Live discussion with Dr Dimitri Gavriloff - 23rd May 2018

Dr Gavriloff will be hosting a live online discussion here on Wednesday 23rd May, 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 she 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 May 2018 at 6:40 PM
  • 21 comments
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  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 1

    Hello, Dr. Gavriloff.
    I have early stage insomnia and I wake up multiple times (3~6 times per night) after 5~10 minutes sleep. It seems like apnea, but it's not.
    After those wake-ups, I got fear of sleeping and even cannot be able to relax. I'm trying paradoxical thinking with no success. Which tips could you give me and how I can use Sleepio to help me with this problem?

  • Sleepio Member

    • 2 comments
    • 1 helped
    Graduate

    Hello Dr. Gavriloff,
    My wonderful mother has been visiting me for the past couple weeks. I've noticed that she also has sleep issues. She wakes up at around the same time I do everyday (4am) and reads or walks the dog but will then go back to sleep for a couple hours at around 6am. This seems to be a pattern I have too (except I can't go back to sleep at 6 during the week with kids schooling and work, so I tend to be quite tired.) I was wondering if inconsistent sleep patterns could, unfortunately, be genetic but then my two older sisters sleep like hibernating bears! ;)

  • Sleepio Member

    • 1 comments
    • 3 helped
    Graduate

    Hello Dr Gavriloff,
    I have just started the Sleepio programme so am completely new to it all. My problem is that I can't fall asleep at all until say 6am! I am sometimes almost falling asleep watching TV about 10pm. I then go to bed but then I just can't fall asleep even though I'm tired. Why? What can I do?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 2

    In discussion with my neurologist, we seemed to have figured out that my lifetime of intermittent primary insomnia and my ~8 years of idiopathic Hypersomnia are actually Delayed Sleep Phase Disorder. I have learned a LOT about sleep hygiene over the years, and do my best to employ it already. Is Sleepio set up to account for sleep phase disorders, and is there anything it can do to help me get well-rested on a semi-normal schedule?

  • Sleepio Member

    • 9 comments
    • 0 helped
    Graduate

    After sleeping relatively week for about a week, 70% sleep efficiency, last 41%. Very disappointing. What has gone wrong.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 1

    Hello Dr Gavriloff,
    Some of the questions I have: – How to “extend” sleeping times? I have no problem falling asleep, but regularly wake up between 4 and 5, without being able to fall back asleep – How to increase REM and deep sleep? I seem to have large variations in my RE sleep, ranging from 20-30 mins per night (those days are quite difficult) to 1:30. I haven't been able to find a pattern in terms of what creates a better quality night – What is the average REM and deep sleep for males around 50?

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    I am in my 4th week of the program. Week 3 says nothing in the bedroom but sleep. I like to listen to soft worship music when my husband is out of town. Is this permissible? Also, he has restless legs ( & arms) due to a medical condition that really affects me sometimes.
    I have been on sleeping pills for about 8 months but they make me groggy I am weaning myself off of them & using natural supplements & oils.

  • Sleepio Member

    • 121 comments
    • 45 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

    • 1 comments
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    Graduate

    I am in first week of sleep restriction and have been advised to cut back on my time in bed by 2 hours. I seemed to be even more tired than usual. IS it probable that I overestimated my awake time and thus received a recommendation to cut back on sleep too much?

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi Setsu. Thanks for your question.

    It looks like you’ve made some real progress on increasing your sleep efficiency there, well done! I’m also sorry to hear that you've hit a bit of a snag when it comes to your tapering. The unfortunate truth is that it’s not uncommon for people to encounter bumps whilst discontinuing certain sleep medications. Although I can’t give you medical advice when it comes to your medication, developing a really well-structured tapering/withdrawal schedule with your doctor is probably the most helpful route here. I’m assuming from what you’ve written that you’re in close consultation with your physician and so keeping them in the loop with how you get on and is important.

    I can completely empathise with how difficult starting up sleep restriction must be when there doesn’t feel like there’s much there to restrict in the first place. The important thing to bear in mind however is that despite the challenge, the principles of CBT-I still apply here – this is just a bump in the road. If the total sleep time you’re currently experiencing is significantly shorter, sticking to other elements of the treatment that you'll already be familiar with, such as stimulus control, relaxation exercises and the 15-minute rule will be important things upon which to lean.

