Live Discussion with Dr Jen Kanady - 16 October 2019

Dr Kanady will be hosting a live online discussion here on Wednesday 16 October, 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.

Posted 10 Oct 2019 at 6:25 PM
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  • Sleepio Member

    • 2 comments
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    Session 4

    I just started SR 4 nights ago with a very positive attitude; however, I'm beginning to realise that I was naive to assume that if I delayed my sleep until 12:30am, I would be able to sleep through to 6am without waking up. I've been waking at about 4am every night for 1-2 hours, and might get back to sleep for 30 minutes max before having to get up at 6.

    Have been managing on 4 hours sleep a night since starting the SR, and am struggling to find the motivation to force myself to stay awake for 2.5 hours after my normal bedtime, knowing that I'm unlikely to sleep through until I have to get up anyway. How long does it typically take for night wakings to be squeezed out after implementing SR?

    I would be happy to survive on a 5.5 hour sleep window if I knew I was going to sleep for 90-95% of that window, but 4 hours is killing me – especially because I have to either work or look after my 2 year old during the weekdays. Do you have any encouraging, but realistic, advice for someone in my situation?

  • Sleepio Member

    • 6 comments
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    Graduate

    My sleep is deteriorating badly in the last week of the course, not getting back to sleep again after night time waking. I am not even reaching the restricted total of late. Took two Valium in the middle of last night to get back to sleep, very reluctantly. Separately am having help with anxiety which I had been very positive about till this week. At my wits end.

  • Sleepio Member

    • 6 comments
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    Graduate

    PS l note my problem is very similar to other people posting comments. I shall be very interested in what Dr Kanaday can offer as advice and encouragement.

  • Sleepio Member

    • 9 comments
    • 3 helped
    Graduate

    I still wake up twice at night but an average 6:30 sleep and SE over 90% means I will probably increase my window every week.
    When do you know you are getting enough sleep?

  • Sleepio Member

    • 9 comments
    • 1 helped
    Graduate

    Dr Kanady

    I have had poor sleep for many years due to work and life stress but it only turned into insomnia this May caused by an anxiety disorder(GAD) which I have had for just over a year.
    Then I made an association between my fatigue and sleep and from that day on I have had trouble with sleep, some nights getting none. But in the last month my sleep has gone back to pre insomnia pattern of 6.5-8 hours a night. As I have made great leaps in my anxiety but at least 1 night a week I wake at 2 and can't sleep. This has been normal for many years but then I would put on tv or DVD and it was a case of when I fall back to sleep and I always did. But now my first thought is what if i don't and then without fail I can't due im sure to a little adrenaline spike. This lack of sleep can roll on for days and is causing trouble with work as I have time off as I can't do my physically demanding job.

    Can I break this pattern or is it ingrained in me now as for the first time in my life i see myself as having a sleep disorder?

    I need to solve this or my job will go then I will have serious problems.

    I should say my job now is not the one that caused my stress to start with so I don't want to loose it.

    Thanks.

  • Sleepio Member

    • 2 comments
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    Graduate

    Dr Kanady,

    Can you tell me what to do if i am working in shift pattern? I have done the first 3 weeks, but from yesterday i am working night time.
    I swithed my sleep window from 11pm-6am to 9am-16pm. Will it be good?

  • Sleepio Member

    • 376 comments
    • 120 helped
    Expert

    Hello Sleepio Community!

    My name is Dr. Jennifer Kanady. I am a sleep psychologist and am here to answer any and all sleep related questions for the next 1.5 hours.

  • Sleepio Member

    • 14 comments
    • 9 helped
    Graduate

    Dr. Kanady,

    Are there ever any issues with someone who has general anxiety disorder doing sleep restriction? Any potential worsening of that anxiety during the daytime?

    And does the medical literature talk about any limits to sleep restriction for people with anxiety or depression?

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Dory2,

    I am sorry to hear that your sleep has declined. Changes to our schedules -- going on holiday, a new job, etc. -- can certainly impact our sleep. My general recommendation for nocturnal awakenings is sleep restriction and stimulus control. And it sounds like you are already doing a great job implementing these techniques! One option would be to further decrease your time in bed by getting into bed later. Getting into bed later would increase your sleep drive, making it more likely that you are able to sleep through the night. And great job avoiding daytime naps because as you learned in the Sleepio program, taking a nap actually decreases the sleep drive. It’s also great to hear that you are getting out of bed during nocturnal awakenings. While reading is a fine activity to do as part of the 1/4 of an hour rule, sometimes reading can be quite stimulating. Maybe something more passive like watching television, relaxation exercises, or listening to music will better induce sleepiness. I also like to remind people: you tackled your sleep problems once and you have the skills to do it again.

    Please feel free to reach out with any additional questions.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Guest
    Expert

    Hi Jacquie,

    Thanks for your message. It sounds like you are dealing with a lot and I am sorry to hear that this is impacting your sleep as well. While treating sleep can be helpful for symptoms of depression, anxiety, and pain, it is generally recommended that you speak to a medical professional on how to best treat sleep in the context of other medical and mental health conditions.

    That being said, here are a couple of additional thoughts:

    It sounds like you already have a nice foundation of sleep skills that have been helpful for you in the past. Revisiting those skills might be one way to get your sleep back on track. For example, as difficult as it is to get out of bed during nocturnal awakenings, lying in bed awake teaches your brain and body that the bed is a place for wakefulness and associated frustration. When the house is cold, I generally recommend that an individual set up a cozy space outside the bedroom before going to bed that night. Maybe a spot on the couch with a nice cozy blanket. Having a place set aside ahead of time might make it easier to get out of bed. For sleep-related anxiety, revisiting the cognitive therapy skills from session 4 and session 5 would likely be helpful. As you learned in Sleepio, worries about sleep maintain the sleep problem. Another way to get your sleep back on track is sleep restriction. Reestablishing a sleep window based on the actual time you spend asleep is helpful for kicking the sleep drive into gear.

