Live Discussion with Dr Jen Kanady - 12th August 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 12th August 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, 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.

To keep up with new comments as they are posted you will need to refresh this discussion page.

To do this

On PC hit CTRL and R keys or the F5 key
On Mac hit CMD and R

Posted 7 Aug 2020 at 5:49 PM
  • 30 comments
  • 0 helped

Comments

Show older comments
  • Sleepio Member

    • 2 comments
    • 2 helped
    Graduate

    Hi. I am about two weeks into the SR phase and doing reasonably well. My sleep has been consolidated, I go to sleep relatively quickly most nights. I am now sleeping about five hours per night. The SR has had the beneficial effects of making me so tired that I love to get in bed for sleep and will sleep if I can avoid doing things which interfere with that.

    My sleep problems have been long-standing. I have been good at keeping myself awake. Churning thoughts, such as politics or a difficult interaction during the day, have been a problem for me in the past. Also problematic for me has been thoughts associated with planning for the next day or having to do with complicated projects. Recently, however, my chief impediment to sleep has been heightened awareness, mostly having to do with body tension. I have found, for myself, that techniques and strategies involving thinking about how my body feel, are not helpful, at least when II am trying to fall asleep. These include progressive relaxation and breathing exercises. I do these but just not in my winding down phase or when I am actually in bed.
    I find that mild whole body activities such as gentle balance exercises or walking works well for me to put me in a reasonable frame of mind for falling asleep. I hope this is helpful to somebody.
    One question for the Professor. Is insomnia partly a side effect of the human capacity for recursive thinking?

  • Sleepio Member

    • 376 comments
    • 120 helped
    Expert

    Hello Sleepio community!

    Welcome to the live expert chat. My name is Jennifer Kanady. I am a clinical and research psychologist with an expertise and interest in sleep. I will be here for the next 1.5 hours to answer any and all sleep-related questions. Let's get started!

  • Sleepio Member

    • 6 comments
    • 0 helped
    Graduate

    Another question…I'm almost 2 weeks into the SR phase and not doing great. I'm still waking up too early and can't get back to sleep. It's later in the night, since my bedtime is later too, but I don't see much improvement in staying asleep.

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi Gail18,

    Thanks for reaching out. Early morning awakenings can be very frustrating and are often related to differences in circadian rhythm timing. Some people are ‘night owls’ and prefer to go to bed and wake up later and some individuals are ‘morning larks’ and prefer to go to bed earlier and wake up earlier. Differences in circadian rhythms can become problematic when our circadian clock doesn’t align with our social and work obligations.

    In terms of how to combat early morning awakenings, your intuition is great. Circadian rhythms are very responsive to cues in our environment, especially cues of light and darkness. Light therapy is a great way to ‘entrain’ or train circadian rhythms. Notably, the efficacy of light therapy is more robust for ‘night owls’ or delayed sleep phase disorder. However, some evidence demonstrates that light therapy can also be helpful for those ‘morning larks’ or those individuals who wake up earlier than they want to. One thing to keep in mind is that the timing of light is important. For those with early morning awakenings, bright light exposure is generally recommended during the afternoon/evening hours.

    Some other things that can be helpful for early morning awakenings is sleep restriction (e.g., going to bed later often leads to sleeping in later) and keeping a regular schedule. Regular bedtimes/rise times, regular meal times, and regular exercise times are also great for entraining circadian rhythms. Combining light therapy and Sleepio techniques can be helpful for those with early morning awakenings.

    For more information about light therapy, please check out this Sleepio library article: https://www.sleepio.com/library/article/what-is-bright-light-therapy/

    For more specific questions and personalized advice, my recommendation would be to speak to your doctor.

    Please reach back out and let us know how you are doing -- wishing you the best!

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi Joan,

    Thanks for your question. Talking or crying out during sleep is fairly common and these instances typically happen during transitions between the different sleep stages. Causes of sleep talking are not well understood, but some research demonstrates that there may be a genetic component. Sleep deprivation, stress, and poor sleep hygiene have been found to increase the likelihood of experiencing parasomnias (e.g., unusual behaviors during sleep). Sleep talking is usually not disruptive for the individual, but can sometimes be disruptive for bed partners.

    For more information about sleep talking, please check out this resource: https://www.sleepfoundation.org/articles/sleep-talking#:~:text=Sleep%20talking%2C%20formally%20known%20as,rare%20and%20short%2Dlived%20occurrence.

  • Sleepio Member

    • 2 comments
    • 0 helped
    in reply to Sleepio Member
    Session 2

    Hi Doctor, I am in a weird situation at night that I feel tired, yet I can't fall asleep. It seems like I am anxious, and my heart is pounding. What could be the potential problem?

