Live discussion with Dr Bryony Sheaves - 7th September 2016

Dr Sheaves will be hosting a live online discussion here on Wednesday 7th September, 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 1 Sep 2016 at 5:33 PM
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  • Sleepio Member

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    Graduate

    Hi there,

    I'm struggling with the psychological technique called acceptance. I've heard that one of the ways to deal with insomnia is to accept it. I'm really struggling with this concept – the way I see it, how can you accept something which on a physical, social and emotional level is having such a debilitative impact on your life? Are you able to offer some advice on what it means to try and accept insomnia and the outcome of doing so? I can't seem to get my head around this and would really appreciate some advice to see if I could think about this in a different and more positive way?

    Thanks,

  • Sleepio Member

    • 5 comments
    • 1 helped
    Graduate

    Hello Dr Sheaves
    Many thanks for your reply. There isn't really any difference between the good and bad nights, as I've been really strictly adhering to the Prof's instructions – the only one I've found difficulty with is the QHR, either because I'm so tired I lose track of the time, or I feel so bad I don't do it 100% but these have only been a few times . My sleep window is 5 hours, I go to bed everynight at 2.00 and manage to get to sleep quickly (although not always before) then I wake up around 2.5 or 3 hours later, so if I lie for 15 mins and can't get back to sleep, then get up and eventually go back to bed then there's not much time left.
    Chris

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I'm really sorry to hear your frustration. I do appreciate that the terms may not suit all who log on to the course. I hope that by sharing a little more info about the course, this is helpful in some way as I'm mindful that you are in session 1 and have much of the course ahead of you.

    The way the course works is by offering a session each week and each week builds on the previous. As you are on session 1 of course, there is still much of the course remaining, which can be understandably frustrating. Session 1 is all about setting the foundations of good sleep, before leading to later techniques which tend to be more powerful.

    It can be most helpful to run through the sessions in turn and see what can be taken away and applied to your situation. In particular trying out any new strategies so that you can work out which techniques work best for you and your situation.

    The course has been tested in a large research trial and led to large improvements in sleep for people experiencing insomnia, so from this we can hold faith that the techniques tend to help people with insomnia to sleep better. Of course if there are stumbling blocks along the way, we are here each week and ready to post replies to the info you share, or work out how the course may be best tailored to you.

    The community more generally can also be a helpful place to seek further support.

    I do hope that you find something useful for you to take away from the Sleepio experience and I wish you the best of luck with the remainder of the course.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for this info, that's really helpful.

    Well done for sticking to the techniques, I know that that can be tricky at times, particularly when there isn't as much improvement as you'd like. From what you are saying you tend to get to sleep OK, but it is more of a difficulty waking up in the night. Just a few thoughts here for people who report early morning waking:

    -Setting the timing of the sleep window can be just as important as the length of it. For those who are morning people for example, sometimes moving the sleep window slightly earlier (ie. both bed and get up time) can increase the chances of sleep.
    -Is the light blocked out completely as this can be an issue for early morning risers.
    -Caffeine and alcohol can both decrease deep sleep so may be worth considering, if relevant.
    -Are the wind down techniques used both before bed (to decrease chances of waking up) and used with the QHR very relaxing / sleep inducing? If not it may be worth experimenting with something new – there is a thread in the community where there is a long discussion about what people do in this time to get back to sleep quickly. Anything very relaxing or even a bit boring can be helpful.
    -For the QHR this works by increasing bed=sleep connection, but also interrupts any sleep related thoughts, which can get in the way of sleep, so is usually one of the most helpful techniques.

    That's quite a bit there but I hope there is something that is helpful.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    It sounds like you have put a lot of effort into improving your sleep in the past. This will be very useful for the course.

    Whilst I (unfortunately) can't offer a quick solution, the Sleepio course will offer a range of techniques. It is most helpful to try these out and find out what works best for you, before getting to the next session, where you'll be ready for the next technique. These skills are skills for life, so even after the course ends you should hopefully have some tricks up your sleep to keep looking after your sleep.

    RE: medication, I have posted two previous comments which may be relevant and worth looking over.

    Good luck with the course!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Indeed it is a funny term isn't it?! What we mean here is that of course, we are very committed to improving sleep, for all the reasons you mention above, so we aren't accepting the insomnia itself. But, by heading to bed with the acceptance that: “I may get to sleep straight away, or I may not, but if I don't, I have a technique that I can use to help with that” can help one to get to sleep quicker. This is different to what some people with insomnia describe as almost a battle against insomnia, which often results in strong emotions. So we want to accept that this is the case at the moment, but also stay commited to improving sleep.

    Does that make sense?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Interesting question. The clinical guidelines recommend medications for short term insomnia (in the UK defined as less than 4 weeks). For persistent insomnia, CBT courses (like Sleepio) are recommended. So there is indeed a role for sleep meds in short term (acute) insomnia. The down side to medications is that when coming off them, its common to experience what we call rebound insomnia, so the sleep can get a little worse. But if this is the route some people would like, then the Sleepio course can complement by also offering skills which can be used in the long term to aid sleep.

