Live Discussion with Dr Jen Kanady - 10th February 2021

Dr Kanady will be hosting a live online discussion here on Wednesday 10th February, 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 4 Feb 2021 at 11:17 PM
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  • Sleepio Member

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    Graduate

    Thank you Dr. Kanady! Will keep working on removing the negative thoughts!!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Maso82,

    Thanks for reaching out and I am sorry to hear that things have gotten worse. For some individuals when starting sleep restriction, things can get worse before they start to get better. It can take a while for the circadian rhythms to adjust to the new schedule. Also, one of the reasons sleep restriction works is that it increases the sleep drive -- our biological need for sleep. Therefore, experiencing increased sleepiness during the day during the first few weeks of sleep restriction is to be expected. I will often tell people that it means it’s working and if they can push through those first few weeks, things will often get better.

    That being said, increased sleepiness can make it difficult to function during the day and experiencing poorer sleep may lead to increases in sleep-related anxiety, which may exacerbate a sleep problem. For those who feel especially anxious about sleep restriction, another option is something called 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.

    Also, sometimes people find that they are more awake and activated in bed than other places in their house (even after previously feeling sleepy). This is due to something called conditioned arousal. When we worry about sleep (or lack of sleep), our brains can start to associate the bed (or bedroom, or bedtime) with wakefulness and worry (rather than sleep). This is the reason for sleep restriction and the quarter hour rule – to ensure that the time you are spending in bed is time that you’re asleep so that break the connection between being in bed and being awake/alert. For those who find the QHR rule very disruptive, I will sometimes recommend getting creative. For example, maybe try moving to the other side of the bed during awakenings, thereby keeping one side of the bed for sleep and the other side of the bed for wake.

    Finally, during session 4 and 5, you will learn cognitive techniques to help challenge unhelpful thoughts and beliefs about sleep, which can often exacerbate sleep concerns.

    Please feel free to reach out with any additional questions.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi LadyShovelHead,

    Thanks for the question and certainly a noisy environment can be disruptive to sleep. Earplugs are a great idea, but you are right, for some they can be quite uncomfortable. Some people have had luck trying different types of earplugs. Another solution that has been helpful for some is experimenting with white noise, which can help mask ambient sounds (e.g., a fan, a white noise machine). There are also curtains that can help drown out noise as well. And finally, hanging things on the wall and using rugs (if you have hardwood floors) can help reduce the echo in a room. Keep us posted and let us know if you find a solution that works for you!

  • Sleepio Member

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    Expert

    Hi LesM,

    Great question. Sleep restriction has been applied safely and effectively in those on medications. That being said, for those individuals who are taking medications, the general rule of thumb is to not have a minimum sleep window of below 6 hours. Also, while feeling sleepy during the day following sleep restriction is to be expected (see my response to Maso82 above), there are certain situations where it is important that you be mindful of how sleepy you feel to keep you and others around you safe. For example, if you feel sleepy when driving or operating heavy machinery. In those cases, the recommendation is to take a nap until the sleepiness subsides. All that being said, Sleepio is a self-help program. For specific concerns about the interaction between sleep restriction and medication use, we recommend that you speak to your doctor.

    Thanks, LesM.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Helen,

    Thanks for the great question and what a lovely example of the power of conditioning. Our brains are very good at making associations and often our pre-bedtime routine can be closely tied to sleep. Generally speaking, listening to a podcast before bed may be a great way to wind down for the night. Now, the recommendation from hardcore behaviorists would be to make sure that you aren’t listening to the podcast in bed because the bed should be for sleep (and sex) only because of that cool conditioning thing our brains do. One thing that might be helpful is asking yourself what the function of the podcast is. For you, it sounds like the podcast is a helpful distraction from racing thoughts. One idea for a substitute is applying the cognitive techniques taught in session 4 and session 5. For example, scheduling a worry time can be helpful for teaching your brain that there is a dedicated place, space, and time for worrying so that worries start to interfere with sleep less.

    Please keep us posted about how things go!

  • Sleepio Member

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    Expert

    Hi Bee,

    Thanks for reaching out. It can be so frustrating to put in the work and see your sleep start to backslide. I am sorry that has been your experience. A couple of thoughts.

    First, everybody experiences the occasional bad night of sleep, even healthy sleepers. But for those with a history of sleep problems, the occasional bad night or two or three of sleep can lead to sleep-related anxiety and a fear that the sleep problem is returning, which can then lead to more nights of poor sleep (a cycle I am sure that you are familiar with). The cognitive strategies taught in session 4 and session 5 can be helpful for challenging unhelpful thoughts about sleep. One thing that I have told patients in the past is that if they’ve tackled their sleep problem once, that means they can do it again.

    Second, sleep restriction works differently for different people. Some people see improvements in their sleep immediately, whereas others have to wait a bit longer to see an improvement. The idea is that eventually you will reach your optimal sleep window and will no longer need to restrict sleep (but can do so again if sleep starts to get worse). One thing that is helpful to maintain permanently is a consistent sleep schedule. 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.

