Live Discussion with Dr Dimitri Gavriloff - 13th February 2019

Dr Gavriloff will be hosting a live online discussion here on Wednesday 13th February, from 7:30pm to 9:00pm British Time or 2:30pm to 4:00pm US Eastern 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 7 Feb 2019 at 1:36 PM
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  • Sleepio Member

    • 12 comments
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    in reply to Sleepio Member
    Graduate

    I think your bedtime should be based on your lifestyle and what time you need to be awake. Shouldn't base it on what others do. 10pm might be to early for some people. And waking at 3am doesnt sound realistic; only if you need to be somewhere at 5am.

    I think the 1:30 – 6:30 am would be best.

  • Sleepio Member

    • 17 comments
    • 4 helped
    Graduate

    I get up to go to the toilet most nights (have been doing this for the best part of 25 years). Is this something Sleepio will eventually iron out? So far, I have had a couple of nights where I have slept right through and I would really like to improve on this. I am 70 and wonder if this is just part of the ageing process although starting this in my 40s was nothing to do with ageing.

  • Sleepio Member

    • 38 comments
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    Graduate

    Quick question on sleep efficiency: My problem is generally falling asleep quickly, but waking up (and staying up) very early.

    Say I have a sleep window of 12-6, but wake up at 5, get kicked out of bed by the QHR at 5:15, and don't get back into bed. Should I log that as “final awakening 5am, out of bed 5:15”?

    If so, that would seem to produce a high efficiency which will extend the window, even if I'm not “sleeping through the window” yet. What have I missed?

  • 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

    • 3 comments
    • 0 helped
    Graduate

    Can you change your sleep window once it set

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Cartycater,

    Thanks for the question. I think it's probably one that is helpful for lots of people in the community.

    It's a tricky one but I'll do my best to answer. For lots of people, “heightened cognitive arousal” or 'being on edge' before bed can be a pretty boring and consistent irritant that prevents us from nodding off quickly. The kinds of relaxation techniques we employ are useful for trying to face that head-on by dealing with the autonomic arousal but they're also useful because they help us to take our focus away from trying to fall asleep. Viktor Frankl once said “sleep is like a dove which has landed near one’s hand and stays there as long as one does not pay any attention to it”. When we really get into these techniques, they help us to focus on the technique so that the “dove” can come and sit next to us, as it were. So, just because you feel relaxed doesn't necessarily mean that the techniques won't be helpful.

    I suppose it's also important to remember that the heavy hitters with CBT-I are stimulus control and sleep restriction. These are the techniques for which we have the biggest “effect-sizes” in the clinical trials. Sleep restriction, which you'll have started last week will take a little while to get used to and should help to consolidate sleep, which is probably why you're seeing an increase in your sleep efficiency (well done by the way!). There might be a little way to go with the sleep efficiency yet and so perhaps as that improves, so will the total sleep time.

    Another factor that might be important to consider is the timing of the sleep window. Our sleep-wake is regulated in two main ways: the homeostatic sleep drive (i.e. sleep pressure that we build up through the day) and our circadian rhythm (which ebbs and flows over the course of the day). When the two are aligned, there are “sleep gates” when the sleep pressure is high and the circadian rhythms are “low” and it's at these points that we typically go to sleep. Going to bed too early, even if one is really exhausted can mean that the opportunity for sleep is not yet optimal. Our natural circadian rhythms are manifested in whether or not we're a “night owl” or a “morning lark”, for example. If you're an owl and try to get to sleep too early, it might be a struggle.

    I haven't given you a huge amount of advice there but the advice I do have is to keep up with the programme – especially with the sleep restriction and the stimulus control! Things might take a little while to get going but keep the faith. Let us know how you get on and keep up the good work!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Cindif,

    Keep it up! Minor wobble on the screen time is no big-deal – you're clearly aware of what is sensible and that is the main thing!

    Keep up the great work and let us know how you get on.

  • Sleepio Member

    • 38 comments
    • 18 helped
    Graduate

    I'm currently watching movies to stay awake until the window opens at midnight. That's a lot more stimulation than I would normally have so late. I'm still falling asleep very quickly, because I'm utterly exhausted, but is there any connection between late-evening overstimulation and waking early?

