Live discussion with Dr Bryony Sheaves - 18th October 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 18th October, 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 Oct 2017 at 1:33 PM
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  • Sleepio Member

    • 35 comments
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    Graduate

    I don't know if I can manage another day on 3.5 hrs sleep, and am thinking of taking half a sleeping pill tonight to try to catch up a bit – I was feeling like at the end of my tether with tiredness today, could barely function.

  • Sleepio Member

    • 35 comments
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    Graduate

    Hi I just joined a few minutes ago – there seem to be a lot of questions and comments here, but only 4 replies from Dr. Sheaves. Am I missing something somewhere?

  • Sleepio Member

    • 843 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    Many people take medication whilst running through the Sleepio course. There are a couple of discussion forums here which Sleepio members have set up:

    https://www.sleepio.com/community/discussion/using-medication-while-doing-the-sleepio-course/

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

    In terms of the CBT and medication, having a plan with the prescriber is important. And choosing when to taper is really up to the individual and prescriber. Some people chose to run through Sleepio first so that they are armed with the sleep skills before tapering, whilst others have a goal to stop medication earlier. Either way, having a consistent plan set up is helpful.

    In terms of how quickly to reduce, it's best to check out what is recommended with the person prescribing as they will know best how long it takes for the body to adjust, and also what to expect when you do initially reduce the dose.

    Good luck and sorry not to be more specific.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Thanks for logging in live. The replies have been slower as they are quite detailed.

    I'm really sorry to hear that you are having such a tough time with the sleep. How long has the 3.5 hours been going on for?

    I notice that you are on session 4, does this mean you have just started sleep restriction? I wonder what other strategies you've been using so far and how they've been going?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Thanks for your question. I haven't heard of these as being recommended so did a quick search to see if there was any evidence. No research popped up. I tend to refer to clinical treatment guidelines, in Europe (and UK particularly) and in the US, CBT is the recommended treatment for persistent insomnia, based on the available evidence at the moment. That's not to say that we wont discover new evidence based sleep aids in the future (I hope we do), but at the moment the science tells us that CBT courses like Sleepio are the recommended treatment of choice.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    This is a common question on the Sleepio forum. Our expert Dr Kyle has written an article about some of the science linking insomnia and manopause here:

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

    A big trial that was published last year (McCurry et al., 2016) showed that a CBT course (like Sleepio) improved sleep and also reduced the daily interference from hot flashes, which is good news.

    Some people also find that some practical strategies can also be helpful, for example, ensuring there is a cold flannel or cold drink by the bed to alleviate the hot flashes quickly. If you find any other helpful tips it would be great if you could share them here too as this is something that people often ask about and I think we need of increase our bank of helpful tips.

    Good luck with the rest of the course.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks so much Dr. Bryoni for your answer

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi, yes I'm in week 4, second week of sleep restriction, it didn't seem too bad at first, and I got used to getting up at 6 and being active, but generally it's been 4.5 to 3.5 hours sleep every night, and I feel that the longterm lack is starting to build up and affect me. I follow the QHR, though at the start of sleep – i.e. 12 midnight, if I don't get to sleep straight away, it feels counter-intuitive to get up and go downstairs again after 15 minutes, as this would wake me up still more, I feel I need to give it longer than that?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm not familiar with Unisom but looked it up and it looks like it's an antihistamine. I'm afraid I'm not clear on the long term effects of taking them so it would be best to speak to the pharmacist for more info. Sorry I can't be of more help.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    It does seem counter-intuitive doesn't it?! I often say to people that if it feels like you are drifting off then you may want to be slightly flexible with the 15 min rule, some might leave it 20-30 minutes for example (and just an approximation rather than clock watching). But as a general guide, if someone thinks 'I wonder if I should get up now', that probably means that it's time to get up.

    There are two rationales behind the 15 minute rule, the first is that we want to associate bed with sleep. But also, getting up also interrupts thought patterns that can get in the way of sleep and helps us to reset the mind. If we have an active mind, or are simply not sleepy enough yet, lying in bed isn't helpful for winding down – research finds that we get to sleep quicker if we get up and wind down elsewhere.

    Sleep restriction is tough, it's been labelled a bit of a 'no pain no gain' technique as we know it's helpful (it's been tested as a stand alone element of the course) but it's also tough. I think there are threads in the community which may be worth checking out for further support from others who have been through the SR element.

    If you do feel dangerously tired we recommend taking a short nap earlier in the day (just 20 minutes before 3pm).

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    There is actually a guide written on the topic of shift work and sleep, including tips for completing the course as a shift worker:

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

    With your partner, there are a few things that people try out. For example separate beds just for the duration of the course (and having a second goal of moving back to sleeping in the same bed), or if the 15 min rule is disruptive, ensuring that the partner heads to bed later. In general it can be a case of negotiation, finding the best way to allow both people to maximise their opportunity for sleep and working it out together.