    Below is an article that you might find to be of interest: https://www.sleepio.com/library/article/sleep-restriction-the-science/

  • Sleepio Member

    • 13 comments
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    Graduate

    Since enrolling in the Sleep program, I fall asleep with minimal problem and sleep more soundly with uninterrupted sleep. However, I usually awaken after five solid hours of sleep and are then unable to fall asleep again despite deep breathing, meditation, relaxation techniques, repeating the word “the”, etc.
    No matter what I try…. I can't fall back to sleep.
    Any suggestions?????

  • Sleepio Member

    • 13 comments
    • 2 helped
    Graduate

    Since enrolling in the Sleep program, I fall asleep with minimal problem and sleep more soundly with uninterrupted sleep. However, I usually awaken after five solid hours of sleep and are then unable to fall asleep again despite deep breathing, meditation, relaxation techniques, repeating the word “the”, etc.
    No matter what I try…. I can't fall back to sleep.
    Any suggestions?????

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Maso82,
    Your experience sounds really frustrating. It can feel quite defeating to put in a lot of great work and not see much improvement in sleep. I appreciate you taking the time to explain your situation. Sleepio is a self-help program and may not be a good fit for everybody. For those who feel like their sleep is worsening or that Sleepio isn’t helping, the recommendation is to speak to a doctor who can provide more personalized advice. Some people require a little more support than a self-help program can provide. Also, during times of significant distress or feelings of hopelessness, it can be helpful to speak to your doctor, contact your local emergency services (i.e., 911 or go to nearest emergency room), or speak to someone you trust.

    Please feel free to follow-up with any additional questions.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Caroline,

    There are some really great questions here. My thoughts are below:

    First, I am so glad to hear that sleep restriction is helping you to fall asleep faster. That is exactly how it is supposed to work. It increases the sleep drive -- the biological need for sleep -- making it easier to fall asleep and stay asleep at night.

    Second, another reason sleep restriction works is that it stabilizes circadian rhythms. Circadian rhythms, an important process for regulating sleep, love regularity and function best under stable, regular conditions. When we vary our rise times (e.g., sleeping in on the weekends), we are essentially jetlagging ourselves. Even though we aren’t traveling to a different time zone, our circadian rhythms become confused as to when we are supposed to be awake and when we are supposed to be asleep. That is why the rise time should stay the same every day, regardless of what time you fall asleep.

    Third, let’s talk about sleep inertia. Sleep is not an on-off process. E.g., it’s not like a light switch. Just like it takes us time to fall asleep at night, it also takes some time for us to wake up in the morning. Those initial feelings of grogginess upon awakening and that urge to return to sleep are totally normal and are to be expected. It is something called sleep inertia, which is the transitional state between sleep and wake. This is all to say that feeling groggy upon awakening and wanting to return to sleep doesn’t necessarily mean that you didn’t get enough sleep or good sleep, it just means that your brain needs an opportunity to wake up. Some of the best ways to push through sleep inertia is to get out of bed immediately (don’t snooze), expose yourself to bright light, and splash some cold water on your face.

    Finally, the QHR is meant to be an estimate. If you wake up in the middle of the night and are awake for 15 minutes, but feel like sleepiness is coming soon, then it probably doesn’t make sense to get out of bed. One thing that can be helpful is experimenting and figuring out when it makes sense to get out of bed for you. Also, to reduce the alerting effect of getting out of bed, some things that can be helpful is reducing movement (e.g., moving to the bedroom floor rather than a different room) and making sure the environment remains dark.

    Keep us posted about how things are going.

  • Sleepio Member

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    Expert

    So many great questions today. I wasn't able to get to them all in the allotted 1.5 hours. I have a few meetings right now, but will come back to answer the rest of your questions later this afternoon. Live chat to be continued soon …

  • Sleepio Member

    • 394 comments
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    Expert

    Thanks for your patience. I am back to answer the remainder of the questions.

  • Sleepio Member

    • 394 comments
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    In reply to a deleted comment
    Expert

    Hi onadiet,

    Thanks for reaching out and I am very sorry to hear that things have been so challenging lately. (And thank you for all that you do as a home carer). Sleep is very closely related to stress and as we all know, we are living through some pretty unprecedented and stressful times. Therefore, it is not surprising when I hear people tell me that their sleep has gotten worse during times of high stress. The good news is that treating sleep can help reduce stress and improve mental health. It sounds like Sleepio has been helpful in the past, which is great. For some, continuing to apply the Sleepio techniques can be helpful, even during times of high stress. That being said, Sleepio is a self-help program and is not a good fit for everybody. If you are working through Sleepio and aren’t seeing an improvement in sleep, you may require some additional support. A doctor or mental health professional will be able to provide more personalized advice.

    Thanks again for reaching out.

