Live discussion with Dr Bryony Sheaves - 21 February 2018

Dr Sheaves will be hosting a live online discussion here on Wednesday 21st February, 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 including that about medication. 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 15 Feb 2018 at 4:22 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Session 2

    Kitten, I understand some of what you are going through. My aunt is dying young of cancer. I have a sick kitty (kidney failure).

    Hope you and I can find rest soon. <3

  • Sleepio Member

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    Expert

    Evening everyone and welcome to this evenings live session. I'll be here for the next hour and a half to answer any questions you have about sleep or the Sleepio course. Just a note about me – I'm a clinical psychologist with a special interest in sleep. I'm therefore well placed to talk about the psychological techniques but for specific medical advice, including about medication, you're best placed to speak to a medical doctor.

    Let's get started!

  • Sleepio Member

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    Expert

    Hi,

    Firstly, congrats on your sleep improvement – I'm really pleased for you!! And I'm sure it took a lot of hard work, so well done.

    Sleeping in the same bed as a partner is a common difficulty shared on this forum. I wonder if anyone else has already shared any top tips?

    Sleeping in the same bed again after so long may feel like a big step, but the good news is that having gone through the programme there are tips already there which can help.

    One of the most powerful techniques is sleep restriction, which works by increasing sleep pressure. Some find it helpful to maximise sleep pressure if there is a reason why sleep might be more difficult. For example, on the night that one goes to bed with the bed partner, go to bed later, or perhaps rise earlier the morning before so that sleep pressure has time to build across the day. Using this alongside the 15 min rule tends to maximise the benefits.

    Prioritising the wind down on these nights can also help to calm the mind and body in preparation for sleep. Lastly, it may be that there are specific thoughts about the situation that would be good to run past the 'thought checker' – what runs through the mind when lying in bed on those more difficult nights?

    Just a few thoughts. It's exciting that you're at the stage of taking this step and really am delighted your sleep has improved so far. You have a good model to work off now, so it's just about extending it to a new sleep situation.

    Good luck!

  • Sleepio Member

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    Expert

    Hi,

    I'm really sorry to hear that you're feeling pessimistic about the course.

    I'm wondering if you have read some posts about sleep restriction? This is a badly named strategy that is in fact very powerful for improving sleep. Or perhaps you haven't seen the benefits that you'd like to have after just a couple of sessions. It would be good to hear more about the concerns you've shared.

    You will shortly be moving into the most powerful aspects of the course, including sleep restriction. These are proven techniques for improving sleep, but are difficult to implement and in the short term. Once you get onto these do remember we are here to answer any questions, or for general support.

    And just to reassure, courses like Sleepio have been tried and tested in many randomised controlled trials (the gold standard test of any programme of help) and found to significantly improve symptoms of insomnia, including the total time users spend asleep. I really hope you see these benefits too.

    Good luck with the rest of the course

  • Sleepio Member

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    Graduate

    My sleep problems appears to have been a result of two primary things that I have recently changed.
    1st I retired from Nuclear Medicine as a Technologist after38 years. Particularly the PET imaging time.
    2nd was moving welbutrin from am to pm taking.

    I now fall asleep quickly at night and depression appears to be lessening as well anxiety attacks.

  • Sleepio Member

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    Expert

    Hi,

    This does sound like a challenging cycle. In general what the body likes (in terms of sleep) is consistency across nights. What can happen with sleeping medications is our body starts to get used to the chemicals and then when we stop them we get what is often termed 'rebound insomnia', where the insomnia can become worse, and so then it's tempting to go back on the medication and so on.

    If coming off the tablets is a goal, we always recommend discussing with the prescriber to work out a clear plan for reducing the meds. This can increase the chances of success. Or, if helpful at the moment, discussing the option of taking them now but reducing after the course, once the sleep strategies are learnt and integrated into routine.

    For other difficulties such as panic, we would recommend discussing with a GP/primary care physician to ensure that the treatment for this is also optimised.

    I hope you see some improvement soon.

  • Sleepio Member

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    Expert

    Hi, I'm pleased that you have seen some improvement in your sleep, good news!

  • Sleepio Member

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    Expert

    Hi,

    I'm so sorry to hear that you lost your home in the fires. As well as processing this incredibly difficult experience I imagine you also have a lot of practical things on your mind too which is a lot to manage.

    Sleep difficulties are incredibly common when going through times of acute stress so you are not alone. If we're having a difficult time, I think it's important to take the time we need, be kind and compassionate to ourselves and patient, including with sleep.

