Live discussion with Dr Dimitri Gavriloff - 22nd Aug 2018

Dr Gavriloff will be hosting a live online discussion here on Wednesday 22nd Aug, from 7:30pm to 9:00pm British Summer Time or 2:30pm to 4:00pm US Eastern Daylight Time.

He will discuss as many topics as possible in the hour and a half and, as always, you are welcome to ask any questions at all about sleep or the Sleepio program. If there are a lot of questions, he may not be able to answer all in the time available, but will try to answer as many as he can.

Please do note that, as per our guidelines, Dr Gavriloff will not be able to give personal medical advice including those about medication. His 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 17 Aug 2018 at 11:02 AM
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  • Sleepio Member

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    Graduate

    Hello Dr. Gavriloff,

    Since coming off restricted sleep I have had difficulty in getting sleep from 10pm with 10:30pm being the earliest with a view to 8 hours sleep by 6am latest, most times I have gone off to sleep before or even after midnight.

    In the last week, I have struggled to shutdown to sleep even if I felt drowsy all day! While I endeavour to minimise physical activity at bedtime, it is difficult to ignore needs of the rest of my body. Theefore, even creaming merely a small part can break that drowsy feeling and get my mind if not body into alert.

    Added to this, despite sitting up 15 minutes post an awakening having done some reading in recent days found difficulty getting back to sleep until some 3 to 4 hours later!!!

    Thankfully my family is away on holiday and I am currently at home therefore, have the opportunity to sleep till I wake without disturbance of an alarm indeed family. I dread to think how I will survive when alarm goes off at 6am!!!

    Kindly advise on way forward.

  • Sleepio Member

    • 6 comments
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    Graduate

    Hello Dr Gavriloff,
    Last night was my first SR night. I was so anxious about falling asleep in a quarter of an hour that I knew I wouldn't…and therefore didn't! I assume I can't lengthen this time to half an hour, so becoming more relaxed about the urgency and therefore, hopefully, falling asleep within that extended time…?
    Thank you for your thoughts.

  • Sleepio Member

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    Graduate

    Hello Dr. Gavriloff,
    I am a recent graduate although I did not achieve the sleep efficiency the program suggests. Oddly enough, after graduation I have now had a straight 3-night 90+% efficiency. It's remarkable since I have had sleep problems for decades. My question is when I sit down to watch TV anytime from, say, 2:00 p.m. to 4:30 p.m. I almost always nod off (I'm retired). My husband wakes me up. I have to physically stand up or I will continuously nod off. Is it OK to take a nap during the day and, if so, how long can I nap? By the way, the “the the” suggestion really works. Thank you so much!

  • Sleepio Member

    • 121 comments
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    Expert

    Good evening everyone and welcome to this week’s live session. I’m Dr Dimitri Gavriloff, a clinical psychologist with a special interest in sleep and I work in both clinical practice and research. I’m here to answer as many questions as I can over the next hour and a half and will aim to make my answers as helpful as possible to the community in general.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Renew,
    Thanks for your questions! It looks like there are a couple of things here and so I’ll do my best to answer them in turn. Well done on completing the programme by the way!

    Right, sleep restriction first. It sounds to me like your sleep window might still be a little longer than it needs to be at present. It can be really tempting to widen the sleep window when we've increased our sleep efficiency and finished a period of restriction. However, even though you’ve been through a period of sleep restriction, you can still return to restricting sleep again if your sleep efficiency is below 85%. Ideally, we aim for sleep efficiency to be around 90%, increasing the sleep window at that point only such that 90% sleep efficiency is maintained. This is where the sleep diary comes in very handy to help us get an estimate of our sleep efficiency. You can, of course, return to Session 3 to remind yourself of the details of sleep restriction here. It’s also worth bearing in mind that it's perfectly normal to have the occasional night of poor sleep, in the greater context of improved sleep efficiency. There’s more about this in the library here: https://www.sleepio.com/library/article/my-sleep-efficiency-is-slipping---should-i-be-worr/

    Alert mode next. It sounds like you’re doing well to limit strenuous physical activity before bed. However, it’s important not to take this to mean that we don’t do any activity at all. It’s perfectly alright to do moderate activity in the run up to bed (e.g. having a shower, walking round the house etc.), it’s just strenuous physical activity that is often disruptive (e.g. physical exercise). If you’re not waking during the night and it’s primarily the ‘racing mind’, ‘feeling on edge’ that is getting in the way of you being able to shut down then it might be sensible to return to setting up some cognitive strategies that tackle this. If you can identify whatever it is which is causing you to feel “alert”, then you can tailor the strategy to meet it. For instance, if it’s thoughts about the next day, these can be written down of a piece of paper next to the bed in order to “put them away for the night” or you could try using the other relaxation strategies from the programme found in the library. If it’s physical feelings of being on edge in the run-up to bed, why not try a restful and mindful body-scan. There are a number of really good free recordings that can be found on YouTube. Alternatively, you could try using progressive muscle relaxation from session 2, more about which can be found here: https://www.sleepio.com/library/article/progressive-relaxation/.

