Live discussion with Dr Bryony Sheaves - 18th January 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 18th January, 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. 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 12 Jan 2017 at 12:28 PM
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  • Sleepio Member

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    Expert

    Hi,

    Thanks for logging in live. Well done for giving the sleep restriction (SR) good go – it's a tough strategy so well done for keeping it going!

    A few thoughts: If people are already at the minimum window I would usually prioritise boosting up the effectiveness of other strategies rather than restricting further.

    For example, the 15 minute rule is helpful for increasing the chances of falling asleep and staying asleep. Have you tried this alongside the SR? Wind down strategies can also increase the chances of sleep when heading to bed by targeting hyperarousal. Another common issue when people are struggling with a very restricted window is that it can be tempting to take a nap to reduce daytime fatigue, however this is best avoided to ensure there is high sleep pressure later that night,

    Lastly, is the sleep window set at the best time for you? For people who are morning people, sleeping earlier in the window and waking earlier can be more fruitful. Whilst for an evening person, it can be helpful to stay awake longer and have a sleep window later in the night. Here is an article with more info:

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

    A few different ideas to consider there. Do any of them sound like they may fit?

  • Sleepio Member

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    Expert

    Really great to hear that you're sleep well, super news.

    Pleased to hear you have some strategies to boost the memory.

  • Sleepio Member

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    Graduate

    I would like to add to Midnightwalkers comment, but this is not a question – just an observation. When I first used the fitbit I didn't have it on sensitive and it told me I was sleeping through the night. This I knew to be false as I had been listening to the BBC World Service and was well aware of being awake. So I set it to 'sensitive' and got on with the programme which seemed to help my sleep, but now it tells me I am awake when I think I am asleep. I think I have to follow Dr Bryony's advice and listen to my body not the electronics on my wrist.

  • Sleepio Member

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    Expert

    There could be a few different reasons:

    For some people who can sleep well but just at the wrong times (e.g. daytime) this can be an indicator that the body clock has shifted, what we call a circadian rhythm problem. Trying to gradually retrain the body to sleep when preferred, by gradually shifting the time of sleep can be helpful. In addition, giving the body cues about when it is daytime by getting lots of access to natural daylight, exercise and regular meals can also be helpful.

    Another explanation is that at night there can be more pressure to sleep, and this can drive anxiety / hyperarousal. If this is the case the course has some good strategies for this. In particular you could look out for what is called the 'paradoxical intention' technique.

    Lastly, if the individual hasn't slept all night, then their sleep pressure will build up. And if this reaches a peak in the morning, then it will be much more easy to sleep by morning than hours earlier at night time.

    Just a few thoughts…

  • Sleepio Member

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    Expert

    Hi,

    It's a tricky, but common problem. So common that Prof Espie wrote an article on it:

    https://www.sleepio.com/library/article/poor-sleepers-impact-on-their-bed-partners/

    Great to hear about the practical strategies you're already trying. Are you both able to use the course techniques to try and increase the chances of falling back to sleep? In particular, in this situation I may wonder if it's possible to do the 15 minute rule as a team and head to another room to do some relaxation together?

    Or, if there have been some good improvements in sleep, may be the next step of sleeping in the same bed could be taken gradually, e.g. start with one night and then slowly build up to the full week. This may allow the sleep improvements to be sustained for longer before the next step.

    Good luck

  • Sleepio Member

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    Graduate

    Hello Dr Bryony Sheaves,
    Through my childhood and as a teenager I always needed a lot of sleep and I slept well, but at the age of 19 I married and moved to another part of the country to start a new life, after that I never slept very well and this has continued generally for forty years, I have come to the conclusion that leaving the security of my childhood family home has caused my sleep problem, even though all those years have neither been paticulally unhappy. Would you agree that this is a probable reason for poor sleep. Maybe this is too much of a complicated subject to comment on though. Maybe it depends on a persons upbringing and if a person has been raised to cope with lives every day pressures.
    Thank you Anna.

  • Sleepio Member

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    Expert

    Hi,

    We used to think that the sleep problems were 'secondary' to depression, but lots of research has shown that it is common for sleep problems to persist even when mood improves. So you aren't alone.

    Whilst sleep difficulties can be triggered by a stressor (e.g. depression), often what keeps them going is the pattern of thinking and behaviour which we can so easily fall into when we are having trouble sleeping. Sleepio works by trying to break these patterns, for example by setting a consistent sleep window to boost sleep pressure each night and finding ways to wind down before bed.