    To help manage stress before sleep it can be really helpful to prioritise a time to put the day to rest (e.g. planning tomorrow, writing down how the day has gone) and then aim for a wind down time (some people call this 'me time' if there's lots going on). This can be time to relax, to switch off and prioritise oneself among the stresses. The course will run through this in more detail, and I'm sure the Prof will do a better job than I have done in explaining it!

    The other techniques can also help to maximise the chances of sleep when we head to bed. And if we get better sleep it can help us to manage stresses more easily the following day. So I hope you see some benefits from the course soon.

    If however the stress is also affecting other areas of life it can be helpful to seek help from a professional about this issue specifically.

    I hope things ease for you soon.

  • Sleepio Member

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    Expert

    Hi,

    The sleep restriction element of the course can be tough, I completely agree. How are you managing it at the moment?

    I think the key with it balancing a sleep window that maximises sleep pressure each night, whilst also ensuring that it is manageable. Ideally when doing this we should be aiming to feel as sleepy as possible by bedtime, and if it's difficult to stay awake that's brilliant, it means it's working. But if one is so sleepy that it's too tough to stick too this isn't OK. The last thing we want is a night of oversleeping because we're too tired, because the sleep pressure will be back to square one the next night.

    I hope the above helps you to work out a way for SR to work for you, balancing high sleep pressure with ensuring it's manageable.

    I wonder if anyone else logging in has tried SR and has any top tips?

    Good luck with it – we do tend to find it is a no pain no gain type strategy so hopefully the fact that it's tricky means you'll see some improvement in sleep soon.

  • Sleepio Member

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    Expert

    Hi – sorry to hear you're unwell. That must be very tricky for sleeping. I'm afraid I don't have any suggestions, have you spoken to a doctor?

  • Sleepio Member

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    Expert

    Hi,

    This does sound tough. When fatigue is causing daytime difficulties I'd first check out any underlying causes:

    -Are sedating medications taken at the best time and dose – here it can be helpful to liaise with the prescriber to talk through options.
    -Low mood can also be a big cause of fatigue, in which case we always want to ensure that that is receiving treatment.
    -Being sedentary can also increase fatigue, and here it sounds like you are already trying lots of good things. Keeping active and ensuring access to as much natural daylight as possible can be helpful. Particularly planning this for the times when naps are most likely can be useful.
    -If there is another sleep, psychiatric or physical difficulty we always want to ensure that the treatment is optimised, especially for apnoea. It sounds like you are already receiving treatment for this which is good news.

    Are any of these helpful?

  • Sleepio Member

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    Session 2

    I already do all of these things. My presleep ritual is strictly adhered to, timed, and organized. I spend half an hour drinking tea and reading a relaxing novel. I shower, perform yoga stretches slowly, followed by meditation. It is frustrating that the only answers I get from this course seem to be things I already know.

    I try hard to go to bed at the same time every night. I am in bed by 930 unfailingly. I am unsuccessful at falling and or staying asleep.

  • Sleepio Member

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    Graduate

    Picking up a comment to Mariosy regarding “ rebound from insomnia” when coming off meds. For a lot of us we need the help of meds. to compliment Sleepio. Are you saying discontinuing meds. makes insomnia even worse in the future? Ideally I want to stop them and just use Sleepio, but I’m not ready to yet. It sounds like a no win situation? Please advise.

  • Sleepio Member

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    Expert

    Hi,

    Sorry to hear that there is a lot on your mind, and I do hope your cat and mother in law are being well looked after.

    What you are describing is the insomnia racing mind. When there are few distractions in bed, worries can really flourish and take hold. Annoyingly the harder we try to push thoughts away and keep a blank mind, the more they come flooding back in. Have you heard of the pink elephant experiment? Perhaps spend 30 seconds trying really hard not to think about a pink elephant… my prediction is that the thought of a pink elephant pops up, even though you have worked really hard not to think about it!

    I suppose the idea of this is that our minds do wander and sometimes they wander onto worrying thoughts. This is OK and normal, rather than block them out we can acknowledge them and then gently bring the mind back to something that leaves us feeling more calm. Perhaps a calming memory or image.

    The course will cover lots of techniques for the racing mind as it is such a common issue. The above is just one approach until you get to that aspect of the course.

    Good luck and do check back in here if you have more questions throughout.

  • Sleepio Member

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    Expert

    Hi,

    The rebound insomnia is short lived but usually worse if meds are stopped abruptly.

