Live Discussion with Dr Jen Kanady - 10 March 2021

Dr Kanady will be hosting a live online discussion here on Wednesday 10 March 2021, from 8.00pm to 9.30pm British Time or 3.00pm to 4.30pm US Eastern Time.

They will discuss as many topics as possible in the hour and a half and, as always, you are welcome to ask any questions at all about sleep or the Sleepio program. If there are a lot of questions, they may not be able to answer all in the time available, but will try to answer as many as they can.

Please do note that, as per our guidelines, Dr Kanady will not be able to give personal medical advice including those about medication. Their replies to questions will be made in such a way as to help as many people as possible who might have similar issues.

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Posted 7 Mar 2021 at 2:53 PM
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  • Sleepio Member

    • 4 comments
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    Graduate

    Hi,
    I would like to ask what is your view of shift working and sleep pattern? At least two mornings a week, I need to wake up at 5am for my work. For the rest of the week, I usually wake up at about 7am. Sometimes on my non-working days, I'm starting to feel restless about 5am, but then I am able to go back to sleep after some time.
    My sleep has improved since I started sleepio, however would shift working/changing waking time have any negative effect on sleeping.
    Thanks

  • Sleepio Member

    • 2 comments
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    Graduate

    Hi,

    Can I ask about the best way to deal with the upcoming clock change?

    Is it better to switch suddenly by the hour and continue as usual, or to switch by 15 minutes over a few weeks?

    Because I’m already changing my times so much for sleep restriction and am going to bed so much later and getting up earlier than usual, I have time to move my sleep hours around, and could start shifting my wake up time earlier until the clock change.

  • Sleepio Member

    • 5 comments
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    Graduate

    Dear Dr Kanady

    I graduated a few months ago. My sleep did improve a little from 2-4 hrs per night to 5-7. But the last 3 weeks I've nosedived again to 2-4 hrs.

    When I was on the 6 week course I found the sleep restriction caused me massive anxiety and I only started to see improvements when I took the schedule into my own hands and tried to focus on relaxing above all else. The QHR sometimes worked, but more often I wouldn't get any sleepy feeling back, despite having only had an hour or so sleep (I can always get to sleep quickly, my problem is waking in the night), and then I'd begin to panic, thinking I could hear someone in the garden, or just feeling painfully alone and like the night would never end.

    In this recent bout of insomnia I've focussed again on relaxing, meditating, keeping a quiet mind, and I've cut out caffeine, refined sugar, doing all the lifestyle stuff that Sleepio recommends. At night I try the QHR, but the times it makes me panic I go back to bed & relax. Some nights I'm getting a good stretch of 5-6 hrs in, but others I'm barely sleeping at all.

    I'm in two minds about whether I should be following the sleepio guide to the letter, despite the near panic attack state it can put me in. My instinct is telling me I need to give my method some time, to continue focussing on keeping a relaxed mind. This approach is at least keeping my daytime mood on a good level, and at night I have no anxiety or worries.

    I wish I knew why I wasn't sleeping, there doesn't seem to be a reason. The bad nights began 2 nights before I got the Covid jab. I was really anxious about it because I was on a list of people with underlying health issues, which was news to me. The health “issue” turned out to be nothing much, but maybe that stress knocked out my sleep pattern, and it's just going to take a while to get back to normal??

    If you have any thoughts on any of that, please let me know!

  • Sleepio Member

    • 9 comments
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    Graduate

    Hi, I'm just now on week 2. I suffer from sleep maintenance insomnia…no issue falling asleep, but wake after about 4 hrs on average and can't get back to sleep. I understand how the sleep restriction / sleep schedule probably works for people who awake frequently, but how does it work for people with sleep maintenance issues? My efficiency is only about 50%, but will reducing time in bed really result in longer sleep? Or am I just going to be shifting my bedtime later but still only getting 4 hrs? Does that make sense?

  • Sleepio Member

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    Expert

    Hello Sleepio community and welcome to the live expert chat. My name is Jennifer Kanady. I am a clinical psychologist with an expertise in sleep and am here to answer and and all sleep-related questions for the next 1.5 hours. Looking forward to chatting!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Massimo,

    I am sorry to hear that you have been struggling with intense dreams. During times of stress, the content of our dreams can become more distressing. For example, a study looking at sleep during COVID-19 found that people are reporting more nightmares and pandemic-related dream content during this period: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560506/.

    Unfortunately, Sleepio doesn’t target dreams or dream content. However, there is some research to show that cognitive and behavioral interventions can lead to reduction in prevalence of nightmares. Some other things that can be helpful are exercise and avoiding alcohol use before bed. If this continues to be a problem, my recommendation would be to speak to a doctor who can prescribe/administer behavioral interventions (e.g., imagery rehearsal therapy) or medications that can target nightmares specifically.

    Wishing you the best and keep us posted about how things are going.