    The 15-minute rule is also an important one, and one that’s best to keep following even if you’ve finished the programme (well done for still following it!). We certainly don’t want any of the hard work you’ve done during your time on the programme to be lost. I suppose one thing that might be worth bearing in mind is that we only return to bed when we feel sleepy and that feeling sleepy/drowsy might be affected by the type of reading that we’re doing – so if you’re reading a really exciting page-turner that might not be the best bet. Alternatively, instead of reading, why not try a relaxation exercise instead?

    I love having the house to myself (which I do on occasion!) and it can make for a lovely quiet space in which to relax and sleep soundly. It certainly sounds like you’re enjoying the opportunity to wake naturally and that’s great. I may be completely wrong but I wonder if that might also mean that you’re waking at different times each day? This might also link to the first point about your sleep window being a bit wider too. It’s really important to keep to a regular rise time each day and for this to be in line with the sleep window you’ve created for yourself. If 6am is a little early, you could try moving this forward a little but this will necessitate a later bed-time. Once you’ve got yourself a rise-time with which you’re happy, sticking to it (despite having finished the programme) is still really important.
    In short, the techniques you’ve practiced will still all be useful here and you’ve still got access to them all as a Graduate. Taking each point in turn and using what you’ve already been through is probably the best bet. I hope that’s been of some help but do ask again if there are more questions.
    Best of luck!

  • Sleepio Member

    • 121 comments
    • 45 helped
    in reply to Sleepio Member
    Expert

    Hi ABCDE,

    Thanks for the question – it's a really helpful one for everyone I'm sure. I'm sorry to hear about the minor hickup with last night's sleep. It's certainly not uncommon for people to experience the pressure of feeling 'the need' to get to sleep in 15 minutes as putting them on edge! I guess the first thing to say is to remember that the thought “now I'm not going to be able to sleep”, is just a thought. It's not a fact or an objective truth. Challenging the thought when it does arise will be an important part of the cognitive techniques that you'll get more on as you move through the course. Simple techniques you might try could include picturing putting the thought on a leaf and letting the leaf blow away or float downstream. The trouble is the anxiety that the thought elicits, not the thought itself.

    Importantly (and ironically here) the 15-minute rule is there to give people a simple means of taking the pressure off, rather than putting it on. It might be helpful to think of it slightly differently, as the “not-sleepy” rule, whereby you get out of bed if you're not sleepy regardless of whether or not 15 minutes have actually passed.

    I love the spirit of your idea however – “how do I take the pressure off myself so that I can fall asleep?”. When it comes to putting this kind of thing into practice, it's also worth bearing in mind that ideally we're putting all these different techniques into play all together. We have the Sleep Restriction window set up, we're also using the 15-minute rule to guide us, but why not also use a relaxation technique or try paradoxical thinking (https://www.sleepio.com/library/article/paradoxical-thinking/) as an extra means of taking the load off in the run up to falling asleep?

    Sleep restriction is also, probably, the most challenging part of CBTi. However, it's also one of the most powerful elements to the treatment and so it's worth persevering! Keep up the great work ABCDE and let us know how it goes.

    Best of luck!

  • Sleepio Member

    • 121 comments
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    in reply to Sleepio Member
    Expert

    Hi there SleepyGMW,

    Thanks for the question – it's another good'un.

    Firstly, great work on the sleep efficiency – fab stuff! In terms of the napping, it's an interesting one. Our sleep-wake cycles are thought to be principally regulated by two processes: our circadian rhythm and our homeostatic sleep drive.

    When we nap during the day it affects our sleep drive, the natural sleep pressure that we build up throughout the day from when we wake up to when we fall asleep. Napping reduces sleep pressure and we end up having a reduced sleep pressure when the time comes to go to bed. For some people this can really impact their nightly sleep and lead to them taking a longer time to nod off (because they have to stay awake longer for the sleep pressure to build to the threshold for sleep onset).

    Incidentally, this period of the day is one in which many people can experience a “post-lunch dip” as it is sometimes called, so you're not alone! Not everyone experiences them in the same way but for some people this means that they feel especially drowsy during this period. This is principally because of what is happening with our circadian rhythm, and it's overlap with building sleep pressure.

    So, in short, we generally don't advise napping during the day, particularly if you experience problems sleeping. If you find that watching television in the afternoon is leading to napping inadvertently then perhaps it might be better to do something a little more active during this period of the day so as to keep yourself awake.

    Hope that helps.

  • Sleepio Member

    • 121 comments
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    Expert

    Well, that's all folks! We'll see you here for another live discussion next week!

  • Sleepio Member

    • 6 comments
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    in reply to Sleepio Member
    Graduate

    Many thanks, Dr Gavriloff. I hadn't got to session 5 so couldn't read the paradoxical thinking article until I had. Now read and understood, thank you!

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