  • Sleepio Member

    • 38 comments
    • 18 helped
    Graduate

    One other idea: Right now the window is 12-6. Staying up until 12 is very hard, and I'm often awake well before 6. Does it make more sense to “give in” to this and reset the window to say 10-4 (and then try to stretch it to later rise times), or will that ingrain bad habits?

  • Sleepio Member

    • 121 comments
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    in reply to Sleepio Member
    Expert

    Hi Wordplex,

    Firstly – congratulations! Well done on getting through the course – great stuff.

    Secondly – those questions are taken from a standardised questionnaire that we use and so that's why they are given to everyone. The point you make, however, is a very sensible one and I'll make sure to pass that on to the team.

    Thirldy – I'm really sorry to hear that you've been getting caught up in anger. It's a powerful emotion and once we get caught in it, it can be difficult to consciously put down. I'm sorry to hear that you had some difficulty finding one of the Prof's techniques helpful. Although the relaxation techniques are probably helpful ways to deal with being wound up for many of us, it's really variable and will depend on what has wound us up and what situation we happen to find ourselves in. Mindfulness is a useful practice for learning to spot emotions, such as anger, rising up and then learning to watch them as they manifest and eventually disappear. There are several really good self-help books that you can find on the subject and that will take you through a self-led mindfulness course. Additionally, there are great books on anger management – Overcoming Anger and Irritability by Dr William Davies is a good example. The main thing about managing “arousal” (i.e. the state of getting wound up) is noticing it when it's stirring and actively intervening (either through a relaxation technique, challenging the thoughts or something similar) before letting it get to its zenith. Noticing what it does to you in your body is a great way to do this. For instance, when I get stressed I really notice that my shoulders start to ache and rise up (almost to the level of my ears at times!). This is a sure sign that something's got me riled up and so I take it as a sign from my body to actively intervene. I usually stop what I'm doing, actively relax my shoulders and stretch and maybe even consciously “thank” my nervous system in a jovial way for keeping an eye out for me (silly I know but the levity often helps to dissipate the anxiety/stress). The point is, catch it early and make a conscious acknowledgement of it, then actively choose to find something else to do. If it happens again, simply repeat. What many of us do is ignore it or “jump” straight into it and begin interacting with the emotion – these are both sure fire ways to keep it hanging around!

    Hope that helps. Well done again on getting through the course.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Featherly,

    This is a great question. There are in fact two ways of doing the same kind of thing. We call them Sleep Restriction and Sleep Compression. Sleep Compression is, as you say, a technique that reduces the sleep window in a much more gradual way and was a technique that was originally used for older adults. Sleep restriction is far more commonly used and is, as I've mentioned in an earlier post, one of the techniques with the greatest effect sizes in clinical trials. It's definitely a bit “brutal” to reduce the sleep window abruptly but it's a great way to “prime the sleep homeostat” (i.e. to get you really sleepy) so that you fall asleep quickly and so that sleep is consolidated. It's also a good way to get the programme working as quickly as possible so that people make relatively rapid progress.

    Hope that helps answer

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Goofygirl,

    Great questions. The sleep restriction is by far and away the most tricky part of the programme. However, as I've mentioned, it's the technique that is the heaviest hitter – it really helps to consolidate sleep quickly. It can, however, be a technique that people can really struggle with. The key to getting through the tricky part is to make sure that you've got stuff that can keep you awake in the run up to your time to get into bed and things that help you get out of bed the other end of the night.

    Finding something to keep you awake is the first thing. I've heard people who've decided to do the ironing or cook their lunch for the next day, people who take the dog for a quick walk or people who do some yoga. The idea is that you do something active enough to stop you nodding off, but not too active (i.e. gym) to stop you falling asleep later on. The second thing is getting up the next morning. A technique with which many people I've seen have had success was putting their alarm clock across the room. Because they have to get out of bed to turn the alarm off, they can use the momentum to then head off and have a shower, which helped wake them up. This is just a suggestion, but the bottom line is that Sleep Restriction takes some gumption, that's for sure! Important thing to keep in mind is that it works and that it will get easier – use that to help motivate you too.

