Live Discussion with Dr Jen Kanady - 12 May 2021

Dr Jen Kanady will be hosting a live online discussion here on Wednesday 12th May 2021, from 8.00 pm to 9.30 pm British Time or 3.00 pm to 4.30 pm 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 Jen 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 9 May 2021 at 1:10 PM
  • 16 comments
  • 1 helped

Comments

  • Sleepio Member

    • 12 comments
    • 0 helped
    Graduate

    Good evening, Dr. Kanady,
    I have a Fitbit watch, and when I look at the sleep data, I see that when I sleep less, light sleep increases and deep sleep decreases in the following nights. I thought that if you sleep less, sleep pressure increases and deep sleep increases. How can this be explained? Could it be due to a mood disorder?
    Thanks in advance.

  • Sleepio Member

    • 6 comments
    • 1 helped
    Graduate

    Hello Dr Kanady,
    I'm 73 and have recently been diagnosed with ADHD.
    I've had sleep problems since I can remember but never knew why.
    I don't want to take medication because of side effects. Can these Sleepio methods help me or is my ADHD too deeply ingrained?
    I'm so keen to find help naturally. Many thanks.

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    Dr. Kannada, could you please tell us how long it takes to establish a good bed-sleep connection if we follow the advice from Sleepio? And does it work for someone like me whose issue revolves around waking up in the middle of the night and staying awake for 1–3 hours?

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    An additional question. With 40+ years struggling with insomnia, I am hesitant to do both sleep restriction and bed-sleep practices so I’m working on the bed-sleep part first. I don’t want to face the torture of fighting to stay awake until a later-than-usual bedtime and then find myself awake for a long time knowing that I have to get up so early! Is that alright?

  • Sleepio Member

    • 64 comments
    • 18 helped
    Graduate

    I’ve just started sleep compression. My window is 1:00 AM – 8:45 AM. I’ve had two nights of 90% efficiency, but for one of those I woke up at 8:15, and got up then.

    Is the goal to decrease my SW by 15 minutes per week until I’m sleeping through the night most nights? I know the goal is to decrease until 90% efficiency is met, but so far it seems that SE is not my current problem, rather I’m just not consistent with how long I can sleep for. So for me it makes sense to aim for a SW that I can consistently fill most nights. I’m thinking 6 out of 7 nights would be reasonable.

    My sleep has been inconsistent for decades and I would like to fix that, without expecting perfection.

    I’m happily surprised at how quickly my sleep efficiency has improved with compression. Eventually my goal is to have a wake-up time of 7AM, if that matters at this point.

  • Sleepio Member

    • 394 comments
    • 125 helped
    Expert

    Hello Sleepio Community and welcome to the live expert chat. For those of you who don't know me, my name is Jennifer Kanady. I am a clinical psychologist with an expertise in sleep and am here to answer all your sleep-related questions for the next hour and a half.

  • Sleepio Member

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

    Hi Stroop,

    Thanks for reaching out and I am glad you asked this question. When looking at the output of wearable devices like the Fitbit, it is important to interpret the data with caution. First, the accuracy of these devices are tested with healthy young adults and results may not be generalizable to other populations (e.g., individuals with insomnia). Second, validation studies have demonstrated that these devices do an okay job for gross sleep estimates (e.g., total sleep time), but that accuracy for measuring sleep stages is little better than chance. Therefore, I always encourage individuals to not get too bogged down in the details of the output.

    Rather than focusing on the sleep stages, instead I encourage individuals to use these devices to look at patterns in their sleep. E.g., variations in bedtime, variations in total sleep time. Also, for some individuals, focusing on the output can make them more anxious about their sleep! It is something that happens so commonly that the sleep field has termed it “orthosomnia.”

    Therefore, taken together, I encourage people to focus on how they feel during the day rather than the output of the wearable device.

    For concerns about a mood disorder or other mental health diagnoses, it is best that you speak to your doctor.

    Please feel free to reach out with any additional questions.

  • Sleepio Member

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

    Hi Hesterclancy,

    Thanks for reaching out. Unfortunately, I am unable to provide medical advice and specific questions about diagnoses need to be addressed by your doctor. However, that being said, I can speak to your question more generally.

    The efficacy of Sleepio has never been tested in individuals with ADHD. However, the skills introduced in Sleepio have been shown to be effective in many comorbid conditions, including early work demonstrating efficacy in ADHD (https://pubmed.ncbi.nlm.nih.gov/31340804/). If you are using Sleepio and find that your sleep isn’t improving, my recommendation would be to speak to your doctor who can offer more personalized advice.

    Please keep us posted about how things are going.

  • Sleepio Member

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

    Hi Mckwag,

    This is such a great question and a difficult one to answer because it varies from person to person. Some individuals notice improvements in a couple of weeks and for others, it takes longer. Research demonstrates that the more you practice a skill, the easier it becomes/more effective it is. Therefore, my general suggestion would be to practice the skills meant to strengthen the bed-sleep connection whenever appropriate and possible. Also, yes, the bed-sleep connection also applies to middle-of-the-night awakenings. That being said, applying the QHR (quarter of an hour rule) in the middle of the night can be quite challenging. E.g., Who wants to get out of their warm and cozy bed in the middle of the night? Some things that can be helpful for facilitating this is setting up a comfy space beforehand. E.g., putting a blanket and a pillow on a couch or a chair. What also can be helpful for some folks is rather than switching rooms (which can be activating), instead moving to the bedroom floor and making that space comfortable. Also, it is important to be mindful of the activities you do in the middle of the night. Activities that folks find to be helpful include relaxation exercises or listening to music. It’s best to avoid activities that have an arousing or alerting effect (e.g., chores, paying bills, responding to emails).

