Live discussion with Dr Bryony Sheaves - 9th September

Dr Sheaves will be hosting a live online discussion here on Wednesday 9th September 7pm-8.30pm BST.

She will discuss as many topics as possible in the hour and a half and, as always, you’re welcome to ask any questions at all about sleep or the Sleepio program. Please do note however that, as per our guidelines, Dr Sheaves won’t be able to give highly specific medical advice. He will however try to help as best as she can!

To keep up with new comments as they are posted you will need to 'refresh' this discussion page.

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Posted 3 Sep 2015 at 12:55 PM
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  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Dear DougieG,

    Thanks for logging in live and saying hello!

    And a very good question! The sleepio course is based on CBT techniques, so over the sessions the course helps people learn more about sleep and suggest techniques to try out. I like to think of these techniques as tools which are added to the tool belt. The course will encourages users to try things out and find out what works. What this means is that sleepio users have their tools for life, and in any situation, so the changes made are often more sustainable/durable than found with say sleep medications.

  • Sleepio Member

    • 5 comments
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    Graduate

    Dr. Sheaves, thank so much for the response. As mentioned, I find my job very stressful, and oftentimes have difficulty managing that stress, which affects my sleep. I actually believe that stress is largely at the root of my insomnia. I know that CBT can also be used for “stress management”. Do you have any comments about CBT specifically for “stress management” and anxiety, and how this can be used along with CBT for insomnia?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Dear Trevor,

    Many thanks for your question. Research into sleep problems for people who have a range of other diagnoses is starting to build. This emerging area shows that cbt type treatments can lead to improvements in insomnia.

    What we tend to recommend is ensuring that treatment for any other problems is optimised and that the impact of medications on sleep (and fatigue) are taken into consideration (some like to discuss this in more detail with their prescriber). Some people find it helpful to discuss the techniques from the course with their other doctors to ensure that they are aware of the self help techniques you are trying and can think through how this might impact on what they are recommending.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Dear Dougie G,

    What you describe is very common. In fact some researchers have theorised that there is a 'hyperarousal' mechanism which leads to both sleep problems and stress/anxiety. And of course this can turn into a vicious cycle whereby we sleep worse so feel more stressed, and then because we're stressed we sleep worse.

    Some of the techniques included in the course are therefore helpful for stress management too. For example, relaxation downloads (in MP3s), learning ways to 'put the day to bed' and challenge some of the thoughts that come to mind when in bed.

    For some people, it can be beneficial to get some extra help for stress/anxiety and we recommend speaking to the GP or primary care physician.

  • Sleepio Member

    • 13 comments
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    Graduate

    Hi Bryony,

    I have a question about my sleep window. It was set at 7 hours but since then my average sleep has gradually dropped and is currently 5 1/2 hours with no improvement in sleep efficiency. I've been wondering if my sleep window is too long and should be reduced or if it would be better left at 7 hours?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Dear bkarrer1,

    Difficulties sleeping after a night shift is very common. In fact because of this there is a whole library article dedicated to shift work:

    https://www.sleepio.com/library/article/shift-work-and-sleep/

    For shift workers, the challenge is to help the body's biological clock to adapt to the new sleep schedule. Just like we do when we go on holiday.

    Things that can help to adapt:
    -If embarking on a night shift some people find it helpful to nap prior to the night shift (rather than during) so that sleep debt has enough time to build up by the following day (when the person wants to be sleeping)

    -Considering the sleep environment at the time when one wants to be asleep. E.g. if trying to sleep during the day, ensuring there are good quality curtains/blinds to block out light, using ear plugs to block out noise etc.

    This is in addition to the usual sleepio strategies such as sleep hygiene and following the 15 minute and sleepy tired rule, taking time to wind down after a busy shift. I see you are on session 2 so some of these are still to come.

    Good luck with the rest of the course.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Dear mudstickandbones,

    The sleep window is usually in line with the amount of time spent asleep.

    It is based on recent sleep diary data so we encourage all users to keep the sleep diary data up to date. Tips on filling it in can be found here:

    https://www.sleepio.com/library/article/how-to-fill-in-your-sleep-diary/

    For some people the sleep window is less restricted – this is based on answers to the sleep test at the beginning of the course. This could be if an individual is experiencing other health difficulties where we would recommend a slightly less restricted sleep window.

    Good luck with the remainder of the course.

  • Sleepio Member

    • 13 comments
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    Graduate

    Thank you for your answer, I have a jawbone UP and have done since starting sleepio so my sleep is definitely being recorded accurately and is always up to date, but my time asleep average has deteriorated since SR started.

    Just wanted to check I wasn't doing SR incorrectly by having too long a sleep window given that my hours asleep have reduced quite significantly now- I'd like to do this correctly so I can start to see improvements! Other people seem to struggle with SR due to how short their sleep window is but mine seems really generous so my only struggle would be to sleep that long!

    On a side note my anxiety around sleep is much better now which is good.

  • Sleepio Member

    • 131 comments
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    in reply to Sleepio Member
    Graduate

    Hello Dr Bryony thank you for the reply I will bear in mind what you have said ! Sorry it's late replying my memory is not so good
    Thanks again .
    Trevor.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Dear Westraypuffins,

    Many thanks for your question. You are not alone in finding some aspects of the course challenging so it is great that you have checked in for advice.

