Live discussion with Dr Bryony Sheaves - 6th December 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 6th December, 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 4 Dec 2017 at 6:35 PM
  • 27 comments
  • 2 helped

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  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Hi Dr. Sheaves,

    My question links slightly to one of the comments above about sleep patterns becoming ingrained. I've been on the course 6 months now and improved my sleep efficiency enormously – recently improving to a SE average of 92% for a week or so.

    However, I've just noticed a pattern in my sleep diary where I have a night of extremely poor sleep (sometimes as little as a couple of hours) and simply don't feel tired. Looking at my sleep diary, this seems to occur on the 4th/5th/6th of the month without fail…and that happens to be around the date my insomnia started last year. Could this be an ingrained pattern? Thankfully, as mentioned above, I can have very good weeks. It seems odd it's so consistent – and I can't explain it with environmental explanations etc.

    Many thanks,
    forty

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    hi,

    how do we record the qhr? If we get up after 15 mins because we haven't fallen asleep, then go back to bed when w are sleepy, is that whole time 'time taken to fall asleep'?

    When to extend the sleep window during sleep restriction? Are we looking for each day of the week to be >90% or just the week's average? Eg I've had five nights about 94% but two (Non-consecutive) nights that were below 90%.

    I am getting the physical sensations of anxiety- heart racing, wide awake, but without any conscious worry going through my head. What's the best technique for this?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 1

    Is there a DIY way for me to check if I have sleep apnea or do I need to go to a professional clinic to do that?

  • Sleepio Member

    • 5 comments
    • 2 helped
    Session 4

    Hi,Doctor, I have been with Sleepio for around three weeks now. I am completing my sleep diary everyday as recommended.
    However I am a little confused as what to do when I have nights when I don’t really know if I have slept or not. It doesn’t feel like I have slept but I am unsure. On those occasions I have put in my sleep diary that I haven’t slept at all. Am I correct in doing this?

  • Sleepio Member

    • 26 comments
    • 2 helped
    Graduate

    Hi Doctor

    I feel like I'm making progress. The only problem I have is once I have a bad nights sleep then the insomnia cycle starts. Can you give me specific tips on what to do and what not to do on the day after a bad night's sleep
    Thanks
    Sag

  • Sleepio Member

    • 843 comments
    • 143 helped
    Expert

    Evening all! Welcome to this evening’s live session. I’ll be here for the next hour and a half to answer any questions you have about sleep or the Sleepio course. Just a bit about me, I’m a clinical psychologist so am well placed to answer questions about the psychological techniques covered in the course. If you have particular queries re: medication or specific medical advice these are best directed to a GP or Primary care physician. Let’s get started!

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi, many thanks for your question. I’m not sure I totally understand the timings, just to clarify are you saying that you are broadly sleeping 10pm until 5am, but your body clock would prefer you wake at 7am? So are you satisfied with your sleep window duration, but looking to shift the timing of it? It can be tricky to shift the body clock, we all have a natural rhythm and it’s easier for us to sleep at times which are best matched to our rhythm. My initial thought in this scenario is therefore to wonder whether any morning tasks might be best moved to another point in the day, e.g. evening?
    If this isn’t possible, things that can help to boost arousal and energy first thing in the morning include: exposure to natural daylight (e.g. opening curtains or some people choose to use a light box), motivational music (e.g putting a radio by the bed so it can be turned on soon after waking), morning exercise and lastly, ensuring a long wind down prior to going to sleep to increase the chances of getting to sleep earlier. I see you are currently on session 2, so in the next session with the Prof you will focus on the sleep window and optimising it to increase the chances of good sleep. Do come back here if you have further questions.

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi, this is an interesting question. As you mention, becoming a parent is a common trigger for insomnia and many parents say that they don’t sleep well after, even when their child does. Many explain that this is either because of heightened vigilance, in case their child needs them in the middle of the night for example or because of the unusual pattern of sleep that they have gotten used to. I wonder if you’ve seen any other posts in the community about this and if not, whether you might be interested in starting a thread? I’d be fairly sure there are many people experiencing a similar scenario.
    Whilst there can be a variety of different triggers for the start of insomnia (e.g. stress, or other challenges to the sleep system including parenthood), what keeps the insomnia going in the longer term is the pattern of thinking or sleep routines that people do in order to cope with the sleeplessness, but which unfortunately can actually keep the insomnia going. It is these factors which the course will cover each week in order to increase the chances of good sleep each night.
    Given that parenthood is a common trigger for insomnia it would be very interesting to do a research study to see what factors predict whether or not parents develop longer term sleep problems, so that we can help stop the development of insomnia for this group of people. I’ve not seen any research on this but it’s a good idea!

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi, many thanks for the post this evening. It sounds like you are getting a good number of hours sleep each night on the whole. Do you feel rested after the 9 hours?

    I'm just wondering what the question is that you'd like help with? Sorry I wasn't sure from the info in your post

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi, sorry to hear this, it sounds really tough.

