Live Discussion with Dr Jen Kanady - 16th September 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 16th September 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 10 Sep 2020 at 10:11 PM
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  • Sleepio Member

    • 13 comments
    • 5 helped
    in reply to Sleepio Member
    Graduate

    Hi Kathryn, there should be some feedback for you if you've submitted two weeks. Log on and go the the case file section, then click on Visit the Prof window he should guide you through your results. SE of 87/88 is still good, and the prof will probably reward you with an extra 15 minutes. I know I had some weeks in the 80s and I got them. Its normal to feel tired as you're getting started I had a couple of very tiring weeks at the start. Hang in there! It takes time but this program does work. I graduated a couple of weeks ago and am still learning but now sleep 6 hours pretty straight, which is way way better than when I started.
    Does anyone know how to listen to the Dr Live discussions? I've never been able to work it out?
    Alison

  • Sleepio Member

    • 13 comments
    • 5 helped
    Graduate

    DR K
    Can you please talk about how we know when weve reached our capacity with our sleep window. When to we stop taking the extra 15 minutes? Ive had a SE of 90 this week and can take the extra 15 minutes (I want to because I'm tired) but am I ready enough, I still wake from time to time and have to get out of bed for the QHR
    How do I access the live discussion on Thursday? I am in Melbourne
    Thank you
    Alison

  • Sleepio Member

    • 11 comments
    • 0 helped
    Graduate

    My problem is the QHR. I understand how bad it is to lie awake fretting in bed. I get up, I meditate, but I almost never reach the sleepy-tired point you are supposed to reach before you go back to bed. Right now I am waking well before my scheduled waking time and not going back to sleep. Sometimes I do go back to bed, try to stay relaxed, but seldom fall asleep again. What can I do?

  • Sleepio Member

    • 1 comments
    • 2 helped
    Graduate

    I'm dealing with decades of poor sleep. I've found this program's sleep restriction helpful but struggle to crunch all my sleep needs into one window. Even thought I started with 6 hours, I still wake early (about 4.5 hours?). This is clearly not enough. I've gone off the wagon a few times out of necessity. What's weird (and this is my question)... is that when I follow the strict 6 hour window, I have felt a bit more energized and generally better. Unfortunately, the cumulative fatigue catches up every few days and isn't sustainable. If I try to sleep longer (like I used to), I end up feeling very tired and extremely achy (ankles, feet, legs). Any thoughts as to why this may occur? You would think adequate sleep = feels good vs less sleep = feels bad? I'm in good physical and mental health… the only reason for poor sleep that I can identify, is maybe hyperarousal?

  • Sleepio Member

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    Graduate

    I struggle to actually feel sleepy at the start of my sleep window so I end up not sleeping as much as I want. I keep earning the extra 15 minutes each week because I follow the rules and keep my sleep efficiency up, but it isn't helping me feel sleepy earlier so I'm getting frustrated with the lack of sleep. Do I just need to hang in there and wait it out for a few more weeks (I'm already on Week 7)? Should I move my earned 15 minutes to wake later instead of go to bed earlier? Or am I doing something wrong?

  • Sleepio Member

    • 8 comments
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    Graduate

    I have a very similar problem to JudeD – I am now falling asleep really quickly and easily, which is great, but I consistently wake up again 10-15 minutes later and have to start again. I'm not being woken by any external factors.

    Do you have any thoughts about what might be causing this and any advice?

    Many thanks.

  • Sleepio Member

    • 1 comments
    • 1 helped
    Session 4

    Hello Dr. Kanady, I’m 62 years old and I’ve been struggling on and off with insomnia since 1996. I was able to wean myself from medication about 18 months ago with the help of homeopathy. Unfortunately, my insomnia returned with a vengeance last March. As of late, my sleep efficiency plummets sometimes to 5%, but on average it remains at about 50%. I have regularly at least 5 awakenings per night. It leaves me with the impression that I barely slept. I’m only about two weeks into the program. I am clueless as to what causes those awakenings. It leaves me feeling extraordinarily anxious. My hope is to not return to medications, but I feel so depleted that I feel as if I have no alternative. Can you offer any advice or suggestions to me? Thank you so much!

  • Sleepio Member

    • 12 comments
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    Graduate

    Hello Dr. Kanady,
    I have been struggling with psychosis and insomnia for the the last 10 years. When I am at high risk of relapse or even when I am really psychotic I have more vivid dreams only at waking up.I also have more nightmares. I can't differentiate if it is a hypnopompic hallucination, or if I am waking up having a nightmare or starting a delusion while awaking. Could you explain me the differences? Thank you so much!

  • Sleepio Member

    • 394 comments
    • 123 helped
    Expert

    Good day, Sleepio community!