  • Sleepio Member

    • 3 comments
    • 1 helped
    Graduate

    Hi, I have aphantasia. I cannot imagine things in my mind, I cannot form images and actually 'see' them. So, imagining a thought locker, imagining clouds that float away with my thoughts, imagining a calm place etc. None of these things work for me. I can THINK of those things, but I cannot SEE them as if they are real. A lot of meditation techniques are based on visualisation. Imagine my shock when I found out that 'counting sleep' wasn't just a metaphor but people can actually see the sheep in their minds. I was always told to imagine a flickering candle during meditation, but all I saw was black. I thought 'visualising' meant thinking about something. I wonder if there are other meditation techniques than can help for people who cannot visualise things.

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Gesa,

    You are raising such a great question, the question of sleep need. We have all heard the adage that we should be getting 8 hours of sleep per night. But it turns out that 8 hours is an average and that sleep need differs from person to person. The general recommendation is that adults get between 7-9 hours or sleep and that older adults get between 7-8. That being said, there are some people that need only 6-7 hours to feel their best and there are others that need closer to 9-10. So I think your hypothesis is an interesting one. My general suggestion would be to experiment with and monitor your sleep. E.g., how do you feel when you get 6 hours of sleep? How do you feel when you get 7? 8? Etc? What sleep duration makes you feel your best and that can help to determine your individual sleep need. Also, as LadyShovelHead noted, there are other things that can also contribute to headaches outside of sleep. So paying attention to other triggers like water intake, caffeine use, alcohol use, and exercise can also help determine the root of the headaches. If this becomes a serious concern and/or for more personalized advice, my recommendation would be to speak to your doctor.

    Keep us posted and let us know what you find!

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Savannah42,

    So many things to celebrate here. First, I am so glad to hear that all your hard work is paying off and that you have been sleeping better. Second, I am happy to hear that you are finding ways to connect, even in the midst of social distancing.
    A couple of thoughts:

    It’s important to not get too bogged down in what we’re “supposed to do.” Adhering too strictly to guidelines can sometimes lead to anxiety, which as you know, can perpetuate sleep problems. So allowing some flexibility (as long as it’s not impairing sleep) is generally okay.

    In terms of what to do about a bedtime/rise time, the general rule of thumb is that it is okay to make the bedtime later, but you want to wake up at the same time every day, regardless of what time you went to bed. Keeping a consistent rise time is important for stabilizing circadian rhythms, an important process for regulating and promoting healthy sleep.

    Keep up the great work!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi JZ101,

    Your question sounds very similar to the question that Helen asked above. Please see my response to Helen for more information.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Jazzy Lady,

    It sounds like you have put in a lot of great work and done some good problem solving around this. Another thing that might be helpful is to take note of anything that might be waking you up in the middle of the night to identify any environmental cues you can eliminate (e.g., noise, temperature, needing to use the restroom). Of course, sometimes we wake up despite having a very sleep-friendly environment. It also might be helpful to pay attention to the thoughts you are experiencing when you wake up. Are you thinking about what you have to do today, are you worried about falling asleep, are you thinking about things that happened in the past. Identifying the thoughts you are experiencing can help to figure out which cognitive technique (introduced during session 4 and 5) would be most helpful. Finally, sometimes it’s helpful to experiment with the sleep schedule. E.g., does getting into bed earlier and waking up earlier help with these awakenings.

    Please do reach back out as needed.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi cookm,

    Thanks for reaching out. You are right that a lot of techniques involve visualization. But there are techniques that don’t involve visualization that may be helpful for sleep. For example, progressive relaxation introduced in session 2 can be helpful for those who feel tense before bedtime. Some of the cognitive techniques introduced in session 4 and 5 can be helpful for those who experience sleep-related thoughts. For example, scheduled worry time does not require visualization. There are also mindfulness techniques that don’t involve visualization such as the 5 senses (what do you smell right now, what do you see, what do you feel …).

    Below is a community discussion you might find to be useful:
    https://www.sleepio.com/community/discussion/meditation-and-relaxation-techniques/

  • Sleepio Member

    • 394 comments
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    Expert

    Ok, Sleepio community, I am signing off now. For any outstanding questions, please take advantage of our next live expert chat on Wednesday, February 17th.

    As a final thought, it’s really common for people with sleep problems to also struggle with low mood and depression. This is likely especially true given the number of significant stressors going on in the world. The good news is that you may notice that as your sleep improves, you feel better all around. However, if you find yourself feeling hopeless or develop thoughts of harming yourself at any point, please immediately speak to your doctor, contact your local emergency services (i.e., 911 or go to nearest emergency room), or call one of the crisis hotlines below:

    For the UK:
    Suicide Prevention Lifeline, Samaritans: 116 123
    Or chat online here: https://suicidepreventionlifeline.org/chat/

    For the US:
    National Suicide Prevention Lifeline: 800-273-8255
    Or chat online here: https://suicidepreventionlifeline.org/chat/

    Wishing everybody happy and healthy sleep!

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