    Besides, one of my friend recommend me the Isotonix TurnDown, which contains vitamins, amino acids and minerals. It claims it is good for relaxation. Should I take it?

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi Sleepy82,

    Thanks for your question. You are definitely in the thick of it. Sleep restriction is hard, especially during the first couple of weeks. The reason that sleep restriction works is that it increases sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night. I usually tell people that if they feel sleepy during the day, that means it’s working! However, the benefits of sleep restriction can take awhile to kick in. And unfortunately, everybody responds to sleep restriction differently and there is no way to predict how things will look for you in a couple of weeks. For example, for some, sleep restriction can actually increase anxiety and make initiating sleep harder (which is the opposite of what we want to happen!). In those cases, I sometimes will recommend sleep compression. Sleep compression is 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 the sleep window again. The important thing to pay attention to is how you are feeling during the day rather than how much sleep you think you “should get.” 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.

    My general recommendation is to stick with the sleep restriction program as much as possible. Generally, if people can push through the first couple of weeks, sleep restriction typically gets easier. However, it is important to note that Sleepio is a self-help program and only you know what makes the most sense for you and your functioning during the day.

    For more information about sleep restriction, you can check out these two Sleepio articles:

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

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

    Please feel free to reach back out and let us know how you are doing.

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi Junjichu,

    Unfortunately, I am unable to provide medical advice and I would suggest speaking to your doctor before starting a new treatment (even if it is over the counter). Generally, my recommendation for determining whether something is efficacious is to take a look at the research. Has research been conducted on the product/treatment? Who conducted the research? Was there a peer-review process? Was there a control group and if so, what was the control group? What were the outcome measures and how were they measured? Questions like these can help inform whether something is effective or not.

    But again, please consult your doctor for more personalized advice.

    Wishing you the best!

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi SLEEPMORE99,

    I am sorry to hear that you are struggling. It can be really frustrating to put in the effort and not see an improvement in sleep. Also, it sounds like you are not alone in experiencing poor sleep during a heatwave. Please see my response to Katecelyn above for recommendations about how to sleep during a heatwave.

    In terms of what you are experiencing in your legs, unfortunately, this is difficult for me to diagnose without more information. As such, I am unable to provide medical advice and my recommendation would be to ask your GP if he/she can refer you to a sleep specialist.

    If it is restless leg syndrome, generally treatment will consist of medications (generally for more severe RLS) and lifestyle changes (e.g., avoiding caffeine/alcohol/nicotine use, exercising regularly). For more information about restless leg syndrome, please check out these Sleepio resources:

    https://www.sleepio.com/library/article/what-is-restless-legs-syndrome-rls/

    https://www.sleepio.com/community/discussion/does-restless-leg-syndrome-keep-or-wake-you-up-dur/

    Research has demonstrated that the cognitive and behavioral techniques used in Sleepio are helpful for treating insomnia in individuals with restless leg syndrome. However, if you are using the Sleepio interventions and are still struggling with sleep, you may require more personalized care. Again, your GP or a sleep specialist will be able to provide you with more personalized advice.

    Please reach out with any additional questions.

  • Sleepio Member

    • 4 comments
    • 1 helped
    Session 5

    Hello,
    thanks for your reply above.
    As I mentioned, I'm week #1 in the SR program…

    This is a stupid question … in the SR program, there are different times set aside to “finish off work”, “relaxation and wind down” “pre-bed tasks” prior to getting into bed. All of these stages seem to amount to a total of 4.5 hrs.

    I'm getting wrapped up with each of the stages beginning and ending and what is done during each … can I just consider the entire 4.5 hours as a form of “pre-bed relaxation” and not get wrapped up in the individual stages?

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Thanks for the suggestion, NetteC!

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi bkleene,

    Thanks for taking the time to outline your experience and the modifications to the Sleepio program that you have found to be helpful for you. I imagine that many will find this information to be informative.

    In terms of your question, you have great insight. Insomnia is closely related to hyperarousal, which can take many forms (e.g., worry, anxiety, recursive thinking, tension). More specifically, insomnia exhibits a bidirectional relationship with hyperarousal in that the more hyperarousal we experience, the worse we sleep and the worse we sleep, the more hyperarousal we experience. The good news is that treating sleep can often result in decreases to hyperarousal.

    Again, great insight and thanks again for taking the time to highlight your experiences.

  • Sleepio Member

    • 28 comments
    • 3 helped
    Graduate

    Hi
    How does the Sleepio program target insomnia with Restless Leg Syndrome?

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi again Sleepy82,

    Thanks for following up and I am sorry to hear that you still aren't seeing much improvement in your sleep. Please see my response to your first question above, which speaks to some of these points.

    An additional thought is that sometimes adding additional interventions to Sleepio can also be helpful. For example, adding light therapy, regular exercise times and meal times, and energy generating activities during the day (e.g., exposing oneself to bright light, exercising, socializing) can also be helpful for further improving sleep.

