Live Discussion with Dr Jen Kanady - 13th November 2019

Dr Kanady will be hosting a live online discussion here on Wednesday 13th November, 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.

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Posted 7 Nov 2019 at 6:25 PM
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  • Sleepio Member

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    Graduate

    I entered the program end June, so, I graduated quite some time ago. When I started I had been sleeping between 1 ½ and 3 hs for a very long time, rarely, out of exhaustion, would I sleep some more. I never took any medication [prescription or otherwise] and already followed CBT-I recipe for lifestyle, bedroom & etc. [ exercise daily, no alcohol, no smoke, coffee in the morning, tea early afternoon], no health concerns.
    I’m an academic translator, very used to reading papers and research, so I was aware of the importance of sleeping [specially at my age, 66], but also of the fact that I was building a kind of conditioned reflex of dread approaching bedtime. It was not easy, but I managed to challenge the negative thoughts around my lack of sleep and it helped a little, but the sleep restriction was a game changer. Even if it was not easy to stay awake up to 11:30,it didn’t cost me because I was beyond hope and I jumped to sleeping a solid block of 6 hs. Then, I started earning more time which I seldom managed to fill, I went on regressing consistently and now I seem to be stuck in 4 hs. I am an extreme lark, but I trained my mind to be awake because I was a classical musician and I had to perform. For that reason, the 15 min rule doesn’t work for meat all, once I’m up, that’s it: I’m wide awake. As far as I remember, I follow the pattern of waking up in the middle of the night, staying awake in bed for quite some time, than sleeping again. Of course, this a window where any problem will fit and keep me awake for good, but right now it is not the case. I fall asleep easily when I go to bed and wake up around 2:30 [not even Sleepio expects one will get up that early]. Should I go back to the sleep restriction and, if so, what should be the time frame? By the way, I’m not a natural short sleeper. I only feel really good in the rare occasions when I sleep 7/8 hs.

  • Sleepio Member

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    Expert

    Hello Sleepio community,

    I am happy to be back as your live sleep expert! For those of you who don't know me, my name is Dr. Jennifer Kanady. I am clinical psychologist with an expertise in sleep. I am here to answer any and all sleep-related questions for the next 1.5 hours.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Terry17,

    That sounds really frustrating. Not only are relationship difficulties and household responsibilities incredibly stressful, they can also impact your sleep. Unfortunately, I am unable to provide any advice about how to navigate your relationship with your husband. One thing you could consider is speaking to a mental health professional or someone you trust about these current stressors. Please feel free to reach out with any additional questions.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Sun6,

    Thanks for your question. The sleep and anxiety relationship is a tough one! As I am sure you have experienced, anxiety makes it difficult to sleep and not sleeping well exacerbates anxiety. The good thing is, research demonstrates that improving sleep can help reduce anxiety symptoms.

    I see that you are on session 3, which means you have a lot to look forward to! The content of session 4 and session 5 specifically addresses anxiety that interferes with sleep. One technique that I have found to be helpful for others with anxiety is “scheduled worry time.” The idea behind this technique is that you set aside 30 minutes in your day to worry. You write all your worries down for these 30 minutes. Then, once the 30 minutes are up, you are finished worrying for the day. Then, when you wake up in the middle of the night and start worrying, you can tell yourself either (a) “I already worried about that earlier” or (b) “I have time scheduled to worry about that tomorrow.”

    Another thing that can be helpful for anxiety in the middle of the night is sleep restriction. Sleep restriction increases the sleep drive, which makes it less likely that you will wake up in the middle of the night. By reducing nocturnal awakenings, you are also reducing the anxiety that comes up during nocturnal awakenings.

    Please feel free to reach back out with any additional questions.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Is it possible for me to see Dr. Kanady's answers to the questions posed? I think I can learned from those questions and answers. If so, how do I do that? Many thanks.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Tica,

    All my responses will appear at the bottom of the page (not under the questions asked). If you refresh the page, you should be able to see my answers as I post them. I hope this helps!

  • Sleepio Member

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    in reply to Sleepio Guest
    Expert

    Hi Jacquie,

    Great question and absolutely! The term for this is “sleep state misperception.” Sleep state misperception is mistakenly identifying periods of sleep as wake.

    In terms of your sleep diary, this tool is meant to be an estimate and doesn’t have to be exact. The sleep diary is a subjective measure and is supposed to be filled out as such. Therefore, your best guesses for when you are awake and when you are asleep is perfect.