    Many people doing the course will be on sleep meds.
    The research (by Prof Morin's team) indicates that taking them as and when (known as PRN) tends to be less helpful for sleep in the long term than reducing slowly (tapering) according to a clear plan.

    Coming off meds is a common goal, but the general advice is come up with a plan to decrease meds with the prescriber.

  • Sleepio Member

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    Expert

    Hi,

    Really sorry that you are feeling frustrated. I appreciate that it's irritating hearing ideas that you already know.

    Sometimes when the stress management strategies aren't kicking in, it can be helpful to shift focus and think about the other sleep strategies.

    You will (next session I think) be coming up to the section which thinks about sleep timings. These tend to be the most effective for improving sleep. It will think about consistent routine (so great you already have that section sorted!) but also the optimal duration of sleep.

    To maximise this I also tend to focus on sleep timings to ensure that the sleep window is matched to the internal body clock. For example, an evening person has the best chance of getting to sleep later whilst a morning person tends to sleep better if going to bed earlier. Sometimes people experiencing insomnia can head to bed early (to maximise the opportunity for sleep) but in fact this is too early for the body clock (and before the release of the sleepy hormone, melatonin) and so it takes a long time to get to sleep.

    I mention this because a 9:30 bedtime would suite someone who is very much a morning person. When you get to the section on sleep restriction, it may be helpful to consider the timing of the window and check out that it's matched to your body clock.

    I really hope you see an improvement in your sleep soon.

  • Sleepio Member

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    Expert

    Hi everyone, we'll stop there for this evening. Thank yo for all your posts. I wish you all a better night of sleep tonight,

    Bryony

  • Sleepio Member

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    Graduate

    Thanks for the thoughtful comments Bryony. – I am certainly trying to schedule medications in order to experience as few as possible negative side effects. There is some frustration to this – with the onset of my symptoms and then my diagnosis I was actually relieved to discover justification for developing (among other symptoms) an uncharacteristic loss of energy and stamina, and the ability to concentrate. My working life has been diverse, ranging from demanding physical work before my 30s to increasingly technical and mentally demanding professional work in the last 20 years. I feel that I never even understood the concept of “fatigue” until about 2 years ago, when mysterious overwhelming and irresistible mental and physical tiredness would repeatedly seize me. There were other symptoms which I finally put together, as I began to learn about RA. I had thought that my CPAP had solved so much of my previous sleep issues. Many other causes for sleep difficulty seem to have affected me over time. The course is really helping me gain perspective on separating my sleep time from time to deal with “problems”, rather than making sleep a problem time. – I have taken Citalopram for many years. It has flattened out the mood issues I used to experience. I am used to considering my mood – for example one thing I puzzled over as my RA fatigue developed, was whether this was some manifestation of depression, when I didn’t actually feel any other sense of depression. Mainly I was puzzled by suddenly wanting to sleep outside my normal fitful sleep time. – Sunlight. It has been a hot summer here (in the Southern Hemisphere). My desk is beside a floor to ceiling window. I have been out walking in the sun almost daily. I have been exercising at the swimming pool (though a little less often with an influx of hopefully temporary New Year resolution attendees…). I can do more, and shall. Actually yesterday, as I considered my question for you, as I was tempted to creep away for a nap, I consciously stood and experienced the sun streaming in beside my desk. And yes, it helped me through :-) – I now take a precautionary approach to nighttime pain, and take pain meds before bed.
    Yes, addressing apnoea has been huge for me (and my partner). It was again a relief to be diagnosed, and it has been really amazing to use CPAP.
    I have had quite a few days of improving sleep quality, and I am finding the strategies really useful.
    What I hope is that I get to a point where I can apply the strategies very naturally.
    Thanks Bryony

  • Sleepio Member

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    Graduate

    Thank you, it’s reassuring to know that when I eventually stop the meds the “ rebound insomnia “ will be short lived. I thank you for your reply.

  • Sleepio Member

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    in reply to Sleepio Member
    Session 4

    Dear Dr Bryony Sheaves,
    I looks like i am doing one step forward 3 steps back. I am trying to cut on pills but when i cant sleep at night i go crazy. I tried to do the sleep restriction not very successfully. Last night i had a new thing to me. I was naturally sound asleep and woke up in the middle of the night to drink water as i normally do and then i could not get back to sleep. I tried but no success. I tried not to take the pills. I ended up not sleeping again (only 4 hours before that) and my stomach was like a knot. i tried breathing. Saying the “the” to block thoughts. Nothing helped. And i do not what to do.
    i hope that it wont repeat. But pls tell me what to do if happens again.

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