    In terms of the imagery – if that doesn't work, there's no need to use it. Some people find imagery to be less helpful than the other techniques. Both the imagery and the other techniques are trying to achieve the same ends and so if the breathing and PMR work then stick to those – which is sounds like you've had some real success with!

    Keep up the great work – hope this helps.

  • Sleepio Member

    • 121 comments
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    in reply to Sleepio Member
    Expert

    Hi again Featherly,

    This is another great question. Generally my recommendation is that since it's easier to “anchor” the rise-time, starting with a later bedtime is better than going to bed early (sorry Depak!). The idea is that we're trying to use the sleep pressure that you build up during the day to get you to sleep very quickly and my experience is that that is best achieved by staying up later the first night and then taking things from there.

    Hope that helps clarify.

  • Sleepio Member

    • 121 comments
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    in reply to Sleepio Member
    Expert

    Hi Goofygirl,

    So, the first thing to say here is that we can't really give any advice on medication – the best thing here is to talk to your doctor about whether or not to continue the melatonin. Melatonin is very different from Ambien (zolpidem) and is sometimes prescribed for different reasons (albeit both sleep-related).

    Continuing it during the programme, however, shouldn't affect things and there are plenty of people who use Sleepio alongside a sleep aid.

  • Sleepio Member

    • 121 comments
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    in reply to Sleepio Member
    Expert

    Hi again Wordplex,

    Great question. Nocturnal urinary urgency is certainly something that people experience more in older adulthood and, as you mention, this can happen for a number of reasons earlier on in life too.

    Although Sleepio doesn't specifically set out to address this, increased sleep consolidation may mean, like you've experienced, that you sleep through some nights. However, even if you don't sleep through, hopefully Sleepio will have helped enough that you're able to nod off straight away when you get back into bed from having gone to the loo.

  • Sleepio Member

    • 121 comments
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    in reply to Sleepio Member
    Expert

    Hi Mgriffin,

    Good question. Recording things like that does make sense – so long as you stay out of bed at 5.15. I take your point about the sleep efficiency calculation but the increase is only 15 minutes/week and so isn't much. It should give you time to catch up and for the sleep to become more consolidated. The theory is that the sleep restriction will increase the sleep pressure you experience in the run-up to your bedtime and help you get to sleep quickly too. The other thing to think a bit about might be to use an earlier bedtime and make the use of the 5am start, you can then extend the window from the morning as you go. Sleep restriction does take a few days to get working but as I've mentioned, it's the technique with some of the best evidence in the clinical literature for consolidation of sleep.

    Hope that helps.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    HI Trixielucky12,

    I don't think you can (although I could be wrong?) and the best thing to do is to stick with the sleep window that you've come up with so that the consistency will aid your sleep. You can also ask the team at hello@sleepio.com if you're unsure about a window that you've created and that you might want to rejig before you start your sleep restriction.

    Keeping the consistent sleep and rise times is a key part of the technique and so other than the changes based on the sleep efficiency calculations that's why it's not great to change them once you've started.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Mgriffin,

    The late night movies might not be a great idea because of the stimulation but also because of the light that you're getting from the television. If you make sure that you're not sitting too close, that should minimise the effect. Waking early might be due to several reasons but sleep restriction (along with stimulus control) is the right technique to be using to target it.

    Moving the sleep window too much isn't generally a good idea once you've started sleep restriction as we're trying to build consistency which helps. However, as I mentioned in my earlier post, if you think that going to sleep and getting up earlier would mean more consolidated sleep, then doing that seems sensible and simply pushing your rise time later may be helpful. Generally, anchoring the rise time is easier for people and so that's often what I recommend but it's all about doing whatever is easiest for you to keep up with the programme!

    Great work on falling asleep quickly!

  • Sleepio Member

    • 121 comments
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    Expert

    Well, that's all we have time for this evening folks.

    Thanks for the great questions and keep up the great work everyone!

    We'll be back again next week for another Live Discussion.

  • Sleepio Member

    • 8 comments
    • 2 helped
    Graduate

    I am only in week 1, so I am happily completing my sleep diary.
    However, reading in the community about sleep windows and sleep restrictions, I feel I didn't quite know what I signed myself up for. I guess I'll find out soon!

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