Live Discussion with Dr Gwen Keenan - 11th December

Dr Keenan will be hosting a live online discussion here on Wednesday 11th December 7pm-8pm (GMT).

She will discuss as many topics as possible in the hour, starting with the most popular questions with answers being given in a way to give the most benefit to the general Community.

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+ post a question or comment ahead of the discussion, by clicking the blue ‘Add a comment’ button; or
+ vote on other people’s questions, by clicking the blue ‘Yes’ button underneath the relevant comment.

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Posted 5 Dec 2013 at 4:05 PM
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  • Sleepio Member

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    Graduate

    Good evening everyone. Nice to be here tonight. I hope you are all doing well. There are a few questions posted already so I will start working my way through them.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there, it can feel hard to resist a nap- especially when you have not slept well the night before. The problem is that napping contributes to poor sleep at night time (when you should be sleeping). Unless it is absolutely essential that you have a nap (for example if you are about to do some driving but feel exhausted) then you should avoid napping. What we want to do is expend energy throughout the day to increase sleep pressure. This will then help you both fall asleep and stay asleep at night time. The more that you can do that, the more your bed-sleep connection improves, the more your sleep quality improves and over time your sleep quantity will increase. At the moment you are on session 2 so as the course goes on you will get more support with this but some tips just now would be to try and get some fresh air when you feel tired throughout the day, increase the light levels if you can, participate in a light activity, phone a friend, take a walk etc. Maybe you can identify times you are most at risk of napping (for many this is in the afternoon after lunch time) and schedule in an activity at this time. Maybe you could evaluate your sleep related thoughts- when you want a nap do you become preoccupied with thoughts of sleep or maybe you start to think that you “must” sleep. Can you reframe these thoughts or maybe distract yourself from such thoughts? The benefits of giving up napping will come in the form of improved night time sleeping. This will then reduce the desire to nap. It will take some effort initially but sleepio is here to provide you with tools and support.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there, sleep restriction is a challenging component of the course and well-done for all the effort you have made so far. Please be reassured that many people find it difficult to start with however improvements to your sleep efficiency should be noticeable soon. Sleep restriction squeezes out all periods of wakefulness from you bed time so that you i) build sleep pressure and ii) increase sleep efficiency which then iii) strengthens your association between bed and sleep. I think this night time sleepiness is very understandable while you are on sleep restriction; you have built sleep pressure and are therefore feeling sleepy tired when you go to bed. It is a shame that are not falling asleep when you go to bed and I imagine this is to do with having a history of sleep problems and a weak association between bed and sleep- you may even associate bed with feelings of anxiety and wakefulness. It might be helpful to try implementing a relaxation exercise when you go to bed? How about using the thought checker? Are you having negative thoughts about sleep that are creating anxiety? Can these be evaluated and reframed? I am a big fan of mindfulness- have you tried that? I would stick with the sleep window for a little longer and try out some of my suggestions. It is possible to push your sleep window back a little but you might find that it is very difficult to get up at such an early hour. Persevere- although this is challenging it is a fundamental and effective component of the sleepio program. Good luck.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi AnneZ, this is a very interesting and highly relevant point that you raise. I think you are looking to open up discussion rather than asking a specific question here. When we refer to something being “psychological” we mean something arising within the mind or being mediated by mental (thought) and emotional processes and Cognitive Behavioural Therapy is a treatment that works upon psychological processes; it is a psychological therapy. You are absolutely correct in your observation that there are psychological factors underlying and influencing the development and maintenance of insomnia. In addition to these psychological processes insomnia can sometimes occur due to some organic, physiological process or disease such as neurological conditions or hormone problems. For most cases of insomnia however, psychological processes will play a role in the maintenance of the problem. So, for example, someone might have a physical problem that triggers insomnia. This then causes anxiety and stress which make the sleep problem worse. As this increases, someone might try out a range of coping strategies to overcome the problem such as napping throughout the day. This increases the problem and the bed-sleep connection reduces. This causes many negative thoughts about sleep, heightened anxiety and poorer sleep. You can see here that insomnia triggered by a physical problem can then become a psychological problem impacting on thoughts, emotions and behaviours. The professor has carried out an abundance of research examining the psychological processes that predispose a person to insomnia and the processes that maintain the problem. You are right in thinking that this is likely to differ between people and the sleepio program or Cognitive Behavioural Therapy for Insomnia should help people develop an awareness of their own thoughts and behaviours that influence their sleep difficulties and also provides a range of tools to help overcome these.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there, sorry I missed this question there! I think this is okay as long as it is not disturbing your sleep. If this is something that you find helps you fall back asleep and you are not lying in bed awake for more that 15 minutes then I think you have found a useful strategy that works for you! My concern would be that the radio might interfere with subsequent sleep so make sure the volume is down low or can you have it on a timer?