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

  • Sleepio Member

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

    Thank you for sharing. Progressive muscle relaxation can be helpful for promoting relaxation, which in turn, can promote sleep! I am glad to hear that this skill is working for you.

  • Sleepio Member

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

    Hi Jim43,

    Thank you for sharing. I am glad that you have found a routine that works for you!

  • Sleepio Member

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

    Hi Jdeacon85,

    You are definitely in the thick of it! Sleep restriction is by far the most challenging component of Sleepio, but also the most powerful. Unfortunately, there is no answer to the question, “how long does it take for sleep restriction to start working?” I have seen some instances where it worked instantaneously, but more commonly, I have seen instances where it takes several weeks for the circadian rhythm and sleep drive to adjust.

    My general rule of thumb is to try to stick to the sleep restriction protocol as best as you can. That way, you will get the full benefit of the intervention. However, it is also important that you consider your functioning and safety. Ultimately, Sleepio is a self-help program and it is up to the users to figure out the best way to implement sleep restriction for them. In other words, only you know whether or not it makes sense to adjust your prescribed sleep window (e.g., get into bed earlier).

    Good luck and let me know if I can be of further help.

  • Sleepio Member

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

    Hi johnhassan,

    I am very sorry to hear about your current struggles. It is very frustrating to put in so much good work only to see your sleep start to deteriorate again.

    Sleep and anxiety exhibit a very close, bidirectional relationship. The more anxiety we feel, the poorer we sleep and the poorer we sleep, the more worries we have. The Sleepio program introduces several skills that can be helpful for anxiety, particularly the cognitive therapy skills introduced in session 4 and session 5. Thought exercises and relaxation techniques can help to reduce anxiety and promote sleep. However, if an individual feels like anxiety is interfering with life and making it difficult to function, then my general recommendation is to consult a mental health professional.

    Please feel free to reach out with any additional questions.

  • Sleepio Member

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

    Hi Leejohn,

    Great question, thank you for asking!

    My general rule of thumb is that you stop increasing your sleep window when one of two things happens. First, if you feel like you are getting enough sleep and are functioning well during the day, then you can probably leave your sleep window as is. Second, if you notice that your sleep problems are starting to return (e.g., it’s taking longer to fall asleep, you are experiencing more nocturnal awakenings), then you may have increased your sleep window too much. In those cases, I generally recommend that you restrict your window slightly again (e.g., go to bed 15 minutes later).

    Everybody's sleep need differs and a good way to know if you are getting enough sleep is to ask yourself how you are functioning during the day.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Eddie06,

    Thanks for the question. It sounds like you have made great strides in your sleep, that’s wonderful to hear.

    Anxiety about not sleeping is one of the key factors that can maintain insomnia symptoms. A person wakes up in the middle of the night, becomes anxious about not being able to fall back asleep, and then, that’s exactly what happens. The cognitive therapy techniques introduced in session 4 and session 5 of Sleepio can be helpful for addressing sleep-related anxiety (for example, challenging negative thoughts or paradoxical thinking). However, if an individual feels like anxiety is interfering with daily functioning and quality of life, my general recommendation is to consult a mental health professional.

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

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Etniez,

    Great question. It can be very difficult to balance shift work and sleep. Please see below for some general recommendations:

    For sleep restriction, as you will be unable to keep the timing of your sleep window consistent, the general rule of thumb is to keep your time in bed consistent. E.g., if you are prescribed a 6 hour sleep window, try to maintain that 6 hour window, regardless of the window occurs.

    Some additional tips for protecting your sleep after your night shift include:

    (1) Follow the same bedtime routine. This will condition your brain that it is time for sleep. Ideally, your bedtime routine should be something relaxing and can include taking a warm bath, listening to music, or meditation.
    (2) Use your bed for sleep and sex only.
    (3) Avoid having an alarm clock. Knowing the time can make people feel anxious.
    (4) Use blackout curtains, shades, and/or an eye mask to make your sleep environment as sleep-promoting as possible.
    (5) If you live in a noisy environment, look at soundproofing your bedroom with double-glazing, carpets, heavy curtains and even wall insulation. Ear plugs could also help to preserve your peace and quiet. (6) Keep a visible record of your sleep and work schedule somewhere so your partner, family or housemates can see it, so that they don’t inadvertently wake you up.

  • Sleepio Member

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

    Hi Krystin,

    Great question. The minimum sleep restriction window does differ depending on medical and mental health conditions. For somebody with either, it is generally recommended that the window not be decreased to under 6 hours. When you are having sleep difficulties in the context of other mental health conditions, it is generally recommended that you talk to your mental health provider about how to treat sleep in the context of your other mental healthcare.

    Please feel free to reach out with any additional questions.

  • Sleepio Member

    • 376 comments
    • 120 helped
    Expert

    Signing off now. Thank you for all the great questions. For any lingering questions, please take advantage of our next live expert chat on Wednesday, October 23.

  • Sleepio Member

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

    I posted the last comments those on a pretty bad day. Since then things have been much better. I have just had 3 very good nights sleep! I would like to stress I think this is mainly due to 3 things: the sleep restriction regime which I now strictly adhere to, even if it leaves you feeling tired for a lot of the time; a lot of pretty heavy physical activity (it’s not always possible to do this, but at least I know it’s always something I can fall back on); and thirdly, the very beneficial effects of a course in compassion focussed therapy I am doing, where the benefits will be permanent, I am pretty sure. For anxiety I have tried many approaches, and this, for me anyway, is easily the best.

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