Live discussion with Dr Bryony Sheaves - 25th October 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 25th October, 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 19 Oct 2017 at 1:31 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    There is an established link between hormonal changes and sleep. There is an article on associations here:

    https://www.sleepio.com/library/article/hormones-and-sleep-a-two-way-street/

    I haven't heard of any specific strategies that are effective at this time, but in general it may be a time to prioritise the cbt techniques that have been helpful, e.g. taking longer to wind down.

    If anyone else logging in tonight has found anything helpful, it would be great to hear your thoughts…

  • Sleepio Member

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    Expert

    Hi,
    Thanks for asking for further detail – SR is a tricky part of the course so it's good to have a full rationale. There are a few questions on it tonight so I've popped in quite a bit of detail.

    SR is aiming to optimise our sleep pressure/drive each night. As sleep pressure increases the longer we spend awake, if we restrict the sleep window, pressure should be nice and high. If we follow it each night, we increase the chances of sleep each night. Once the habit of going to bed and falling asleep is re-established (as it should be, if one is very tired each night), then the sleep window is very gradually increased. The reason for the gradual increase is to ensure that only small changes are made to sleep pressure which the body adjusts to, but without losing the habit of going to bed and falling asleep.

    The question about the body clock is an interesting one. We are indeed creatures of habit and sticking to consistent times is helpful, but if we make these small adjustments when our sleep efficiency is high, we should adapt well to an increase in sleep window.

    The key with the body clock is actually to make sure that the timing of the window (rather than duration) is best matched to the natural rhythm. E.g. I'm an evening person, so I'm more likely to sleep better if my window is later (I know for example that a 9pm bedtime just doesn't work for me, but a mid-night bedtime is perfect).

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    Hi,

    The replies are coming in gradually – I'm typing each live and working in order. At the top of each post it says 'in reply to…' to link it back to the question

  • Sleepio Member

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    Expert

    Hi,

    I'm really sorry to hear that you haven't seen more progress. I wonder if you are logging in live and whether you could tell me more info about your current pattern and how things are in the daytime (e.g. are you managing to stay awake to do the things you want to do)?

    If getting to sleep is working well but someone is waking too early, we often think about moving the whole window earlier (especially if someone says they are a morning person).

  • Sleepio Member

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    Expert

    Hi,

    Really pleased to hear that you've seen some good progress – congrats!

    Increasing the sleep window can be quite a gradual process so it may be that the body is just adjusting to the new opportunity for a slightly longer sleep. Boosting this with other strategies (e.g. a good wind down in the evening and working on any pre-sleep thoughts that can drive hyperarousal before sleep) can also be helpful for lengthening the sleep time.

    The cue that the optimum sleep window is reached is when it is consistently difficult to increase the window any further without reducing the sleep efficiency.

  • Sleepio Member

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    Expert

    Hi,

    I see you're on session 1, so firstly, welcome to Sleepio!

    The questions about medication are best directed to a medical doctor or pharmacist as I'm a psychologist so this is outside of my area of expertise.

    Re: the question about staying asleep, the course will have lots of techniques to help stay asleep, and get back to sleep more quickly if woken. It starts by setting up some of the foundations for good sleep, to ensure these are in place and then moves through some of the more powerful techniques. Ones to look out for are the 15 minute rule and activities to do to wind down (you can do these in the night, as well as in preparation for sleep in the evening). The course may also adjust your sleep schedule to reduce the chances of the awakenings happening in the first place.

    Good luck!

  • Sleepio Member

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    Expert

    Hi,

    Many people take medications (particularly sedative meds) whilst running through the course. The key for coming off meds is to have a good plan set up with the prescriber. Some chose to reduce meds throughout the course and some after (it depends on the individual goal).

    The specific details of how to reduce meds (e.g. over what time period and amount to reduce by) depends on the medication (e.g. some medications need to have the dose tapered slowly whilst others can reduce more quickly). It can also be helpful to find out what to expect when reducing medication, and in particular the potential impact on sleep.

  • Sleepio Member

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    Expert

    Hi,

    To my knowledge we don't have good evidence for the best point to taper. Some people are keen to reduce meds (this is their key goal) so do it early on, whilst others prefer to learn the strategies first.

    (also see my previous post for further info on tapering)

  • Sleepio Member

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    Session 4

    Do you have any tips to deal with the 'I can't deal with tomorrow if I don't sleep' syndrome. This fear, particularly on nights when I have to drive the next day(dangerous without sleep), perform or persuade. I usually end up having a bad night and need some advice about countering this self-fulfilling fear.