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there, welcome to sleepio! These are fantastic questions and they will be answered over the course of the programme so don’t worry and try not to race ahead- you have a few weeks before sleep restriction starts. I am not sure exactly what you mean by severe bedroom anxiety however. I am wondering if this is something that has occurred due to your sleep problems? Many people find when they have had sleep problems that they become anxious about the thought of going to bed- lying awake all night can be a very unpleasant experience and can result in anxiety about going to bed. The sleepio program aims to address such difficulties using a range of cognitive behavioural techniques (e.g. addressing sleep hygiene, evaluating thoughts and strengthening the bed-sleep connection). These techniques will help you with your bedroom anxiety. Sleep restriction is the part of the programme where we try to consolidate your sleeping time into one sleep. The purpose of this is to increase sleep pressure and to consolidate sleep time to the time you are in bed (therefore reducing the amount of time you are lying in bed awake). It should be done in your bedroom so that we are redeveloping a more healthy and good quality sleep routine. The professor will recommend a sleep window to you on the basis of your sleep diary information however it can be adjusted to suit. The most important thing is that the amount of hours recommended is stuck to. I won’t say anymore as we really are skipping ahead- just focus on the session you are on. Every session is helpful. Best of luck!

  • Sleepio Member

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    Graduate

    Hi there Dr. Gwen!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks for your comments and questions Jim- I too get the professors voice in my mind!

    It is great to hear that you are trying hard with the programme and using it as a set of tools to help overcome your difficulties with sleep- this is an excellent approach as different tools help different people so it is good to test them out and find your unique “tool box”. I am glad to hear that “putting the day to rest” has been helpful- it is great when a relatively simple strategy helps. It would appear however that your planning thoughts have been replaced with a preoccupation and anxiety about sleep itself. May I reassure you that this should improve overtime as your sleep naturally improves as you continue to implement the programme. Having said that I would hope we can find a way to help you manage these feelings. I have heard people saying similar things about the “thought checker” in therapy- many people find it very helpful when they have identified their unhelpful thoughts however they do not always feel that they benefit from the new, more accurate thought. Sometimes it is difficult to emotionally connect with the new thought, especially when you might have spent many years with the old thoughts! It might be helpful to not only reframe the thought but to also think about the evidence you have for and against the old thought and the new thought. This might help you recognise the new thought as being more accurate. Of course, that kind of thinking is probably a day time activity so maybe note down the thoughts and spend some time evaluating their validity throughout the day. This might improve your connection with your new, reframed thoughts.

    For some people mindfulness is an effective way of dealing with negative thoughts. I think it is great to hear you are working on implementing this throughout the day as to get the full benefit from this approach it is about changing your mindset. As you will know, mindfulness is about being in the present moment, experiencing what is there without judgement. This mindset can help one deal with negative thoughts as you learn to accept them for what they are (just thoughts) and let them pass without letting them impact on your emotional well-being. Implementing a mindfulness meditation in bed might help reduce anxiety about getting to sleep as you take in the present moment, keeping your mind focussed on the present moment and letting thoughts come and go.

    My understanding of paradoxical thinking is that you use it when you would typically be trying to get to sleep. Instead of trying to get to sleep you say to yourself “I will stay awake”. This paradoxical thought then reduces anxiety. It sounds as though you have given it a good go however you are not finding it helpful- that is okay- perhaps that tool is not for you.

    It might be helpful to continue practicing progressive muscle relaxation as it sounds that this has been helpful for you- it is great to hear that this has induced sleep for you. The more you practice it the better you will get at it so I would keep going with this one. You state that you don’t always think it helps the racing mind- I wonder if you had tried repeating the word “the”- a thought blocking technique?