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi again,

    It looks like Nicolacat has answered your question (thank you!). This is a text-based live expert chat. You are welcome to input your questions beforehand and I will answer the questions in the order they were received.

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi LadyShovelHead,

    This is such an important question, thanks for asking.

    It turns out that sleep need differs from person to person (with most adults needing between 7-9 hours; but some needing as few as 6 and as many as 10). So the magical “8 hours” that we are all familiar with is just an average. To figure out sleep need, I generally suggest paying attention to how you feel during the day. If energy levels are high, then you may be getting enough sleep. If energy levels are low, you are cranky, or are having difficulty concentrating, then you may need more sleep.

    In terms of when to stop increasing the sleep window, the suggestion is generally the same. There are two things that are important to pay attention to: (1) how you are feeling during the day and (2) has your sleep started to get worse? If you notice that you are starting to take longer to fall asleep or are waking up more in the middle of the night, then you may have extended the sleep window too far.

    Congratulations on your sleep; it’s always so nice to see when somebody’s effort pays off! Great work!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi PolarBearDS,

    Another great question, and yes, please check out my response to LadyShovelHead above as it applies here too.

    Some added thoughts: the sleep window (and adjustments to the sleep window) is not a one-size fits all. For some individuals, it may take a couple of weeks to reach their optimal window (e.g., not increasing the window any further) and for others, it may take a few months. Generally, if a person feels good about their schedule and functioning during the day, then keeping the window as is makes sense.

    Another thing that might be helpful to consider is experimenting with the schedule. E.g., what happens when you go to bed 15 minutes earlier and embrace the earlier rise time that is happening naturally? Or, how do you feel when you increase the window? Do you feel better? Do you feel worse? Sometimes experimentation can be helpful for figuring out what works best for you.

    Keep us posted and congrats on the great progress!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Secret Squirrel,

    Thank you for raising this as this is something that comes up often.

    Sleep diaries are designed to be an estimate and best guesses are encouraged! Insomnia and other related-sleep problems are subjective disorders. E.g., it is the subjective experience of sleep that is important. So I am glad to hear that you are not clock-watching in an effort to be as accurate as possible. When you wake up in the morning, estimating how long it took you to fall asleep, how long you were awake in the middle of the night, etc, is the perfect approach.

    Here is an article that might be helpful: https://www.sleepio.com/library/article/why-is-it-so-important-to-keep-a-sleep-diary/

    And please do circle back if you have any additional questions!

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Sylvia,

    Thanks for reaching out. And I bet that sounds awfully tempting, doesn’t it? In general, I would encourage individuals not to slip back into old habits that may exacerbate or perpetuate sleep problems. Our circadian rhythms -- an important process for regulating sleep -- love regularity. Maintaining a regular sleep schedule (even on the weekends!) is a great way to map circadian rhythms onto the 24-hour day and promote healthy sleep.

    Now, that being said, if it doesn’t feel like you are getting enough sleep upon graduating the program, the general suggestion would be to continue gradually increasing the sleep window every week. What’s nice is that you are still able to visit the Prof every week (even after graduating) to review the sleep diary and adjust the sleep window as necessary.

    Also, my responses to LadyShovelHead and PolarBearDS above might be of interest.

    Keep us posted about how things are going and congratulations on completing the course!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Ellenyork,

    Thanks for contributing to the really great questions this week. It sounds like you modified the Sleepio program beautifully. For some, some of the interventions introduced in Sleepio can elicit more anxiety, which as you noted, can make it even more difficult to sleep. If you find that the QHR is not feasible at the moment due to increased anxiety, then skipping that intervention likely makes sense. I also generally suggest experimenting with QHR. E.g., if you wake up in the middle of the night, but feel like sleep is coming soon, maybe wait a bit before getting out of bed (e.g., longer than 15 minutes). Or, rather than leaving the bedroom, try moving to the floor during periods of wakefulness (to decrease activity and subsequent alertness). Sleepio is a self-help program and it is up the individual to figure out how to best apply the interventions taught in a way that makes sense to them. It sounds like you did some really great problem solving on your own.

    Also, during session 4 and 5 of Sleepio, the Prof will introduce interventions that specifically address sleep-related worry and anxiety, which also may be helpful.

    Circle back in a couple of weeks and let us know how it’s going!

  • Sleepio Member

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

    Many thanks indeed, Dr Kanady. Your advice is very reassuring and helpful.

    I should thank Kurly too for gently encouraging me in this direction. The combination of structure, resources and support throughout these weeks is great.

