Live discussion with Dr Bryony Sheaves - 19th July 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 19th July, 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 13 Jul 2017 at 2:06 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    The Sleepio course should be helpful for stabilising sleep and reducing the chances of nightmares to some degree. Relaxation before sleep can also be helpful for reducing arousal which we know can increase the chances of nightmares.

    Other considerations: nightmares are more likely the longer we sleep (because we get more REM, dreaming, sleep), so if there are nights when people catch up on sleep then these can be helpful to work on – which Sleepio can help with. Managing worry can also be helpful before bed – look out for the strategy 'putting the day to rest' in the programme which can be helpful for this.

    If nightmares are recurrent some people find a technique called imagery rescripting helpful – writing a new ending to the nightmare, where things turn out OK or even end well. Then using the imagination to bring this new script to mind in lots of detail.

    Lastly, some medications can increase the chances of nightmares (as can cannabis withdrawal) so this can be worth considering.

    I hope you see some improvement.

  • Sleepio Member

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    Graduate

    I an going on holiday next week and my sleep window is 12 -7, but as I may be staying up later than 12 do I still need to get up at 7 or can I stay in bed for the 7 hours.

    I am mostly doing really well and don't want to jeopardise it.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Sorry to hear that your not happy with your sleep quality.

    One thing to note is that the usual way of looking at different sleep stages (e.g. deep sleep) is through a technique called polysomnography. This involves taking lots of measurements which we don't think health trackers can't easily replicate. So if the health tracker data is increasing your concern it may be worth bearing in mind.

    Ways to increase deep sleep however include sleep restriction (increasing sleep pressure), decreasing arousal before sleep (e.g. relaxation), vigorous physical exercise and avoiding alcohol. Might any of these be relevant?

    It may also be worth reading my previous post re: dreams and nightmares.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Good question. Continuing with a 7am wake time keeps sleep pressure high (and in fact higher than usual) and therefore increases the chances of sleep the following night. Others chose to adjust the sleep window during a holiday, e.g. 2am until 9am. The sleep pressure would still be the same, but it's like moving time zone by a few hours, so may take the body a short while to adjust to it and then adjust back. Really up to each individual.

    Hope you have a fab holiday!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    After experiencing sleep difficulties bed can become associated with wakefulness, so heading to bed can lead to wakefulness. Following the sleepy-tired rule (as you are) is usually helpful for this but it can take a little while for the connection between bed and sleep to build back up.

    For other people there can be thoughts which pop up which can increase wakefulness at bed time. For example, 'I must sleep tonight, or I wont perform well tomorrow'. These can be helpful to target in the thought checker in one of the later sessions.

    Others still find that going to bed is almost like performance anxiety for sleep. In this case, going to bed actually with the intention of staying awake (rather than trying to sleep) can be helpful for taking the pressure off.

    I hope the above offers a few different ideas and hope that the habit of going to bed and falling asleep is back on track soon.

  • Sleepio Member

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    Session 1

    Hello! I'm in my first week and debating if this course will really work for me with sleep restriction.

    Although my sleep efficiency and number hrs I slept are very poor, I do not take naps during the day, go to bed early and rarely do I sleep late either. I have problems falling asleep, staying asleep, and waking early. I have problems sleeping at all. Things get worse with even a little stress..which is often. I'm only able to work a few hours per week.

    One of my problems is that the more exhausted I become the harder it is for me to sleep ANYTIME. I also have ADD and that might have something to do with it…not sure.

    I think knowing how much I NEED the sleep when I get exhausted and can't function works against me. I literally can go weeks without feeling I slept AT ALL. Times I have to work more hours….especially f/t feels like I'm dying. The more exhausted the less I can sleep because the stress is so high.

    How I cope is I try to relax with meditation. Sometimes I “nod” off slightly here and there but it's not for long and not deep But even those few and little times keep me from committing Harakiri!

    So this whole concept of sleep deprivation really really scares me as I don't know if I fit in this category of napping, going to bed early and sleeping late to catch up, which is what sleep restriction is for. I'm afraid I'll fall into this vicious” inability to sleep” cycle.

    I do lie in bed awake a whole lot and the quality is poor. Maybe that puts me in the category for sleep restriction to work for me?

    PS I've had this for 47 years since age 7.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Using meds alongside CBT, or not using them, can both be OK. If taking meds during CBT it's important to have a prescription plan for them and follow this carefully – we recommend speaking to the prescriber. An example of a med plan: some people are prescribed sleeping meds for a few weeks and then very gradually decrease the dose. From clinical experience it is often less helpful to take them on odd nights, when they feel necessary, as this decreases the learning opportunity from the CBT strategies. i.e. we can't tell if the cbt strategy has worked if meds are taken as a last resort. And coming off them can result in rebound insomnia (i.e.. worsening sleep for a short time). Consistency across nights is helpful for CBT courses like Sleepio.

