Live Discussion with Dr Gwen Keenan - 13th November

Dr Keenan will be hosting a live online discussion here on Wednesday 13th November 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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Posted 7 Nov 2013 at 5:50 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Fine. Please go ahead whenever. If it will help the others by all means.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there Marysue, it can feel like quite a shock going onto SR and implementing the QHR but it is a very effective temporary solution to a long standing problem! The first week is usually the hardest as it can take a week or two until your sleep becomes consolidates. However, by doing this you are improving your sleep pattern; you are building sleep pressure which will reduce the time it takes you to fall asleep and reduce night time awakenings and increase sleep efficiency. This might help motivate you; a published study found that those who found it most difficult in the first week (in terms of daytime functioning) actually had the most improved sleep four weeks later- stick with it. Remember to make use of the online community as well- it helps when you know you are not alone.

  • Sleepio Member

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    Graduate

    Thanks Caliman, I think some of this will help others too. I am pleased to hear you have consulted your doctor about taking sleeping pills and that you have decided to give the CBT programme a try without the use of them. As Dr Horne described a couple of weeks ago, the use of sleeping pills should not hinder the outcome of the programme overall, however it may mean that you are not having to implement aspects of the programme (eg progressive muscle relaxation) or having to persevere with the more challenging aspects of the programme (e.g SR and QHR). As sleeping pills are not a long term treatment for persistent insomnia (although they do provide effective relief from acute insomnia) you will inevitably stop using them at some point. When this happens you may experience deterioration in your sleep quality and quantity. As you will not have had to fully implement the CBT programme while using sleeping pills it could feel quite difficult to then implement. I believe you will get maximum benefits from the programme by giving it a go without the use of sleeping pills. The use of a non prescription sleep aid is up to personal choice (along with medical advice). I would be interested to hear how this helps you. I guess by implementing this just now you will not know what is working for you; the CBT or the non prescription sleep aid. If you were to implement CBT alone then you would be able to make reliable attributions regarding changes to your sleep efficiency. Attributing change to the CBT programme would mean that you have developed an “internal locus of control” (you are the agent of change) over your sleep problems which can be empowering and helpful. It would also reinforce your use of the programme and help you to stick with it. Attributing changes to your sleep pattern to the use of a sleeping aid may enhance the belief that you need to take something to sleep better. It may also mean that you do not fully implement the CBT programme and then your sleep problems may increase. Although the use of sleeping aids is very tempting as it is can seem an easier approach the evidence of it having a long term benefit to persistent insomnia is lacking. There is however ample scientific evidence for the effectiveness of CBT for insomnia.

    Week 3 is a big step however please be reassured that this is a temporary solution to your sleep difficulties- we are kick starting your sleep pattern so that you develop sleep pressure throughout the day and experience a more consolidated sleep pattern. Although it is challenging it is effective. Once your sleep efficiency improves you can start increasing that sleep window. Good luck with it.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I agree with what you have said in response to Mary Sue. I echo what she said about Week 3 being a huge change, a shellshocker if you will. We need all the help we can get since this is such a huge change and it takes time to see results. And since we are all dealing with many other things, it's hard to stay with this. We do see encouragement from others who have tried it. :-)