    Here is a library article and discussion thread that may be relevant:

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

    https://www.sleepio.com/community/discussion/how-can-you-minimise-the-effect-of-your-insomnia-o/

  • Sleepio Member

    • 35 comments
    • 5 helped
    in reply to Sleepio Member
    Graduate

    thanks Dr. I'll try again tonight!

  • Sleepio Member

    • 843 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    Thanks for the question. I think it makes sense to allow a bit of leniency with the sleep window if the awakenings aren't within control. But an adapted version of sleep restriction would be to set a slightly wider limit, which is used if woken for external reasons.

    The reason SR is effective is that the longer we are awake the more sleep pressure we build up, and this increases our chances of sleep. For this we need to wake early enough and avoid naps. Following this principle broadly should ensure that it's still possible to benefit from SR, but just using an adapted version and also be a caring mum too.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi

    Thanks for your question. I think this one is best directed to a pharmacist or prescriber. Sorry I can't be more help

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm really sorry to hear that the thoughts have been keeping you awake.

    Later on in the course there are a range of strategies to help manage thoughts which can get in the way of sleep.

    In the meantime, some people find it helpful to write down thoughts, just as they come to mind. It's called expressive writing and can help to take the sting out of emotive thoughts. It would involve taking time (preferably before winding down for sleep), to write down any thoughts that come to mind. Some people then put them in a draw or throw them a way as a way of closing them off.

    I hope that the thoughts calm down soon and you see some improvement in your sleep.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I wrote a longer post about this earlier on so would be worth scanning back through. Often people say they just don't feel tired enough for sleep yet, so you aren't alone. Research shows that getting up and winding down again, rather than sitting with thoughts of wakefuless or any other thoughts that pop up, actually helps us to get to sleep more quickly. It's counter-intuitive, but does seem to work.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm so sorry to hear that you have been struggling with the tiredness. It's really tough not getting the sleep we need.

    I'm guessing if the course has been congratulating you on better sleep that the melatonin has been helpful? If so, I'm really pleased.

    I just noticed in your post that you are longing for one longer night of sleep to help catch up. I can very much sympathise with this, it's really rough feeling sleep deprived for a long time. I just wonder if the goal could be slightly adjusted so that the aim would be to get a little bit more sleep across each night of the week (rather than in one day). The reason I say this is because if we bank sleep one night (and of course feel loads better the next day!), we often disrupt sleep the subsequent night as our sleep pressure (or sleep drive) isn't high enough, and so the cycle of insomnia continues.

    I'm not sure if it was just a turn of phrase, but just thought I'd mentioned in case this was one of the things preventing your sleep getting better.

    I really hope you see some improvement in your sleep soon. And if you wanted to let us know more detail about what has been helpful / unhelpful for your sleep and also details of your current pattern of sleep, I'd be happy to think through in more detail about any further strategies. I'm logging in same time next Wednesday (7-8:30 UK time).

  • Sleepio Member

    • 843 comments
    • 143 helped
    Expert

    That's all for tonight folks. Thanks for the questions and I wish you all the best with the sleep tonight.

    best wishes

    Bryony

  • Sleepio Member

    • 2 comments
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    in reply to Sleepio Member
    Graduate

    Thank you so much for your thoughtful response. I'll definitely give this a try and look forward to learning more later in the course.

  • Sleepio Member

    • 6 comments
    • 1 helped
    Session 3

    Hi Dr Bryony,
    I am just new to the course and have already found so much help from this discussion alone.
    Last night, being new I wanted to see how the question answer session worked and have just gone on today to catch up, so this question is probably too late.
    I have developed problems following a health scare. I practise mindfulness and visualisation and a bedtime routine. My problem is that I can relax into the point of dosing off, but for some reason my brain doesn't want to take the next step. This has been going on for 5 months.I have been on proprananol, which I am now coming off and zopiclon, which I am also coming off first onto melatonin (as soon as it arrives at the chemist) and then hopefully sleepio alone with maybe a“snore and go” will do the trick.
    Are you able to explain what is happening;why I am experiencing the off button being pushed, but not engaging? It means I can't benefit from extra catch up during the day, and feel less and less able to drift back in the morning. Sometimes if I try too often; drifting off and coming back, I start to get a feeling of mild dread each time I drift. My sleep quality has been very poor for 5 months. An excellent night for me would be 6 hours sleep. At present it's 4-5 hours in total. I am having to work very hard to keep focused on other stuff during the day, to try and keep some perspective. Is this a common problem?

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