Live Discussion with Dr Jen Kanady - 15th July 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 15th July 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.

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Posted 9 Jul 2020 at 4:22 PM
  • 19 comments
  • 11 helped

Comments

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    I've just learnt about sleep restriction. I'm not sure how I can do this, I take clozapine and mirtazapine, both of which make me sleepy long before 2:15 (my recommended threshold time).

  • Sleepio Member

    • 3 comments
    • 1 helped
    Graduate

    In week 3 now and just got to know the recommended threshold time and sleep window which will intercept with my morning office hours, now that I am back to work after 2 weeks of staycation. I moved the recommended threshold by 3 hrs earlier to rise early for office. Is that ok? to try for sleep-restriction?

  • Sleepio Member

    • 11 comments
    • 6 helped
    Graduate

    Hi Dr Kanady,

    I'm not sure when I should be returning to bed after getting up in the night. I understand (from reading a CBTi book) that 'sleepiness' not 'tiredness' should be the trigger.

    Currently, I'm heading back up after about ten minutes or so – I don't think I'm feeling sleepy, just tired.

    I suppose I'm concerned that I might not become sleepy no matter how long I wait. I'm also concerned about staying too long out of bed.

    To wit, is it ever acceptable to 'give up' on a night's sleep (if necessary) by saying 'I won't return to bed until I feel sleepy'? And treating that feeling (heavy head, eyes, drowsiness) as the supreme authority? I feel as if this is the most painful, but also the most effective way of building a positive sleep-connection to my bed – but I would like your advice on this!

    I would feel less anxious about being awake at night, knowing that I have a definitive and recommended threshold to 'aim' for.

    Thanks,

    Luke

  • Sleepio Member

    • 2 comments
    • 0 helped
    Session 4

    Hi,

    Do you have any advice in addition to the files on this website to assist with sleep/working shifts please? I will be starting a new job shortly that involves working a shift pattern. Earlier (from around 3-330) to lates that could finish around 2am. I'm trying to make a plan beforehand to assist withy adjusting sleep pattern. So any help advice would be great. As much as you can give, I will take it all on board. Thank you, Steve

  • Sleepio Member

    • 9 comments
    • 2 helped
    Graduate

    Hiya,

    What do I do about waking and QHR close to the end of my sleep window? My time asleep ends at 6am, but – for instance – last night I woke at 4.15, couldn’t get back to sleep by 4.30 so QHR kicked in. I was beginning to feel sleepy by 5.30, but there didn’t seem any point in returning to bed for 30 minutes. Any suggestions?

  • Sleepio Member

    • 8 comments
    • 0 helped
    Graduate

    After 3 weeks of Sleep Restriction I have 93% average SE and am getting close to 7 hours average – which is amazing. But I still have a feeling of jetlag every day since starting SE. I feel dopey, don't function well and end up being less active, though I always get morning daylight and a walk. It's not as strong in the first couple of weeks, but still very marked. It's something I've only experienced after long-distance flights, and when I first did the Sleepio programme last year. Why is it so different from my normal (probably more wired) feeling of tiredness when sleeping badly? It's a mystery to me.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    Hello Dr Kanady

    I am in week 5 , SR window 12 to 6 am,but have a problem with keeping track of time. I have trained myself not to fret too much about not sleeping but to rest with eyes closed breathing gently. I know that I doze/fall asleep throughout the night, generally after a period of around 3 hours shortly after turning the light out. I get up at 6.00am (now using an alarm) but I cannot be sure what has happened in between. If I definitely wake up, I get up usually to go to the loo and walk around, maybe sip some water and go back to bed. Time estimates are distinctly hit and miss, so I am concerned that my returns are giving an inaccurate picture of what is happening. no meds or sleeping pills etc Have you any advice for me please?

    Daybreak Watcher

  • Sleepio Member

    • 394 comments
    • 123 helped
    Expert

    Hello Sleepio Community!

    For those of you who don't know me, my name is Jennifer Kanady. I am a clinical and research psychologist with an expertise in sleep. I am available for the next 1.5 hours to answer any and all sleep-related questions. Excited to dive in!

  • Sleepio Member

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

    Hi flicbuk,

    Thanks for reaching out. Sleep restriction can seem very daunting and certain circumstances, like medication use, can make it seem even more daunting. Your hesitation and uncertainty is understandable.

    Sleep restriction is one of the powerful interventions introduced in Sleepio. Sleep restriction works by increasing sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night. Given the increase in sleep pressure, some individuals may feel worse before they start to feel better. I usually tell people that if they feel sleepy during the day or before their threshold time, that means it’s working! That is exactly what we want to happen! Generally, if individuals are able to stick with sleep restriction for a few weeks, things start to get much easier and sleep starts to become more consolidated. Given this, I usually encourage people to give sleep restriction a try whenever circumstances allow.

    Now, Sleepio is a self-help program and it is up to users to figure out how to best apply sleep restriction in a way that works for them. One option may be trying “sleep restriction lite.” For example, if Sleepio has your sleep window at 6 hours, maybe try a sleep window of 6.5 hours and see how that feels. Another option is something called 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.