  • Sleepio Member

    • 9 comments
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    in reply to Sleepio Member
    Graduate

    Hi Dr Kanady, I have been progressing well on sleep restriction, however I've not been able to function properly in the day taking until mid afternoon to wake fully. Very frustrating. I,ve been able to extend my night to 10.45pm but frustratingly have woken to go to the loo around 3.45am and not been able to get back to sleep again. Have you any advice for me please? should I get out of bed for 15mins like is advised when you go to bed, and then try again?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Pitt,

    Thanks for your thoughtful responses to Jacquie’s question above. I agree that the Fitbit can be a useful tool for filling out the sleep diary. The one caveat I would add is that I typically encourage people not to hyperfocus on the numbers provided by these consumer wearable devices (e.g., Fitbit, Apple Watch). While they do a decent job estimating gross sleep parameters like sleep duration, the research indicates that they aren’t very accurate for identifying wake in the middle of the night and sleep stages. So, while I absolutely think that these devices can be helpful tools, I would also suggest that individuals take their output with a grain of salt. Also, for some individuals, focusing on sleep estimates provided by consumer wearable devices (e.g., Fitbit) can actually make them more anxious about their sleep. I am very glad to hear that you are not one of those individuals!

    I hope this is helpful.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for the recommendation, Leejohn.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Tim,

    Thanks for sharing your experience. Falling asleep during the wind down routine is actually quite common (especially if you are applying sleep restriction!) and your description of this experience as a “vicious circle” is apt. This is a great example of a vicious cycle that we are trying to break, which will give way to better sleep.

    For individuals who struggle to stay awake until their prescribed bedtime, I usually recommend that they engage in less relaxing activities as part of the wind down period. For example, if you enjoy watching television as part of your wind down routine, try watching television sitting on a stool rather than the couch. Or try pacing the room as you watch T.V. You could also incorporate other activities into your wind down routine such as light household chores or speaking to a partner/friend/roommate either in person or on the phone. Anything that isn’t too stimulating, but that will help you to stay awake to your prescribed bedtime.

    Another option would be to shift your sleep schedule to be a bit earlier. But this would mean shifting your rise time too. For example, if your current sleep window is midnight to 6:00 AM, you could switch this window to 11:30 PM to 5:30 AM.

    I would encourage you to play around with these ideas to figure out what works best for you.

  • Sleepio Member

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

    Hi prak72543,

    Such a great question, thank you for asking! Sleep restriction is a hard tool to implement, especially if your schedule fluctuates due to classes, work, or social obligations. The general rule of thumb is that you want to keep your rise time the same, regardless of what time you go to bed the night before. Maintaining a consistent rise time can be very challenging at first. But the more you wake up at the same time every day, the easier it gets. Your circadian rhythms eventually learn that this is the time that you are supposed to wake up!

    That being said, it is also important that you are kind to yourself. Everybody slips up and sleeps in! Even sleep experts! If you accidentally sleep through your alarm, my general recommendation is to do your best to get back on track the next day. The more you stick with it, the easier it gets.

    Please let me know if I can be of further help.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Rose53,

    Thanks for your message. It is clear that you are well versed in healthy sleep habits and are doing a lot of really great things!

    It sounds like sleep restriction worked really well for you initially. The tricky thing about sleep restriction is knowing when and how to adjust the sleep window. My general recommendation is to keep the sleep window the same if (a) you are feeling better during the day (e.g., more energy) or (b) if your sleep problem starts to return. Given that sleep restriction worked for you in the past, reimplementing sleep restriction might be a helpful technique to get your sleep back on track. I generally recommend that individuals start with a 6 hour time in bed window. If you are filling that window with sleep (e.g., a sleep efficiency of 90+%), then you can add 15 minutes to either side of the window for the following week. If you start to notice that you are sleeping worse, then keeping the window the same or decreasing the window by 15 minutes can be helpful. Also, the timing of the sleep window is up to you. As you noted that you are a morning lark, you may want to consider an early but reasonable rise time.

    Also, light and darkness cues can be helpful for early risers. Maintaining dim light conditions when you want to be asleep and bright light conditions when you want to be awake is a great way to train your circadian rhythms!

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Olga,

    Thanks for the question. Nocturnal awakenings and daytime fatigue can be very frustrating. A couple of thoughts:

    I am glad to hear that you are progressing well with sleep restriction. One thing that can be tricky is knowing when to stop adjusting your sleep window. My general recommendation is that you keep your window the same if you notice your sleep problems starting to creep back in. For example, if you noticed that you are waking up in the middle of the night and can’t return to sleep, then you may want to keep the sleep window the same or consider decreasing the window by 15 minutes.

