Live discussion with Dr Dimitri Gavriloff - 25th April 2018

Dr Gavriloff will be hosting a live online discussion here on Wednesday 25th April, 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 20 Apr 2018 at 12:53 AM
  • 18 comments
  • 1 helped

Comments

  • Sleepio Member

    • 42 comments
    • 2 helped
    Session 4

    I have asked this question before – joined Sleepio in September and December through February I was getting 6 hours good quality sleep. It started to deteriorate in March. Im now down to 3 hours broken sleep and am again missing work. This pattern – being able to sleep really well in winter (I live in Ireland) but being unable to get more than 3 broken hours for the rest of the 9 months – has repeated for the last 12 years. I keep my bedroom dark all year round.

    First question: have you come across a case like this? What is your best theory?

    Second question: Im currently on a 4.5 hour sleep window but cannot get more than 3 broken hours sleep. Should I reduce down to a 3.5 hour window?

  • Sleepio Member

    • 1 comments
    • 1 helped
    Graduate

    Hello! I am interested to know what chemical / genetic factors can cause people to suffer from insomnia. I have a history of bad sleep in my family, and it makes me wonder if there's something going on on a more physical level. Would be interested to hear your thoughts!

    Thanks.

  • Sleepio Member

    • 2 comments
    • 0 helped
    Session 4

    Am interested to know do sleep problems due to menopause get better with time?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 1

    Any tips on getting back to sleep after waking up to feed an infant?

  • Sleepio Member

    • 9 comments
    • 0 helped
    Graduate

    I am approaching the end of week 3 on sleepio an my sleep has, improved ever so slightly in that time. Don't know if this is due to Amitriptyline and Zopidem off Gp or the sleepio programme. How long can I keep doing the sleepio course and should I continue with the meds at the same time. I have been reducing the meds a tiny bit over the last week but think I am already experiencing some withdrawal.

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 4

    I find it difficult to determine how many times I wake up in the middle of the night. It feels like I wake up several times and I am only awake for 5-10 minutes at a time. How should I go about recording this in the app. Many times I don't feel like I have had a restful sleep but my sleep efficiency rating is high. Thank you.

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 4

    It seems like I always get 4-5 hours of sleep. After that, it's always broken up and restless. Why is this? What are some strategies/techniques that I can incorporate to sleep through the night?

  • Sleepio Member

    • 5 comments
    • 0 helped
    Graduate

    Its hard to force myself to get up after that 15 minute window of wakefulness. How can I convince myself to get up and out of bed instead of just laying awake in bed?

  • 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

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

    Hi Zander1983, thanks for your questions.

    Firstly, I’m sorry to hear that things are difficult during this part of the year. I’ve certainly come across people whose sleep seems to change rather inexplicably as the days lengthen. As I’m sure you’re aware, there can be seasonal influences on the way we sleep due to changes in, amongst other things, natural light levels (particularly in more northerly countries where there can be quite stark summer-winter differences). More information on this can be found here: https://www.sleepio.com/library/article/seasonal-effects-on-sleep/. Keeping the bedroom dark and cool (e.g. using black out blinds, fan etc.) is a sensible approach to minimise the influence of summer seasonal changes to your bedroom (although it sounds like you’re already doing these kinds of things). Similarly, although not necessarily relevant in your case, it's important to be aware of the influence of bright blue light emitted by phones and tablets, particularly in the run up to bed.

    However, this also sounds like it’s been a pattern for a long time and I wonder whether you’ve had a chance to talk your hypotheses on what might be going on through with your family doctor/GP? Although CBT-I is recommended as the first line treatment for insomnia in American and European clinical guidance, there are other treatment options (e.g. melatonin, light therapy) that can be used alongside it and might be worth exploring with your GP.

    In terms of reducing the sleep window, we wouldn’t recommend reducing it to that degree, chiefly because of the impact that it might have on your daytime sleepiness. Sleep restriction is an important element of this treatment that has been shown time and again to produce some of the most powerful results in scientific trials. However, having said that, it’s certainly not the most straightforward element to put into practice and it can certainly take time for changes to gradually take place.

  • Sleepio Member

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

    Hi there Bex, thanks for your question. I should probably caveat my answer by saying that I’m not a geneticist (!), however there is growing evidence that genetic factors do impact upon several sleep disorders, including insomnia. As I understand it, the precise role that they play in insomnia is as yet unclear. However, simply put, it seems likely that, at least to a degree, insomnia does run in families. Epigenetic mechanisms (i.e. how genes are ‘read’ by the cells themselves) particularly in relation to sleep regulation and to dealing with stress may predispose people to developing insomnia. It’s also worth bearing in mind that sleep itself is at its core a pretty complex physiological process that interacts with other areas of our experience, such as our environment, thinking patterns and behaviours. Regardless of our predispositions there is still an important role for CBT. This is because it addresses the ways in which these various elements are getting us stuck and thereby helps us give ourselves the best opportunity to sleep well.

