Live discussion with Dr Bryony Sheaves - 5th July 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 5th July, 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 29 Jun 2017 at 12:30 PM
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  • Sleepio Member

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    Expert

    Hi,

    Are you referring to sleep restriction? This does indeed aim to increase sleep efficiency.

    The way that this works is by keeping a very consistent sleep window each night and avoiding naps. This means that sleep pressure builds up and increases the chances of sleep. What we often see when people have sleep difficulties is that they aim for a window, but because they're tired small amounts of catch up sleep occur in the form on lie ins, naps or early nights. Is this the case for you?

    In subsequent sessions there will be additional techniques to supplement this. They are aimed at decreasing arousal before sleep (often caused by stress / anxiety or other strong emotions), reducing the time it takes to fall asleep and reducing the likelihood of night time awakenings.

  • Sleepio Member

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    Graduate

    The biggest challenge I'm having is getting out of bed when being awake more than 15 minutes or so. I've come to believe that lying in bed, resting, gives me a better chance of falling back asleep than getting out of bed. I understand the concept of associating bed with sleep and, if you're lying awake in bed, that behavior can disrupt that association, but I'm having a hard time putting it into practice. Your input would be appreciated!

  • Sleepio Member

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    Expert

    Hi,

    The snooze button – I think as a society we both love and hate it!

    I came across the following video on YouTube. Not created (or necessarily endorsed by) Sleepio, but has some interesting ideas in, have you seen it?

    https://www.youtube.com/watch?v=P6zcSFA7ymo

    In generally, we think it is more helpful to invest the time in quality sleep and experiment with setting the alarm later, and getting up immediately. It often leaves one feeling more refreshed. And after a while often the body learn to just wake up at that set time.

    If it's helpful to have a couple of alarms to wake up, I usually recommend setting two or three alarms a minute apart, before the opportunity to fall back to sleep.

  • Sleepio Member

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    Expert

    Hi,

    So many people say this – it's hard to get up out of bed when what you're really after is sleep. It seems counter-intuitive.

    However, it is actually a helpful (and evidence based) technique for overcoming insomnia when tested as a single strategy. As well as associating bed with sleep it also interrupts the thoughts and emotions that can get in the way of sleep and provide a more fruitful means of winding down again. I.e. rather than lying with anxious or frustrated thoughts, or generally with a racing mind, it is more helpful to interrupt this by getting up and winding down again. This decreases arousal and increases the chances of sleep happening more quickly.

    The result is investing in quality sleep, rather than lying resting, which whilst comfortable, is not usually necessarily increasing the chances of sleep.

    When people say this to me, I often ask whether there is a way of making getting back up more appealing. E.g. leaving a comfy blanket or something relaxing to read in the sitting room?

  • Sleepio Member

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    Expert

    HI,
    I'm sorry to hear this. The good news is that you have seen progress previously, so we have a good model to work from. It's just a case of getting back there.

    It's difficult to talk through specific strategies in this scenario without knowing a little more about the current sleep pattern and thoughts on what may be getting in the way of sleep. If you're logging in live, I wonder if you could share some further details on your sleep if you feel happy to share?

    Or if you're logging in later, my overall thought in this scenario would to think about the sleep window. Increasing sleep pressure (sleep restriction) is one of the most powerful techniques from the course so some find it helpful to reduce the sleep window slightly to increase the sleep pressure and increase the chances of sleep.

    And it can be helpful to remember that it's very common for even the very best sleepers to have a blip in sleep.

  • Sleepio Member

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    Expert

    Interesting question! Sounds like you are referring to a dip in our circadian drive for arousal (our body clock having a bit of a low point in the afternoon). At that time it can be helpful to plan in energy giving activities. Anything physically active or mentally very stimulating is helpful. Energy works like an elastic band – the more we stretch it the more it gives back. So if we do things which we think may use energy, we can get more back in return. It can be helpful to play around with different activities and monitor energy levels to find the most helpful ones.

  • Sleepio Member

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    Expert

    Hi,

    Sorry to hear you were sick. Did you manage to catch up with the course? If so, it shouldn't impact, but you could drop hello@sleepio.com an email to check out your account end date if you're concerned about being limited for time.

  • Sleepio Member

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    Expert

    Hi,

    I'm really sorry to hear that you haven't seen much benefit. If you feel happy sharing more details about your sleep, what are the key barriers for sleep and the things you've tried, we could put more thought into this. Or if you aren't logging in live you could post in next weeks session and log in live for further conversation.

    Your question about the relationship between insomnia and depression and anxiety is an interesting one which is receiving lots of research attention at the moment. We know that treating sleep can be helpful for how we feel in the daytime, particularly for alleviating depression, but we do recommend that each problem receives the help it deserves. And there may be knock on effects on sleep. Have you received any treatment for your depression or anxiety?

  • Sleepio Member

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    Graduate

    I am only up to 4hrs 20 min on average at present and due to graduate next week so this worries me also

  • Sleepio Member

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    Expert

    Hi,

    I think what you are describing is very common in new mums. The maternal instinct increases hyper-vigilance which means that with the smallest sound one is woken. For others it's almost like a sleep habit is developed, whereby, if they are used to being woken at a particular time, they continue to do so.

