Live Discussion with Dr Audrey Espie - 2nd April

Dr Espie will be hosting a live online discussion here on Wednesday 2nd April 7:00pm-8:30pm (BST).

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 27 Mar 2014 at 12:52 PM
  • 28 comments
  • 2 helped

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  • Sleepio Member

    • 17 comments
    • 5 helped
    Graduate

    Hello,

    My concern is around accurately recording time spent awake during nighttime awakenings and time of last awakening. I have an app I use at night, Sleep Cycle, that monitors my sleep phases. I don't ever look at the clock during the night bc I'm aware that contributes to anxiety.

    So with sleep cycle I'm estimating how long I've been awake and asleep. Sometimes the app is plain wrong (didn't record an accurate phase) and sometimes I feel that I was awake much longer than indicated.

    In recording this information in our sleep diaries, how can I be sure that I'm not overestimating or underestimating? I don't trust that the information I'm including in the diary is always accurate.

    Point blank I want to be at 90% SE consistently to add more time to my window.

    Is the sleep diary just an estimate?

    What's the most effective way to record awakenings and time without the use of a clock? Or do most people just use the clock?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 4

    Does it make any difference that I have sleep apnoea and use a c-pap machine? I find it sometimes makes a difference to how I sleep but sometimes it doesn't. Should Sleepio profiles record that kind of thing as part of the week 1 questionnaire?

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Good evening everyone. Thought I should clarify that the session was originally intended to be with Dr. Keenan but there has been a slight change of plan. Dr. Keenan won't be joining us Live but she has had the opportunity to look over some of your posts. Responses therefore will be a joint effort.

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Hi HelenW and welcome to Sleepio. It is great to hear that you are attempting progressive muscle relaxation. This technique has been around for some time and we don't think it should increase anxiety- we haven't heard of that before, wonder if they were simply referring to the fact that when you are in a more 'desperate' situation (trying to get some sleep), it can prove to be counter-productive. However you are right, it should be practiced. Practice is key to maximising the benefits of relaxation exercises. The more you do it the easier it is to implement. I would aim to practice it at a time when you know you will not be disturbed during the day time. Once you feel that you are achieving regular relaxation through this technique (decreases in muscle activity, blood pressure and heart rate) you could try implementing when in bed. There is an MPS file you can download from Sleepio that gives you the scripts for relaxation. Use these as often as you need them and remember, if you have not been in the habit of relaxing, it can take time to develop the skill.

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    A further point or two on relaxation – These techniques have been shown to work best for those having difficulty falling asleep, but may also be effective for those with sleep maintenance problems too. Given that cognitive arousal (“the racing mind”) is more common than bodily arousal (such as elevated heart rate and body temperature) in poor sleepers, relaxation techniques may directly help to quieten the mind when preparing for sleep. Relaxation exercises also help towards better sleep by giving people a skill set which leaves them with a stronger sense of being in control. Good luck with it and remember that there are resources in the library on this topic.

  • Sleepio Member

    • 243 comments
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    Session 3

    Good evening qualitynotquantity welcome to sleepio. Excellent name and this is a great question! You are right, overcoming sleep problems is not just about manipulating the length of time in bed but about improving the quality of sleep. I am wondering if you have any sleep pattern disturbances in addition to feeling you have poor sleep quality? The clinical term for problems with sleep quality in the absence of sleep pattern disturbance is ‘Non-restorative sleep’ (NRS). Results from the Great British Sleep Survey (GBSS) indicated that about 9% of poor sleepers experience NRS and it can lead to daytime distress and dysfunction.
    CBT has been shown to lead to improvements in sleep quality, post-treatment. Indeed, the Sleepio course which features CBT techniques was shown in clinical trials to increase sleep quality by 114% on average. The course does not just address sleep using sleep restriction and offers assistance by providing you with a range of cognitive and behavioural techniques to improve sleep and reduce the associated distress caused by sleep problems (for example, improving sleep hygiene, teaching a range of relaxation strategies, dealing with anxious thoughts about sleep and a racing mind, developing a bed-sleep connection). I don’t want to jump ahead and I would suggest that you take the programme week by week, learning what you can about your sleep and techniques to improve it. It is this range of techniques that help improve not just sleep quantity but sleep quality. By the time you reach SR you should hopefully be developing a range of skills to combat your sleep difficulties.

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Are there any graduates out there who would like to comment on what has been posted so far?

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Hello there PAT and welcome to Sleepio. It sounds like you also have this feeling of not getting a good enough sleep, perhaps you have frequent night time awakenings or wake up feeling groggy? It is really interesting when you start to keep a sleep diary and many people find that they are surprised by how much sleep they are actually getting. This can be one of the first aspects of the course that help people feel less anxious about their sleep. It can be reassuring to find that rather than having no sleep, you have had several hours. As you progress through the programme you will be taught a range of techniques as I have just described that will help you develop a better sleep pattern and sleep quality. I would not skip ahead and start thinking about sleep restriction just yet. Just concentrate on the sessions week by week. Please let me reassure you that there is more to Sleepio than sleep restriction and also that there is a lot of support online to help you when you get to that part of the programme. Your sleep will never be restricted to less than 5 hours (6 hours if you have health problems) and is taken from examining how much sleep you are currently getting- you should not be reducing the time you sleep but rather condensing it all into one block. This helps build sleep pressure and improve sleep quality. But, as I say, focus on each session as it comes and remember we are here to offer advice and support. Good luck!

