Live discussion with Dr Dimitri Gavriloff - 29th May 2019

Dr Gavriloff will be hosting a live online discussion here on Wednesday 29th 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 23 May 2019 at 1:50 PM
  • 20 comments
  • 2 helped

Comments

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    Effect of alcohol on dreaming would be handy.

  • Sleepio Member

    • 11 comments
    • 1 helped
    Graduate

    Hi, I asked a question of Dr Vicki Creanor in last week's discussion and she replied to me but as I can't be there to see the discussion as I'm usually taking dancing classes that night, I have another question that I'm hoping you might be able to answer.

    I'm just wondering would it not be a good thing to figure out what causes us to have broken sleep (if there is a way of doing that, is there?) and trying to improve on that, rather than what Dr Creanor said, which was to use sleep restriction to consolidate all the broken sleep together?

  • Sleepio Member

    • 7 comments
    • 8 helped
    Graduate

    Yes Hi l have a similar question re improving broken sleep as have used SR and have gradually improved SE so now have a longer sleep window and generally have about 6and half hours sleep but I am still waking up about 3times a night and sometimes have difficulty going back to sleep. Are there any other techniques that have improved this issue. Thanks

  • Sleepio Member

    • 121 comments
    • 42 helped
    Graduate

    Hi I have realised that a reason for feeling dozy in the early evening could be because I have just eaten. Do you have any advice about this? Would it be better to eat nearer bedtime or are there certain foods that I should avoid in my evening meal? Conversely are there foods that are most suited to have between 6 and 7 pm when my bedtime is 11.45? I have to eat something at six or soon after because I am hungry.

  • Sleepio Member

    • 15 comments
    • 9 helped
    Graduate

    Hello
    I'm on week 2 of the programme and keep hearing about sleep restriction which is frightening me a bit. Can you talk about this, how it works and how it helps please.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 3

    Hello,

    This is related to the previous question on 'sleep restriction':

    I'm on week 2 of the programme which I started while withdrawing from caffeine 'cold-turkey'. I'm 11 days off caffeine but still suffering at night though no longer during the day. I have had 2 years of ongoing stress and insomnia.

    The main reason for my current insomnia are severe migraine type headaches that are part of the caffeine withdrawal and are keeping me awake for up to 3 to 5 hours a night. The only relief I use are ice packs--everything else gave me rebound headaches or side effects and I no longer use them.

    My concern is: a) Should I have started the Sleepio programme while in the acute stages of caffeine withdrawal? b) How can 'sleep restriction' work when it's the headaches that are keeping me awake?

    I'm not looking for medical advice which I get from my GP, it is purely with relevance to the Sleepio programme.

  • Sleepio Member

    • 50 comments
    • 18 helped
    in reply to Sleepio Member
    Graduate

    Hi, there is an alternative to CBT and using RS (like for Sleepio) but it's rather extreme. I came across Free Running Sleep in my research. This article is quite comprehensive but includes info on Free Running Sleep.

    https://supermemo.guru/wiki/Good_sleep,_good_learning,_good_life:_Summary

  • Sleepio Member

    • 129 comments
    • 49 helped
    Expert

    Good evening everyone and welcome to this week’s live session. I’m Dr Dimitri Gavriloff, a clinical psychologist specialising in sleep disorders 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

    • 15 comments
    • 9 helped
    in reply to Sleepio Member
    Graduate

    Good evening Dr Gavriloff,
    I'm new and not sure how these sessions work, so hello. I hope you are well and I'm really grateful for the opportunity to use the Sleepio programme; thank you.

  • Sleepio Member

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

    Hi FredFlintstone,

    Thanks for the question – it's a great one to get us started. There's a great library article here that talks more about alcohol and sleep in general.
    https://www.sleepio.com/library/article/alcohol-and-sleep/

    Essentially, alcohol is a central nervous system depressant and it's sedating effects are pretty self-evident to anyone who's had a couple of drinks before bed. As the article says, it can dramatically reduce sleep onset latency (the time it takes to fall asleep) and so is sometimes used by people as a sleep aid. The trouble is that it has a range of effects on our physiology that then perturb sleep and interfere with the normal, natural sleep that we really want. Probably the most prominent of these is that alcohol increases slow-wave sleep (the deep sleep we get in the first third of the night) and initially suppresses REM sleep (the period of sleep most strongly associated with dreaming). The important thing to bear in mind here is that each and every sleep stage is important and happens in sequence and for good reason. As alcohol is then metabolised by the body, the sedating effects begin to wear off and we may experience a “REM rebound” later in the night where REM may become more prominent than it might otherwise be. We also experience lighter sleep during this period and more awakenings, meaning more fragmented sleep. Alcohol is also a diuretic which makes us want to go to the loo more and bladder urgency often results in awakenings.

