Live discussion with Dr Bryony Sheaves - 2nd August 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 2nd August, 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 27 Jul 2017 at 1:16 PM
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  • Sleepio Member

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    Expert

    Hi,

    This sounds like a very common pattern. Any strong emotions (like anxiety or frustration) can get in the way of sleep. And when we have sleep difficulties often our attention becomes pre-occupied by sleep and this too can get in the way of sleep.

    Some find it helpful to take the pressure off sleep by using what we call paradoxical intention. Basically going to bed and expecting to get up again for the 15 min rule, rather than expecting to sleep. Essentially accepting that sleep may not come at bedtime, and wakefulness is ok. Some people even prep for it, taking a blanket to the sofa, a good book and preparing to be awake. Taking the pressure of sleep can increase the chances of getting to sleep more quickly.

    The thought checker can also be helpful for this. Checking out the thoughts that come to mind at bedtime and checking out whether there are more helpful or realistic thoughts to bring to mind instead.

    How do the above sound?

  • Sleepio Member

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    Expert

    Hi, I did a quick search of the research before we started and found one small pilot study that was carried out with athletes which reports that those who used the training reported an improvement in sleep quality compared to those who do not. But this needs to be replicated.

    CBT has many many trials and when we put all this data together we can see that it leads to 'moderate to large' reductions in insomnia by the end of the programme compared to no treatment. Results last longer than medication. And of course Sleepio itself has been tested in a high quality trial (against a psychological placebo) and has been demonstrated to improve sleep.

    I think the brain entrainment music may need more evidence before we would want to routinely include it in a programme.

  • Sleepio Member

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    Expert

    Hi,

    Really pleased to hear that you've seen some improvement.

    This is a really interesting question and one that I think we should look further into in our research. Some people see very quick gains in sleep and some are more gradual but we aren't sure how to predict what kind of trajectory that people will take.

    Broadly speaking, we think that if someone has had a sleep problem for longer, then it may take longer to see improvements, but not always. The key thing is to keep up the hope – it's great for instance that you have already seen some improvement. And implementing the strategies across each night is usually a good ingredient for success.

    Congrats again on the improvement you have seen – I'm sure this must have taken hard work. And I hope you continue to see the further improvements you're hoping for.

  • Sleepio Member

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    Expert

    Hi,

    Really pleased to hear that you've seen such improvement! Well done!

    Many people say that their thoughts can get in the way of sleep. I think what you are referring to is a particualr thinking style. We know that ruminating on past events or worrying about the future can fuel emotion which disrupts sleep. These thinking styles are almost like thinking habits, which are often long lasting, but can also be worked on. For example it can be helpful to make night time a 'worry free zone'.

    Some people for example find it helpful to: 1. put some thoughts into the worries/thoughts early in the evening (e.g. around 6pm) to prep for good sleep in advance (so that the thoughts have been dealt with already) and 2. if they come to mind in bed, interrupt them early on before they take hold by either 3. gently taking the mind to somewhere else that brings more calm emotions or 4. if this is tricky, get up and feed the mind with something different like relaxation.

    Some people find that having a talk back to the worries helps, e.g. saying 'I'm not going to worry about that now'. It's essentially all aiming to postpone the thoughts until morning, when we are often much better placed to manage them. It can take a lot of effort to start with, but after a while, the postponing comes more naturally.

    How does this sound to you?

  • Sleepio Member

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    Expert

    Hi,

    This is a good question – it's really important that we match our sleep window to our natural body clock. This will increase the chances of sleep.

    Our chronotype (morningness or eveningness) tends to be reasonably stable when we compare ourselves to others. For example I've always been more of an evening type compared to friends my age. But, across our own life time our preference can alter. For example, teenagers become 'later', preferring to go to bed later and wake later. But by early adulthood we are starting to shift back to being earlier. And this continues across our adulthood.

    By heading to bed later, it may be less to do with the timing and more to do with the fact that you have been awake longer and therefore more sleep pressure has built up (the longer we are awake the more likely we are to fall asleep). The next session (session 3) will help you to use sleep pressure to your advantage and also work out the best timing for your sleep window. You can move it further forwards or backwards to match your natural clock.