    Ellen

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Olma,

    Shift work can certainly add a layer of complexity. In a perfect world, my general suggestion would be to keep the same wake time every day. E.g., if you have to wake up for work at 5:00 AM twice a week for work, that should be the rise time every day. Our circadian rhythms -- an important process for regulating sleep -- love regularity. Keeping a regular rise time is a great way to map the circadian rhythm onto the 24 hour day and promote healthy sleep. In general, I would suggest asking yourself if this rise time is practical and if so, give that rise time a try to see how that works. Now, keeping the same rise time on workdays and non-workdays isn’t always feasible due to work/family obligations. And this becomes even more complicated when people work night shifts and are sleeping during the daytime hours. So experimenting with a consistent schedule during non-work days and using light and darkness cues to promote sleep and alertness may be helpful.

    Here is an article that has more information on the impact of sleep and shift work: https://www.sleepio.com/articles/shiftwork/

    Thanks for reaching out and keep us posted!

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi EmMore,

    The dreaded clock change, something that we sleep researchers and clinicians generally dislike.

    It’s such a great question. Generally I would recommend gradually shifting your schedule before the clock change so that it is less of a shock to the system. Some tips I usually suggest are:

    1) It can help to gradually change your sleep pattern in the week before the clocks change so you’re not doing it all in one go. Over the week, shift the times you go to bed and wake up by just 15 minutes – that’s 15 minutes earlier by the way! So by the time Sunday hits, you’re already there!

    2) Respect the clock on Sunday. Avoid the temptation to lie in on Sunday morning! It’ll make the rest of your week easier if you wake up at your normal time according to the clock… even though you’ll feel like it’s an hour too early!

    3) Make the most of daylight. Natural light helps kick-start your waking process. So once you’re awake on Sunday, get out and enjoy as much of the day as you can! This will help you sleep better on Sunday night and hopefully help avoid that jet-lag feeling on Monday morning.

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Jennifer,

    I am sorry to hear that your sleep has backslid, that can be incredibly frustrating. I do want to reassure you that experiencing poor sleep during times of stress is to be expected. And for many, when the stressor is removed, sleep will return to baseline levels. So it is entirely possible that your sleep will revert back to where it was prior to these current stressors.

    I also want to point out that you have tackled your sleep once, you can do it again. You have all the skills, it is just a matter of reapplying them. If relaxation and cognitive strategies were helpful before, this seems like a great jumping off point. If that alone isn’t sufficient, then one could consider introducing additional interventions, like sleep restriction (the most powerful, yet often stressful intervention!) or QHR. For many, sleep restriction can be quite anxiety provoking and sometimes it’s helpful to creatively apply this intervention. E.g., if you aren’t comfortable restricting the sleep window, instead try keeping the same schedule every day of the week. Another option is sleep compression. Sleep compression involves gradually decreasing the sleep window rather than gradually increasing the sleep window. For example, if you are sleeping 5 hours, but are spending 8 hours in bed, you gradually decrease the sleep window by 15-20 minutes per week until you see a sleep efficiency of above 90%. E.g., week 1, your sleep window is 7.75 hours, week 2 your sleep window is 7.5 hours, week 3 your sleep window is 7.25 hours … and so on. Once you achieve the 90% sleep efficiency, you can either keep your sleep window as is or start to gradually increase it again. It’s most important to pay attention to how you are feeling during the day (e.g., how alert/wakeful you are) rather than the number of hours. While 8 hours is the typical recommendation, that need for sleep actually differs from person to person. You may find that you function just fine with 6.5 hours, for example.

    Finally, Sleepio is a self-help program. If you are finding that the interventions in Sleepio aren’t helping, then the recommednation would be to speak to your doctor who can provide personalized advice.

    Please keep us posted about how things are going and wishing you the best of luck!

  • Sleepio Member

    • 394 comments
    • 125 helped
    in reply to Sleepio Member
    Expert

    Hi SleeplessinEDH,

    Great question. Sleep restriction is intended for individuals with either (or both) sleep initiation or sleep maintenance concerns. Sleep restriction works by increasing the sleep drive -- our biological need for sleep -- making it easier to fall asleep and stay asleep at night. Another intervention that might be helpful is the quarter of an hour rule (or QHR; also introduced during session 3), which encourages individuals to get out of bed if awake for ~15 minutes to strengthen the bed sleep connection.

    Please check back in with us once you have done sleep restriction for a week or two. It is one of the most powerful interventions for sleep, but can also be one of the most challenging. So please use the sleep experts and other Sleepio community members for any questions and/or support.

  • Sleepio Member

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

    Thank you Dr Kanady. I'll stick with the rules…yes, it will nice to still be able to visit the Prof : )

  • Sleepio Member

    • 394 comments
    • 125 helped
    Expert

    OK everybody, I am signing off now. We had some really wonderful questions this week; thank you for participating! For those who have remaining questions, please check out our next live expert session on Wednesday, March 17!

    In the meantime, wishing everybody happy and healthy sleep!

  • Sleepio Member

    • 4 comments
    • 0 helped
    in reply to Sleepio Member
    Graduate

    Thank you very much for your help. I will keep an eye on how things are progressing and adapt my sleep schedule accordingly.

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