  • Sleepio Member

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    Graduate

    I've read in the library section of the site about larks & owls & the body clock. It seems I am extreme owl, but I want to try to change my body clock to be more “normal”. Dr.Audrey Espie previously suggested that I shift my window back by 15 minutes each week, but I'm finding it difficult for the reason I mentioned earlier (snoozing my alarm) You see, when I fall asleep, it seems I sleep very deeply, for most of the time that I am asleep, which is why I think it takes me so long to wake up.
    Is it possible to sleep deeply for most of the time that I'm asleep or is that not really possible, as the articles in the library say that deep sleep takes place in the earlier phases of sleep. Is there anything I can do to not sleep so deep, I've tried sleeping sitting up – especially if I have to get up at a specific time for an appointment & other crazy stuff but as you can imagine, this did not really help!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    “Bang On”, as the Professor says. You have stated the case for to do or not to do with regard to sleep aids very well. My doctor gave me the choice of using a sleep aid or not. I sort of came to the same conclusion as you told us here, namely, that by stopping these sleep aids, I will get a better sense of the CBT program that is not influenced by medications. I think it's a big shock to my system to make both changes at the same time, namely, no sleep aids and ramping up to week 3, but that's what I have done. Thanks for addressing my concerns in such detail.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there Ewa, congratulations on becoming a graduate- the sleepio course can be a tough course and I can see that you have tried hard to implement the programme despite having had some difficulties along the way. I really admire your determination to address your sleep difficulties and panic attacks. I am sorry to hear that you are still having difficulties however I am afraid that although the active part of sleepio only lasts six weeks, continued implementation is important. It can take time, particularly if sleep difficulties are a long standing problem. I have noticed that you are tackling a lot of things at once; insomnia, panic, reducing diazepam and underlying health problems. This can be difficult and I wonder if you are placing very high demands upon yourself. I wonder if you might want to discuss medication with your GP; I am wondering if this is a good time to start medication reduction? Any decision to make changes to your medication should be done on the advice of a medical practitioner.

    In regards to the second two points that you make, when implementing sleep restriction you should not be increasing your sleep window until you have had 7 days of sleep efficiency at 90%. When you do increase it, only increase it by 15 minutes by either going to bed 15 minutes earlier or getting up 15 minutes later. You then continue with that sleep window until you again have experienced 7 days of 90% sleep efficiency. Just to remind you, this is to consolidate your sleep pattern so that you develop a strong bed sleep connection which will improve the automaticity of sleep. Although SR is a difficult process it is effective. I understand that sleep/rest is very important to your medical condition so never restrict your sleep window to less that 6 hours and if you are implementing the QHR try and do something relaxing like reading, meditating or doing a relaxation exercise. However, if this is causing you high levels of distress and anxiety I wonder if you should try and implement some kind of relaxation exercise in bed? I think I recall you do mindfulness yoga- how about using mindfulness at these times? Or, progressive muscle relaxation? Try to reframe awakenings as an opportunity to relax your body and mind. I seem to recall that you did not think you could use QHR so make sure you discuss this with your cardiologist. In regards to falling asleep in the early evening whilst watching the television, I wonder if this is a typical pattern for you? If so, could you try and do something else at this time that is a little more active and less likely to lead to sleeping. Remember, you need to build sleep pressure to reduce the time it takes to fall asleep and to reduce night-time awakenings. Could this be a time you could give a friend a phone call, do some light housework or maybe take an evening stroll? I hope some of this is helpful to you and please do not hesitate to ask for help and support- that is why we are here!

  • Sleepio Member

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    Graduate

    I am glad that has been helpful Caliman. I think you have raised a very important topic of conversasion that was worthy of attention this evening.

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    Now for your other points, yes you are right week 3 can be quite a change and you have obviously had a tough time with a sleep efficiency of 50% however this will get better as you build sleep pressure, reduce time to fall asleep and reduce night time awakenings. The more that you have good quality consolidated sleep the better you will feel and the stronger your bed-sleep connection will be. In general improved day time functioning lags a week behind your improved sleep efficiency so stick with it. So, now onto week four. There are a few new concepts introduced and it sounds as if you are feeling a bit overwhelmed by all of this new information. I would view week four as the time when you equip your toolbox! You now have a range of techniques to draw upon to help you cope with your cognitions and anxieties about sleep as well as tools to help you get to sleep. In regards to which tools you use, well this is about personal choice and what you feel contributes to your sleep difficulties. In week four, intrusive thoughts are discussed. Some people find that they are kept awake by planning and problem solving thoughts, others suffer from heightened awareness of their mind, body and the external world and others may become preoccupied with thoughts about getting to sleep. If you are someone who gets preoccupied with thoughts about sleep (e.g. “I really must get to sleep otherwise tomorrow will be a nightmare”) then paradoxical thinking can work very well. If you are someone who cannot stop planning for the day ahead, then a combination of “putting the day to rest” and mindfulness might be very helpful. Maybe you just can’t stop thinking about the past or the future- if so, thought blocking might be best. It is about reflecting on your own cognitive and behavioural processes that contribute to your sleep difficulties and then selecting and trying out the tools that might help. You do not have to use every one of these tools but you can try them out and see what works best for you- I would be interested to hear how you get along- good luck.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there, I am just preparing an answer for you but I wondered if you had read the following article in the library about deep sleep.