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Hi there Caliman and thank you for this post. You have actually given me a lot of information here which is helpful. It sounds as though you are now falling asleep with relative ease but it is sleep maintenance that is the problem and you recognise that sleep anxiety is playing a part here. There are a number of things I would encourage you to continue doing. I like that you are sometimes giving up trying to sleep however it sounds as though you are then engaging in stimulating tasks and waking fully. Is it possible to have the mindset of not worrying about continued sleep, or even try the paradoxical thinking technique of trying to stay awake, but continue with low level stimulation/ relaxation during this time? We are both agreed that you might fare better if you tried not to worry about getting to sleep but instead concentrated on NOT sleeping. As the course refers to, good sleepers don't usually have to try – it just happens. By not trying too hard to sleep you may discover that paradoxically you do manage to sleep. Does this make sense? I am also wondering if you have given up on the QHR? I just ask as you have said you are reading in bed. The QHR can be difficult to implement however it is an important component of the programme. I wonder if there is anything you could do to make it easier to put this into practice. Could you have a quiet, warm and relaxed place to go that is waiting for you should you need it. Perhaps prepare if with nice lighting levels and a relaxing book? QHR is more difficult without this kind of preparation as it can feel pretty lonely sitting in a cold and uncomfortable place!

  • Sleepio Member

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

    Hi there Dr Espie,
    I do have frequent waking, and for about one in three nights I take up to an hour before I get properly asleep – I doze. I've been on low dose amitryptilene for nearly 2 years – prior to that I would find I was staying awake when I woke. I've just done my week 2 session – and have a couple of things to try – thought checker, and no alcohol within 4 hours of bed, though I only ever drink on 2 or at worse 3 nights. Everything else suggested I have already addressed- I am under guidance from my local sleep centre. I may delay any further SR -I ended up on 5.5 hours per night and gradually extended it from January onwards. I currently have 6.5 hours but have now been advised not to push it either way, until I've completed an in patient sleep study. With 5.5 hours I was something of a danger to myself and others I was so shattered, and I was signed off work for a month.

    Racing mind is certainly an issue – but when I get mega exhausted I can't even tell what the thoughts are…. Being conscious of them is a positive sign!! I'm good at clearing the thoughts – I am not dwelling on them. It's just my brain seems very hyperactive of its own accord.

    I've started the 10 minute meditations on myheadspace.com – but conk out very early on, and drift I and out of sleep -is that meant to happen?

  • Sleepio Member

    • 243 comments
    • 50 helped
    in reply to Sleepio Member
    Session 3

    Qualitynotquantity, are you saying that the meditations are simply resulting in the same outcome? You mention that 2 or 3 nights a week you doze and can take around an hour to get properly asleep. I would continue with the meditation as I assume from what you have said it is relatively new and I would persevere a bit longer.

  • Sleepio Member

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

    Hi FitNSS7 I began to use sleep cycle last summer, as like you I felt looking at the clock was counter productive. The downside was I'd occasionally get woken by my phone clattering off the back of the bed! I then bought a fitbit. It is much more accurate I find at reflecting my version of my sleep, and you wear it on your wrist, you can set the alarm remotely (it vibrates so great for not disturbing a partner) and it avoids you using a phone screen. Some nights I have been so shattered I cannot for the life of me remember how many times I woke or at what time, so if you can afford something like fitbit it's great. It also measures steps etc, great for upping the exercise. And it can show you when you do in fact get good sleep. My other half got one, for fitness and because he felt he too was having problems. However it helped him realise he was pretty much ok, and that in turn made him realise how rubbish I must be feeling when we compared.

