Live discussion with Dr Bryony Sheaves - 8th November 2017

Dr Sheaves will be hosting a live online discussion here on Wednesday 8th November, 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, which includes advice on 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 2 Nov 2017 at 2:45 PM
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  • Sleepio Member

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    Expert

    Hi,

    It sounds like you have been putting lots of effort into improving your sleep. Whilst I'm sure it's frustrating not to have seen more improvement, this effort will be really helpful for getting as much as possible out of the Sleepio course. There are many things which can help with wakings and the course will run through new strategies each week. Each should increase the chances of sleep. Session three in particular will optimise your sleep schedule to reduce the chance of these wakenings, which can be one of the more powerful techniques.

    I hope you see some improvement soon.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hello Dr. Sheaves,
    Thank you so much for this article and your thoughtful response. This is going to be quite an adventure, both the travel and the jet lag! I appreciate your kindness.

  • Sleepio Member

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    Expert

    Hi,

    Delighted to hear your sleep is improving! Sleep restiction has been tested as a standalone element of CBT courses and shown to improve sleep, but many people share similar concerns.

    What you are describing is a very practical problem and I wonder if other community members may be able to help?

    There is a discussion forum from the community which has a range of ideas:

    https://www.sleepio.com/community/discussion/what-relaxing-things-can-we-do-when-we-wake-in-the/

    Some general thoughts: puzzles, sudoku, listening to radio, knitting, mindful colouring, writing a diary, organising photo albums….

    Anyone else have ideas?

  • Sleepio Member

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    Expert

    Hi,

    It sounds like the idea of not sleeping is very stressful. I'm sure many people logging on will connect with this experience. The course will have a range of strategies to work on this. Some will be things you can do to increase the chances of sleep, for example heading to bed at the best time for sleep. Others will involve managing stress more directly, for example with relaxation. And other strategies will look at the thoughts that pop into your mind when you feel concerned about not sleeping and find ways to check out these thoughts in terms of the evidence supporting them.

    In short, there are lots of strategies and the course will run through each in detail in the forthcoming weeks. If you have further questions or any difficulties implementing a new strategy do check back in here and we'll be happy to help.

  • Sleepio Member

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    Expert

    Hi,

    I'm so sorry that you are having such difficulty with the wakenings. Sleeplessness really tough going and can have a real impact on how we feel in the day. Do you have people you can turn to for support?

    I see you're a graduate of Sleepio. How did you find the course? Have any of the techniques helped with this?

    It's tricky to pinpoint one technique in particular to help without knowing more about the situation. For example, how is your sleep schedule looking at the moment? If you find that you are waking early like this, is it possible to head to bed a little earlier to increase the amount of sleep you get overall? It would also be helpful to know what happens when you wake, how are you managing this at the moment?

    Sorry I appreciate that's more questions than answers but if you are online and feel happy to share more detail we could think this through together.

  • Sleepio Member

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    Expert

    Hi,

    I'm not a medical doctor so I'm afraid I'm not best placed to answer the cortisol query. However, waking in night, or too early in the morning, is a very common symptom of insomnia. We see many people come through the programme and find that after they are able to sleep through the night. A few factors can be driving this:

    -Feeling hyperaroused before bed (either stressed, anxious, or even excited).
    -The sleep pressure not being high enough. This builds up across the day and session 3 helps to ensure that sleep pressure is high enough to increase the chances of sleep.
    -Sometimes wakenings can be due to other difficulties, like sleep breathing difficulties or nightmares.
    -This can be due to the body clock being out of sync with the light dark cycle. For example some people say that they are an extreme morning person. In these cases light exposure can help.

    These factors can differ from person to person. The Sleepio course will target the top two (common) factors well. If at the end of the course there is still room for improvement please do check back in here and we can think through together.

  • Sleepio Member

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    Expert

    Thanks for sharing this level of detail – it's helpful to know how things have been working and also to hear all the work you've put into improving your sleep.

    What you are describing is quite common – almost like a performance anxiety for sleep. This usually fades, but is common at the start of SR.

    A couple of thoughts: have you tried paradoxical intention? The idea here is that sleep is meant to be an automatic process and the more attention we pay to whether or not we are asleep (or trying to sleep) the less chance we actually have of falling asleep. It's almost like we let go of the expectation of falling asleep and instead just try to stay awake.

    The 15 minute rule is also quite handy for this. Some people find it helpful to set up a separate room so that it is more appealing to get out of bed and then head to bed actually expecting to get up and head there after 15 mins (it also draw on the paradoxical intention idea). The 15 min rule also interrupts the process of monitoring sleep and encourages the wind down again. Sleep related thoughts tend to reduce the chances of sleep so interrupting them by using the 15 min rule tends to lead to speedier sleep.