    You make a final point about wondering whether you are overthinking which tool to use- I think that is a great insight. It is easy to become preoccupied with sleep and how to “fix” it when you have been deprived of it however this can make the problem worse as you devote more attention to the problem. A slogan I use with parents who are having difficulty managing their children’s problematic behaviour is “Whatever you focus on grows.” Obviously you are not participating in this parenting program however I think this has relevance- you can imagine how sometimes we focus on a problem and it becomes bigger in our minds and we devote more attention and behaviours to the problem. How about focussing on what is going well? Devote your attention to what has worked, what you enjoy, the time you have slept and see if that helps at all. These tools are all designed to help however they can coexist with other skills or tools you already have. I do hope this has been of some help to you! These tools alongside the other elements of the program (sleep hygiene and sleep restriction) should start to make a difference soon- it can take time to overcome long standing difficulties so stick with it. Your commitment to the course is impressive- well-done!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi, I thought I was all alone tonight! How are you?

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Enjoying your responses. I know that Mushmellowstar posted a more detailed question re: the bed anxiety on another expert thread which doesn't seem to be in use at the moment and I'm not sure M is online. Would it be too bold of me to repost it here? Perhaps I'll just mention to M to repost for next week.
    Angie

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Anna, I am sorry to hear that- please try and have some self-compassion- it is not easy suffering from poor sleep and managing a working day. I wonder what we can do to help you. It is difficult getting out of bed during the winter. Could you maybe organise a warm place that you can go to when implementing QHR? Maybe have a duvet set out on the sofa? That way the trip out of bed will be a little more pleasant. It might be an idea to have a recap of each session and see if there is anything there you can use? Although I understand your need to call in at work today trying to keep your day time routines going is important as the more energy you expend throughout the day, the more sleep pressure you develop and the more likely you will sleep. It might also be an idea to review your medication with your doctor and ensure you are taking them as prescribed- your doctor can advise on this.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I think that might be a good idea to mention it to M. I wonder if you could convey the gist of what was posted maybe it is something I can help with?

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Sorry, I had not noticed you had posted this extra comment on your bedroom anxiety. It sounds as though you have been struggling for quite a while with poor sleep and now have developed a range of habits that have offered some help but that are maybe not long term solutions! I think it would be a good idea to implement this programme in the bedroom. This programme directly addresses this kind of anxiety therefore I think it will be very helpful for you (and your partner!) You are on session one just now so as I said, take it one week at a time, learning about your sleep difficulties and developing tools to overcome them.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    okay the gist of the post was being terrified of the bed and being able to fall asleep only on the couch
    Angie

  • Sleepio Member

    • 409 comments
    • 91 helped
    Graduate

    That is time up already- that hour flew by! Quiet this evening- thanks for joining me Angie! I am not scheduled to be on until after Christmas so I hope you all have a lovely festive season and wishing you all good health and good sleep in 2014!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks for that- that sounds really difficult! I think the recommendations I have made should help but I do hope M gets in touch next week if needs be. Good night.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks you too Dr. Gwen!

  • Sleepio Member

    • 344 comments
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    Graduate

    Thanks Angie for rallying for me. I was at the hypnotherapist and could not make it. =(....The Dr. managed to address the issue on where the sleep restriction should take place, but unfortunately still not sure how to handle my situation in the mean time. I would like to fast forward to sleep restriction week. I feel like I am just hanging on in the meantime. Need to know HOW to start addressing the bed anxiety issues. Thanks Angie and Dr. Gwen.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    This was a fantastic post. I have read it many times and each time I see something I missed. This is what I really like about Sleepio. The willingness of these experts to “go the extra mile” with us and help us. I hope what she said helped each of you. Good Night!
    Sleep Tight! Don't Let the Bedbugs Bite! :-)

  • Sleepio Member

    • 25 comments
    • 8 helped
    Graduate

    Thanks, Dr Gwen, for the informative response to my question on the psychological aspects of insomnia. I'm sorry I missed the Live Chat, I had intended to join in but something came up and I missed it, but I think you covered everything there.
    The info is very useful,
    Anne

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