Live discussion with Dr Bryony Sheaves - 3rd August 2016

Dr Sheaves will be hosting a live online discussion here on Wednesday 3rd 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.

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Posted 28 Jul 2016 at 4:23 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Whilst one is working on their sleep, trying to improve it, we usually recommend avoiding naps. But once sleep has stabilised people can start having a bit more flexibility with these guidelines. But always in the knowledge that they know what they need to do if sleep starts to become a problem again. Ie. if increased naps decrease SE, then it may be helpful to cut them out again. The usual guidelines in my previous post may also be helpful to read.

    Hope that helps.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    It's very common for people to have some nights of disruption when starting SR – it isn't an instant fix unfortunately. The previous post I wrote outlining the science behind SR may be helpful to read.

    You've hit on an important point with the 'nodding off' question – we recommend following the sleepy-tired rule. This means that the recommended time to head to bed is when one starts to feel sleepy (e.g. nodding off, scratchy eyes etc). Relaxing or even boring (wind down) activities can help to bring this on around the time of the start sleep window. We do usually recommend sticking to the sleep timings where possible as this ensures that sleep pressure should be at it's highest at the same time each night, making it more predictable and easier for the body to re-learn the habit of going to bed and falling asleep.

  • Sleepio Member

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    Expert

    Hi,

    So pleased to hear that your sleep has been stable for the past month – great work!

    In general we all tend to sleep better with a consistent routine, but of course there are other life demands which can mean that we want to have a little flexibility with our sleep times.

    When someone feels like they are in a good routine with sleep they may want to introduce small adjustments, particularly to start with. If sleep is OK, that's great, however if it doesn't adjust so well then the Sleepio tools and techniques are right at hand to fall back on. There isn't a hard and fast rule about when would be the right time, it comes down to the individual and their goals.

    I wrote in a previous post about sleep pressure and the body clock – some people find these helpful concepts to bear in mind when they get to the step of adding a little flexibility into sleep timings. If, for example, I sleep until mid day on a Sunday morning, by sleep pressure wont be high on Sunday night, so I need to adjust my expectations of when I'll sleep that night and I may go to bed later to build up the pressure I need to fall asleep. Hope that makes sense.

  • Sleepio Member

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    Graduate

    I was wondering about the issue regarding staying asleep during the night. This is listed as my top goal, yet it seems like all of the focus is on raising sleep efficacy. I just finished week 3 of the program. Is there a point in the program where the focus will be on my top goal of “Staying asleep through the night” ? The community discussions and article library do not seem to have much information on this problem either. Any information or suggestions would be greatly appreciated. I definitely think this should be something covered in more detail. Thank you!

  • Sleepio Member

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    Expert

    Hi,

    Thanks for your post. I wonder if you've noticed any triggers? In this scenario I would usually ask for example about 1. A change of environment 2. Worries / anxieties that can get in the way of sleep. 3. What happens with sleep before the first night of sleep onset difficulties? If that happens to be a slightly longer sleep for example then it would be usual to take longer to get to sleep.

    After the first night of sleep onset insomnia I'd then be wondering what keeps it going for that week. Does that night for example spark an anxiety about sleep the following nights?

    The key thing though in this scenario is what to do about it. Are any of the Sleepio techniques helpful? One thought may be (for example) to reduce the sleep window slightly to see if that helps to establish a more consistent pattern.

    If concerned about another medical issue that be be involved (you mentioned that you'd wondered for example about hormones) it can be worth asking for a medical from GP / primary care physician to put the mind at ease.

  • Sleepio Member

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    Graduate

    Hello, it there a science behind the ORDER of the stages leading to bed time?

    The steps are “finish up work,” relaxation-wind down,” and then “get ready for bed,” Bed Time.

    As opposed to “finish up work,” “get ready for bed,” “relaxation-wind-down,” Bed Time.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Thanks very much for raising this. The course has been shown to be helpful for both sleep onset insomnia (difficulties getting to sleep) and sleep maintenance insomnia (difficulties staying asleep) so whilst framed around the goal of sleep efficiency, the techniques are very relevant.

    I think you are at the stage of starting sleep restriction, this works by increasing sleep pressure so that when one is asleep they are less easily roused and in turn we hope to reduce the night time awakenings. Pre-sleep strategies such as the wind down routine, relaxation, putting the day to rest should also decrease arousal prior to sleep, which should increase sleep quality and help the person to stay asleep. Investment in these strategies in the daytime are all an investment in maintaining sleep for longer. The other side of this is that when one wakes in the night, we want them to get back to sleep more quickly, so things like the 15 minute rule and going back through the wind down routine can help.

