Live discussion with Dr Bryony Sheaves - 20th May

Dr Sheaves will be hosting a live online discussion here on Wednesday 20th May, 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. She will however try to help as best as she can!

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Posted 15 May 2015 at 4:14 PM
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  • Sleepio Member

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    Expert

    Good evening everyone!

    Welcome to tonight's live session. I'm here for the next hour and a half to answer as many questions as possible about sleep or the Sleepio course. Please feel free to post any questions or thoughts. I'll work through them in order but will also check in with anyone who is posting live so we can hopefully have an interesting live chat too!

    Just a quick note, I am clinical psychologist so am well placed to answer questions about the psychological aspects of the course. If you have any highly specific medical questions, or are seeking medication advice it's always best to speak to your GP or primary care physician as they are best placed to answer these.

    Let's get started!

  • Sleepio Member

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    Expert

    Hi Lizzb,

    First and foremost, you don't sound pathetic in the slightest. I think it is quite remarkable that you been managing your sleep problems for 12 years and have clearly put a lot of thought and effort into improving your sleep. Well done for the improvements you have made in getting to sleep quicker – whilst this might not be where you'd like to be with your sleep please remember to celebrate the steps along the way as I'm sure it took a lot of effort to achieve this.

    It sounds like it would be helpful to clarify what your next sleep goal is. There are a few things you mention – coming off of medication, trying to sleep earlier, and working on how you feel in the day. Work on these one by one.

    If you feel ready to come off your medication, it's important to have a clear plan for this (in terms of decreasing dose and time between each decrease). Your prescriber is best placed to offer this advice and talk through any changes you might notice coming off the meds, so you know what to expect.

    It's common to have insomnia and also a disrupted body clock. We can get quite out of sync when we have difficulties getting to sleep. So, in terms of possible delayed sleep phase – here are a few pointers:

    -Whilst it might be tempting to use the time you are awake at night productively, this will likely delay you getting to sleep further, try to do something relaxing, or even boring, to decrease your arousal.
    -Our bodies love regularity, so try to start this 'wind down' time at a regular time each night. Particularly, try to reduce physical activity, exposure to bright lights and food. These are all important inputs to the body clock.
    -light therapy is recommended. The timing of this is key. You can use this online questionnaire to ensure you are getting it at the right time:

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

    You mentioned your mood has been affected by your sleep. You might want to speak to your doctor more about this if it is problematic. This can impact on sleep and then sleep of course impacts on mood.

    I hope that's helpful. I'd suggest picking one of those areas, trying out techniques to work on it and then move onto the next. And celebrate any small steps towards your goals.

    Good luck.

  • Sleepio Member

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    Graduate

    My tinnitus has been hightened by my sleep disorder. i have had tinnitus for 8 years through being exposed to noise pollution in my previous house and my current one.
    Due to my fitness level in the past and somewhat presently, my sensitivity to noise has increased compared to an unfit individual. This has been proven by research professors in acoustics. There are CBT programmes that can help, but, that is the psychological part of the process. The physiological part is that my hearing has been altered by the noise pollution. You hear with the brain. The ear is just a conduit to process outside sounds/noises.The sleeping brain is as active as when awake. Hoping that Sleepio guides me to return to my regular sleeping pattern.

  • Sleepio Member

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    Expert

    Hi Marymimo,

    I'm sorry that you are experiencing nightmares. Regularly experiencing nightmares is common and can really impact on how we feel the next day. Here are a few thoughts:

    -Are you taking any medication that might impact on dreams / nightmares. Some meds can impact on sleep architecture so it might be worth speaking to your prescriber if you are.
    -Similarly alcohol can impact on dreams. You could use the compare sleep tags tool in the sleep diary to see if this is having an impact for you.
    -Dreams and nightmares tend to occur in the second part of sleep. If you notice that you are regularly 'oversleeping' to catch up on lost hours, then you will be experiencing more REM sleep and hence, more dreams. Keeping to a consistent rise time and trying to avoid the very tempting oversleep.
    -Relaxation before bed can be helpful – are you using this element from the sleepio program?
    -It's completely natural for nightmares to impact on how you feel. They seem so real and elicit strong emotions. Try and plan a nice comforting start to the morning after you have had one. Perhaps playing some uplifting music, a nice breakfast, or whatever will leave you feeling a little brighter.

    The course will have a host of other tips to help. If you have further questions do check back in here.

  • Sleepio Member

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    Expert

    Hi cranny

    Welcome to the session tonight. It's interesting to hear that you are more sensitive to noise. This is a common experience of people with sleep difficulties. Do you find your tinnitus more problematic at night?

  • Sleepio Member

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    Expert

    Hi sleepmk,

    The sleep diary is designed to capture all your sleep so I'd keep adding in each day, even if you have travelled.

    When you travel are you travelling abroad / to a new time zone? This can naturally take a period of adjustment as our body clock has to 're-sync'. Here is an article which might be of interest:

    https://www.sleepio.com/blog/2012/04/27/sleep-patterns-what-keeps-us-in-sync/

    For your sleep at home I'd keep working through the techniques covered by the course, and see if you can try out new strategies each week. By the end you should have a good toolkit to help you get a better night sleep at home and adjust after travelling. Good luck and do check back in here again if it's helpful.

  • Sleepio Member

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    Expert

    cranny – have you seen this article? Other uses have similarly had problems with tinnitus. You might find it helpful to read others' experiences:

    https://www.sleepio.com/community/discussion/tinnitus/

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi mascott,

    Firstly it's really common to wake up in the night, this is a normal part of sleep architecture and these awakenings increase later in life (I'm not sure of your age though!). I'm afraid I'm not clear exactly what could be causing you to feel so uncomfortably hot. A few thoughts are: are you waking up after a nightmare / night terror? Feeling anxious can increase body temperature. Similarly, if the temperature takes some time to increase could it be related to that feeling of frustration at not sleeping. Feeling too hot is common when people have difficulties getting to sleep or staying asleep. Or, perhaps depending on age and your gender, could it be hormone related?

