Live discussion with Dr Bryony Sheaves - 1st June 2016

Dr Sheaves will be hosting a live online discussion here on Wednesday 1st June, 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.

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Posted 26 May 2016 at 12:38 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    A few thoughts spring to mind with night time awakenings:

    -Are there any other reasons you may be waking? E.g. dreams/nightmares, sleep breathing problems, light/noise in the bedroom?
    -Are you managing to get through the day without naps?
    -When is the sleep window and is it best matched to the body clock? E.g. a morning person may find that they wake early, so it can be helpful to move the sleep window earlier for that person.

    It can helpful to know if there is a pattern to the wakening to help think about the above.

    Lastly, it is really common to wake in the night, so if someone wakes but is able to return to sleep and get enough sleep to function OK the next day then this may not be a concern.

  • Sleepio Member

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    Expert

    Hi,

    Melatonin is recommended in UK guidelines for older adults with insomnia and is used to augment other treatment options. For younger adults guidelines recommend CBT programs (such as Sleepio) for persistent insomnia (>4 weeks) or sleep medication for more acute sleep problems.

    There is an article here that includes melatonin, that may be interest:

    https://www.sleepio.com/library/article/sleep-aids/

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks for your comments.
    Dreams do sometimes wake me, not necessarily stressful ones.
    Have blackout curtains, not aware of noises.
    Definitely no naps in the day!
    Silly question but how would you know about breathing issues?
    Going to be 1hr+ later at the moment but still awake around 3/4am. Can it just be a habit develops years ago and I should worry less? At least I have strategies to use now.

  • Sleepio Member

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    Expert

    Hi,

    There can be many reasons for experiencing unrefreshing sleep. Here are some options I'd usually think about:

    -Is the amount of sleep varying each night, so that one night there is not enough sleep and the next night one is oversleeping? Both under and over sleeping can leave us feeling suboptimal the next day.

    -Is there an alternative reason why there is a feeling of fatigue? E.g. medication side effects or an underlying medical condition. If this is a possibility it's always best to link in with medical doctors / prescriber.

    -Is the sleep itself poor quality? Other problems such as sleep apnea (sleep breathing difficulties) or nightmares may be something I'd ask about. Again, these may be worth seeking extra advice about.

    For people at the start of the course it can be worth checking out with a GP / primary care clinician and letting them know about Sleepio (CBT course for insomnia).

  • Sleepio Member

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    Expert

    Hi,

    Thanks for your reply. Indicators of possible sleep breathing difficulties include:
    -Heavy snoring
    -Wide neck circumference
    -Being over weight
    -Waking gasping for air
    -A bed partner noticing
    -Waking with a dry mouth / headache

    An alternative reason we are more easily roused from sleep can be feeling stressed / anxious when going to sleep. If this may be the case the course has other strategies that some find helpful, e.g. relaxation / mindfulness / putting day to rest.

    Of course it may be a habit that takes a little longer to respond. And if at a routine time in the night it may coincide with REM (dreaming) sleep when we can be more likely to wake.

  • Sleepio Member

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    Expert

    Hi,

    I'm really sorry to hear that SR has been so difficult. Have you linked into the community as I know others have found this can be helpful, to get support from others who have done SR.

    If anyone feels like they are not managing or are dangerously tired then we usually recommend either increasing the window slightly or taking a short 20 min nap at some point before 3pm.

    The key with SR is creating a sleep window that is manageable each night but also increases sleep pressure to the degree that when heading to bed the individual feels very tired. If it is not manageable then adjustments may be needed.

    Re: the darkness in the winter, this is really helpful for sleep. Are there ways of creating this artificially in the summer months? Some people buy stick on black out blinds to ensure an extra dark bedroom, or turn the big lights out in the evening and just sit with low lighting during the evening (which can also feel more relaxing).

    Good luck with the rest of the course.

  • Sleepio Member

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    Expert

    Hi,

    Only just seen this post in addition to your last one, sorry. For anyone with another health condition (physical or mental health) we recommend a more lenient sleep restriction window. Do increase your window to a time period that feels manageable each night. We would never want to compromise other health conditions in completing the course.

    Some also like to inform other key members of their care team that they are completing a CBT for insomnia course in addition to other treatments.

    There is also this article in the library that may be of interest:

    https://www.sleepio.com/library/article/fibromyalgia/

  • Sleepio Member

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    Graduate

    Thank you.

