Live Discussion with Dr Gwen Keenan - 2nd October

Dr Keenan will be hosting a live online discussion here on Wednesday 2nd October 7pm-8pm 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 26 Sep 2013 at 9:34 AM
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  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there Reveur, that sounds like a frustrating problem! I am afraid the advice I would give to you would be to reduce liquid intake in the evening but it sounds like you find that difficult! In particular you would want to avoid diuretics; these are substances that promote the production of urine and can be found in some foods and coffee, tea and alcohol. If you are finding if difficult to reduce your liquid intake in the evening and you are experiencing the need to go to the toilet numerous times throughout the night I would advise you seek advice from your GP. However, there are other things you could try that might help limit the impact of this. Make sure you keep the lighting at a low level when you go to the toilet, ensure the house is still at a comfortable heating level and avoid turning on the television or electrical appliances. When you return to bed, if you find that sleep is not coming, try implementing a relaxation strategy or using some mindfulness techniques. I wonder if you are having any “catastrophic thoughts” about the impact of going to the toilet on your sleep patterns and if so could these be replaced with more realistic thoughts? I hope that helps but as I say, a visit to the GP might be a good place for advice.

  • Sleepio Member

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    Graduate

    Hi Pierette,
    Thanks for your question. You have done very well to improve your sleep efficiency and I am delighted to hear that you are getting solid sleep! However, I am sorry to hear that your sleep window is at 5 hours despite you extending it by 15 minutes. I can see why you must be feeling stuck. Just a recap, sleep restriction works as it helps restore normal levels of sleepiness; it increases sleep pressure and synchronises your body clock. It sounds as though your body has actually responded well to this process and this is why you are sleeping for 5 hours solidly. I wonder if you have more difficulty staying up until your sleep threshold time or do you have more difficulty waking up in the morning? It might be an idea to add the 15 minutes onto the time when you feel the strongest drive to sleep? Although we do not recommend you change the length of your sleep window until you have improved sleep efficiency, you can move it to a more appropriate time? I wonder if you think that might be helpful. Another thing to bear in mind with sleep restriction is expectations- whilst I hear that you have been doing this for several months now I wonder how long you suffered from poor sleep? It sounds as if you have made some great progress; longer, uninterrupted and more restorative sleep. Try out some of my advice and see if it helps increase your sleep window. Another point you make there is about exercise. Expending energy does help increase the drive to sleep however you should not need to take excessive amounts of exercise to feel the benefit. Maybe try implementing 30minutes to an hour of exercise a day. Do not do this close to bed time as that can actually make sleep worse! This will help increase your sleep drive and your sleep efficiency. I wonder if it might be an idea to introduce some relaxation exercises to your day so that at least you can feel you have relaxed even if you have been awake. Keep with it, you are doing well.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there,

    I am sorry to hear about these sudden jerks that are awakening you! This does sound like it is related to your anaemia and treatment for this should help. I am wondering how much of your sleep difficulties are about this symptom? Another well known symptom of anaemia is day time tiredness and this might make it more difficult for you to implement sleep restriction. We advise that for some people with medical problems, that they should never reduce their sleep window to less than 6 hours and this would apply to you. You can delay implementing sleep restriction if you would prefer though and this might be best. You can 'pause' your programme and resume the course at a later point. If you choose to do this you won't be penalised; your next session will be available for you when you choose to return, and you can either estimate your diaries for your time off, or wait an extra week to collect more accurate diaries before starting your next session.

    If possible, it is a good thing to at least keep your Sleep Diary. Your sleep pattern may be different whilst you are ill or otherwise unable to follow the course but it is still worth recording as part of life's natural variance.

    There might be other causes to your night time jerks. These can also be caused by night-time stress, anxiety and sleep deprivation. Some of the techniques you will learn over the course will have an impact on some (if not all) of these factors which might reduce these jerks. You are early on the course and there are lots of effective techniques to improve the pattern and quality of your sleep. All the best.

  • Sleepio Member

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    Graduate

    Anyone else here with me tonight?

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    Hi Adrastea,

    Welcome to Sleepio! The racing mind is a real pain when you are trying to sleep- I am sure there are lots of people on here who can empathise with that. Firstly I would like to reassure you that this will be covered in the Sleepio programme but not until session five. This program has been developed and evaluated as a structured intervention and I would advise that you stick with the programme as it is structured instead of skipping ahead. To summarise, you will learn more about thoughts that keep people awake and you will learn more about your thinking style specifically and how it keeps you awake (are you a constant planner? are you attending to every noise you hear? are you worrying about the past?). You will learn methods to cope with this including recording and checking out your thoughts, changing your thoughts, ‘putting the day to rest’, relaxation strategies, thought blocking and mindfulness techniques. These are all evidence based interventions to help you over come your racing mind. Lets not race ahead though, for just now stick to what you have learned so far. You will find that all of the techniques you learn from week to week will help. Good luck!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Klem,

    I see you are also new to the programme- welcome! What an interesting question! You are right that exercise produces cortisol. Cortisol is a stress hormone as it is released at times when our bodies are under stress. As exercise is a form of stress for the body, this hormone is released and it enables us to deal with pressures and threats. It is sometimes described a ‘fight or flight’. However, regular, moderate exercise taken during the day or in the early evening should not impact negatively on your ability to sleep at night. In fact, it should have the opposite effect and it is something that we recommend. Healthy people generally sleep better than unhealthy or unfit people. In addition, reduced levels of physical activity relate to higher prevalence rates of insomnia.