    I'm sorry that's quite broad. If you feel able to share more details we could put some more thought into it.

  • Sleepio Member

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    Expert

    Hi vladimirez,

    That does make sense and you are clearly experiencing very intense dreams. You mention you are experiencing them every other night – you could try monitoring things in your sleep diary (using compare sleep tags tool) to see if there is anything different. There are many things which affect dreams:

    -medications
    -alcohol
    -how much sleep you have had the previous night
    -how long you have been asleep for (you have more REM sleep and hence more nightmares in the second half of your sleep, so if you are oversleeping some nights, you might want to limit this)

    Insomnia and nightmares / bad dreams often co-occur. I see you're in session one, I hope you find the course helpful to manage your insomnia. Some of the strategies also overlap with treatment for nightmares so I hope you see some improvement.

  • Sleepio Member

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    Graduate

    I'm 52 and the hot sensation wakes me up. I don't recall any nightmares associated with this. I am curious about the hormone aspect you mentioned. I'm male don't think much about my how my hormones effect me. :-)

  • Sleepio Member

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    Expert

    Hi Jenny,

    I think there are a few options here, depending on what you think might be behind this.

    -It sounds like you are feeling more anxious about sleep now that it has been restricted. Finding ways to manage this so that your arousal is lower when you go to sleep could be useful to decrease the wakenings. There are several things that could be useful – having an enjoyable wind down routine, using relaxation, imagery or mindfulness techniques. And I think in the next session you will also cover ways to check out the thoughts that pop up when you are feeling more anxious about sleep, or the daytime consequences of sleep problems. So this could be helpful to take the pressure off of sleep.

    -The other option is to consider the timing of your sleep window. Do you think it is best matched to you? You could consider shifting it slightly earlier if you think you are more of a 'morning' person.

    -Many people are waking earlier at the moment due to the early sunrise in the northern hemisphere. Is your room dark enough? If not you could try leaving an eye mask by your bed or getting a black out blind to block out more light (you can buy temporary stick on ones online).

    Good luck and keep going. Sleep restriction can be tricky but it's a really good technique to get your sleep back on track and the community are usually really supportive so you might want to login and speak to other users

  • Sleepio Member

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    Graduate

    Is there going to be time for you to answer my question Dr Bryony?

  • Sleepio Member

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    Expert

    Hi kasedith,

    I think what you have described is a very common experience – many people say this. But the good news is there are definitely things that can help. I see you have just completed session 2 – have you tried the progressive relaxation and autogenic training mp3s? It can be helpful to work on relaxing the body so that your mind has the message that it's now time to unwind.

    The course has a whole host of tips that will be useful for this, particularly sessions 4 and 5. I'd recommend trying out things each week and then the next week you will be ready to build on it. One at a time you will be adding new tools that will stack the odds in favour of sleeping well each night.

    Good luck and do check back in here if you have particular questions

  • Sleepio Member

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    Expert

    Hi 2springers,

    Sorry, yes there is time!

    As we get older our sleep naturally becomes more fragmented. So we are more likely to wake up too early or wake up more often in the night. This is in part because we produce less melatonin. Here are a few thoughts.

    -Light suppresses the production of melatonin so with the early sunrise you might find you have particular difficulties at the moment. Make sure you have good black out blinds or you could try and eye mask.
    -For people aged over 55, UK guidelines suggest considering modified release melatonin. A CBT type course like sleepio is the first line treatment but you might want to talk to your GP / primary care physician to see if this would be appropriate for you. They will know more about this.

    As you have tried the techniques of the course you could also do an experiment over the next week, adding in a nap each day. But try doing this earlier in the day, ideally before 3pm and for around 20 minutes, so that your sleep pressure has time to build up again before bed. If you are sleep deprived you might notice that it doesn't impact on your sleep later that night, in which case you can add it to your routine.

    Hope that's helpful 2springers!

  • Sleepio Member

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    Expert

    Hi mascott – I was wondering about age and gender because in ladies of that age the hormone changes can cause hot flushes which might have impacted on awakenings. If you are concerned about this or think there could be another problem underlying the temperature increase you could speak to your GP / primary care physician. I can't think of a clear reason for this but I will ask the clinical team and get back to you if that's ok.

  • Sleepio Member

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    Graduate

    That would be appreciated. I should add that I'm fit, active, eat a whole food diet and I'm not overweight.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Lizzbrown,

    If you are still experiencing nightmares which are disrupting your sleep you could speak to a doctor about medication or being referred for Imagery Rehearsal Training (IRT) which is a CBT type therapy (like sleepio) targeting nightmares. IRT has a good evidence base for people experiencing PTSD, which I recall you mentioned in your first post.

    Lots of options. Good luck.

  • Sleepio Member

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    Expert

    Great, I'll get back to you by replying on here once I've hear back

  • Sleepio Member

    • 478 comments
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    Expert

    That's the end of this evenings session. Thank you all for sharing your experiences and posting your questions. Good luck with the course.

    Best wishes

    Bryony

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi mascott, as promised, I've checked in with the rest of the clinical team. It sounds like the temperature is waking you (rather than after waking), it is happening regularly at around the same time each night and you are otherwise fit and well. As this is a new problem we'd suggest speaking to your doctor. Whilst it could just be environmental factors (heating, blanket etc), it is worth getting checked out to ensure that there isn't another physical cause.

    You can of course keep going with the rest of the sleepio course to help with your pre-sleep routine and in getting back to sleep quickly.

    Bryony

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