Live discussion with Dr Bryony Sheaves - 24th January 2018

Dr Sheaves will be hosting a live online discussion here on Wednesday 24th January, 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 19 Jan 2018 at 1:15 PM
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  • Sleepio Member

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    Expert

    Lovely thoughts, thank you. I like your phrase ‘pause some of the chaos’ – offering permission to pop these on hold for the sake of a good night sleep. And I wonder if we are able to do this, and sleep better perhaps the chaos will feel more manageable to deal with the next day…

  • Sleepio Member

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    Expert

    Hi, thanks for your question and I’m really pleased to hear about your good progress through the programme – congrats, I’m sure this has taken a lot of hard work on your part.

    Early morning waking is a question that is often posted on the live sessions, so you aren’t alone in experiencing this, and it can be quite frustrating! When people ask about this I first of all wonder about the timing of the sleep window. Do you think you are a morning person (as opposed to an evening person)? For this group it can be helpful to time the sleep window earlier in the evening and this can help people to sleep through. The next thing I’d usually consider in this scenario is the 15 minute rule. As much as it can feel very appealing to stay in the comfort of bed when it’s so close to the wake time, getting up (and avoid the half-awake half-asleep scenario) can increase sleep pressure and increase the chances of sleeping through the following night.
    Have you tried the above? If so it would be good to hear how this went.

  • Sleepio Member

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    Expert

    Hi, I'm sorry this does sound incredibly tough, is there anyone who is helpful to talk to about thist?

    When you say you have had therapy is this related to the difficult experiences you had with your father? If this is still a current difficulty and may be an additional factor fueling the sleep difficulty we do recommend also discussing with a medical professional to ensure that everyone is getting the right level of support.

    In terms of negative thoughts, these of course are more likely to pop to mind when we are lacking sleep and be really tricky to manage. Have any of the course strategies been helpful? I guess I'm thinking of the thought checker or mindfulness downloads particularly.

  • Sleepio Member

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    Expert

    Hi,
    I'm really pleased that on the nights at home things have seen a shift, this is really encouraging and shows that your body is clearly responding the course. It sounds like the next step is to target these particularly difficult nights at your partners.

    It sounds like there is a lot of anxiety linked to these nights, which is understandable given that they've been problematic. Is this a general pattern or related in any particular way to the setting, or other stressors related to these nights?

    I also wonder whether what sorts of thoughts are running through your mind when unable to sleep? Anything that might be helpful to consider with the thought checker?

    In terms of sleep, anything that can decrease the hyperarousal on problematic nights is typically helpful, for example prioritising a wind down routine, relaxation and putting the day to rest. Some people find it helpful to do this alongside a partner, relaxation for example can be a nice activity to do together.

    There are also good CBT treatments for panic attacks which has a very good evidence base and some find that they additionally want separate support for this too.

    I hope you see some improvement on these nights soon and well done again for the improvements you have seen.

  • Sleepio Member

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    Expert

    Hi,
    Are you able to remember your dreams? I'm wondering i this is triggering the wakening and anxiety?

    If people are experiencing many dreams the first thing I consider is whether there is anything that might be impacting on the amount of REM sleep they are getting and whether there is anything that can be done about that. For example, particular medications and illicit substances can cause a change in REM sleep, and having a long sleep window or additional daytime naps can increase the amount of REM we get at night simply because the longer we sleep the more REM sleep we get.

    Are any of the above relevant? Other things that can help with getting deep restorative sleep are sleep restriction, intensive exercise and feeling more relaxed when going to sleep.

    I hope you see some improvement in these soon.

  • Sleepio Member

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    Hi,

    The current treatment guidelines in the UK and US recommend CBT for insomnia strategies as the first line treatment for insomnia. We have much evidence now that this leads to good improvement in sleep even when people have a range of mental and/or physical health problems alongside. However we do always ensure that people are getting optimal treatment for the other problems and particularly if they are linked to sleep as hypothyroidism can be.

    Alternative therapies are not currently recommended for the treatment of persistent insomnia. However by signing up to Sleepio, you are signing up to a CBT based course which has been tried and tested and shown to lead to large improvements in sleep. I really hope you find some of the strategies of value and do link back in here if you find you have extra questions as you run through the course.

  • Sleepio Member

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    Expert

    Hi,

    I'm really sorry that the sleeplessness is so tricky. Many people describe the real physical impact that sleeplessness can have including for example changes in appetite. Lots of people with insomnia agree that bedtime is a time that they dread. The good news is that Sleepio has a range of techniques to help with this. Each week there will be a range of techniques introduced which we encourage people to try out and find out what works. These can then be added to the toolbox of techniques available each night to improve sleep.

  • Sleepio Member

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    Hi,

    Good question. Ideally, if it's possible to use the 15 min rule, wind down again and then head back to bed within the sleep window this would be the optimum. If this isn't possible, a short nap early in the day can be OK.

    Essentially, we want to ensure that sleep pressure has enough time to build back up again after the nap so the shorter the better and the earlier the better, in terms of increasing the chances of sleep the following night.