  • Sleepio Member

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    in reply to Sleepio Member
    Session 1

    I did post another question. This is in response to your comment to my first question

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm sorry, this sounds really tough. And it sounds like you have been managing this for a long time. What is good to hear is that you have found some strategies that can help you to nod off, even for a very short while.

    Sleeplessness can be very very difficult to manage. You mentioned that there is a relationship between stress and sleep, and that getting a little sleep stops you from committing Harakiri (which, I think I'm right in saying is suicide in UK terms). I wonder if you are seeking any support from health care services, and particularly when things feel this difficult? If feeling desperate, or like life is not worth living, we encourage anyone to seek face to face support from a local healthcare provider, and from people in the local support network (e.g. family, friends). We know it can be really tough managing sleep difficulties, and it's really important to be getting the right face to face support over and above the course.

    Sleep restriction can be a more challenging element of the course and people only complete what feels manageable (anyone can stop any element at any time). In sleep restriction, sleep should not be restricted below the time the person actually spends asleep currently. And if people report any health vulnerabilities, the sleep window suggested by the programme is less restricted. Before getting to this element, it may be helpful to share the information that the course suggests within an expert session, given things sound like they can be very difficult.

    There are also many other aspects to the course (beyond sleep restriction) which can help with sleep. And these are more accessible. For example, finding ways to effectively wind down ready for sleep, boosting the connection between bed and sleep, and ways to check out sleep related thoughts. These are all aimed at increasing the chances of sleep. CBT courses like Sleepio are a whole package of techniques which means that there are a few different options which can help sleep.

    I hope the above makes sense and please do keep linked in with these live sessions with further questions or if you have any concerns.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I have worked with many people in clinical practice who are on varying psychiatric medication (and often more than one medication) and we have found positive results from CBT for insomnia courses. We recommend that any other health complaint (physical or mental health) is also receiving optimal treatment.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi, really sorry, looks like you were logging in early before I was online

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi couple of thoughts which come to mind: first, it can take a while for sleep to improve and this can in part depend on how there have been difficulties getting to or staying asleep, so patience is often helpful to take the pressure off. Second, it can be helpful to consider whether the timing of the sleep window should be adjusted. E.g. if not difficulty getting to sleep, it may be optimal to move the whole sleep window earlier, particularly for 'morning people'. Lastly, and this may sound obvious, but is there anything causing wakenings? E.g. Early morning light coming in? If so, black out blinds can be helpful.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi, I've posted below, hopefully you can see it. Also just to let you know that I've also written to the other experts, just to check out whether they have any other thoughts, particularly as it sounds like things can be very difficult with your sleep and how you feel in the daytime. Hope this is OK.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Pleased to hear that your sleep is improving.

    It may be helpful to read my previous post on a similar topic.

    The other thought in addition to that, is that for some people they notice other sleep difficulties which can cause awakenings, e.g. snoring / breathing difficulties or nightmares for example? If anyone has any additional concerns like these then we recommend having these checked out.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    This is a very common experience for people experiencing insomnia. Some people say that life becomes very revolved around sleep and night times feel particularly anxiety provoking. The course will have several techniques to tackle this. You will soon be coming to some techniques around the sleep schedule which can be very powerful for helping people feel sleepy when they go to bed. Then later in the course look out for the thought checker and what we call paradoxical intention (trying not to sleep when going to bed). I hope you see some improvement in your sleep soon.

  • Sleepio Member

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    Session 1

    I'm not sure you received a reply as I sent it from email.

    Is there a way to have one on one sessions with an expert on your team??

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I guess a few ways – one would be feeling refreshed enough in the daytime to go about daily business (and bearing in my even the v good sleeper can feel sleepy at times in the day), and second, if it is very difficult to increase the sleep window further. This can be an indication that the sleep window is at its optimum.

    Very exciting to hear that you have been considering this question… sounds like you've seen some improvement which is great to hear!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    This isn't something that is typically provided as part of the course unfortunately. We will however endeavor to offer as much support as we can through the expert sessions and I will get back to you as soon as I hear back from the team re: my earlier query to them. As things sound very difficult I want to ensure that we all put our heads together re: your post. Just to warn it may not be for a day or so as they aren't usually online at this time (it's evening time in the UK). Do you have other sources of support in the meantime?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi – I think the time that you go to bed with the intention to sleep makes most sense

  • Sleepio Member

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    Expert

    Hi everyone, thank you for all your posts this evening, I'll be logging off now. I wish you all the best with the sleep this evening. Best wishes, Bryony

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