Live Discussion with Dr Jen Kanady - 14 August 2019

Dr Kanady will be hosting a live online discussion here on Wednesday 14 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.

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Posted 8 Aug 2019 at 7:01 AM
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  • Sleepio Member

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    Expert

    Hi senora,

    Thanks for the comment. I am working on answering all of the questions posed now. I will be sure to answer all questions posted, even if that means going over the allotted 1.5 hours.

  • Sleepio Member

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    Expert

    Hi Sandy T,

    Thanks for expressing your concern. Unfortunately, the rate at which people improve often varies. In general, it usually takes individuals a few weeks for their brain and body to adjust to the new sleep schedule. In these cases, it is generally recommend that individuals do their best to stick to the sleep interventions. Another possibility that I sometimes recommend is that individuals shift their sleep schedule earlier. Early morning awakenings become more common as we age due to shifts in our circadian rhythms. Sometimes shifting the bedtime and rise time earlier can help to mitigate some of these awakenings.

    Please feel free to check back in with the live experts if you are still experiencing these problems in a couple of weeks.

  • Sleepio Member

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    Expert

    Hi Nubie Q,

    Thank you for your great questions.

    It is generally recommended that a person maintain a consistent rise time, regardless of what time they went to bed the night before. The reason for this is that our circadian rhythms -- those important biological processes that regulate sleep and wake -- thrive best under consistent conditions. Maintaining a consistent rise time is one of the best things that an individual can do to stabilize and optimize circadian rhythms. Actually, shifting rise times is the same thing as jetlag! Even though sleeping in doesn’t involve traveling to a different time zone, our brains don’t know that. The circadian clock becomes confused as to when we are supposed to be awake and when we are supposed to be asleep. This makes it that much harder to wake up Monday morning! Maintaining a regular rise time may be difficult at first, but it gets easier over time as the brain learns that this is the time we wake up.

    And yes, feeling drowsy first thing in the morning is to be expected! Sleep is not an on/off switch and just like it takes time to fall asleep at night, it also takes time to wake up in the morning. Those initial feelings of grogginess and the initial urge to return to sleep is totally normal and is something called sleep inertia. Your brain just needs an opportunity to wake up! The best way to break through sleep inertia quickly is to get out of bed immediately and to expose yourself to bright light!

  • Sleepio Member

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    Expert

    Thanks for the great questions, senora.

    While sleep restriction is the most powerful of sleep interventions, it is also the most difficult to implement, especially in the first couple of weeks! The way sleep restriction works is it increases our homeostatic sleep drive -- it increases our need for sleep. Thus, those feelings of sleepiness that you are describing actually means that sleep restriction is working! The idea is that you are going to be so sleepy once bedtime rolls around that you are going to fall asleep quicker and be more likely to sleep through the night. Another way sleep restriction works is that rather than being worried about falling asleep, you are now shifting your thinking to worrying about how to stay up! This shift in thinking takes the pressure and focus off of sleep. Some ideas that other users have found helpful for staying awake until the prescribed bedtime include doing household chores, gentle stretching, talking with a partner/peer, and watching television.

    Navigating sleep with a bed partner can be challenging! Typical recommendations include having a conversation with the partner and trying to come up with a reasonable compromise that works for both parties. For more information about sleeping with a bed partner, please click on any of the links below:

    Poor sleepers’ impact on their bed partners:
    https://www.sleepio.com/library/article/poor-sleepers-impact-on-their-bed-partners/

    Community Discussion: How can you minimize the impact of insomnia on your bed partner?
    https://www.sleepio.com/community/discussion/how-can-you-minimise-the-effect-of-your-insomnia-o/

    Community Discussion: Sleeping with your bed partner:
    https://www.sleepio.com/community/discussion/sleeping-with-your-bed-partner/

    Great question regarding listening to podcasts in bed! Generally it is recommended that the bed is for sleep and sex only. The reason for this is that our brains are really good at making associations and the more time we spend awake in bed, the more our brains learn that the bed is a place for wakefulness. We want to break the association between the bed and wakefulness by keeping the bed a sacred place for sleep.

    For more information on the bed-sleep connection, please click on the link below:
    https://www.sleepio.com/library/article/the-bed-sleep-connection-the-science/

  • Sleepio Member

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    Expert

    Hi Brightskies,

    I am unaware of any research that demonstrates that wearing earplugs to bed is detrimental. That being said, it is generally recommended that individuals have a comfortable sleep environment, which would include comfort with things like earplugs and eye masks.

