Live Discussion with Dr Dimitri Gavriloff - 23rd January 2019

Dr Gavriloff will be hosting a live online discussion here on Wednesday 23rd January, from 7:30pm to 9:00pm BT or 2:30pm to 4:00pm US ET.

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.

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

To do this:

On PC hit CTRL and R keys or the F5 key
On Mac hit CMD and R

Posted 17 Jan 2019 at 1:24 PM
  • 16 comments
  • 8 helped

Comments

  • Sleepio Member

    • 291 comments
    • 135 helped
    Graduate

    Hello Dr. Dimitri, I frequently see Sleepios commenting that they are awakening in the morning, an hour or so earlier than they would like, and can’t get back to sleep. Is there a common reason for this? What suggestions would you make that would help us sleep all the way until our desired wake time? Thank you for your help.

  • Sleepio Member

    • 12 comments
    • 3 helped
    Graduate

    I can be super tired, exhausted and when I get in the bed and try to sleep, I all of a sudden wake up, mind starts to wander and then I get frustrated and can't get comfortable.

    I take sleeping pills every night, for many years, and now they don't work half the time. I need to wean off them, and have CBT to work or I am screwed. And that thought makes me very very nervous and anxious.

  • Sleepio Member

    • 17 comments
    • 4 helped
    Graduate

    I read a lot about needing to be exhausted and tired on going to bed to be able to sleep. All of this I am every night but still find it hard to switch off (thought checker and relaxation don't work). Also, my sleep window is 6 hours but feel I need more than this to actually get the sleep. My eyes are very sore and feel like they are on stalks also I get headaches from lack of sleep. Sorry, I'm struggling to explain myself as I feel so exhausted and tired. I'm on week 3 and finding it really tough. Even though on two nights my SE was over 90% I still felt I hadn't had enough sleep. Feeling confused.

  • Sleepio Member

    • 2 comments
    • 2 helped
    Graduate

    I'm a Sleepio graduate and have been doing the program for almost 3 months. I'm finding that I'm so exhausted with my current sleep window that I'm unable to stick with my schedule (I've been sleeping in often and then am not tired at my targeted bedtime). As a result, I've also seen my efficiency drop way down to where it was when I started the course. Do you have tips for preventing burnout and exhaustion while still making incremental progress in sleep efficiency? I'm struggling to strike a balance and can see that lack of sleep is affecting my mood, my work performance, and my energy levels quite substantially.

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 2

    I sleep good

  • Sleepio Member

    • 3 comments
    • 0 helped
    in reply to Sleepio Member
    Session 2

    I do not drink water before sleep, so I sleep throughout the night

  • Sleepio Member

    • 129 comments
    • 46 helped
    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

    • 129 comments
    • 46 helped
    in reply to Sleepio Member
    Expert

    Hi Auntie Hoho,
    Thanks for your question – it’s a great one with which to kick off.

    Why we wake early is likely to differ from person to person but these experiences are a common part of the wider picture of insomnia.When we think about insomnia, we often focus on 1) the difficulty getting off to sleep initially (sleep onset difficulties) and 2) the waking throughout the night (sleep maintenance difficulties). However, early morning awakenings, as they’re known, are just another part of the puzzle. I tend to see this less in my younger patients and more often in older patients.

    Interestingly, our sleep changes throughout the night as move through our sleep cycles – 90-minute(ish) cycles of going up and down through the lighter and deeper stages of sleep. Early night sleep tends to be deeper and more robust “slow-wave sleep” and there is commensurately less Rapid Eye Movement sleep (REM), which is when we do the bulk of our dreaming. As we move through the night we see more REM sleep, and the brain activity during these REM periods is remarkably similar to that of our waking state. REM and the lighter sleep we experience closer to the morning is also a much more fragile sleep state and so it's more easily disturbed. This is probably particularly the case if you're worried about something (even your sleep) and I know I certainly experience an early morning awakening if I've got something important that I don't want to miss the next day.

    The important thing is that this is simply a part of the wider picture of insomnia and it doesn't affect the way we'd go about treatment – i.e. we stick to the CBT-I plan. If you do find yourself waking early, remember the 15-minute rule and if it's particularly difficult and you can't get back to sleep, you could use it as an opportunity to do something that you've struggled to find time for during the day. Don't let it get you down, getting up early (tiresome though it might be at the time) will help you develop some more sleep pressure for the night to come!

    Hope this helps.

  • Sleepio Member

    • 129 comments
    • 46 helped
    in reply to Sleepio Member
    Expert

    Hi Goofygirl,

    Thanks for the message. I'm sorry to hear you're finding it difficult to get to sleep despite the initial exhaustion but you've certainly come to the right place!

    The experience you've described of being absolutely zonked and then getting into bed only to find your eyes wide open and mind racing away is something we see a great deal. Often if people have struggled to sleep for some time and toss and turn in their frustrated attempts to get off to sleep, the bed ceases to be a much needed sanctuary and becomes a battleground instead. This kind of 'paired association' as it's known is well reported by people with insomnia and is where the good “bed = sleep” association has become disrupted over time.