  • Sleepio Member

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    Expert

    Hi,

    In fact this is such a common issue that we have a whole guide written on it by Prof Espie:

    https://www.sleepio.com/articles/jetlag/

  • Sleepio Member

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    Graduate

    Thank you!

  • Sleepio Member

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    Hi,

    Often if people describe this then I'd be thinking about the key drivers for our sleep: 1. Is sleep pressure high at night? If SR is being followed then the answer is yes. 2. Is the sleep window matched to the persons natural body clock (e.g. if an evening person is the sleep window starting and ending late enough, vice versa for a morning person) 3. Is enough being done to decrease hyperarousal that can get in the way of sleep – meditation and other ways of relaxing are helpful for this.

    Lastly, if there are any other health difficulties then it can be helpful to discuss sleep issues with the medical professional treating them so that they can ensure treatment is optimised for that problem and also for sleep (e.g. timing and dose of medications).

    As there was such a sudden onset to the insomnia, I wonder if anything particular changed at that time?

  • Sleepio Member

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    Graduate

    Hi ,
    I'm on the firth week of the programme and I'm getting less sleep now than before I started.
    Is this normal and when should I expect to see an improvement?
    Thanks

  • Sleepio Member

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    Expert

    Hi really sorry to hear you are having panic attacks. CBT has a good evidence base for treating panic so helpful to hear that you are receiving help for that too. Getting up to wind down again is what we'd usually recommend for any anxiety difficulty at bedtime so good that you are already doing this. The course will also build on this to walk you through many other strategies to increase the chances of sleep each night. Good luck with the course and do check back in here if there are any further comments or questions that we may be able to help with.

  • Sleepio Member

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    Graduate

    Im taking Amytriptyline but it isnt have much effect

  • Sleepio Member

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    Expert

    Hi, really sorry to hear this.

    This can sometimes be a brief side effect of sleep restriction. The idea behind this is to get back into the habit of going to bed and falling asleep by restricting sleep, but then the second crucial part is gradually increasing the sleep window up to the goal duration. This second part happens once the habit of going to bed and falling asleep has been established.

    Could this be why you are getting less sleep, or are there other reasons?

  • Sleepio Member

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    Graduate

    It sounds good. The strange thing is I dont get insomnia on weekends or during holidays. Its always during the work week. Do you have any idea why this is?
    Thanks
    Sag

  • Sleepio Member

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    Expert

    I'm sorry to hear that. Did any of the ideas in my post connect with you?

  • Sleepio Member

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    Expert

    Hi,
    This is quite common and often because the pressure is off at weekends – no demands the next day and no time limit on sleep. Could this be the case for you?

  • Sleepio Member

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    Graduate

    Yes. I actually had success with them. For about 7 months I waa in the habit of falling asleep on the sofa then waking up and going to my bed where I had no problem falling asleep. When I tried to change the routine back to my bed the insomnia kicked in again
    Thanks
    Sag

  • Sleepio Member

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    Graduate

    Hi Dr Sheaves
    Yes I work as a teacher. So it is completely the case for me. Its really frustrating though. Im very bad at sticking to the 15 minute rule. But Ill get better with more discipline
    Thanks
    Sag

  • Sleepio Member

    • 26 comments
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    Graduate

    Hi Dr Sheaves
    Yes I work as a teacher. So it is completely the case for me. Its really frustrating though. Im very bad at sticking to the 15 minute rule. But Ill get better with more discipline
    Thanks
    Sag

  • Sleepio Member

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    Expert

    Hi,

    Some people experiencing insomnia describe that bed has become a place associated with wakefulness and anxiety. So heading to bed is a big step after sleeping on the sofa. But usually this will ease with time and sleep will improve. Is there anything that can make bed seem like a more relaxing and desirable place? E.g. buying some nice new bed sheets?

    We don't usually recommend relaxation in bed, but if anxiety is particularly triggered by bed, it can sometimes be helpful to do a little relaxation in bed to reconnect bed with feeling calm. And then gradually working towards doing this before bed.

  • Sleepio Member

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    Expert

    Thanks for all your posts this evening. Wishing you all the best with the sleep tonight!

    Good night

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