    https://www.sleepio.com/library/article/deep-sleep/

    Are you feeling sleep deprived? How did you get along with moving your sleep window back? I wonder if what you are actually experiencing is non restorative sleep and that is why you feel drowsy in the mornings? Stick with me while I prepare an answer addressing your points!

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    Could you tell me a little more about your current sleep-wake cycle?

  • Sleepio Member

    • 21 comments
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    Graduate

    Hello,
    I graduated a few weeks ago and although I am now falling asleep much more quickly than I ever used to and generally only waking up briefly in the night, I still often wake up very early (4:30 or 5:00 am), not every day but often enough. I also never feel as though I have slept deeply and rarely wake up feeling rested. I am using a lot of the techniques taught throughout the course, which I've found really helpful, and I'm still sticking to my sleep window, and I generally feel very positive about the course. But I would like to feel more rested, like people who sleep well seem to. I've had one really really good night's sleep which made me think that that's what good sleeping is all about but I haven't had a repeat night like that! Should I just accept that this is the quality of sleep I have, or is there something else I could do to improve the quality of my sleep? Or is it a matter of just a bit more time? Thanks.

  • Sleepio Member

    • 409 comments
    • 91 helped
    Graduate

    Hi there,
    You have raised a few points there. You are right that you go through sleep cycles of which deep sleep is a part- I hope the article I have shared with you is helpful. You have the most deep sleep during the first third of the night. I am wondering if you are still in this stage of sleep when your alarm goes off? If so, then focussing on sleep restriction and shifting your sleep window will help. You need to try and expend energy throughout the day, and avoid napping etc throughout the day. Maybe revisit earlier sessions to ensure your sleep hygiene has not slipped and that you are addressing the lifestyle factors and environmental factors that contribute to poor sleep. Once you have set your desired sleep window you should try and stick to it. This sounds very difficult for you as you have identified yourself as an extreme night owl! Although pressing the snooze button is incredibly tempting it is not in anyway helpful. I wonder if you could try getting out of bed and going straight for a shower to waken yourself up? Some people find implementing exercise at this time works well. Have you considered using a light box or making sure you get up and have your lights on- light can help shift our daily rhythms and for some this can really help. It sounds as if you are fighting against your biological clock and resetting it will take some persistence but this is do-able.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I don't feel tired until after 3am at the earliest (which i think is linked to being abused as a teen, as it always happened after 3am) So my “normal” bedtime is usually to try to go to sleep any time between 4.30am-6.30am (but sometimes, like the past few months it can be much later than 6am) Sometimes it takes ages to fall asleep but a lot of the time I don't actually get into bed until I'm actually dozing at my desk so it does not take too long to fall asleep. Then I typically wake up between 2.30pm – 5.30pm depending on the time I actually fell asleep (sometimes it can be much later, like the past few months because I'm not falling asleep untill between 9am-11am)

  • Sleepio Member

    • 24 comments
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    Graduate

    I am not even aware that I'm snoozing my alarm when I'm doing it, that's why it's so frustrating when I'm actually wake enough to realise that I've snoozed it

  • Sleepio Member

    • 409 comments
    • 91 helped
    in reply to Sleepio Member
    Graduate

    Hi there Jenny, I am glad to hear you have improved your sleep and have found the sleepio course helpful. That is a shame that you are feeling as though your sleep is not as restorative as you would like. I agree that this is early days for you and you will need to carry on implementing the techniques from the course to see continued improvements.