  • Sleepio Member

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

    Hi there Jake66, thanks for your question. Sleep difficulties during the menopause are, unfortunately, pretty common. More on this here: https://www.sleepio.com/library/article/menopause-and-sleep-problems/. It's also difficult to say whether someone's sleep difficulties will abate as they move through this period. This is particularly the case because of the level of variation in individual experiences of the menopause and the associated physiological changes that are taking place. However, it's important to bear in mind that CBT-I can still provide some really useful input here. This is because, generally speaking, when we experience sleep disturbance we quite naturally change our behaviour to address the problem. The trouble is, however, that this in itself may sometimes lead to more difficulty. A simple example of this might be going to bed early one night to ‘catch up’ on sleep only to find that we struggle to nod off and have a restless anxiety-fuelled night or instead wake very early because we've used up our 'sleep pressure' earlier in the night. Using CBT-I to boost your toolkit and give yourself the best chance of getting to sleep, despite difficult circumstances, is therefore still a good idea. The article above does talk about other treatments for sleep disruption during this period that can be used alongside CBT-I and can be explored in more detail with your GP/family doctor.

  • Sleepio Member

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

    Hi Sjs, thanks for your question. As a parent myself I’m just reflecting on my own experiences of sleep disruption as a result of having a baby joining the family. It is, of course, a time of wonder and joy but it does have its tricky elements too and sleep disruption can certainly be one of those! I suppose the main thing is to be aware of what might be affecting our sleep. For instance, is it the anxiety surrounding the expectation of being woken again in only a few short hours to feed once more? Or perhaps it might also be the ‘pressure’ of feeling the need to get to sleep quickly and make the most of that short window before the baby wakes up again. These kinds of thought patterns engender an anxiety-based response in us that means we may struggle to get to sleep because we're 'on-edge'. Finding useful and practical means of winding down can be really helpful here. This might require a bit of trial and error but it's important to find things that work for you. For instance, you could try a relaxation exercise when you get back into bed, something like a ‘mindful body-scan’ or a breathing exercise that allows you to take the pressure off the mind. Dealing with the 'racing mind'/anxiety is covered in future Sleepio sessions too, and so this is something you’ll come across with the Prof as you move through the programme.

  • Sleepio Member

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

    Hi Ritchie, thanks for your question. First off, I’m really glad to hear that your sleep is improving, even if just slightly for now, that’s great news. You’d be best off talking to your GP/family doctor about the specifics of your medication, particularly any concerns about changing dose or withdrawal. However, there’s no reason why you can’t continue with your Sleepio course alongside whatever you doctor has prescribed.

  • Sleepio Member

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

    Hi Rmaciel, thanks for the questions. I guess there are two parts to answering your first post. Firstly, it’s important to understand that all of us regularly wake up at points during the night, usually after we’re coming out of a ‘sleep cycle’. For most people, they'll nod off again almost immediately and won't have much recollection of these 'awakenings' in the morning. If these brief awakenings aren't disruptive then they're really not a cause for any concern. However if you're up for longer periods of time then it's probably helpful to record that information in the sleep diary. Estimating how many times you were awake can be difficult retrospectively but I suppose if the awakenings are roughly similar in length, you could find a way to keep a tally somehow (e.g. paper and pencil by the bed) and simply add them up in the morning and add that information into the sleep diary.

    The second point sounds like it might relate to what's termed 'non-restorative sleep'. There's more here on this: https://www.sleepio.com/library/article/what-accounts-for-unrefreshing-sleep-/.

    In relation to your second post about restlessness and broken sleep, it's difficult to say exactly why it's the case for you as an individual. There are lots of reasons why people might experience broken sleep. However, CBT-I has been shown to result in consistent improvements to sleep continuity in numerous scientific studies and is the recommended first line treatment in clinical guidance. I notice that you're currently on session 1 and consolidation of broken sleep is something that is explored a little later on in the programme through techniques that you'll be introduced to in due course. Keep up the good work and stay tuned the rest of the sessions.

  • Sleepio Member

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

    Hi Plantzp, thanks for the question. This is undoubtedly one of the more challenging elements to the programme. However, getting out of bed after 15 minutes of wakefulness (or earlier if you start to feel frustrated) is a really important part of the process of re-establishing a healthy sleep-bed association, something that often gets disrupted in people with sleep difficulties.

    I suppose there are a couple of things you can do to make things a little more straightforward for yourself. Firstly, you can make sure you’re as prepared as can be in advance of going to sleep. That means, have the whole process designed and worked out before you go to bed so that when you do have to get up you know exactly where you’re going and what you’re doing. Somewhere quiet and dimly lit, something relaxing (you might even want to practice/try it out before bed so that you know what to expect). Secondly, keep the rationale clear in your mind. This isn't about torturing yourself by kicking yourself out of bed, it's about healing and re-establishing the bed-sleep association that's so crucial to giving ourselves that optimal chance for sleep. It's a tricky business, no doubts there, but it really is worth doing and the science says so too. Keep it up, you can do it!

  • 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

    • 3 comments
    • 0 helped
    in reply to Sleepio Member
    Session 4

    Thank you for answering my questions. I really appreciate it.

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