    Thanks very much for raising the library article idea. I agree this would be a helpful addition! It's on our radar so watch this space…

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    What a great question!

    The second order does indeed make a lot of sense. When one starts to feel sleepy tired then all they need to do is pop to bed. As a general guideline I think whatever works best and fits with the usual routine already established.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Just wanted to let you know I am logging in live as requested. Happy to wait my turn but just a little worried we might run out of time before you get a chance to answer my question. Thanks

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    The short sleep window aims to increase sleep pressure throughout the day to increase the chances of sleep. But should also be used in conjunction with the sleepy-tired rule – the two together should increase the chances of heading to bed and going to sleep (and staying asleep). Once this habit is established then the sleep window is gradually increased to increase total sleep time, whilst trying not to compromise sleep efficiency. Hope that makes sense!

  • Sleepio Member

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    Expert

    Hi,

    Thanks for letting me know you're logging in live!

    Eating is a process that helps keep our body's circadian rhythm (24 hour body clock) synced to the light-dark. So eating at regular intervals (usually 3) across the day may be helpful for sleep. We tend to want to avoid eating too close to bedtime as this will keep our body awake digesting the food. Similarly we want to avoid going to bed hungry as this will also stop us sleeping.

    But if food has been associated with anxiety then there may be another focus that could help sleep. The course will cover many techniques which should help with feeling relaxed before sleep, which should help with maintaining sleep, if anxiety (related to eating) is getting in the way of sleep.

  • Sleepio Member

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    Graduate

    Since I take my shower at night, it has been a struggle to pop into bed after my shower. Thank you, I did not want to change without expert advice. So, it's ok then to get ready for bed, and then have relaxation-wind down time?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi

    An estimation of time is enough for the course. What we want to avoid is clock watching as this can be unhelpful for sleep. Your 'best guess' would be ok.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    I think this makes a lot of sense

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    CBT courses (like Seepio) have been shown to be helpful for people who have insomnia and many other difficulties. I think for people who may be missing out on cues for day and night it can be helpful to re-establish these. E.g. if lying in bed, ensure curtains are open in the day as light is the most important input to the body clock. Keep meal times regular and try to save sleep just for night time.

    There are many other techniques the course will cover but some people find the above pointers helpful additions.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi

    I see you're in session 1. The course will cover many techniques for helping with night time awakening. You may also want to read one of my previous posts about how particular techniques may help with reducing night time awakenings.

    Our general advice is to take each week at a time, see what can be attempted or changed that week and then one is in the best position the following week to learn the next step.

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

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    Focus on sleep can indeed increase anxiety about sleep, which will get in the way of a good night sleep. I have written a previous post about night time awakening so do have a read back through as this may also be relevant.

    If however there may be an additional reason for waking up several times then some people find it helpful to speak to their GP / primary care physician. This may be for example breathing difficulties during sleep, pain, nightmares or another medical condition. If this is relevant then we'd usually recommend seeking further medical advice.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    In this scenario there are two things that I'd be thinking about. First, it's quite normal to feel sleepy first thing in the morning as it takes some time to wake up, this is known as sleep inertia. However, if someone is getting an adequate amount of sleep (I'm not sure on your sleep times so not sure if this is the case) but still feeling unrefreshed it can sometimes indicate that there are other contributors to the tiredness which are worth investigating for example sleep breathing difficulties, an infection or other medical complaint. If this is the case we usually recommend speaking to the GP / Primary Care Physician.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    It is difficult isn't it. In a way the sleepyiness is a good thing as it should increase sleep pressure and therefore increase the chances of getting to sleep and staying asleep the following night. After the habit of getting to sleep and staying asleep is re-established then the sleep window is increased which should decrease the daytime sleepiness.

    If however anyone feels dangerously tired (and e.g. if driving for example) then we'd recommend a short nap earlier in the day (before 3pm and no longer than 15 mins).

    Good luck with the rest of the course.

  • Sleepio Member

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    Expert

    That's all for tonight folks – sorry for the slow replies, my computer has is old and slow and struggling to keep up with the pace! I've run a little over to make up for it, hope that's OK.

    Good luck with the rest of the course and all the best for a good night of sleep tonight.

    Bryony

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