Live discussion with Dr Bryony Sheaves - 7th June 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 7th June, 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 31 May 2017 at 11:28 PM
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  • Sleepio Member

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    Graduate

    Hi Dr Bryony,

    I have recently started the Sleepio program. I am finding it useful, however to date, there has been no discussion about sleep issues that are linked to grief. I often dream about my loved one, which is unsettling and makes it difficult to get back to sleep. There also hasn't been any mention of sleep disruption due to partners. My boyfriend is a snorer and fidget, which wakes me up throughout the night. Can you recommend reading material that can help with these issues?

    Best wishes,
    Melissa

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    Hi – thanks for logging in live!

    I think there are two questions in your post, the first is how much sleep do we need and the second is about the structure / architecture of that sleep.

    Re: how much sleep people need, there are no set rules and people definitely differ. Some people can be happy on very little sleep whilst others can feel extremely tired. The average amount of sleep people get is around 7-8 hours, but I usually recommend that people aim to find the right amount for them personally. The sleep restriction element of the course helps with this (which I think you may have just started). It reduces the time in bed so that people get back in the habit of going to bed and falling asleep. Then once this habit is consistent, the next step is gradually increasing the sleep window. Of course there will come a point eventually when you no longer need to increase the sleep window because the amount of sleep is actually what you need, and increasing the window just means that it takes much longer to get to sleep (decreasing sleep efficiency), because you don't actually need more sleep. Does that make sense?

    I'll press post on this and then answer the second part so you can read in the meantime…

  • Sleepio Member

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    Expert

    Hi,

    I think it can be very difficult to know what is enough deep sleep. Many sleep trackers offer this data, but its accuracy has been questioned. The best way to look at sleep staging is to attend a lab and get a polysomnography assessment, but this is only usually recommended if there is marked sleep disturbance and it is unclear what is causing it. It's not needed for an insomnia assessment for example.

    Many people however are aiming to improve the quality of sleep, so that it is more restorative. Physical exercise has been associated with more deep sleep and some people I have worked with have remarked on how helpful it can be for improving sleep, as long as it's not too close to bedtime.

    There are also some substances and medications which can change the structure of our sleep, for example alcohol, cannabis and some psychiatric medications.

    Sleep restriction, which is covered in the Sleepio course, is also very helpful for improving sleep quality.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Many thanks for your post and I am pleased to hear that you have been finding Sleepio of benefit.

    I'm really sorry to hear of your loss. It is very common for dreams soon after a bereavement to involve the person who has passed away. On the whole these become less frequent over time.

    However if they do not pass and are problematic, a common technique is to re-write the ending of the dreams so that the ending is something that leave the person feeling better. And then rehearsing this new ending using the power of imagination. Research trials have shown that this can be a helpful for reducing the frequency of these recurrent dreams / nightmares.

    Other helpful things can be: using techniques from the course to wind down before sleep, avoiding over-sleeping (e.g. catching up on lost hours one night) which sleep restriction is helpful for, and checking out whether medication / substances may be altering the amount of REM (dreaming sleep), e.g. some anti-depressants have a side effect of bad dreams. In that case, worth liaising with the prescriber.

    The second part was about bed partners. As well as the usual practical strategies for helping to reduce disruption (e.g. ear plugs), some find it helpful to include them in the Sleepio course and devise the sleep plan together (e.g. would it work better for them to head to bed later / earlier, do relaxation exercises together, or support in other ways). Others find it helpful to start the course sleeping separately, until sleep has improved and then take the step of sleeping next to each other again.

    I'm sure the other Sleepio members will have lots of other top tips for this.

  • Sleepio Member

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    Expert

    Hi,

    Sorry that you have been experiencing sleep difficulties for more than ten years. The good news is that courses of CBT, like Sleepio is, are recommended in international guidelines for improving even very persistent insomnia.

    I see you're on session 2 so have much of the course ahead of you. There are many techniques which can be helpful for increasing the chances of a good night of sleep and in particular tackling the thoughts which can get in the way of sleep. In the next session you will come across sleep restriction, which is one of the more powerful techniques. In subsequent sessions there will techniques which boost the effectiveness of this, for example the 'thought checker' to work on some of the negative thoughts that can come to mind when unable to sleep. The Prof will cover these in much more detail in sessions to come.

    I hope that you find some benefit from the course and do check back in if you have further questions.

  • Sleepio Member

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    Expert

    Hi,

    For people with persistent difficulties getting to sleep guidelines recommend CBT for insomnia, which is what Sleepio is. These are now recommended as the first line option. So I would follow this and offer the full package of techniques (as there are many and all are designed to improve sleep). If I was to pick the most powerful, from experience these tend to be sleep restriction and the 15 minute rule. They are both designed to help people to fall asleep more quickly and used together can be very powerful. The trick is to try using them consistently across night, which can be difficult. I think you will come to sleep restriction in the next session, which is good and do remember that there is lots of community support when running through any of these elements of the course.

  • Sleepio Member

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    Expert

    Hi,

    I'm not sure I fully understand the question, sorry. Our circadian rhythm is our body's natural 24 hour clock. The timing of this 24 clock is linked to the environment (the light / dark cycle), and is kept in sync by sunlight, activity, food etc. The clock can be out of sync, for example some people can be extreme 'morning people' or extreme 'evening people', or, follow no rhythm at all. It can often be tricky to tease apart whether someone has insomnia of circadian rhythm problems, so often helpful to try out the techniques for insomnia first and then see if the sleep-wake schedule is still out of sync.