    In terms of dreams, which is what you ask about, alcohol's effects on REM sleep likely account for why people often describe more vivid dreams if they've had a drink. Because their sleep is also shallower during this period and because of the alcohol, they are probably more likely to remember their dreams and feel like they are getting less restorative sleep.

    Hope this helps to clarify.

  • Sleepio Member

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

    HI MartinaMac,

    Thanks for the question. It's a good point. The truth is that there are several reasons why we might experience nocturnal awakenings (what we call Wakes After Sleep Onset; WASO) and these are going to vary from person to person. For instance, the answer above illustrates how something like alcohol can lead to more frequent awakenings in the latter part of the night. People may also wake during the night if they have another sleep disorder, such as obstructive sleep apnoea, experience pain, urinary urgency, or for any number of medical conditions.

    For people with insomnia, it's likely that in a large part people struggle with awakenings at night do so because when they do wake they get 'stuck'.

    Most of us will experience natural brief awakenings during the night, usually at the end of a sleep cycle. For many, this is something that won't even be remembered in the morning. For others, it might mean flipping the pillow onto the cold side (a personal favourite of mine although one that invariably irritates my wife!) and simply shuffling position and going back to sleep. These awakenings are probably evolutionarily quite prudent and allow for us to “check” that the environment isn't radically different and that we can continue to sleep. What tends to happen with people who struggle with sleep, however, is that when they do wake, they are acutely aware of having woken up – something that they're already worried about before going to bed and are primed to respond to. That then may trigger autonomic arousal and frustration that then doesn't allow them to get back to sleep easily.

    For some people, this may be compounded by the fact that they have extended their sleep window too far. Let me illustrate this by way of analogy. If you hold a piece of tissue paper in both hands and begin to pull one edge further and further away from the other, you'll probably notice that tears begin to appear along the edge. This is where the physical integrity of the tissue is unable to manage the force of being pulled and so gives way. When we stretch our sleep out (i.e. by going to bed too early and sleeping in too late), in a similar way you may end up with patches of the night where the sleep is fragmented.

    The important thing to bear in mind is that sleep restriction therapy is the most effective means we know to treat this because it allows for us to get back to basics and start by ensuring a shorter sleep window is properly consolidated before gently stretching it out until our sleep need is met.

    Hope that helps!

  • Sleepio Member

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

    Hi JC51,

    Thanks for the question. I'm really glad to hear that you've made some progress with SRT and I hope the answer above helped clarify things a bit. I think one thing that I often make a point of talking out with people is the fact that SRT can take time. Unfortunately, there are no quick fixes when it comes to these kinds of things. However, sticking with the stimulus control (e.g. QHR etc.) and sleep restriction are the best ways to go about it. I also often recommend trying to integrate some of the relaxation and mindfulness-based techniques that people often report are helpful into WASO management. When you notice you have had a nighttime awakening, don't rush to see what time it is (because invariably you'll only be disappointed), instead, use it as an opportunity to do a brief mindful body scan (lots of guided recordings that can be found on Youtube) or some progressive muscular relaxation. Alternatively, you could use it as an opportunity to try Paradoxical Intention or using some imagery.

    Hope this helps.

  • Sleepio Member

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

    Hi Peter99,

    Eating is another interesting one. As with many things, invariably this will come down to people's individual preferences. I know that I don't like to eat a big meal late at night and although I absolutely love chilli/spicy food, I know that isn't helpful for my sleep either.

    By and large, my recommendations are pretty general and include avoiding heavy meals or sugary desserts late at night and perhaps having a light snack before bed if you feel you need one.

    There's a good library article here too:
    https://www.sleepio.com/search/?q=eating

    Sorry not to be able to offer you anything more concrete. I guess the best thing to do is to use the scientific method and do some experimentation to find out what works best for you.

  • Sleepio Member

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

    Hi Annah,

    Thanks for the question and for having the courage to ask it!

    Firstly it's worth being frank and acknowledging that sleep restriction gets a bad wrap! I mean, of course it does! Here we all are trying to get more good quality sleep and then CBT-I goes and tells us that we should actually be spending _less _ time in bed!? That's nonsense, surely!?