    Regarding sleeping with a bed partner: a similar comment was posed by another user, which demonstrates how challenging navigating sleep with a bed partner can be! Typical recommendations include having a conversation with the partner and trying to come up with a reasonable compromise that works for both parties.

    For more information about sleeping with a bed partner, please click on any of the links below:

    Poor sleepers’ impact on their bed partners:
    https://www.sleepio.com/library/article/poor-sleepers-impact-on-their-bed-partners/

    Community Discussion: How can you minimize the impact of insomnia on your bed partner?
    https://www.sleepio.com/community/discussion/how-can-you-minimise-the-effect-of-your-insomnia-o/

    Community Discussion: Sleeping with your bed partner:
    https://www.sleepio.com/community/discussion/sleeping-with-your-bed-partner/

  • Sleepio Member

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    Graduate

    Thank you.

  • Sleepio Member

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    Expert

    Hi Ann D,

    Early morning awakenings can be tricky because sometimes it’s a matter of biology. Due to differences in circadian rhythms, some individuals are predisposed to be a “lark” or a “morning person.” In the sleep field, this phenomenon is referred to as “advanced sleep phase” or a “morningness circadian preference.” This shift in the circadian rhythms can become even more pronounced as we age.

    Here is a nice article about circadian preferences: https://www.sleepio.com/library/article/do-you-really-get-people-who-are-owls-and-others-w/

    There are a couple of techniques that may be helpful for addressing early morning awakenings (e.g., waking up at 3:00 AM). One possibility is shifting the bedtime later, thereby increasing the need for sleep and making it more likely to sleep past 3:00 AM. Once the target wake time is achieved, I generally recommend shifting the bedtime earlier until achieving the desirable sleep window. This would be very similar to what you did as part of the sleep restriction protocol in Sleepio. Another possibility is embracing the early morning awakening and shifting the bedtime earlier to account for the earlier rise time. However, this doesn’t sound like an ideal option based on your email. Another thing that can be helpful for early morning awakenings is capitalizing on the impact of light and dark conditions on circadian rhythms. More specifically, evidence suggests that dim light conditions are best when winding down at night and bright light conditions are best first thing in the morning. Reducing exposure to light during times when an individual wants to be asleep can be helpful for adjusting the circadian rhythm to a schedule that is more desirable for the individual.

    Here is a nice community post that further discusses early morning awakenings: https://www.sleepio.com/community/discussion/early-awakening/

  • Sleepio Member

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    Expert

    Hi Helen,

    Unfortunately, I am unable to provide diagnoses and am very glad to hear that you have discussed these concerns with your doctor.

    There are a couple of sleep disorders that are characterized by sudden awakenings during sleep. For example, nocturnal panic is a sleep disorder that is characterized by panic attacks during sleep and symptoms include increased heart rate, difficulty breathing, and feeling like you are going to die. Sleep apnea, another type of sleep disorder, is characterized by breathing interruptions during sleep, which may result in individuals waking up suddenly, unable to catch their breath. Night terrors can also result in sudden, fearful awakenings despite individuals being unable to remember dream content.

    It is generally recommended that individuals consult with their primary care physician when trying to diagnose a sleep disorder.

  • Sleepio Member

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    Expert

    Wow, a lot of really great questions this week! I am still working on answering all questions posted to the forum and will sign off once all questions have been answered.

  • Sleepio Member

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    Expert

    Hi Bridget,

    This sounds really frustrating. Unfortunately, it is difficult for me to know what is causing the muscle jerks. My recommendation is that you consult with your primary care physician about these experiences.

    However, I can provide some information about sleep disorders and sleep phenomenons that have been associated with muscle jerks/movements. For example, there is a type of sleep disorder called restless leg syndrome, which is characterized by an uncontrollable urge to move your legs during periods of rest or immobility. Periodic limb movement syndrome is another type of sleep disorder that is characterized by muscle jerks or twitches throughout the night or when trying to fall asleep. Also, REM sleep is a sleep stage characterized by muscle atonia. That is, when we are in REM sleep, our muscles paralyze so that we don’t act out our dreams. Sometimes people will report twitching and/or jerking in their muscles as they enter the REM sleep stage.

    Generally, it is recommended that individuals consult with a medical professional if these experiences are causing significant discomfort or distress.