    The course can be helpful for following a consistent pattern, which is helpful for increasing the chances of sleep at a particular time.

  • Sleepio Member

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    Expert

    Hi – congrats on graduating and for improving your sleep. I'm sure this will have taken lots of work, particularly during sleep restriction, so great to hear that you are seeing the benefits!

    Are you still following sleep restriction? I.e. still aiming to increase the sleep window further. The process of gradual increases (of 15 mins) can continue after the end of the course and this can help the fatigue.

  • Sleepio Member

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    Expert

    Hi,

    I think your nurse / doctor will be better placed to answer the question re: melatonin as I'm not sure on it's indication in this specific scenario.

    CBT courses like Sleepio can be helpful for people whose wakenings are triggered by other factors (including hormone related). The goals of members running through the course can however be different, for example, rather than wanting to get rid of awakenings it can be helpful to remember that this is a common part of the picture at this time (and will hopefully reduce once the hormones have settled), and rather the goal is to return to sleep more quickly – which CBT is good at helping with.

    Here is also a library article that you may have seen already on the topic?

    https://www.sleepio.com/library/article/menopause-and-sleep-problems/

  • Sleepio Member

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    Graduate

    Hi

    I'm in week 3 – so have started with the sleep restriction – I am struggling with it as I'm pretty tired during the day at work …on average is there an approximate time it takes before your body starts sleeping efficiently in the restricted window?
    Thanks

  • Sleepio Member

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    Graduate

    I just started the Sleep Restriction part of the program. My hours are set for 12 midnight to 6:30. Can they be changed?

  • Sleepio Member

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    Expert

    Hi,

    Sounds like you are referring to sleep restriction. The aim of this is to restrict the amount of time in bed so that it matches the amount of time spent actually asleep (based on sleep diaries). It isn't aiming for reducing sleep beyond what the person is already achieving, but can indeed be a challenging element of the course. It can be helpful to think about the timing of this, e.g. not starting when having a long drive the next day, as it isn't advisable to drive when very sleepy. Many find it helpful to seek support from other Sleepio members and particularly ones who have gone through the course. There is a lot of support in the community. I think it is sensible to think about how this may best fit with your schedule as it needs to feel achievable. I wonder if any other Sleepio users logging on tonight have any comments based on their experience?

  • Sleepio Member

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    Expert

    Hi,

    Not the duration, but the timings, here are some instructions:

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

  • Sleepio Member

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    Expert

    Hi,

    I'm not sure whether there is an average time, good question, some see improvements quickly whilst others take a bit longer to re-establish the habit of going to bed and falling asleep.

    Essentially, feeling tired is a good sign as this will increase the chances of sleep later that night. It can be difficult, and can be tempting to sneak in extra sleeps but the trick to it working is to stick to it consistently across all nights so that the sleep pressure is equally as high each night so there is a good chance of sleep every night of the week. That said, if you feel dangerously tired (e.g. if operating machinery / driving) we do recommend taking a short (20 mins) nap, earlier in the day (before 3pm) so that sleep pressure has time to build again after.

    Some find it helpful to celebrate any achievements along the way to keep the motivation going, e.g. a week of sticking to the window = a special breakfast!

    Good luck with it, I hope the sleep improves soon.

  • Sleepio Member

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    Expert

    Hi,

    I don't have a strong opinion (others may differ), but I would think it should probably count as being in bed – the reason being that part of what the course does is try to build up a strong bed=sleep connection so that the bed cues sleep (there will be more on this in later sessions). The sleep efficiency figure in the sleep diary therefore works towards this goal. Unfortunately other activities (e.g. reading in bed) are usually less helpful for building up this connection and therefore less helpful for sleep.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Best to speak to a GP / Primary care physician re: medication. I'm a clinical psychologist rather than a medical doctor.

    I would say that at session two there is much of the course still to come, and particularly some of the more powerful techniques. Good luck with the remainder of the course.

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    Hi,

    So pleased to hear of your sleep improvement – and I'm sure that many others will find reading this helpful too, thanks for sharing.

    Re: your question, it's totally natural to want to bring in a bit of flexibility with sleep later in the course and particularly when there are other enjoyable things happening.

    The principle behind sleep restriction is to aim for sleep pressure to be high each night. The option to keep sleep pressure highest, would be to stick to the same wake time. This will increase the chances of good sleep the following night. The other option would be to stick to the same amount of sleep, and wake later. This may well also be fine, and if so, that's great! But some find that because sleep pressure has had less time to build up, it can take longer to get to sleep the following night. It may well be that a little experimenting would be helpful. If the latter approach disrupts sleep too much the following night, the 5am wake is there as a back up.

  • Sleepio Member

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    Expert

    Very sorry if an error has crept in somewhere in the system – I'll highlight this to the team and get it amended. Apologies.

  • Sleepio Member

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    Expert

    That's all for tonight folks. Thanks for all your posts and for other Sleepio members logging in and also providing supportive comments to others, really nice to read. Good luck with the sleep tonight.

    bryony

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thank you. I have received advice from another member of the community that I will bear in mind.

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