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi again Junjichu,

    Please see my response above regarding the use of Isotonix TurnDown. I am unable to provide medical advice and my general recommendation is to speak to a doctor.

    In terms of feeling tired, but experiencing symptoms of arousal once getting into bed -- this is actually quite common. Many times when people find that they are becoming more awake and activated as bedtime nears (after previously feeling sleepy), it can be 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). In session 3, you will be introduced to sleep restriction and the quarter hour rule. These techniques 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. In sessions 4 & 5, you will also be introduced to cognitive techniques that can combat arousal at night. Progressive muscle relaxation (introduced in session 2) can also be a helpful tool.

    For additional resources that may be helpful, please click on the links below:

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

    https://www.sleepio.com/library/article/why-you-should-do-nothing-but-sleep-in-your-bedroo/

    It can definitely feel frustrating and challenging – I hope with some time, and sticking as closely as you can to the program guidelines, you’ll notice improvements.

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi SLEEPMORE99,

    Great question. Sleepio was designed to address sleep problems and sleep problems are often comorbid with other medical and mental health disorders. So while Sleepio was not designed to target insomnia symptoms comorbid with restless leg syndrome (RLS) specifically, the interventions in Sleepio may still be helpful for those with insomnia symptoms and RLS. However, it is important to note that some individuals may benefit from modifications to the Sleepio program and Sleepio is not a good fit for everybody. For concerns about Sleepio suitability, please check out our suitability page (https://www.sleepio.com/suitable/) or speak to your doctor.

    I also found an article about RLS that may be of interest to you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805158/

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi LillyBet,

    Not trivial at all! It is understandable and relatable to miss engaging with a behavior that you enjoy. My general recommendation is to continue engaging with stimulus control and keeping the bed and the bedroom for the S’s only -- sleep and sex. It sounds like you are well versed in the importance of the bed-sleep connection and that connection is especially important for those who have sleep problems (e.g., individuals without sleep problems may be able to read in bed without a problem, which can be especially frustrating!). For those who have noticed marked improvements in sleep, my general suggestion is to keep doing what you are doing.

    Now if you want to experiment with this a bit, one thing you could consider is gradually add reading in bed back to your routine and keep track of any changes to your sleep. E.g., if you notice your sleep getting worse, this may suggest that you may want to permanently eliminate this behavior. I usually recommend that people play around and experiment to figure out what works best for them.

    Please do keep us posted and good luck!

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi Katecelyn,

    Oh geez, sleeping during a heatwave can be quite difficult. The recommendations I generally provide are probably things that you have already thought of yourself. For example, wearing layers to bed and keeping layers on the bed (so you can add and remove layers throughout the night as appropriate). Portable fans and air conditioners can also be helpful as can cool compresses on the forehead and chest. Also, some devices that were developed to combat hot flashes during menopause can also be helpful during heatwaves (though, these devices can get quite pricey). I also generally suggest avoiding alcohol use before bed to help better regulate core body temperature.

    In terms of tracking sleep during a heatwave, my general suggestion is to use “best guesses.” Sleep diaries are meant to be approximations and are meant to capture the subjective sleep experience. I tend to encourage not getting bogged down in the details and recording sleep in a way that rings true to you.

    Wishing you cooler nights to come!

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    Hi BarbCK,

    As I mentioned in my response to Sleepy82 above, sleep restriction can be quite hard! Especially during the first couple of weeks. The reason that sleep restriction works is that it increases sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night. So when people feel sleepy before the prescribed bedtime, that means it’s working and that it will likely be easier to fall asleep upon getting into bed. The first couple of weeks are the hardest, but sleep restriction tends to get easier as time goes on. And remember, your current sleep schedule is temporary. As you start to sleep better, your bedtime will gradually move earlier.

    To keep perspective, I like to remind people that when they start a sleep program, they have typically been struggling with sleep for months or even years. Two to four weeks of sleep restriction -- compared to months and years of sleep problems -- is just a drop in the bucket and the effort will pay off in the long run.

    As sleep restriction is fairly new to you, please do reach back out if you are continuing to struggle or if you have additional questions or concerns.

  • Sleepio Member

    • 376 comments
    • 120 helped
    in reply to Sleepio Member
    Expert

    BarbCK,

    Thanks for following up and there are no stupid questions! And absolutely, your creative problem solving sounds like a great idea! Sleepio is a self-help program, so it is up to individuals to figure out how to best apply Sleepio techniques in a way that works best for them. The only thing I generally suggest is protecting the hour or so before bed for a winddown routine. E.g., do something relaxing and enjoyable in dim light conditions to help prepare the brain and body for sleep.

    Congratulations on getting started and keep coming back with any and all questions!

Return to top