  • Sleepio Member

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    Expert

    Hi,

    I'm wondering if your two comments may be somewhat linked. The yoyoing is what we call the 'sleep pendulum' – where one gets better sleep one night and then it can be worse the next night.

    This usually comes down to sleep pressure. If we get a better night one night (more sleep) then our sleep pressure is lower the next night and hence we get a poorer night of sleep.

    For this we recommend aiming for a consistent sleep window every night, even at weekends (sorry…!). Things that people find helpful for sticking to this are: planning something to look forward to soon after waking (e.g. a nice breakfast, or a social commitment), blasting out some up beat music or setting a radio for the wake time to help get going or opening the curtains / window to get some natural sunlight.

    Good luck

  • Sleepio Member

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    Expert

    Hi,

    For someone who has a goal of improving their sleep we want to do anything that we can to increase the chances of good sleep. Caffeine and food are two things that we may consider.

    Caffeine is a stimulant which by it's very nature increases wakefulness. We want to ensure that this isn't in the system at night so that our chances of sleep are higher.

    Re: food, this is so that the body isn't working hard to digest a big meal before going to bed. We want the mind and body to be ready to rest by the time we want to sleep.

    Hope that helps.

  • Sleepio Member

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    Graduate

    Thanks, I do stick to the sleep window, but will try having something specific planned to do at weekends when I get up.

  • Sleepio Member

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    Expert

    Hi,

    I think this is all about taking the principles of the course and implementing them in a way that doesn't compromise other health conditions. Whilst ideally a consistent sleep time is best for improving sleep, sometimes we need to consider the best way to achieve this.

    Some people have found that dawn simulating light boxes can be a more gentle way of waking. Or are there any other alternative solutions? My concern with no alarm at all is that whilst undertaking SR the sleep pressure is higher (this is how it works) so it would be very easy to oversleep and undo all the great work you're putting into building your sleep pressure to improve your sleep.

  • Sleepio Member

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    Expert

    Hi,

    As a clinical psychologist I'm not best placed to recommend other medications I'm afraid. The clinical guidelines have reviewed the evidence for various treatments and recommend CBT programs (like Sleepio) for persistent insomnia and medication for short term insomnia (<4 weeks).

    Here is a link to UK guidelines just as an example:

    http://cks.nice.org.uk/insomnia#!scenario:1

  • Sleepio Member

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    Graduate

    Thank-you, Dr. Sheaves for explaining the principle of the sleep pressure. My SE has improved, so I do not
    want to go backwards! However, as for the light box,
    I don't think that would work as I use a sleep-mask.

    I will look into alternatives, like a radio alarm.

  • Sleepio Member

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    Expert

    Hi

    Well done for your work so far on your sleep and I'm sorry it's been a difficult week. The way the course works is that each week you will learn new techniques to increase the chances of better sleep. In terms of implementing them, it is still early days being in week 3.

    Different people respond differently in terms of response to the course, some see sudden gains in sleep and some take a little longer. The research shows that by the end of the course, those with insomnia typically report large improvements in sleep. Often the key is consistency – trying the techniques each night.

    Would it be helpful to link in with the online community? I think the other Sleepio users and particularly the graduates may provide some helpful stories of their sleep recovery.

  • Sleepio Member

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    Expert

    Sounds good!

  • Sleepio Member

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    Hi,

    It could be either or both! And also I imagine you have put some good work in over the course in associating bed with sleep (e.g. the 15 min rule). This could have paid off last night.

    Really pleased to hear that you got back to sleep, great work!

  • Sleepio Member

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    Expert

    Hi,

    The sleep diary is helpful for the course as it provides the program with an up to date picture of your sleep. Using the 'sleep tags' in the diary may help you to keep a track of when you started the sleeping medication.

    In terms of medications and using the course, this is an article that may be useful:

    https://www.sleepio.com/library/article/sleep-aids/

    And one on melatonin:

    https://www.sleepio.com/library/article/what-is-melatonin/

    And one on the recommended treatments for insomnia (in the UK, but a recent paper also came out in the US with similar recommendations). This is written mainly for clinicians but may have some extra detail on the evidence for different treatments:

    http://cks.nice.org.uk/insomnia#!scenario:1

  • Sleepio Member

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    Expert

    That's all for tonight folks. Thank you all for your interesting questions.

    Wishing you a better night of sleep tonight,

    Bryony

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    It is winter where I live – Australia. In summer the blackout window coverings cope with the light. I actually cannot sleep during the day, so a nap is not an option.

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