    In normal sleepers, experimental studies have suggested that exercise in the late afternoon tends to give the best benefits in terms of subsequent sleep. However studies have also shown that intense aerobic exercise too close to bedtime may actually be over-arousing, preventing the initiation of sleep. So as long as you avoid exercise too close to bedtime, keeping fit and healthy is likely to have a significant effect on your sleep. You will learn more about the various causes of poor sleep and how to overcome it over the course of the programme.

  • Sleepio Member

    • 409 comments
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    Graduate

    We have had some great questions tonight! Anyone else out there with a question?

  • Sleepio Member

    • 219 comments
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    Graduate

    Hi Dr Keenan, I am also very tired in hte day and somewhat stuck at 6 hrs with SE hovering under 90%, for several months. I experience the fatigue as being super-relaxed and floppy, and wondered if there is any particular recommended action to give myself a wake-up in the daytime, other than light, movement etc. Is there more than one kindof tiredness and do they have differet remedies?

  • Sleepio Member

    • 409 comments
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    Graduate

    We still have 15 minutes…anymore questions?

  • Sleepio Member

    • 62 comments
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    Graduate

    Thank you Doc.
    With exercise for 30 mins is it necessary to become puffed? or just increase the heart rate?

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    Hi there Sleepsound, day time sleepiness sounds like a problem for you. There is individual variabilty in how refreshed people feel after sleep and some people might feel particularly groggy in the morning and then perk up and others feel good in the morning and then slump. Typically though, the biggest predictor of day-time sleepiness is sleep quality. Our levels of wakefulness/sleepiness (and other bodily functions) are governed by circadian rhythms. These rhythmic swings occur within an approximately 24 hour cycle and regulate your body’s internal clock. Research has indicated that out circadian rhythm involves a big dip in alertness between midnight and dawn, when we need sleep the most however there is also a smaller dip in levels of alertness between 1pm and 4pm. This is sometimes referred to as the afternoon slump. Many people experience this (and that is without them implementing sleep restriction!). These factors may be adding to your day-time sleepiness. When you are experiencing day-time sleepiness try taking some light exercise or getting out into the fresh air (as you suggested!). A coffee might also help (although avoid this in the early evening onwards). Try not to nap unless you are feeling that it would be unsafe not to. The problem with napping is that you will reduce the need for sleep at your sleep window time. Introducing light exercise into your day may also help improve your sleep efficiency. Keep implementing as many components of the course as you can as they will all help improve your sleep and improve your functioning throughout the day.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi there, no you do not need to exercise until you feel puffed out however you want to be expending more energy than you usually would so you need to raise the heart level a bit over approximately a 30 minute period. This will help increase the drive to sleep.

  • Sleepio Member

    • 219 comments
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    in reply to Sleepio Member
    Graduate

    Thank you, I will keep on, My instinct would be that all fatigue is not the same though – mine feels to be in my muscles.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Sleepsound, sorry I realised I didn't answer your question fully! Sorry. I have attached an article from sleepio that explains the difference between tiredness and sleepiness and I hope that helps. There are also some conditions that can cause excess feelings of fatique such as chronic fatigue. Have you asked your GP about your feelings of tiredness?

    https://www.sleepio.com/library/article/i-feel-sleepy-during-the-day/

  • Sleepio Member

    • 409 comments
    • 91 helped
    Graduate

    Thanks for all your questions and I look forward to joining you again soon. I hope you all have a good evening.

  • Sleepio Member

    • 219 comments
    • 36 helped
    Graduate

    Thanks for sending the article. I probably have a neurological condition, but always want to maximise what I can do as there may be several things contributing.

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    I would definitely suggest you talk that through with your GP. Undertaking exercise might help you feel you are building up some strength. It is good to hear you are trying to take a proactive approach- well-done!

  • Sleepio Member

    • 219 comments
    • 36 helped
    Graduate

    Thanks for your help and good night.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    Hi!
    Since a couple of years, on and off, i expericence night “munchies”... I am more or less awake while i eat. I eat very well during the day and i dont restrict myself. Any informations about this problem? Is it consider a parasomnia, an eating disorder or more anxious in nature?

  • Sleepio Member

    • 10 comments
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    in reply to Sleepio Member
    Session 5

    Thank you Dr. Keenan,

    All of my sleep issues are related to this problem, so I will put the programme on hold for a few weeks to resolve the iron issues.

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