    Sleepio is based on CBT techniques, which is the recommended treatment for persistent sleep problems. Here is a link to an abstract in the Lancet outlining treatment recommendations based on a review of trials:

    http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60750-2.pdf

    The two key techniques within the sleepio course are sleep restriction and stimulus control (learning to associate bed with sleep).

    Sleep restriction works by increasing sleep pressure across the day so that sleep is improved the following night. This can mean either staying up later, or going to bed earlier. Once sleep is improved, the sleep window is expanded slightly, until the individual is content with their sleep improvement. Many users find this a challenging aspect of the course. Here is an article that may be of interest:

    https://www.sleepio.com/library/article/sleep-restriction-the-science/

    Stimulus control (learning to associate bed with sleep) is based on the principles of associative learning. If we spend time in bed awake, bed becomes associated with wakefulness / frustration / stress. What we are aiming to build up is a strong connection between bed and sleep. So if we aren't asleep, it can be helpful to spend time outside of bed doing relaxing things.

    Many report finding these aspects of the course challenging. Some find it helpful to link in with other sleepio users via the various discussions in the community as a source of additional support.

    Good luck with the rest of the course.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Great to hear your anxiety around sleep has improved – excellent news!

    The SR window is based on the sleep efficiency score so it could be helpful to check out that the diary info looks accurately recorded.

  • Sleepio Member

    • 11 comments
    • 4 helped
    Graduate

    Hi, is there some technical reason that this discussion is proceeding so slowly? It's 80 minutes on now and you've only responded to six people; there are still a number of questions, including mine, that were posted well in advance of today's discussion.

  • Sleepio Member

    • 13 comments
    • 2 helped
    Graduate

    Thanks again for getting back to me.

    Yes the reduction in anxiety has been great so at least I feel like I'm on the right track even if there has been a reduction in my sleep time, and I've been more able to cope on days when I've slept really badly.

    I do check that my diary has accurately recorded my sleep every morning as I still need to manually rate my sleep, so I'm certain my diary is correct.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Dear PetraG,

    What you describe is quite common, this library article may be of interest:

    https://www.sleepio.com/library/article/can-you-think-youre-awake-when-actually-youre-asle/

    For people who describe this we may consider the timing of the sleep window. We try to match up the sleep window with whether the person is a morning person (and may sleep better earlier in the night) or an evening person (and may sleep better later in the night).

    We also tend to encourage the other usual sleepio techniques of SR to improve sleep quality and the 15 minute rule, for periods when one considers they may be awake.

    Best of luck with this.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Just getting to this – apologies.

    I'm am not the fastest typer and some answers take a little thought. I will answer all questions.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Hi mc510,

    Again, apologies for the slow response.

    Firstly, great work on trying out the techniques. Has there been any change so far?

    Difficulties with early morning wakening are common with insomnia. If these difficulties persist despite trying out the techniques, here are some things that we might consider:

    First, is the timing of the sleep window right for the individual. E.g. if someone is a morning person, the sleep window might work better earlier in the night (ie. move the bed time earlier). We tend to recommend doing this gradually (e.g. 15 mins at a time), and if the sleep efficiency remains the same, move the bed time even slightly earlier still the following week.

    There is a questionnaire called the morningness eveningness questionnaire which can help users find out if this is relevant:

    http://www.cet-hosting.com/limesurvey/?sid=61524

    If an individual is an extreme morning or evening person they may also consider light therapy to help shift the sleep window. The GP / primary care physician might be helpful to approach about this.

    For some it is also helpful to consider the type of activity that best suits them when carrying out the 15 minute rule. E.g. for some, reading sends them to sleep and is quite relaxing, for others it is absorbing and stimulating. We tend to recommend activities that are relaxing and maybe even a bit boring.

    Good luck with this.

  • Sleepio Member

    • 131 comments
    • 28 helped
    Graduate

    Dear Dr Bryony .
    It's nice that you respond to all the comments that are given to you , so take you're time with the responce's.
    Wishing you well .
    Trevor.

  • Sleepio Member

    • 478 comments
    • 81 helped
    in reply to Sleepio Member
    Expert

    Hi lx,

    The article posted in my previous post may also be of interest. Often we can feel awake, but if measured using polysomnography our brain is in a sleep state:

    https://www.sleepio.com/library/article/can-you-think-youre-awake-when-actually-youre-asle/

    However, there can also be other reasons why people can experience a reduced 'need for sleep' (e.g. if experiencing particularly elevated mood). If this may be a concern for anyone using the course we'd recommend speaking to the GP primary care physician.

    The sleepio course can be continued in the meantime, but if there are other possible factors that might impact on need for sleep we tend to recommend being more reserved with the sleep restriction element of the course which comes later. Do check back in here for advice if this is relevant.

  • Sleepio Member

    • 478 comments
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    in reply to Sleepio Member
    Expert

    Thanks Trevor!

    And I will also work on thinking and typing faster too…!

  • Sleepio Member

    • 478 comments
    • 81 helped
    Expert

    I think we have reached the end of the session now so a big thank you to you all for your interesting comments and questions.

    Best of luck with the remainder of the course.

    Best wishes

    Bryony

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