    As you mention, following the sleepy-tired rule is helpful, so if the exact timings of your sleep window are leading to anxiety, some find it helpful to follow the sleep window loosely but always ensure they are sleepy-tired when heading to bed.

    I hope you see some improvement soon.

  • Sleepio Member

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    Expert

    Hi,

    Getting up can help to boost the bed=sleep connection and also boost sleep pressure in preparation for the following night so can be a helpful strategy.

    Really pleased you've seen some improvement in your sleep – thanks for sharing

  • Sleepio Member

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    Expert

    Hi,

    When peoples sleep time (and presumably sleep efficiency?) dips down, the sleep window for SR can be reduced again. However if stress is the key driver it can be helpful to consider a longer wind down and relaxation strategies. Was there anything that helped previously for winding down?

  • Sleepio Member

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    Expert

    Hi,

    Often when people have difficulty with waking in the night we think to target that time. But in fact reducing arousal before the start of the sleep window can be helpful too and can reduce the chances of waking. Dealing with anxieties with some problem solving, or writing down any worries and shutting them away before bed can be helpful as well as the usual relaxation techniques. Sleep restriction also helps to boost sleep pressure and reduce the chance of waking so reducing the sleep window may be helpful.

    I also wonder whether there are times that there haven't been early wakenings and whether there is anything that we could learn from them to integrate on other nights?

  • Sleepio Member

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    Graduate

    hi Dr. I suppose like a large number of people I find the 'routine' hard… I've completed all 6 weeks and at this stage find my routine still isn't great. in fact 6hrs is good! should i visit the course over again?

    any tips are very welcome

  • Sleepio Member

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    Expert

    Hi,

    CBTi is the recommended treatment for persistent insomnia in the across Europe and the US. Sleeping meds are recommended for short term use, although many take them for much longer. There have also been good results from people doing CBTi plus taking meds and then slowly tapering down the dose of medication afterwards.

    A trial was conducted by Prof Daniel Freeman which tested CBTi for people with diagnoses such as schizo-affective disorder and found large improvements in sleep afterwards in comparison to a group who didn't receive the therapy.

    Did you see an improvement in your sleep from Sleepio?

  • Sleepio Member

    • 843 comments
    • 143 helped
    In reply to a deleted comment
    Expert

    Hi,

    CBTi is the recommended treatment for persistent insomnia in the across Europe and the US. Sleeping meds are recommended for short term use, although many take them for much longer. There have also been good results from people doing CBTi plus taking meds and then slowly tapering down the dose of medication afterwards.

    A trial was conducted by Prof Daniel Freeman which tested CBTi for people with diagnoses such as schizo-affective disorder and found large improvements in sleep afterwards in comparison to a group who didn't receive the therapy.

    Did you see an improvement in your sleep from Sleepio?

  • Sleepio Member

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    Graduate

    I agree I have the same problem filling in my sleep diary makes me more obsessed with sleep as I have to know what time I wake and how long I’m awake for ! I guess getting a fit bit would solve this problem
    Camilla

  • Sleepio Member

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    Expert

    Hi,

    Good question! The sleep window is gradually increased by 15 minutes at a time when the sleep efficiency is high (90%). So the goal is to keep SE high for a week and then the window is extended to work towards the target sleep duration. So no specific duration, but depends on SE being high.

  • Sleepio Member

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    Expert

    Tricky isn't it?! Just an estimate is fine though. A broad gauge is all that the course needs.

  • Sleepio Member

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    Expert

    Hi, some people do indeed find revisiting tips helpful, particularly as sleep changes over time

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi,

    It sounds like the active mind is getting in the way of sleep and perhaps bed has become associated with 'the place that thinking happens'. Some people find it helpful to give those thoughts time and space before bed, by following the wind down routine, or simply writing thoughts down (writing has a funny way of taking the power out of them). Then after wind down heading to bed only when sleepy-tired. If thoughts kick in there is always the 15 min rule, which interrupts the thoughts. After a while the habit of going to bed and thinking (which reduces the chances of sleep) should fade.

    Good luck and I hope you see an improvement soon

  • Sleepio Member

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    Expert

    We'll finish there for tonight Thanks for your questions and I wish you all the best for the sleep tonight.

    Best wishes

    Bryony

  • Sleepio Member

    • 843 comments
    • 143 helped
    Expert

    We'll finish there for tonight Thanks for your questions and I wish you all the best for the sleep tonight.

    Best wishes

    Bryony

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