Live Discussion with Dr Gwen Keenan - 8th January

Dr Keenan will be hosting a live online discussion here on Wednesday 8th January 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 30 Dec 2013 at 5:40 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I am sorry to hear that- I hope this information makes you feel more hopeful. It is good to hear that you are progressing through the programme. It sounds as though you have some anxieties about how much you can improve your sleep? If you have a look at some of the articles in the sleepio library you can find out more about the evidence base for this programme. To summarise, research has shown that long-term sleep problems are helped most effectively by Cognitive Behavioural Therapy (CBT). The Sleepio course, which is grounded on scientifically-sound CBT techniques, has been shown in trials to reduce, on average, the time taken to fall asleep by 50% and reduce time spent awake during the night by 60%,over a six week period in a group of long-term poor sleepers. Perhaps most importantly, the Sleepio course was also shown to improve how participants felt during the day e.g. in terms of improved energy, mood, concentration and social functioning.

    CBT for insomnia has been tested in the same way as medicines have been tested, using what are called randomised controlled trials, or RCTs for short. An RCT provides proof that something works when compared with control conditions. RCTs are important to ensure that people didn't get better just by chance, or because of the placebo affect. There are well over 100 published RCTs ofCBT treatments for poor sleep. It is important to know that CBT has been tested and found to be effective with men and women, young and old, with poor sleep that has gone on for years, and even decades, and even in poor sleep that is associated with medical or psychiatric disorder. It has been found that approximately 70% of people make a good clinical response; this means that their sleep problem has reduced by at least half of its severity, or has gone completely by the end of the treatment. Also, many studies have been conducted to see if treatment effects are enduring … and they are! There are many scientific reviews summarising just how effective CBT is for poor sleep, and it endorsed by authoritive bodies such as NICE in the UK and NIH in the US.

    The notion of being “cured” is quite a subjective experience and it might be helpful to reframe this expectation as you progress through the course. If you have had sleep problems for a very long time then it might be unrealistic for the sleep problem to go away completely after a short period of time. However it would not be unrealistic to expect some improvements. As you continue to implement the programme, the improvements should grow and your expectations about getting better might change again. Sometimes, long standing problems do take more time to improve however stick with it and you should continue to see the benefits. Good luck with it!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I started changing my schedule during weeks 1 & 2 so 3 & 4 wouldn't be so hard. After botching my first night on SR, I did quite well the second night – which was last night.

    I managed to get to sleep at 12:45am (goal was 11:30pm) so it seems I am going to be able to change my sleep time frame better than expected. (fingers crossed since it's only been one night)

    Writing down WHEN to do things (active/earlier) and paying attention to the clock for my evening wind down was helpful.

  • Sleepio Member

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    Graduate

    Dr. Gwen, thanks for that info. If you get a chance, what are some of the reasons that account for the 30% failure rate to your knowledge? Is it from “cheating” or are some people just not “curable”??

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    In response to your second query, sleep restriction is a challenging component of the course however it is also a fundamental component that has been proven to effectively kick start an improved sleep routine. It must be frustrating that you got off to such a great start with it and then you have had a more unsettled week! Variation is normal at the beginning of sleep restriction; you have had an unsettled sleep pattern for a long time therefore it can take some time to redevelop a more predictable routine- you will get there though! One thing you have described is that you have been napping; did you do this on the weeks when you slept well? It can be very difficult to resist a nap when you have not slept well however a key part of sleep restriction is that we want to build sleep pressure; this will help reduce the time it takes to fall asleep, improve sleep efficiency and subsequently improve your bed-sleep connection. Napping in the morning and in the evening will reduce sleep pressure and impact on sleep efficiency. So, let’s have a think about what you could do to avoid napping. It might be an idea when you waken at the end of your sleep window to get some bright light (this helps promote wakefulness) and then take a shower. Maybe get outside for a short and brisk walk? In the evening is there anything you could do? Perhaps you are getting a little too comfy on the sofa- maybe try and maintain an upright posture, phone a friend if you feel tired, get up and walk around a little. I would try and think of as many things as possible that you could do to avoid that nap and build sleep pressure. Most people begin to see improvements in their sleep efficiency after a few weeks and an improvement in day-time functioning approximately one week later- even those with long standing difficulties. It sounds as if you have been worrying that the programme will not work for you given your earlier question; this belief may have had an impact on your motivation to fully implement all aspects of the course. As I said earlier, CBT for insomnia is the first line treatment for chronic insomnia with an evidence base demonstrating its effectiveness so stick with it! Long standing problems can take time to overcome but you will see improvements. Remember to make use of the online community here too as it can be tough when implementing SR.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    That is an interesting question and I will have to look that up- I am not sure what the characteristics of those who do not do so well are. I can say though that it would be very premature to put yourself in that category- stick with it!

  • Sleepio Member

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    Graduate

    Dr. Gwen, I do use a light box every morning for at least an hour. I actually started resting my eyes during the second week of SR, even when I was sleeping decent! I just suddenly found myself SLEEPY tired versus my usual WIRED tired. It was so hard to handle. And I have never been able to nap and all of a sudden it was all I could imagine doing! I know, bad bad! I'm doing better this week. No naps.

    I have faith this will work, there is just always that little birdy that chimes in when I have a bad night that says you are part of the 30%. I'm using thought checker to work on that! It's just frustrating when an improvement is seen initially and then it's taken away after 3-4 long, hard weeks!