    Because it's such an important element in the wider picture of insomnia, CBT-I addresses the bed-sleep association head on. Principally this is done through Stimulus Control Therapy where we limit disruption of the bed-sleep association by asking people to get out of bed after 15-minutes and to go somewhere restful and quiet to let sleepiness return. This way, we don't end up associating the bed with the frustration at not being able to get off to sleep. Getting into bed if you're not sleepy is another thing to avoid for similar reasons.

    I'm noticing that you've had a tough time with the hypnotic medications and that you're pinning all your hopes on CBT-I. Rest easy knowing that CBT-I is a very well evidenced treatment and so we know it works really well. The nerves that are riding on whether or not it'll work might hinder the process somewhat though and so, difficult as it is, see if you can let yourself go with the programme and take each night as it comes. Sticking to the programme is the most important part but we're all here to cheer you on and support you along the way!

  • Sleepio Member

    • 129 comments
    • 46 helped
    Expert

    Hi Wordplex,

    Thanks for the question and for the sentiment – it's really well expressed. I'm really sorry to hear how tough things are at the moment. The stage of treatment that you're currently at is probably one of the more tricky bits and requires some real courage to keep up with. The post above for Goofygirl might apply to your experiences too I think and, once again, it comes back to the bed-sleep association which often becomes disrupted in people who struggle with their sleep.

    Rest assured though Wordplex, Session 3 is where the heavy-hitting behavioural treatments start (i.e. Sleep Restriction and Stimulus Control). These are the components of CBT-I with the largest effect sizes when studied scientifically. They're not easy to do but they work, which is why they're recommended for treating insomnia in international clinical guidance. It's worth bearing in mind that despite being such great treatments, there is often a bit of a lag in the effects when one starts them – the body and mind take time to adjust to new behaviours. Additionally, people often report that sleep restriction can make them *more* tired in the first instance, which is totally counter intuitive for a sleep treatment but is certainly part of the wider experience. The important thing to bear in mind is that this short-term difficulty is done for much longer-term gain in sleep continuity just a little further down the line.

    Keep up the great work Wordplex!

  • Sleepio Member

    • 17 comments
    • 4 helped
    Graduate

    How long is it before someone becomes a graduate and are they booted off the programme when they graduate or can we stay for however long we need to for support and feedback?

  • Sleepio Member

    • 17 comments
    • 4 helped
    Graduate

    Thanks for your encouraging reply, Dr Dimitri. I have to say, I am feeling quite liberated in that I am allowed to stay up late, albeit a little later than I would ideally like. For years, especially while I was working, I felt I had to go to bed at around 10-10.30 to get the sleep I needed to be able to get up for work at 6.45 a.m. As a youngster I was a night owl and this bedtime routine always went against the grain. Being allowed to stay up later has somehow given me the permission to do what I always felt was right for me. I'm pleased to say I had a full, uninterrupted 6 hours sleep last night. My eyes are sore and my head aches but I feel a bit more positive.

  • Sleepio Member

    • 129 comments
    • 46 helped
    in reply to Sleepio Member
    Expert

    Hi Hhwkns,

    Thanks for the great question. First of all, well done for getting through the programme – great work.

    It's a tricky one to answer without much more information on your sleep schedule but I'll do my best.

    I guess there are lots of different reasons why people might struggle to maintain a sleep schedule once they've been through the programme but the likelihood is that it's probably a knock-on effect of something that's happening elsewhere in life. For instance, a bout of illness might meant that our sleep schedule changes a bit as we need more bed rest, a business trip overseas might throw our circadian rhythms out as we cope with jet leg etc.

    The key thing to remember, however, is that if you've managed to make progress through the course once, you can do it again. There's certainly no shame in starting from scratch and taking each of the steps into account once again – tiresome though it may seem. Remember, just because you start from scratch doesn't mean you're in the same place you were when you started – you're much better informed this time and you know that it's worked well once already. This is the kind of thinking that can help spur you on. A fab example of this is you noticing that sleeping in in the morning has affected your ability to feel tired at the target bedtime – well done! I'm really sorry to hear its tough and that it's having an impact on your day to day functioning too but rest assured that the programme still works no matter how many times you have to come back to it. It's a bit like taking up a hobby and not doing it for a while, you might get a bit rusty if you don't practice but you can always start again.

    Let us know how you get on – we're here to cheer you on!

  • Sleepio Member

    • 129 comments
    • 46 helped
    in reply to Sleepio Member
    Expert

    Great to hear Pooja! ;)

  • Sleepio Member

    • 129 comments
    • 46 helped
    in reply to Sleepio Member
    Expert

    Hi Wordplex,

    It's an absolute pleasure – I'm really glad to read the optimism in your message! Well done on a great night last night.

    I see lots of people in clinic who are late chronotypes (“owls”) – particularly those who, like you, who might have pushed themselves into bed earlier than their bodies wanted them to do so. Trouble is that if we're not ready for it, sleep might not come and we end up making things more tricky.

    Super work Wordplex – keep it up!

  • Sleepio Member

    • 129 comments
    • 46 helped
    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.

Return to top