    The other techniques (other than sleep restriction) should be quite accessible. The key one being to try and associate bed with sleep. This means heading to bed only when feeling sleepy-tired, getting up and out of bed when not asleep after 15 mins and trying to avoid activities other than sleep and sex in bed.

    In terms of sleep restriction, some find it helpful to just bear in mind the principles and adapt accordingly. It sounds like you are already having restricted sleep, but I imagine also trying to catch sleep where you possibly can. The longer we are awake the more likely we are to fall asleep, because sleep pressure has had time to build up. So (if possible) avoiding naps in the afternoon / evening will promote better quality sleep at night. Some mums find it helpful to take a morning nap, in sync with the baby, if they allow it..!

    Lastly, it is always possible to do full sleep restriction at a later date, if the above principles do not already alleviate the sleep problem.

  • Sleepio Member

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    Expert

    Hi

    Sorry to hear that you are concerned about progress. Would you feel happy sharing more details about what's happening with your sleep, so we could think through together? There can be common barriers to progress, which require a bit more thought

  • Sleepio Member

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    Graduate

    Hi Bryony
    Could you elaborate on the percentage of people who don't benefit from CBT for insomnia? What makes one in greater risk of being a non-responder?
    I have tried over and over again with CBT, but I don't have much success. Medical reasons have been ruled out, and I don't have sleep apnea. I am not sure whether to continue…
    Kind regards

  • Sleepio Member

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    Graduate

    Thanks, that's reassuring. I was a bit worried that I wouldn't improve without following all the rules! I think this makes sense, as i am also struggling to sleep in the same room as my partner due to being sensitive to every move and noise. Hopefully this will get better with time as i chill out!

  • Sleepio Member

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    Expert

    Hi,

    Good question – if you tend to be more of a morning person (which can be indicated by early morning rising and feeling v alert upon awakening) we do often recommend shifting the window to best match the body clock, just as you have described

  • Sleepio Member

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    Graduate

    By Dr Bryony.

    It started out of nowhere with early morning waking, which I put down to work/health anxiety, but nothing that I hadn't handled previously without sleep problems, snowballed from there into an anxiety about falling asleep and also getting back to sleep after waking during night, always at least once.

    It has turned me very quickly into someone who is completely obsessed and stressed as to whether i will sleep and to be honest Sleepio feeds that obsession by constant reminders to update my sleep diary etc. Now at the point where I have given up ever sleeping 'naturally' again and my mind seems to see straight through the CBT techniques/tricks I try to play on it and is determined not to fall for them.

    For example if I get up as part of QHR I go into an extremely distressed state of hyperarousal which prevents me relaxing as intended for several hours.

    As I say, I have lost all hope regarding the return of natural sleep and that has resulted in despair and depression rather than any positive outcome from the course. Mirtzapine worked for three months and then suddenly stopped doing so, which was a major setback too.

  • Sleepio Member

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    Expert

    Hi,

    Really sorry to hear this. Response to CBT programmes, and in particular, what predicts response is an area of interest in the research world. We know that around 70-80% of people with insomnia respond to CBT (i.e. see significant improvement) and 40% will no longer have an insomnia diagnosis by the end of a CBT programme.

    Have there been any particular stumbling blocks along the way? And do you have a sense of what the key things getting in the way of sleep are for you?

  • Sleepio Member

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    Expert

    Hi,

    It sounds like the focus on sleep is increasing the anxiety and therefore reducing the chances of getting to sleep. And I appreciate that reminders about sleep diaries can be less helpful when sleep is already at the forefront.

    Are there activities in the daytime (and particularly early evening) which can offer some time out from thinking about sleep? There is a concept called 'flow' activities – activities in which we can get totally absorbed and lose our sense of self. For me, it's playing hockey or watching soaps! I'm totally lost in either chasing a ball, or following the story.

    When doing sleep work, sometimes the focus needs to take a shift away from sleep and onto the daytime. Are there any flow activities you could do, particularly in the evening? These can be more challenging to initiate with the low energy and mood, but testing out the impact they have on energy, mood (and then subsequent sleep later that night) can be helpful. Many find that they have positive benefits. And can also help with gaining some valuable time away from sleep thoughts.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi, the course should be well placed to think about this with you. I see you're in session one so have much of the course ahead of you. Some people find changing the timings of their sleep (e.g. making the sleep window earlier or later) so that they best match the body clock helpful for improving sleep quality. E.g. an evening person may feel more rested if their sleep starts later than a morning person would. May be helpful to consider when setting the sleep window in session 3 in a few weeks.

  • Sleepio Member

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    Expert

    Hi,

    Delighted you've seen improvement in your sleep! In terms of depression, we'd recommend seeking specialist advice from your GP or Primary Care Physician.

  • Sleepio Member

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    Expert

    Hi

    I'm afraid we've run out of time tonight. Thank you for your posts and good luck with the sleep tonight.

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