  • Sleepio Member

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    Session 5

    Hi Dr. Sheaves,

    Any thoughts on noise? I don't mean noisy noise, but fixating on small noises (crickets, irregular air conditioner) that results in not sleeping. Ear plugs seems like an obvious one, but I find that these can be disconcerting/disorienting.

    Thanks for your time!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    What you are describing is quite common. I suppose it comes down to the personal goal of the individual. If it is to eventually get more sleep and or better quality sleep then heading to bed later can increase the chances of this by increasing sleep pressure. Essentially, one of the driving forces for sending us to sleep is sleep pressure, which increases the longer we are awake. So by heading to bed later, one should be more likely to get to sleep.

    But you are very right in noticing that we also need to work on the worry about sleep, or the focus on it as this can get in the way of good sleep. The course will cover this in a bit more detail (e.g. look out for the thought checker and mindfulness techniques), but in the meantime things like relaxation techniques can be helpful for winding down for sleep.

    Good luck with the rest of the course.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    I think that noise generally falls under the category of 'sleep threats', that is, things that we can become more hyper-vigilant to, if we are concerned about our sleep. I wonder if there is somewhere else that you can redirect your mind to when the focus comes onto noises? The course will cover this in more detail later, but in general if there is somewhere nice and relaxing we can take our mind to (real or imaginary) when lying in bed this may reduce the focus on sleep threats.

  • Sleepio Member

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    in reply to Sleepio Member
    Session 4

    Thanks, that's interesting. I didn't realise nice recommended meds for less than 4 weeks. I seem to have persistent episodes of acute insomnia! So somewhere in between the two… I think as you will suggest I will continue with sleepio and cbt to address the long term issues and I'll try to be more open to using meds in the short term to stop episodes from developing.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Two thoughts for your first question:
    1. The timing of sleep is important. We sleep best at a time that suits our body clock (morning person or evening person).
    2. If going to bed early results in getting a longer duration of sleep, this can actually lead us to feel just as groggy as if we don't get enough.

    Re: the wakenings, there will be many techniques covered in the course which should help with this. Session 3, which you are just coming to, covers the key techniques, which should help improve sleep quality and reduce night time awakening, so I'll let the Prof provide a better and more thorough explanation than I can here.

  • Sleepio Member

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    Expert

    Hi,

    This is very common, as our minds can be quite prone to wandering when we'd prefer they didn't. The good news is that your next session (session 4) focuses on just this issue! Look out for mindfulness techniques and imagery as I think these may be relevant.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    This is a good way of improving sleep, by improving sleep efficiency (ie. not being in bed when awake). Many say it helps them to get back to sleep more quickly than if they continue to stay in bed so great you are already doing this.

  • Sleepio Member

    • 4 comments
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    in reply to Sleepio Member
    Graduate

    Thank you, I'll look forward to Session 4. In the mean time, sleep compression is tough, because I – wake up, can't fall back asleep in 15 mins, so go read – come back to bed, can't fall back asleep in 15 mins..

    The impact on a compressed sleep window is even less total net sleep. Without a technique to fall back asleep, I'm struggling..

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    Really pleased to hear that you have seen improvements in your sleep, great work!

    I have to say, I'm afraid I'm not sure re: the sugar levels. This would be one for a medical doctor. We do know that eating late in the evening can be less helpful for sleep in general though, as the body is trying to digest the food which is arousing rather than sleep inducing.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    If there is anything blocking the airway during sleep then this can indeed cause us to wake. The term we use is sleep apnoea and we usually recommend speaking to the GP / Primary Care Physician. Here's more info:

    https://www.sleepio.com/library/article/what-is-sleep-apnoea/

  • Sleepio Member

    • 522 comments
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    in reply to Sleepio Member
    Expert

    Hi,

    In general we recommend sticking to the sleep window that is planned and then when it is wake time, getting ready for the day and continuing with the things that one wants to do, where possible. This means that one is tiring themselves out in preparation for sleep the following night (we know exercise is associated with good sleep). In general planning a rise routine (opening curtains, nice breakfast, getting active) can be helpful for combatting sleepiness and boosting energy.
    But finding the right time for exercise, so it's most likely to happen and also be enjoyable is the key. Morning people often prefer to exercise first thing, whilst evening people tend to enjoy early evening exercise.

    I hope you find a routine that works for you.

  • Sleepio Member

    • 522 comments
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    in reply to Sleepio Member
    Expert

    Hi, yes tea, including green tea, includes caffeine in, which increases arousal, so we often recommend avoiding in the afternoon / evening.

  • Sleepio Member

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    Expert

    That's all for tonight folks. A busy session – thank you all for your interesting posts. Good luck with your sleep.

    Best wishes

    Bryony

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