  • Sleepio Member

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    Graduate

    Dr. Gwen,

    My last question for this chat was about reading at night. (Not in bed) It is post #14 on this list, when you get the time. Thanks :)

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Andy, happy new year to you too! I am afraid that this question relates to a number of medical issues and I am not a medical professional but a clinical psychologist. I would suggest that you discuss with your GP the difficulties you are having with the CPAP. Sorry that I cannot be of more help in relation to this issue!

    In regards to your question relating to a possible neurological cause for your sleep problems, it is possible that there is a neurological or physiological factor underlying your sleep problems however sleep problems are best understood within a psycho-physiological model. How we think, feel and behave can impact upon our sleep and our sleep can impact upon how we think feel and behave; the mind and body interact. In many cases of insomnia, it might have been triggered by 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.

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    Oops- sorry! I think you are absolutely right that many TV dramas or films are highly stimulating and books can be very relaxing! Reading is a great activity and many people find that reading helps them to unwind so don’t give this up! What is important here is that it is not done in the bedroom. Reading as part of your wind down routine sounds like a really good plan and it is great to hear you are thinking about this. If you have a look at my answer to Dion earlier I have summarised the reasons for not participating in any activities in bed (other than sleep and sex) and if you look up the following link it will explain the reasons in more detail. It is all about redeveloping a strong bed-sleep connection.

    https://www.sleepio.com/library/article/the-bed-sleep-connection-the-science/

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I really do empathise with how you are feeling and I do believe it will get better. For another bit of encouragement and to help with positive thinking- in a published study it was found that the harder people found it in the first few weeks the better their subsequent improvements in sleep- no pain, no gain!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thank you!

    I just wanted the “seal of approval” from one of the doctors because in session 3 with the Prof it said reading during wind down time was a mental activity and a no-no. It didn't specify in or out of bed. I do better unwinding when it gets closer to bedtime if I turn off the TV and read a novel.

    I was already very good about not doing anything but sleeping in my bed/bedroom so that aspect is not a problem for me.

    Thanks for the answers. :)

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Simon and welcome to sleepio. I have read both of your comments here and that sounds like a distressing phenomenon for you. Hypnagogic hallucinations are vivid, dreamlike experiences that occur around sleep onset. Some people can also experience what is known as hypnopompic hallucinations which are similar phenomena that arise in the morning when awakening. Do you think this is what you are experiencing? It sounds as though you feel you are awake when you experience these images. I would recommend that you discuss this with your GP to rule out any physiological cause for these images. The CBT programme will provide you with a number of tools that I think will be helpful for this. You are on session 1 just now and I do not want you to skip ahead so take each session as it comes and I think you will find some helpful tools. You have already identified that nicotine may play a role in these hallucinations and lifestyle factors will be addressed in the following session- I wonder if you can identify any other potential lifestyle factors that might be influencing the occurrence images? It sounds as though you get very anxious about these images and some of the techniques you will learn later on such a progressive muscle relaxation and mindfulness might be beneficial to you. In addition, the thought checker which will be introduced during your next session might help you deal with any anxious thoughts you have in relation to these images and your sleep more generally. You have said that you worry that you are going crazy- that must create a lot of anxiety and that will impact on your ability to sleep. I wonder if you can reframe your thoughts about these images to something that creates less anxiety. As I said though, you are on week one just now so let’s not race ahead but please keep me up to date with how these tools help with these images.

  • Sleepio Member

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

    Thanks for your helpful input this evening. Yes, Fibromyalgia and sleep disturbance co-exist and there is a lot of research going on just now in this area. Pain when trying to fall asleep can disrupt sleep and then lack of sleep can heighten pain sensitivity (even in those with out chronic pain conditions!) Research indicates that CBT techniques can help both sleep and pain perception in those with insomnia and poor sleep.

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    Hi there, and welcome to Sleepio- I hope that my comments on Fibromyalgia, sleep and CBT have been helpful for you too!

  • Sleepio Member

    • 344 comments
    • 79 helped
    Graduate

    Dr. Gwen, for what it's worth -- you have totally regained my confidence. Thank you so very much.

  • Sleepio Member

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

    Hi there, I am not sure what it is that is causing this experience although it sounds something like a hypnic jerk although these tend to occur as we fall asleep. They are more commonly reported in people with irregular sleep patterns. I am not sure that this would be related to feeling dehydrated however it might be worth while keeping yourself hydrated as thirst can cause us to awaken. It sounds as though this is causing you distress and impacting on your ability to get back to sleep and I would look to the tools described in sleepio to help overcome this. I wonder if you could try and implement a relaxation strategy once you have awoken or maybe try some mindfulness? Remember to implement the QHR too- if you lie in bed awake and feeling anxious for long periods you will come to associate your bed with such feelings. If you have been lying in bed for about 15 minutes, get up and leave the room, do something that you find relaxing and return to bed when you feel sleepy tired. I wonder if this experience will reduce as your sleep efficiency improves.

  • Sleepio Member

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    Graduate

    Hello everyone just popped in to say hello will read the q/a later xx Andy

  • Sleepio Member

    • 409 comments
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    in reply to Sleepio Member
    Graduate

    I am glad to hear that. It is difficult to see the positive side of things sometimes and when we feel down our attention can become biased to the negative. I hope this confidence helps your motivation and helps you to see the progress you have been making.

  • Sleepio Member

    • 409 comments
    • 91 helped
    Graduate

    That is all for this evening- another quick hour with lots of interesting questions! Good night.

  • Sleepio Member

    • 874 comments
    • 209 helped
    Graduate

    Thanks Dr keenan, from us all

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