    Ultimately, I would encourage you to be creative and figure out a way to apply sleep restriction that works for you.

    Here is a Sleepio library article that you may find helpful:

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

    Feel free to reach back out to let us know how you are doing.

  • Sleepio Member

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

    Hi shp,

    Such a great question and a great solution! Sleep restriction anchors on the rise time or wake up time. So if you need to wake up at 6:00 AM for work and your sleep window is 6 hours, then your bedtime or “threshold time” should be 12:00 AM. So your solution sounds perfect. Please feel free to reach back out with additional questions.

  • Sleepio Member

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

    Hi Luke,

    Such great questions and great insight! I love that you distinguished between fatigue (e.g., tiredness) and sleepiness because you are absolutely right, they are two different constructs!

    This is such an interesting question and one that doesn’t have a “correct” answer unfortunately. Ultimately, it is really up to the individual to figure out how best to apply the QHR rule in a way that makes sense for them.

    That being said, I have a couple of thoughts:

    Sleepiness following nocturnal awakenings may sometimes be difficult to achieve because of how the sleep drive works. The sleep drive is our biological need for sleep. When we wake up in the middle of the night, our sleep drive tends to be low given that we are waking from a sleep period. So the fact that you don’t always feel “sleepy” makes sense from a biological perspective.

    That being said, our circadian rhythms are set up to help us achieve and maintain sleep during the middle of the night hours when the sleep drive is low, so all hope is not lost and returning to sleep is definitely achievable!

    Overall, my recommendation would be to play around and experiment. For example, keeping the threshold for when you return to bed high (e.g., “I should have heavy eyes, should be starting to fall asleep on the couch) may prevent individuals from achieving more sleep. Sometimes it’s helpful to get back into bed and try to fall asleep and if you can’t, get out of bed again. You won’t know if you can fall back asleep unless you try. On the other hand, this may prove to be too stressful for some individuals and staying out of bed may make the most sense.

    Ultimately, I would encourage experimentation. Maybe play around with different intervals and different markers of sleepiness until you find a solution that makes sense for you. Also, if you are not already doing so, I would also encourage you to pay attention to the activities you are doing during these periods outside bed. In general, the activities should be relaxing and not stimulating (e.g., don't pay bills, respond to emails, or watch an action movie in the middle of the night) and should be done in dim light conditions.

    Do keep me posted and let me know if I can be of further help.

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    Thanks, that's really helpful!

  • Sleepio Member

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

    Hi Steve,

    Congratulations on the new job and I am happy to hear that you are already thinking about ways to adjust to the new schedule. I have a couple of thoughts, which I have outlined below:

    One thing you might try is gradually shifting your schedule to align with your new work hours. For example, if your current sleep schedule is 12:00 AM – 8:00 AM, start to shift your schedule later by 30 minutes every week until you have reached your new sleep schedule as a result of the new job. By shifting your schedule gradually, it will be less of a “shock to the system.” Now this may not be possible given that you noted your new job starts shortly.

    Another thing I would encourage is maintaining the same sleep/wake schedule, even on days that you aren’t working. When we drastically shift our sleep schedules, what we are essentially doing is 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. Maintaining a consistent schedule is great for stabilizing circadian rhythms and promoting healthy sleep.

    In addition to keeping a regular sleep schedule, also try to maintain consistent and regular meal times, exercise times, and socialization times. Our circadian rhythms love a routine and function best under regular, stable conditions.

    I would also suggest paying attention to light and darkness cues in the environment. This one may seem pretty obvious, but it is important that our environments are dark when we want to be asleep and light and bright when we want to be awake and alert. Investing in things like blackout shades and light boxes can be helpful for achieving this.

    It sounds like you have already checked this resource out, but if not, below is the link to our library article that talks about shift work and ways to adjust:

    https://www.sleepio.com/articles/shiftwork/

    Wishing you the best of luck!

  • Sleepio Member

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

    Hi katecelyn,

    Thanks for reaching out. Your question is similar to the question that Luke posed above. Please feel free to check out my response to Luke in case it is helpful.

    To summarize:

    Unfortunately, there is no “correct” answer to this question and it is up to the individual to figure out how best to apply QHR in a way that makes sense for them. For questions like these, I like to encourage experimentation. Play around with intervals, what you consider to be markers of sleepiness, and activities that you do outside of bed to figure out what makes the most sense for you.

    A couple of additional thoughts:

    In the case you described above, your intuition is a good one. If your rise time is 6:00 AM and you try to return to sleep at 5:30 AM, that could result in feeling worse. For example, if you return to sleep for 20 minutes, when you wake up at 6:00 AM you will likely experience sleep inertia. Sleep inertia is the transitional period from sleep to wakefulness and is hallmarked by feelings of grogginess and a strong urge to return to sleep. Sleep inertia, while completely normal and unavoidable, can sometimes feel pretty terrible in the moment.

