

  • Sleepio Member

    • 4 comments
    • 0 helped
    Session 5

    Hi Dr Sheaves!

    You told Frannie that insomnia is common during and after the menopause, and that CBT is usually helpful. Does this mean that we are not slaves to our hormones, that there are things we can do to mute them? I hate feeling powerless, and fear the idea that hormones are responsible for poor sleep … It makes me feel there is no solution except for medication ( which brings its own set of problems).

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi Scott,

    There are some articles and discussions that you might find helpful:

    Community discussion about mirtazapine: https://www.sleepio.com/community/discussion/sleeping-and-mirtazapine/

    Expert article about mirtazapine: https://www.sleepio.com/articles/sleep-aids/mirtazapine-and-sleep/

    Expert article about the effects of antidepressant medication on sleep: https://www.sleepio.com/articles/sleep-aids/antidepressants-and-sleep/

    Often sleep problems start after some trigger event and it sounds like for you this was related to mirtazapine. Mirtazapine should be out of your system now, given the time that you have stopped taking it. So it sounds like other factors are keeping the sleep problem going. It's great that you have been working hard at each of the techniques as each of these is designed to break the thinking and behavioural patterns that we do that (inadvertently) keep insomnia going. Keep going with trying out the techniques – sometimes it can take a while for sleep to improve to take note of the small improvements and celebrate them!

    It's difficult to say exactly what is causing the 2 nights a week of no sleep without more information. However, your sleep diary might be helpful for spotting any patterns. You can 'add more information about your night' at the bottom of the diary and click on a range of factors, or add your own. You can then compare these sleep tags, e.g for an evening when you exercised versus didn't. I'd also look at how long you slept the evening before the difficult nights – was this longer than usual? Or did you sleep at a different time?

    If you have further info do feel free to post again and we can think about it some more.

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi Roberta42,

    Thanks for your reply. CBT has been shown to be helpful for insomnia, even when people have other mental or physical health complaints (E.g. depression, cancer, pain). What we always recommend is that if people are concerned about other complaints that they ensure that they are assessed and treated optimally, alongside receiving the sleep help.

    As mentioned in my post above – whilst there can be triggers for insomnia, it can often be the things that we do or think afterwards that keep the insomnia going. So it is very possible that whilst hormonal changes might have some role, there are also psychological aspects which can keep poor sleep going.

    Try to remain hopeful – you are getting very good help with your sleep, that has been tested through a good quality research trial. Try to take as much as your can from each session and try things out in between, and seek support from the community. I'm hopeful that you will see things improve.

  • Sleepio Member

    • 522 comments
    • 95 helped
    in reply to Sleepio Member
    Expert

    Hi Blodwen,

    Fatigue is of course a very common experience of insomnia. The course should certainly be helpful for this. However, you might expect to see a gradual improvement in sleep first, and a reduction in fatigue slightly later.

    I'm pleased to hear that you are doing the sleep restriction therapy as this is one of the most powerful techniques for improving sleep (as a stand alone, as well as part of the rest of the course).

    I'm interested to hear what your lazy version of SR is…! As a clinician I've not yet found a shortcut that helps sleep to the same degree so it might be worth us thinking this through to consider whether we'd expect you to get the same results. I mention this only because I really want you to see your sleep improve! ...(and if you do genuinely have a short cut I'd love to use it with others!!).

  • Sleepio Member

    • 522 comments
    • 95 helped
    Expert

    Hi everyone, I think that's the end of this evenings session. Thank you for all your posts and very best of luck with the rest of the course.

  • Sleepio Member

    • 28 comments
    • 2 helped
    in reply to Sleepio Member
    Graduate

    Oh dear! I have obviously mislead you. About 2 years ago, I read about CBT and Sleep Restriction and put myself on the programme, without any outside support or other backup techniques. It really did help with my attitude to insomnia more than actual sleep and I felt very empowered walking the dog at 6.00a.m with husband still fast asleep. I still get up at 6.00a.m but have been very flexible about bedtime. Sadly, I haven't got a wonderful formulae for a successful short cut but the Sleepio pre-bed activities are keeping me awake until my 'sleep window'. Hopefully, I am back on track and will succeed this time with the help of Sleepio and the the Commnunity support.
    Many thanks for your message. B

  • Sleepio Member

    • 3 comments
    • 1 helped
    in reply to Sleepio Member
    Graduate

    Thank you for reply. Apologies I had to be out yesterday evening. I was very much at the mild end of the spectrum. I think the weight loss and the mandibular device have probably helped, but as my wife sleeps soundly I am not totally sure! I used the mandibular device for about 4 months solidly, then I had a cold which made it hard to tolerate and I have used it sporadically since. I am contemplating whether to get another sleep study done later this year or early next to assess if I really need it anymore or not.

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