  • Sleepio Member

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    Graduate

    Thanks for your response. I think some of the hyperarousal/anxiety is definitely related to the setting: it's a flat with occasional noisy neighbours, there's less of a dedicated space for relaxation and wind down, and in some respects I feel less relaxed about doing it anyway if that makes sense. It's almost as if I have to do it as part of my routine but will it work anyway which of course is the start of the battle. Ironically I used to sleep brilliantly there and terribly at home on my own!!

    When I waken up I don't tend to have any specific thoughts that I could tackle with the thought checker it's more about just feeling generally anxious and panicky.

    Can you suggest some CBT techniques or references I could consult to help with panick attacks as that might help to re-settle me at night? I feel sure I can conquer this but at times is still feels like a battle.

  • Sleepio Member

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    Expert

    Hi,

    Thanks for your question, it sounds like you have already done much work in trying to assess this difficulty.

    Many people experience what we call 'sleep inertia' which is the experience of fatigue that we have when our body is transitioning to being fully awake for the day. For some people the boundary between being sleep and wake can be even more blurred, for example if people experience sleep paralysis (the experience of being paralysed, as in REM sleep, but when actually awake). This transition phase between sleep and wake can take longer for some people than others.

    This is my initial thoughts but I'd also like to share this with the other sleep experts so we can all put our heads together if that's OK. When I hear back (often not on the same night) I'll let you know.

  • Sleepio Member

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    Expert

    Hi, I don't have anything specific to recommend for panic, but any course which follows CBT principles is recommended.

    It does sound like there are more challenges for sleeping in the flat, but I guess the good news is that you have a model of sleeping well there and also of improving sleep in your own home. Is there any learning from this that you can take forward to this new challenge?

  • Sleepio Member

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    Graduate

    Thank you so much for your understanding. Yes please feel free to share with the other sleep experts.

  • Sleepio Member

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    Expert

    Hi, there are many techniques that will be covered by the course to improve night time awakenings. In the first instance we want to decrease the chances of them happening in the first place by taking time to wind down and foster relaxation before going to sleep. Exercise as you've noted, earlier on in the day can also help to increase deep sleep. There are also a range of strategies to help return to sleep more quick after waking.

    I wont cover these here as the Prof will do a much better job and ensure that the strategies are well paced but do check back in here if you have any questions along the way.

    Good luck with the course!

  • Sleepio Member

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    Expert

    Super, will reply here when I hear back and post on your wall so that you are alerted.

  • Sleepio Member

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    Expert

    Hi thanks for your post. Can I clarify, are you meaning that you are happy with sleep duration but quality isn't what you'd like it to be?

  • Sleepio Member

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    Expert

    Hi, this does sound like real challenge for sleep. Is there anything that helps with the tinnitus? I'm afraid I'm not sure on the recommended treatments. For any additional health difficulty alongside the sleep problem we always recommend ensuring that the treatment for that problem is optimised, in addition to using the sleep specific strategies.

    I've also just found this discussion thread which has a range of comments from other Sleepio users re: tinnitus, have you seen it?

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

    Whilst there can be many various triggers for wakenings, insomnia can follow if this triggers a frustration or anxiety around sleep. This is where Sleepio can be helpful, it can help one to return to sleep more quickly using a range of strategies introduced each week. I hope you see some benefit from these.

  • Sleepio Member

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    Expert

    Hi everyone, thanks very much for all your questions and sharing your experiences on here. We'll finish here, but I wish you all the best for sleep this evening.

    Best wishes

    bryony

  • Sleepio Member

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    Graduate

    I'm trying a new approach with my negative, stressful thoughts, based on the Sleepio advice to keep a journal.
    We can't control the world, but we can control what we choose to think about. So I'm trying to get into the habit of focusing on the great life i have. It's really hard to be happy when you're tired all the time, but I think i can do it, and hopefully, I'll go to bed in a peaceful frame of mind
    My father, who molested me, is fortunately, dead. But telling my family of origin what he did has led to most of them disowning me. Have not heard from them in 25 years. I have one brother who he also abused, so at least i have him

  • Sleepio Member

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    Graduate

    Thanks for your reply. In my case this repeating wake/REM is more like seconds than minutes. It may be a 10 second dream/then wake. The dreams are not really complete, telling, or have any real meaning.

    Sometime I wake without anxiety but many times I do along with dread.

  • Sleepio Member

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    Expert

    Hi,

    Just getting back to you as planned. I shared your description with the other sleep experts. Unfortunately we haven't any further thoughts. Neither sleep paralysis nor sleep inertia would usually last for 3 hours. I'm very sorry that we haven't any further insights into what sounds like a difficult problem to be managing regularly.

    If concerned we always recommend that people visit their GP or Primary Care Physician who are best placed to do a comprehensive assessment of health needs, including sleep.

    We're pleased that overall you have seen some improvement in your sleep through the Sleepio course. And hope you find some resolution to the problem you shared.

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