    Many people find that their chances of sleep are better at particular times (for some people it's earlier, and others it's later). This is usually to do with the natural circadian rhythm (i.e. whether you are a morning person, evening person or either). You can shift the times of your sleep window, here's some info on how, to ensure that it's optimised for you:

    https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/

    Many people who are feeling desperate in the midst of a particularly difficult few nights of sleep find that even the thought of bed can be quite stressful and their attention naturally becomes quite focused on sleep. I wonder if this is the case for you? The difficulty with feeling stressed and focused on sleep is that it unfortunately decreases the chances of sleep. In this situation I usually wonder if there are things which are relaxing (particularly in the evening) or enjoyable to do? Something that feels manageable given the fatigue, but to look forward to and take the mind away from thoughts of sleep.

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    Sorry to hear you are having trouble getting to sleep. The good news is that the course is very well placed to help with this difficulty. There are a range of techniques that the Prof will run through each week, for example thinking about the evening routine, the timing of sleep, ways to wind down and managing the racing mind. Each of these will increase the chances of getting off to sleep more quickly. The Prof will cover these in turn in each session. The best way to use the course is to try out the techniques each week to eventually build up a range of tools that can promote good sleep in the long term. Sorry to not be able to offer immediate help, but I hope that I've offered a flavour of things to come.

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    Very pleased to hear that overall you have seen such an improvement in your sleep! I'm sure this has taken a lot of work, so congrats!

    This is interesting that you've spotted this consistent pattern. I wonder have you noticed any difference in how you are feeling on those days? Or things that happen? The sleep tags in the sleep diary can be helpful for spotting patterns. Or, for women some find that hormonal changes can cause sleep difficulties at a regular time of the month (sorry not sure if you are a man or woman!).

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    Great to hear you are using the quarter of an hour rule. Yes I think the fact that it is still taking a little while to get to sleep should be reflected in the sleep diary. After a while of using the QHR, sleep should come more quickly, which translates into better sleep efficiency.

    I'm not sure on the exact algorithm that the course uses, but believe it is a mean SE of >90% across the week. The course will suggest an extension to the window, so you shouldn't need to keep the calculations going yourself (unless you're interested in monitoring).

    In terms of managing anxiety, I wonder if you've tried any of the relaxation audios from the course?

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    For anyone concerned about apnea we'd recommend talking through with a GP or Primary Care Physician. The only way to definitively know is to assess respiration during sleep. Some sleep centres offer kits to take home for this purpose so don't require staying in overnight.

    To do an initial brief screen for apnea, there is a questionnaire which many clinicians use called the STOP-BANG questionnaire. There is an online version here:

    http://www.stopbang.ca/osa/screening.php

    But for anyone concerned, we do recommend discussing with a medical professional.

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    This is tricky isn't it?! An estimate is fine for the purposes of the sleep diary. And we tend to recommend not becoming too concerned about monitoring sleep for the purpose of the diary, as this can in itself reduce the chances of sleep. A best guess is fine.

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    The pattern you have described is common. Many people say that the first night of sleep increases the concern about sleep, and that this in turn keeps the insomnia going for a few nights. Is this the case for you?

    In general terms, I'd usually recommend that these difficult nights are the time to prioritise the course strategies. So if sleep restriction has been helpful, then I'd recommend reducing the sleep window slightly the following night to increase the sleep pressure (or 'hunger' for sleep). Or if a long wind down is of benefit then prioritising this, and planning nice relaxing activities can be helpful.

    Some people find that fear of the insomnia coming back can drive the sleeplessness for these few nights. So for these people remembering that it is normal for even the best sleeper to get a bad night of sleep every now and then can be helpful.

    Good luck with this, I hope you are able to reduce the number of these tricky nights

  • Sleepio Member

    • 843 comments
    • 143 helped
    Expert

    Hi everyone, I've managed to get through the questions quicker than usual this evening. Any further burning questions?

  • Sleepio Member

    • 13 comments
    • 2 helped
    Graduate

    My question links slightly to one of the comments above about sleep patterns. having been on the course over 3months now my sleep efficiency has recently improved.

    However, I've had a night of extremely poor sleep (a couple of hours) AND others were even though i've good sleep efficiency my sleep in hours are 5/6. Looking at other comments I'm maybe doing ok but some reassuarance that the programme is working would be welcome. Thankfully, as mentioned above, I'm improving but really do stress that 5/6 hours simply isn't enough.

  • Sleepio Member

    • 843 comments
    • 143 helped
    in reply to Sleepio Member
    Expert

    Hi,

    At Sleepio we think that the members perspective of their sleep is the most important, so if the member is happy that things are improving, we are too. The sleep efficiency guideline is a helpful tool for us to spot these good changes and for the programme to know when to adapt the sleep window.

    For many members improving sleep takes time, and even after an improvement in the right direction, the total sleep time can still leave room for improvement, even after graduating. The good news is that CBT strategies like those in Sleepio are here and available in the longer term, to keep gradually moving closer to the sleep goal.

    I hope things continue to move in the right direction.

  • Sleepio Member

    • 843 comments
    • 143 helped
    Expert

    Thanks for all your comments and questions this evening. I'll stop there for now, but will be back next month.

    Good luck with the rest of the course and I wish you all a restful xmas.

    Best wishes

    Bryony

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