  • Sleepio Member

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    Expert

    Hi Magnes,

    Sleep restriction is always the trickiest sleep intervention to navigate! I see that you are on week 3 of the program, which means you are just getting started. Usually, the first couple of weeks of sleep restriction are the most challenging. It takes our brain and our body a few weeks to adjust to the new sleep schedule. Usually, if individuals can push through the first couple of weeks, the sleep schedule gets much easier because the circadian clock has had a chance to adjust. And remember, your sleep schedule this week is temporary! The Prof will adjust your sleep schedule each week depending on how you are sleeping.

    And great questions regarding your other lifestyle habits. Circadian rhythms -- those important biological processes that regulate our sleep and wake -- love regularity. The more regular we are with our bedtimes, rise times, exercise times, and meal times, the better our circadian rhythms are able to function. Generally it is recommended that individuals do their best to keep to a regular schedule, including regular exercise and meals.

  • Sleepio Member

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    Expert

    Hi Eddie06,

    Thank you for expressing your concerns and bringing up the role of anxiety in sleep. Anxiety and sleep are closely related and exhibit a bidirectional relationship. That is, anxiety can make it difficult to sleep and sleep problems can exacerbate anxiety. Luckily, by targeting one or the other -- sleep or anxiety -- the other symptom will also improve. Some tips that are generally recommended to those who struggle with anxiety include engaging in relaxation techniques before bed and practicing cognitive strategies for coping with and challenging unhelpful thoughts and beliefs about sleep. The good news is that many of these techniques are introduced in the Sleepio program.

    For more information about anxiety and cognitive strategies, please click on the Sleepio library resource links below:

    https://www.sleepio.com/library/article/anxiety-introduction/

    https://www.sleepio.com/library/article/cognitive-techniques-in-depth/

    https://www.sleepio.com/library/article/how-does-relaxation-work-to-help-poor-sleep/

    https://www.sleepio.com/library/article/challenging-your-thoughts/

    If anxiety continues to cause significant distress, it is generally recommended that you discuss your symptoms with your primary care physician or another medical provider.

  • Sleepio Member

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    Expert

    Hi dreamto8sleep,

    Thanks for the great questions. My responses are below:

    1. Generally it is recommended that the mindfulness interventions are done in conjunction with sleep restriction and the quarter of an hour tool. All of these are useful tools for your “sleep toolbox” and work best when combined.

    2. In general, doing all cognitive techniques during the same night would be a lot! Most individuals find a cognitive technique or two that they like best and stick to those practices.

    3. Great question regarding paradoxical thinking. You are right, staying in bed awake is counterproductive as we want the brain and body to learn that the bed is a place for sleep (and sex) only. Generally it is recommended that you don’t spend a prolonged amount of time awake in bed. For more information about paradoxical thinking, please see this library article: https://www.sleepio.com/library/article/paradoxical-thinking/

    4. Another great question! Cognitive strategies actually take a lot of practice because it is not easy to change the way we think. Generally, individuals won’t notice benefits following cognitive strategies immediately and this is something that usually comes with time. It is also recommended that people experiment with different cognitive techniques until they find one that works best for them!

  • Sleepio Member

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    Expert

    Hi BobKSleeps,

    Thanks for the great question. Sleep need actually varies from person to person. I am sure that we are all familiar with the adage that we should all be getting “8 hours of sleep a night.” However, what most people don’t know is that number 8 actually represents an average. Some people function well with 6 hours of sleep and some people need closer to 9 hours of sleep. Generally, I recommend that individuals pay attention to how they are feeling during the day to better understand their own sleep need.

    The sleep stage that is associated with learning and memory (and risk for dementia) is a sleep stage called slow wave sleep (SWS). During sleep we cycle through four different sleep stages and we get the majority of our SWS during the first half of the night. Therefore, if you are waking up after several hours of sleep, you will likely have already received the majority of SWS benefits.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi senora,

    Thanks for the question, please see my reply to your earlier question for a response.

  • Sleepio Member

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    Expert

    Hi Eddie06,

    I am not aware of any research that looks at the association between sleeping positions and anxiety. In general, it is recommended that one chooses a sleeping position that is comfortable for them.

  • Sleepio Member

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    Expert

    Thanks again for the great questions. Signing off now. For any lingering questions, please take advantage of our live sleep expert chat every Wednesday.

  • Sleepio Member

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    Graduate

    Thank you very much.

  • Sleepio Member

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    Graduate

    Many thanks for the information Dr Jennifer Kanady,

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thank you for your feed back Dr Kanady it has really helped to put things into perspective- it really does make a difference when you have a better understanding of what is happening, and it helps to keep me motivated to persevere – especially as I am feeling the difference already. Thanks again also for your feedback to others – it is all so insightful and helpful.

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