    The good news is that there is research showing the it is possible to treat sleep problems when someone also experiences (or has a history of) depression and that improving sleep can also be helpful for mood.

  • Sleepio Member

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    Expert

    Hi,

    I'm sorry to hear that you've been managing your sleep problem for so long.

    It may be helpful to read my previous post. A big stressor can indeed trigger sleep difficulties. However, it can often be different factors that keep the sleep problem going, and it is these factors that Sleepio targets in the weekly sessions.

    Have you noticed any positive changes in your sleep from the course?

  • Sleepio Member

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    Expert

    Hi,

    Thank you very much for your comment. I'm really pleased to hear that adopting a mindful approach at bedtime has helped your sleep. There has been some research into this (mostly led by Jason Ong), showing positive improvements in sleep when combining mindfulness with some of the other CBT techniques that we use in Sleepio.

    Thanks for sharing

  • Sleepio Member

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    Graduate

    Hi,
    I assume you mean the post reply to Jennyrocke.
    Thank you for your concern Dr, yes the course has definitely helped me to sleep better, I've learnt to see my bed as a place to escape my worries and I've learnt the importance of a strick routine. I still havent managed to stick to the restricted sleep window, but I must try again.
    Thank you Anna

  • Sleepio Member

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    Session 4

    so much of this rings true to my life style. I have always kept late hours even when i was young.

  • Sleepio Member

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    Expert

    Hi,

    Thanks for your post. Are you having difficulties getting to and staying asleep, or is the problem primarily sleeping for longer than you'd like?

    A head injury can impact on sleep so we would always advise seeking advice from the specialist in that area too, particularly with regard to recovery.

    There has been preliminary research showing that courses like Sleepio can be helpful for improving sleep in the context of a head injury. So there may be some principles from the course that are of benefit, for example setting a consistent sleep window and finding ways to wind down at the end of the day.

    Of note, in the next session you'll cover sleep restriction, this reduces the amount of time you spend in bed and in the short term can lead to sleep deprivation (but in the long term can lead to improved sleep). We are always more cautious in using this technique with people who have other difficulties which may be affected (this is picked up by the initial sleep test). You may want to check back in to the live session next week when you know the window you have been assigned by the course for further clarification

  • Sleepio Member

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    Expert

    Good luck with the rest of the course and if you'd value some extra support with the sleep restriction the community can be helpful as others who have been through it can share their experiences

  • Sleepio Member

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    Graduate

    Thank you! That helps to answer my question.

  • Sleepio Member

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    Expert

    Hi,

    The course should provide some help in evening out the sleep pattern in winter months. The next few sessions in particular will focus on this.

    The principle of getting access to natural light is helpful for keeping the body clock in tune with the light/dark cycle of day and night, so helpful for sleep. Even on a cloudy the light levels outside are substantially stronger than inside light. Some people also use a light box. These can emit light that is equivalent to a sunny summers day.

    Good luck

  • Sleepio Member

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    Graduate

    Thank you ,
    Yes I will look for the support.
    My problem is al evening I need matchsticks to stay awake , especially when I try to read up on the programe on my I-pad. It seems to trigger off an overwhelming sleep response.

  • Sleepio Member

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    Expert

    Hi, ham mindful that am running out of session time but do have a look back through my previous posts as another member also asked about this!

  • Sleepio Member

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    Expert

    Hi,

    It is common to have sleep difficulties during the meopause and I'm really pleased to see that you've already had a response from another member.

    The practical strategies can be helpful for using alongside the course to help manage the symptoms and return to sleep more quickly.

    Have you seen this library article on menopause and sleep?

    https://www.sleepio.com/library/article/menopause-and-sleep-problems/

    In general, some find it also helpful to remember that wakenings are normal, particularly when experiencing the menopause. It can feel frustrating being woken, but being kind to oneself and managing this frustration can be helpful for returning to sleep more quickly.

    I hope that you see some improvement in your sleep.

  • Sleepio Member

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    Expert

    Hi,

    It can be tricky with the sleep diary as this can increase the focus on sleep, which can be unhelpful.

    In general I recommend completing a sleep diary in the morning and just using an estimate of sleep to avoid clock watching as we do know that this isn't helpful for sleep.

    Other people who have wearable devices (e.g. fitbit / jawbone) also use the data to feed into the sleep diary so that they can avoid the sleep diary.

  • Sleepio Member

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    Expert

    That's all for tonight folks – thanks for your interesting questions and good luck with the sleep tonight.

    Best wishes

    Bryony

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