    The truth is, sleep restriction, along with stimulus control is one of the really heavy hitting treatments that we have for insomnia. It's been the subject of hundreds of robust scientific studies and has been shown time and again to produce statistically significant improvements to sleep (both quicker falling asleep and maintaining sleep) with large effect sizes (the way we measure how strong an effect is in research). In short, we know it works and we know it works well – that's why we use it.

    In terms of the theory behind it, what we're trying to do is to prime the body's own sleep homeostat (the homeostatic sleep pressure that we build throughout the day) and to use this build up to induce sleep. The truncated sleep window then allows for sleep to become consolidated – it has to be fit into a shorter period. We do this by restricting the window in which sleep can take place to the average amount of sleep that you're currently getting.

    I suppose another reason why it can be seen as challenging is because sleep restriction does often induce more sleepiness during the day. Although this can be tricky for some to manage, it's worth bearing in mind that this is what we want – this sleepiness is the homeostatic sleep drive at work and a sign of sleep pressure building. This will only serve to induce sleep more swiftly when we want it.

    Annah, it is probably one of the more tricky parts of the programme but I have faith in your ability to do it! Take it one step at a time and let us know how we can help. Trust in the science behind it!

    If you've been struggling with your sleep for a while (which is why I guess you are here) then it's worth having a go at using one of the best treatments we have, isn't it? Use the community for support too, there are lots of people doing SRT at the moment and supporting each other is an important way of helping make it easier to manage.

    Bon courage!

  • Sleepio Member

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

    Hi Maud,

    Thanks for the question. I notice that both you and Annah are still in the first stages of the programme and so it'll be important to keep going and see yourself through the course before more of the elements of the programme start to make sense.

    In terms of caffeine use – there's a great article from the library here with some useful information: https://www.sleepio.com/library/article/caffeine-and-sleep/

    If you're committed to reducing caffeine intake to zero, then it might just be a case of sticking to your guns and working through the initial difficulties – challenging as that may be for now. I suppose the main thing to remember is that any withdrawal symptoms are unlikely to persist for significant periods of time – if they do, it's worth going to see your GP again to talk this through (which it sounds like you're doing). There are no contraindications that I can see in your continuation with the programme and choosing to stop using caffeine when starting the course is probably quite a common thing for people to do, I would suppose.

    As you say, you've been struggling with stress and insomnia for two years and so although the caffeine withdrawal symptoms might be quite unpleasant at the moment, this is still the best course of treatment that can be recommended based on the clinical literature – i.e. you're in the right place! If the ice-packs work to reduce the intensity of the headaches then doing what you can to mitigate the discomfort is, of course, sensible and can be continued.

    Hope this helps clarify a bit – keep up the great work and let us know if we can help further.

  • Sleepio Member

    • 129 comments
    • 49 helped
    Expert

    Thanks everyone. Another great evening of questions and discussion.

    We'll be back again next week for another live discussion.

  • Sleepio Member

    • 15 comments
    • 9 helped
    in reply to Sleepio Member
    Graduate

    Thank you so much for your explanations. Understanding is trumping fear now, so I appreciate both your clarity and your encouragement.
    Regards to you and all the team

  • Sleepio Member

    • 15 comments
    • 9 helped
    in reply to Sleepio Member
    Graduate

    Hello Maud,
    It's nice to 'meet' you.
    I used to suffer bad headaches too. Sometimes it felt like the same one lasted for weeks and often I couldn't move. This advice sounds simple, but it worked for me:- vastly increase your water intake. How ever much you drink now, double it; drinking deliberately and regularly throughout the day. It took about a week of endless 'peeing', but then my body started to adjust and the headaches stopped. I hope it works for you too.

  • Sleepio Member

    • 8 comments
    • 9 helped
    in reply to Sleepio Member
    Graduate

    Thank you for asking this question – I am in exactly the same stage as you and could feel my anxiety building up when looking at community posts on sleep restriction. The response on the live chat was very helpful.

  • Sleepio Member

    • 11 comments
    • 1 helped
    in reply to Sleepio Member
    Graduate

    Hello Dr. Gavriloff, thank you very much for the explanation. I didn't know that waking up at the end of sleep cycles can be normal. As you said, sometimes it's natural and we don't even remember waking up but the problem lies when we wake up fully at the end of these sleep cycles and then get stuck, as you say. It helps me understand a bit more now.

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