    I’m sorry it’s tricky at present but keep up the great work, stick with it and let us know how you get on.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi BCEFCA08, thanks for your question.

    It sounds like you’re pretty sure that it isn’t sleep apnoea but if you’re at all unsure it might be worth speaking to your doctor to get it ruled out, just in case. It also sounds like you’re doing a great job of identifying the anxiety that’s preventing you from getting back to sleep and trying a really helpful method (paradoxical intention) of dealing with ‘trying too hard to get to sleep’ (i.e. what we call “sleep effort”). I suppose it’s worth bearing in mind that although all the strategies that we employ in Sleepio are evidence-based treatments, there are some that people may find more helpful than others for various reasons.

    I notice that you’re currently in session one and so in the next session, you’ll learn some useful relaxation strategies that target anxiety specifically and that you may find helpful in reducing the arousal that you mention. In the meantime, however, you could try widely available relaxation exercises when you notice that you’re beginning to feel anxious, something like a ‘mindful body-scan’ or breathing exercises that give you a bit of a break from the fear/anxiety. There’ll also be more on ‘the racing mind’ in future Sleepio sessions too and so this is something you’ll spend more time thinking about with the Prof as you make your way through the programme. Paradoxical intention is covered a little later in the programme too and so if you're not finding it's helpful just now, perhaps give it a bit of a break and pick it up again when the Prof talks to you more about it.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi there Etude, thanks for your question.

    It’s an interesting topic! Someone asked a similar question to this the other week and so I hope you won’t mind if I paraphrase what I mentioned to them. There's certainly growing evidence for the impact of genetic factors on several sleep disorders, including insomnia. The precise role that these factors play in insomnia isn’t entirely clear but it’s likely that, at least to some degree, a predisposition to insomnia does run in families. This is mostly down to epigenetic mechanisms (how the genes are ‘read’ by the cells) and pertains to things like sleep regulation and how we respond to stress.

    However, it’s also worth bearing in mind that inconsistent sleep patterns are influenced by several other really important factors, such as the environment, our activity patterns, age, thinking styles and behaviours (and of course kids’ schooling and work!). Despite the place of genetics in the picture, it’s also worth remembering that there is still a really important place for CBT-I. This is because CBT-I addresses the ways in which all these various elements of our lives and experiences come together and might be getting us/keeping us stuck. When we start to make our way through these in a systematic way, we give ourselves the best opportunity of getting back to sleeping well.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi there Sarahjabba, thanks for your question (and welcome to Sleepio!)

    It’s tricky to say for sure what’s going on with your sleep but it certainly sounds tough. If this is a pattern that’s been happening for a while then it could be due to a disruption in your circadian rhythm, i.e. a misalignment of your natural 24-hour body clock (one of the natural processes that regulates our sleep) with your lifestyle and schedule. There’s something in the Sleepio library that talks more about this here: https://www.sleepio.com/library/article/what-is-delayed-sleep-phase-disorder/

    Our sleep is regulated in part by something we call ‘sleep pressure’ (the ‘tiredness’ you build up as you move through the day from waking up to when you fall asleep) and something called our ‘circadian rhythm’ (the internal biological rhythm that is essentially a 24-hour bodyclock moving between alertness and sleepiness). When these and our daily schedules are out of sync we can experience periods of being alert but also feeling tired or groggy due to inadequate sleep. Fortunately, though, you’ve come to the right place. The treatment that Sleepio uses to manage insomnia are certainly useful here. In addition, it might be worth also talking to your family doctor about other treatment options too (e.g. melatonin, light therapy). Either way, there'll be a range of different approaches that you'll explore with the Prof as you move through the programme.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi there Ironica, thanks for your question.

    It sounds like you're in good hands with your neurologist and have come to an understanding of what might be underlying the sleep difficulties that you mention.