    For those nocturnal awakenings, your instincts are correct! If you are unable to fall back asleep within 15 minutes, then the general recommendation is to get out of bed, do something relaxing, and only return to bed once feeling sleepy. This way, you are teaching your brain that the bed is a place for sleep (and not wakefulness!).

    In terms of daytime fatigue, some things that can be helpful for combatting fatigue are exposing yourself to bright light (preferably sunlight) and exercise. A quick walk outside can be just as effective for increasing energy as a coffee or nap.

    Please feel free to reach out with any additional questions.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    Hi Dr. Kanady,
    I'm fairly new to the program, having just completed Session 2. Hearing about sleep restriction is bringing up some questions – I understand the general concept, but haven't “gotten there” yet. My question is, with respect to the above answers regarding sleep restriction, how long do we have to continue with sleep restriction? I'm sure this is different for each person, but is this something that I may have to do long term? Or do we hopefully find that sweet spot and not have to worry about it?
    Thanks so much!
    Alice (RPdd)

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Alice,

    Welcome to the program and great question!

    A quick sleep restriction tutorial:

    Sleep restriction is one of the most powerful tools in your sleep tool box. The general idea behind sleep restriction is that you reduce your time in bed to the actual amount of time you are spending asleep. You do this by establishing a regular sleep window and every week, you adjust your sleep window depending on how well you slept the week before. Sleep restriction works because (1) it increases your sleep drive, making it more likely that you will fall asleep quickly and sleep through the night, (2) you reteach your brain that the bed is for sleep only, and (3) you establish a regular sleep/wake schedule, which is a great way to train your circadian rhythms.

    In terms of your questions:

    You are absolutely right! Everybody adjusts to and applies sleep restriction differently. Some individuals are able to reach their optimal sleep window within a couple of weeks and other individuals need more time. However, it is important to note that achieving your optimal sleep window (e.g., sleeping well, feeling better during the day) doesn’t mean that you can revert back to old habits! The idea is that your optimal sleep window is your bedtime and rise time moving forward. Most people focus on the amount of sleep they get. However, regular bedtimes and rise times can be just as important. Maintaining a regular bedtime and rise time is one of the most powerful things you can do for your sleep and circadian rhythms.

    You have a lot to look forward to! Please do reach out if you have any additional questions once applying sleep restriction in session 3.

  • Sleepio Member

    • 4 comments
    • 2 helped
    in reply to Sleepio Member
    Session 5

    Dear Dr Kanady,
    Thank you for your message and advice!
    If I were to go drinking and clubbing on an occasional night (once a month) and get up the following morning at my rising time would this be suitable? I am desperate to improve my sleep but I do not want to miss out on a memorable university experience, I am torn between the two and would be grateful for advice on this matter.

  • Sleepio Member

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

    Hi again, prak72543. That is the general rule of thumb.

    However, it is important to note that Sleepio is a self-help program and it is up to users to figure out what makes the most sense for them. For example, if maintaining your rise time following a night of clubbing is going to result in significant sleep deprivation, you could also consider sleeping in a bit. You know your brain and body best! My general recommendation is to stick to the prescribed sleep window as best as possible while also listening to your body. For example, I usually tell people to stay in bed longer when they are sick.

    Sleep restriction is not meant to be a party pooper! It is up to you to figure out how to best make sleep restriction work in your life.

    I hope this helps clarify things a bit.

  • Sleepio Member

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

    Hi Krystin,

    First, I am so happy to hear that you have been working with your doctor and have noticed a reduction in your hypervigilance. That is so great and it’s nice to hear that all your hard work is paying off!

    Second, unfortunately, it is difficult for me to comment on what may be driving your daytime sleepiness. My general recommendation would be to consult a medical professional when experiencing excessive daytime sleepiness.

    Some ideas that can be helpful for combatting daytime sleepiness and fatigue are exposure to bright light (preferably sunlight) and exercise. Also, if you are feeling sleepy while driving or operating heavy machinery, then my recommendation would be to take a nap.

    Please feel free to reach back out with any questions.

  • Sleepio Member

    • 376 comments
    • 120 helped
    Expert

    Signing off now.

    Thanks for all the great questions today. As a reminder, the live expert chats are every Wednesday. Until next time ….

    Happy sleeping!

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