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Hi Megan, I am sorry to hear about your broken sleep however I am glad to hear you saying that mostly, you are able to fall back asleep quite quickly. Also, it is great to hear you considering other possible reasons for feeling tired throughout the day- you are right that a number of factors may be influencing how you feel throughout the day and it will not just be down to your sleep at night time. Am I right in saying that you sleep for approximately 2 hours, waken, fall back asleep and then sleep for a another 2 hours followed by another brief awakening etc. First, I would like to reassure you that night time awakenings are very common, even among good sleepers, and most people just fall back asleep without realising that they have woken up. There are a number of things you can do to improve your sleep. A good night sleep is more likely to come if you have expended energy throughout the day as this builds sleep pressure so you might want to think about introducing some exercise to your day if you don't already do so. Alcohol and caffeine should be avoided as these can impact upon sleep quality. You mention that you mainly get up for the toilet – could your caffeine and fluid intake be reviewed? Remember to ensure that your room is comfortable and check out that there is nothing in your environment that might be waking you up. In response to your second question regarding getting sleep quality within a two hour block, the answer is yes. When we sleep we go through several stages of sleep. We get most of our deep sleep during the first third of the night as we tend to progress into deep sleep most quickly at this time. Deep sleep is our most restorative so you will be getting this during your first block of sleep. We cycle through these stages throughout sleep so you will probably also be getting deep sleep during your later blocks of sleep but not as much as you get during your first block. Deep sleep is known to be related to the amount of prior time spent awake (sleep pressure). For example, if one naps during the late afternoon for a prolonged period, the time spent in deep sleep during the subsequent night is reduced. Similarly, if one is sleep-deprived for 36 hours, then during subsequent sleep the amount of time spent in deep sleep is increased (as reward for the accumulated sleep debt). Avoiding naps and expending energy will therefore help to ensure you get this kind of sleep. I hope that is reassuring for you.

  • Sleepio Member

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

    Hi Dr Espie, probably too early to tell if they help getting off. The first night I went out like a light whereas last night involved around 45 mins of tossing/dozing. If they help in the main I suppose I shouldn't be concerned I'm not aware of what's being said!? Lack of deep sleep early in the night certainly seemsto be an issue. Comparing notes with my fitbit has made me aware that on the rare nights I sleep for 45 plus minutes without being restless early on, I feel much much better. However most nights I only appear to sleep deeply for about 30 mins in total in the first two hours in bed. I realised this one night when I woke up feeling fantastic, then discerned it was only 2am!! However fitbit showed me I had been deeply asleep for 1.5 hours non stop. I still felt the benefit the next day despite repeated wakenings after 2

  • Sleepio Member

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

    Hi Dr Espie, probably too early to tell if they help getting off. The first night I went out like a light whereas last night involved around 45 mins of tossing/dozing. If they help in the main I suppose I shouldn't be concerned I'm not aware of what's being said!? Lack of deep sleep early in the night certainly seemsto be an issue. Comparing notes with my fitbit has made me aware that on the rare nights I sleep for 45 plus minutes without being restless early on, I feel much much better. However most nights I only appear to sleep deeply for about 30 mins in total in the first two hours in bed. I realised this one night when I woke up feeling fantastic, then discerned it was only 2am!! However fitbit showed me I had been deeply asleep for 1.5 hours non stop. I still felt the benefit the next day despite repeated wakenings after 2

  • Sleepio Member

    • 243 comments
    • 50 helped
    in reply to Sleepio Member
    Session 3

    Hi FitNSS7, Thats a really valid point regarding how we measure sleep accurately. Short of going into a sleep laboratory and being monitored throughout, we have to rely on some more subjective measures. However, as we mentioned earlier, diaries are beneficial in that they train us to be aware of both when we DO sleep as well as when we don't. In most cases, unless you're using a scientific device, you will be making a guess at times but you will find you will become more accurate as time progresses. In addition, you will hopefully feel more confident about your estimates without resorting to clock watching ( which of course can be counter-productive). For now, I would encourage you to be satisfied that if you're using your clock you are working with the same accuracy each time so be confident in your guesses and see how it plays out at the end of each week – remember measures of fatigue, concentrating etc can also help you identify poor and good nights. Qualitynotquantity mentions some good points too so perhaps you would prefer to explore another device too?

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Hi Josiejo, we anticipated some questionas about clock change so thank you – the short answer is there is no strict rule about how best to manage it. You could try adjusting your sleep threshold time (time you go to bed) and your sleep wake-time by 15 minute or 30 minute increments so that it is less of a sudden change. So for example, go at 9.45 -10pm one night and then 10-10.15 the following night and adjust the wake time accordingly. As long as you keep the sleep window at the same length then you should adjust. Some people just like to go straight for the change- go to bed at the new clock time and wake at the new clock time. The body should adjust quickly. What will help is that you keep your bed time routine the same- start to wind down and this will cue your body and mind to get into sleep mode. Also, most times your anchor (or rising time) has to remain the same (due to work, school etc) thus there is little room for variability in the morning!

  • Sleepio Member

    • 243 comments
    • 50 helped
    in reply to Sleepio Member
    Session 3

    Hi animal, welcome to Sleepio. We were only discussing last week the amount of information that people may want to record at the beginning of the programme so I will take your point back.
    Interestingly, you mention that use of your c-pap results in variable sleep patterns. It would probably be helpful to you therefore to record for your own records when you use the machine and your sleep diary results for that night. I would also suggest that you show this data to your doctor when next reviewing your c-pap programme.

  • Sleepio Member

    • 243 comments
    • 50 helped
    Session 3

    Thanks everyone for posting tonight, hopefully we've managed to get through all your questions. Good night.

  • Sleepio Member

    • 17 comments
    • 5 helped
    in reply to Sleepio Member
    Graduate

    Thank you qualitynotquantity for the recommendation on fitbit and for responding My post. Cheers!

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