  • Sleepio Member

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    Expert

    Hi,

    When people are tapering it is often helpful to get good advice from a pharmacist or medical doctor about ways to increase the chances of success. And in particular, when there is rebound insomnia as a result of a med reduction, it can be helpful to ask how long this may last (ie. how long does it take for the body to adjust to the lower dose). This isn't my area of expertise unfortunately.

    There is however an article on Mirtazapine specifically in the library which may have some helpful info.

    https://www.sleepio.com/articles/sleep-aids/mirtazapine-and-sleep/

  • Sleepio Member

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    Expert

    Hi,

    This does sound tricky. Thoughts like 'if I don't sleep wont cope tomorrow' are common, and increase anxiety just before the time we want to fall asleep which is of course unhelpful for sleep. Later in the course the Prof will introduce you to the 'thought checker' which will help you to generate thoughts which are less anxiety provoking and more helpful for sleep.

    I do agree though that driving is particularly tricky. If feeling very sleepy at the wheel, driving is not advised (and/or taking very regular breaks is a good idea), so it is good that you are cautious. I wonder if it is possible to postpone the thoughts until morning (rather than in bed). In the day time we tend to be best able to weigh up risks and respond accordingly. Often our thinking can become more extreme at night which is less helpful for decision making.

  • Sleepio Member

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    Graduate

    Thank you, I've looked at the article on Mirtrazapine, learnt some new things. I didn't know it was possible to get Melatonin on prescription, as I thought it was illegal in the UK, but it must have changed. I think I may ask the Dr. if I can try some.

  • Sleepio Member

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    Expert

    Hi,

    Sorry that you are finding the daytime so tricky to stay awake. We tend to find that activity and exposure to natural sunlight are some of the most effective things for boosting energy/alertness in the daytime. These can be done at the time of day when most likely to nap. We often encourage people to play around with different activities to find out what's most helpful, and we often take ratings of sleepiness or energy levels before and after to assess it systematically. This is often the last thing that we feel like doing when feeling super sleepy, but it does often seem to be helpful…

  • Sleepio Member

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    Graduate

    I'm on week 5 of the SR and was doing ok gradually until last night. My SR is 01:00 to 06:00. Last night I couldn't sleep at all and I think it was about 03:30 when I finally fell asleep and woke at 06:00.

    I'm hoping this is just a blip but if not what's the best thing to do?

  • Sleepio Member

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    Graduate

    I'm on week 5 of the SR and was doing ok gradually until last night. My SR is 01:00 to 06:00. Last night I couldn't sleep at all and I think it was about 03:30 when I finally fell asleep and woke at 06:00.

    I'm hoping this is just a blip but if not what's the best thing to do?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    The sleep window is usually determined by sleep diary info in addition to questions in the initial sleep test (particularly about current health). If there are errors in the info that was submitted it may be worth contacting hello@sleepio.com to see if they can look into this for you.

    In the meantime, it is possible to move the whole sleep window earlier if the bedtime is too early, see: https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/

  • Sleepio Member

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    Expert

    Hi,

    Blips in the course are very common, and not usually a sign that things are getting consistently worse.

    In fact with less sleep last night, tonight your sleep pressure will be higher than usual so the chances of getting to sleep should also be even higher than usual.

    Things that can help reduce the chances of this are a really good wind down before bed and then using the 15 minute rule if unable to sleep. The 15 min rule is very helpful for interrupting thoughts which often pop up in bed and reduce the chances of sleep (as well as increasing the bed=sleep connection).

    I hope this evening is better for you.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    The question re: Melatonin is really one for a medical doctor or phamacist. In the UK our clinical guidelines suggest that it may be considered for older adults with sleep problems, but CBT courses like Sleepio are the first line treatment option.

    Re: the early morning waking, have you found strategies from the course that are helpful at this time? Couple of thoughts, first, for people trying to lengthen the sleep window it can be helpful to use the 15 min rule and plan in some activities that calm the mind first thing in the morning (e.g. relaxation) to give some cues that it's still time for sleep rather than wakefulness. The other thing that can be helpful is planning an earlier sleep window, particularly for people who are known 'morning people'. It's often easier to head to bed earlier and wake earlier, which can reduce the pressure to sleep in as there has already been enough sleep already.

  • Sleepio Member

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    Expert

    I'm going to end there for tonight all as we've reached the end of the session. Very busy session and I'm aware that I've not got through all the questions but I'll ask the team to move to next weeks live session. Hope this is OK.

    Good luck with the sleep tonight.

    Bryony

  • Sleepio Member

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    Graduate

    Thank you

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