    To improve sleep efficiency it is helpful to do as you suggest and continue using sleep restriction along with the other techniques. Do not increase your sleep window until you have had 7 days of sleep efficiency at an average of 90%. This does sound challenging but it is effective.

    It might be helpful to keep in mind also that the more you build sleep pressure, the more likely you are to fall asleep quickly and experience the deep sleep which is through the first third of your sleep.

    I wonder if using some cognitive techniques (thought checker) might help improve the way you feel about your sleep and day time functioning. Keeping in mind that you will have slept deeply as you had no awakenings during the first part of your sleep might help. I wonder also if you are comparing how you feel with how you think others with good sleep feel.

    It sounds as though you think that they must all feel super refreshed when actually day time sleepiness and especially the afternoon slum affects everyone (good sleepers too!). Is there anything you could add to your day to help you feel more refreshed- a brisk walk, a swim some yoga?

  • Sleepio Member

    • 409 comments
    • 91 helped
    in reply to Sleepio Member
    Graduate

    It does sound as if you have turned night into day here- I can see why you consider yourself an extreme night owl! You are also linking this pattern to past trauma and I wonder if you have considered seeking help for this? Unfortunately sleepio is targeting sleep and I cannot explore this other issue with you however it might well be worth accessing some support for this- it might help with your sleep difficulties too. I would go through each session of the course again- it sounds as if your sleep routine has slipped a bit- this can easily happen but can easily be fixed- remind yourself of the early parts of the course and then get back onto sleep restriction. I hope that my earlier comments and advice might help you get up when the alarm goes off- getting up and staying up will help you feel more sleepy come the evening. Maybe you could timetable your day with activities and tasks to keep you going and then implement a good winddown routine an hour or so before bed?

  • Sleepio Member

    • 409 comments
    • 91 helped
    Graduate

    I am afraid the hour is up! Thanks to all who joined me and for all your questions and comments. Good night.

  • Sleepio Member

    • 24 comments
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    in reply to Sleepio Member
    Graduate

    Thanks for your help. I'm going through CBT & will soon start 1 on 1 councilling, so hopefully these together with sleepio will help. Thanks again for your help

  • Sleepio Member

    • 258 comments
    • 63 helped
    in reply to Sleepio Member
    Graduate

    Hello, Dr.Keenan,

    Just re-read your two long posts to me, and wanted to comment on the second one. You were very good about the first one, sleep aids, and as I said, I decided to give it a go without any sleep aids, so I could better see how this programme works for me and feel more in control. I know this will benefit many of the others.

    On your second comment, thanks. You have done a very good job of reiterating intrusive thoughts and describing the tools to deal with them. This is the hard part for me, and I see that it will take some practice. I am near the end of week 4 and see that while I am having some success with these intrusive thoughts, I don't seem to have a system for when to use them. So far, it's been more experimental on my part.

    Clearly, thoughts about planning, the future and the past, and anxiety about sleeping are all going on and here it will help the others as well as me if you say more about this.

    Planning thoughts don't arise that much now, and I am not sure why. I don't think meditation has a lot to do with it as I have always practiced meditation when I could not sleep. The schedule does force me to put the day to rest rather than just going to bed right away and maybe that helps a bit. The best thing for me is just to get out of bed before I start to ruminate about this, hence the QHR.

    Thinking about the past and the future can also be alarming. Sometimes I have dreams about this. I know from my meditation practice that there is no past and no future, just right now. So, maybe these thoughts are not that important for causing me not to sleep. I do practice thought blocking when just about any unwanted thought pops into my head, even though I will not learn more about it until this week (5). I tell myself to Stop!

    Finally, there's my anxiety about not getting enough sleep. I am aware of this so it's the most real of the three intrusive thoughts for me right now. I see that paradoxical thinking is called for here. That's rather difficult to introduce as there is not much guidance about it either in the library or by the community. But I think I “get it” that when these thoughts arise while I am in bed, I tell myself that the best way to deal with them is to get out of bed, rather than stay in bed and ruminate about it. I also have used humor to try to tell myself to lighten up. If that's it, then I am doing it.

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