    I would also note that when applying QHR, it is important to use your best guess. I would discourage looking at the clock and getting out of bed immediately after 15 minutes have passed. Rather, if it seems like 15 minutes have passed and you aren't sleepy, then get out of bed. Also, if 15 minutes have passed, but you are on the brink of returning to sleep, it is probably best to stay in bed as sleep is arriving soon.

    Definitely a tricky situation, but lots of opportunities for some creative problem solving.

    Let us know how it goes!

  • Sleepio Member

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

    Hi Penny Brohn UK,

    Thanks for reaching out and this is a tough one! From your question, it sounds like you have a really nice understanding of sleep and how it is regulated and are already doing some really great things. Also, congratulations on the 93% sleep efficiency! That is incredible and I am glad to hear that all your hard work is paying off!

    While it is difficult to know the cause of these feelings of jetlag, I have a couple of thoughts:

    The first is that sometimes we can feel jetlagged when we are not sleeping at a time that aligns with our circadian clock. As you may know, some of us have “advanced circadian rhythms” and are considered “morning larks” and some of us have “delayed circadian rhythms” and are considered “night owls.” It can sometimes take the circadian rhythms several weeks/months to adjust to new schedules. Things that can help circadian rhythms to adjust faster include keeping the same sleep schedule every day and maintaining regular meal times, exercise times, and socialization times. Also, using light and darkness cues strategically can be helpful as well (e.g., dark when you want to be asleep and light and bright when you want to be awake).

    Another thing to note is that sometimes feelings of fatigue and/or jetlag symptoms aren’t the result of poor sleep. Other things that can cause these kinds of symptoms include boredom and inactivity. Paying attention to triggers can be helpful for identifying causes and coming up with creative solutions. E.g., if jetlag symptoms are the worst during long meetings, try sitting up straight in your chair, or pacing during the meeting.

    Finally, some great energy boosters that aren’t sleep include exposing oneself to bright light (preferably sunlight) and exercise. E.g., going on a walk outside. (it sounds like you are already doing this, which is great!)

    Wishing you the best!

  • Sleepio Member

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

    Hi Daybreak Watcher,

    I am glad you raised this question and I love your intuition. In particular, thank you for sharing that you don’t fret too much about sleep and that you aren’t keeping track of time. This is great! While a lot of the Sleepio interventions use time as a measure, the idea is for individuals to use their “best guess.” For example, answers to sleep diary questions should be estimates. The last thing we want is for people to watch the clock, trying to get an accurate assessment of how long it took to fall asleep. The same goes for the quarter of an hour rule. While we recommend that individuals get out of bed after 15 minutes, this too is meant to serve as a “best guess.” Clock watching can be anxiety provoking, which can make achieving sleep more difficult, the exact opposite of what we want to happen. So keep up the great work!

    My general recommendation is to do as you described. If you know you are awake and can’t fall back to sleep, get out of bed. This doesn’t have to be perfect. And not knowing what happened in the middle of the night is likely an indicator that you spent a good chunk of that time asleep. One thing to be mindful of, however, is that you don’t want to be spending prolonged periods of wakefulness in bed. As you learned in Sleepio, the brain is very good at making connections. When you are awake in bed, tossing and turning, and becoming frustrated about not sleeping, you are teaching the brain that the bed is a place for wakefulness. Instead, we want our brains to learn that the bed is a place for sleep.

    To summarize, the interventions don’t need to be applied perfectly. It is up to the user to figure out what works best for them. I would say that the most important thing to pay attention to is how you are feeling during the day. If you are feeling good, then it is likely that you are making good progress.

    Really appreciate the question and keep us posted about how things go!

  • Sleepio Member

    • 394 comments
    • 123 helped
    Expert

    Signing off now. Thanks for the great questions! For any additional questions, please do check out the next live expert chat on Wednesday, July 22nd.

    Happy sleeping to all!

  • Sleepio Member

    • 52 comments
    • 22 helped
    in reply to Sleepio Member
    Graduate

    Hello Shp,

    I moved my Sleep Window (SW) in Session 3 when I was given it for Sleep Restriction (SR). I moved it by roughly a couple of hours. As I couldn’t do the Sleep Restriction (SR) times I was given. So I originally had around 3.45am to 9.45am and moved it to 1.00am to 07.00am. A six hour SW. I didn’t have any problems. As long as you stick to the SW you have been given eg 5 hours and as long as you stick to getting up at the same time and going to bed at the same time everyday, including weekends it will be fine.

    You will eventually be rewarded by the Prof with 15 minutes added to your SW when you get to a Sleep Efficiency (SE) of 90%.

    Best of luck with SR.

    LoM.

  • Sleepio Member

    • 52 comments
    • 22 helped
    in reply to Sleepio Member
    Graduate

    Hi Flicbuk,

    I have extended my SW and shortened it. I have also done Sleep Compression. If you are going to do the Sleep Compression by 15 minutes a week sometimes it can take longer then a week for you to adjust to the time. Some people can take up to two weeks to adjust. So don’t worry if you haven’t adjusted to the new time in a week.

    Hope you are doing well in SR.

    LoM.

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