    Although Sleepio uses techniques that specifically target the various elements that commonly result in insomnia, there's certainly a great deal of what it covers that is applicable and useful for treating Delayed Sleep Phase Disorder too. There's some more information on Delayed Sleep Phase Disorder that can be found in the Sleepio library here: https://www.sleepio.com/library/article/what-is-delayed-sleep-phase-disorder/

    As you move through the programme, there might be elements of the treatment with which you are already familiar (i.e. sleep hygiene), but there'll probably be new things too that you may not have tried. Although sleep hygiene is certainly an important part of the overall approach, it's only one part of the programme and for it to be really useful it's important that it's used alongside some of the more effective behavioural techniques that you'll come across in due course. In addition to Sleepio, you might want to talk to your neurologist about other treatment approaches that can be used in parallel with CBT-I, such as light therapy or melatonin.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi Ritchie, thanks for your question.

    I'm sorry to hear that you've hit a tricky patch but well done on getting your sleep efficiency up over the past week! It's easy to get caught on when things are difficult but it's important to bear in mind that there's always going to be some variability in our sleep – even in people who consider themselves good sleepers.

    There's a good article by Dr Simon Kyle in the Sleepio Library that talks about just this experience: https://www.sleepio.com/library/article/my-sleep-efficiency-is-slipping---should-i-be-worr/

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi there Rom, thanks for your questions.

    It sounds like you're asking a few things here so I'll try to answer in as comprehensive a manner as I can. What it sounds like you're coming up against is something often termed 'early morning awakening' – a common manifestation of insomnia for some people. The good news is that, like with difficulty falling asleep and maintaining sleep during the night, CBT-I has been shown to be effective at treating early morning awakening in numerous high quality scientific studies, so you've come to the right place!

    In terms of age related sleep change, that's a really interesting one. There is evidence that total sleep time and slow wave sleep (“deep” sleep) does gently decrease with age, as does REM sleep to a lesser degree. I'm afraid I don't have any averages to hand. I'm also interested in how you've managed to measure your REM sleep as this is typically something that is done clinically using polysomnography (PSG)?

    I also notice that you're still on Session 1 and so hopefully you'll get more of a sense of what Sleepio can offer you as you move through the programme over the next few weeks.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi Kingskid, thanks for your question.

    Well done on your progress through to week 4! I guess the important thing about why we suggest using the bedroom only for sleep is to help us re-establish a good bed-sleep association. This is something often becomes disrupted in people who have difficulty sleeping and is something that can be very inhibitory for sleep when it has been disrupted. In general, I'd always recommend sticking to the rules for this one as we're trying to really be clear that the bed is for sleep rather than for anything else. However, there's absolutely no reason why you can't sit somewhere really comfortable and dimly lit and listen and enjoy the music elsewhere, until of course you feel sleepy and then head to bed. Hope that helps answer your question – keep up the great work!

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    Hi there Charr3lax, thanks for your question.

    First and foremost, let me start by saying that sleep restriction is often the part of the treatment that people find most tricky. It's pretty counter-intuitive and it can make people feel a lot more tired during the day, particularly if it's a relatively big restriction.

    It's really difficult to say whether or not you've overestimated your awake time but if you've been keeping your sleep diary regularly you'll have most likely been getting it right. My advice would be to stick with it, particularly as this is one element of the treatment that we know can produce the most effective results (despite the fact that it's probably safe to say it's not the most fun part!). So long as you're not restricting it to below around 4.5 hours a night, you should be on track despite the fact that you may be experiencing more daytime sleepiness. One thing we would also say is that it's really important to keep yourself safe during this part of the treatment and so if you're really tired during the day it's best to avoid driving and using heavy machinery.

    I know it's tough but keep up the good work Charr3lax! If it helps to do so, you could try reflecting on the fact that sleep restriction has been really well tested in clinical research and we know that this part of the treatment is one of the more powerful parts.

  • Sleepio Member

    • 121 comments
    • 45 helped
    Expert

    That's it for me this evening folks! Thanks for your questions and keep up the great work. We'll be back again for another live session next Wednesday.

  • Sleepio Member

    • 4 comments
    • 0 helped
    in reply to Sleepio Member
    Graduate

    Thank you for your help Dr. Gavriloff! Sleepio has been very helpful for me!

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