    Wishing you the best of luck and congrats on getting started and putting in the work.

  • Sleepio Member

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

    Hi again,

    Another great question. Ultimately, Sleepio is a self help program and it is up to individuals to figure out the best way to apply the skills for their circumstances and life. I also want to acknowledge that sleep restriction is hard. It is the most challenging of interventions. But it is also the most powerful. Sleep restriction works because it capitalizes on the two processes that regulate sleep; i.e., it strengthens the sleep drive (builds the need for sleep) and stabilizes circadian rhythms. For some, when starting sleep restriction, things can start to feel worse before they feel better. What I usually tell people is that means it’s working! If you are feeling sleepy during the day, that means you are more likely to fall asleep and stay asleep at night. Usually, if you push through those initial weeks, things start to get better. Once you start sleep restriction, I might encourage you to use the Sleepio community for support. There are a couple of threads about sleep restriction. The live expert chats may be useful as well.

    Below are some links to library articles that you may find to be helpful:

    1. https://www.sleepio.com/library/article/sleep-restriction-putting-it-into-practice/

    2. https://www.sleepio.com/library/article/sleep-restriction-the-science/

    3. https://www.sleepio.com/library/article/i-cant-put-sleep-restriction-into-action-right-now/

    Keep us posted about how you are doing!

  • Sleepio Member

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

    Hi NicolaCat,

    Great question. For those that are unfamiliar with the difference between sleep restriction and sleep compression, here is a quick tutorial.

    Sleep restriction is what is introduced during session 3. It involves restricting the sleep window to the amount of time spent asleep and then gradually increasing the sleep window by approximately 15 minutes per week as sleep efficiency increases (the threshold in the program is an average sleep efficiency of 90%).

    Sleep compression is different. Sleep compression involves gradually decreasing the sleep window by 15 minutes every week until sleep efficiency increases (~90%). Once you hit the 90% sleep efficiency, you can either keep the sleep window as is or gradually start increasing again.

    From the sound of your question, it sounds like you are talking about sleep compression. And yes, the goal is to decrease the sleep window by ~15 minutes per week until your sleep is consistently consolidated (e.g., an average sleep efficiency of 85-90%). Then once you hit that, you can keep the window as is. Or if that doesn’t feel like enough sleep, you can start increasing again.

    I like your approach to flexibly thinking about the “rules” of these interventions. Striving for perfection can be a dangerous game and can make individuals more anxious about their sleep, which of course is counterproductive. So certainly looking to have consistent sleep for the majority of the week sounds reasonable.

    I am glad to hear that you are already noticing improvements and that all your great work is paying off!

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

  • Sleepio Member

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

    Hi,
    Thank you for your reply but I'm surprised no research has been done about Sleepio and ADHD, given that ADHD is quite a common problem. Also, as poor sleep is very often experienced by people with ADHD there may well be lots of Sleepio participants who have undiagnosed ADHD. I wasn't diagnosed till age 73!

  • Sleepio Member

    • 64 comments
    • 18 helped
    Graduate

    Dr. Kanady,

    Thank you for your reply and encouragement.

    I’m still confused about the SE rule when doing sleep compression.

    So let’s say I finish one week and my SE average is still 90%, but I got there by waking up earlier than my SW time on several nights.

    I think this suggests my SW is too long and I should be decreasing it to see how it goes? With the goal and hope being that in the second or third week, I might still have 90% SE, but am sleeping through to my official wake up time, instead of achieving high SE simply by getting up early on some days.

    So If I take my window down to 1 AM to 8:15 AM by decreasing 15 mins per week, perhaps I would be able to sleep through to 8:15 most days.

    One of my issues is alternating good and bad nights. Meaning I only really sleep well after a bad or less good night. I’m thinking here of total time asleep rather than efficiency as such. I’m trying to get to the point where I sleep more or less the same number of hours each night. Does this make sense?

    It might be a great addition to Sleepio to add sleep compression to the Prof’s toolkit. Then he could be adjusting my SW!

  • Sleepio Member

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

    Hi Nicolacat,

    Thanks for following-up and gotcha. You are right, if you are waking up before your intended rise time and are getting out of bed, your sleep efficiency will be high, which can make adjustments to the schedule confusing.

    For early morning awakenings (e.g., waking up before the intended rise time), I generally encourage individuals to play around with the schedule. If you want to sleep until 8:45, then one option would be to make the bedtime later, increasing the sleep drive, and making it more likely that you will sleep until your intended rise time. Another option is shifting the entire schedule earlier. E.g., keeping the sleep window the same, but going to bed and waking up 30 minutes earlier. A final option is to do sleep compression, but on the rise time instead of the bedtime. E.g., compress your schedule by making your rise time earlier.

    There is no perfect approach and different things will work best for different people. I usually recommend that people approach their sleep schedule with curiosity. Put on that scientist hat and run some mini experiments to figure out what works best for you.

    Also, if your sleep is quite variable, my hypothesis is that compressing the window will be helpful. E.g., as you compress the window, the more consolidated and consistent your sleep will be.

    And that's a great suggestion regarding adding sleep compression to the program and is certainly something we are considering as we continue to make improvements.

    Thanks again for following up.

  • Sleepio Member

    • 64 comments
    • 18 helped
    Graduate

    Thanks Dr. K, this helps enormously! I will let you know how it goes!

  • Sleepio Member

    • 394 comments
    • 125 helped
    Expert

    Thanks everybody for the great questions this week. I am signing off now. For any lingering questions, please take advantage of our next live expert discussion next Wednesday, May 19th.

    Wishing everybody happy and healthy sleeping!

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