    I am 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

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

    Hi JudeD,

    Thanks for reaching out. A couple of thoughts in response to your questions:

    (1) It makes sense that you are experiencing awakenings during the first 5-20 minutes of the sleep period. During sleep we cycle through different sleep stages. The first sleep stage is called stage 1 sleep (creative name, I know). Stage 1 sleep is a transitional sleep stage between wakefulness and sleep. It is a very light sleep stage and it is easy to be woken up during stage 1 sleep. So awakenings during this sleep stage are quite common.

    (2) Sleep is not an on-off switch and it is common to take up to 30 minutes to fall asleep at night. Falling asleep as soon as a head hits a pillow may indicate not having gotten good sleep or enough sleep the night before.

    (3) I love to hear that you are paying attention to your sleep, great work! My general recommendation is to approach sleep with a sort of curiosity. Everybody experiences the “odd” sleep night and the occasional night of poor sleep. When this happens, it may be helpful to think, “Hm, that’s interesting, I wonder what was different last night?” However, it’s important that individuals don’t hyperfocus on sleep or become overly anxious about sleep because that can create a sleep problem.

    Please feel free to reach out with any additional questions!

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Kathryn,

    Welcome to the Sleepio program and congratulations on doing such a great job filling out your sleep diaries! The sleep diaries are a core component of Sleepio and will be used to tailor your sleep window as part of sleep restriction introduced during session 3. It sounds like the Prof will have a lot of great data to work with.

    Thanks for the question about sleep efficiency. Sleep efficiency is one marker of sleep health. It is measured by dividing total sleep time (how much time you are actually asleep) by time in bed (how much time you are spending in bed). Generally, a healthy sleep efficiency is anything above 85-90%. So you are in the healthy range, great job! Once you achieve a sleep efficiency of 90%, the Prof will increase your sleep window by 15 minutes for the following week. That means, over time, you will not only have a healthy sleep efficiency, but you will be increasing the amount of sleep you get too.

    A lot of things can contribute to feeling tired during the day. For example, having a variable sleep/wake schedule can contribute to feelings of fatigue. Other contributors can include dehydration, time of day (e.g., mid-afternoon), and boredom. Also, it is not uncommon to feel more tired/sleepy during the first few weeks of sleep restriction. But individuals who can stick with the prescribed sleep schedule and push through the fatigue often report feeling much better.

    I hope this answers your questions. Please keep us posted and let us know how you are doing.

  • Sleepio Member

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

    Hi Alison,

    Thanks for responding to Kathryn. Also, I am not sure I understand your question about listening to the Dr. Live discussions. The live expert chat is what you are participating in right now. The format is text based question and answers. The sessions are live and last for 1.5 hours every Wednesday (the time of day differs depending on the expert). However, if you can’t make the live session, you can submit your question beforehand and look at the answers afterwards. Please let me know if I can clarify anything else.

  • Sleepio Member

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

    Hi again Alison,

    I love this question and am so glad that you asked. The first thing I want to note is that a 90% sleep efficiency is fantastic. So happy to hear that your hard work is paying off! Also, it’s important to note that everybody wakes up in the middle of the night (even the healthiest of sleepers), it’s inevitable. These awakenings really only become problematic when they are prolonged and/or if they cause significant distress. So I don’t typically recommend using nocturnal awakenings or using the QHR as a way to figure out whether a person has achieved the optimal sleep window. Rather, there are two things I encourage people to pay attention to: (1) Is the sleep problem starting to return? E.g., Is it taking significantly longer to fall asleep at night? Are you waking up more often and are these awakenings prolonged? If so, that may mean that you increased your window too far and may want to keep the window as is or decrease it by 15 minutes. (2) How are you feeling during the day? If you are feeling good during the day, that is another indicator that you may have reached your optimal sleep window. Sleep need varies across individuals, some people may need closer to 7 hours or sleep, while others may need closer to 9. Paying attention to how you are feeling during the day is a great way to figure out your own sleep need.

    Please see my response above in regards to the live expert sessions.

    Please do reach out if any additional clarification is needed.

  • Sleepio Member

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

    Hi Bev,

    That is really frustrating. Early morning awakenings can be one of the most stubborn sleep problems and it sounds like you are putting in a lot of great work and effort. Nice job sticking with it! Let’s see if we can come up with some additional things for you to try. A couple of initial thoughts:

    (1) Keep up the good work. As you noted, tossing and turning in bed is counterproductive. As a refresher, being awake in bed teaches the brain that the bed is a place for wakefulness (and often, associated frustration). Instead, we want the brain to learn that the bed is a place for sleep. Protecting the bed and keeping it for sleep and sex only is a great way to capitalize on that important conditioned response!

    (2) One thing to pay attention to is the amount of light you are exposing yourself to when you get out of bed. It is so great that you are using the QHR intervention to meditate. One thing I like to remind people is to make sure to engage in middle-of-the-night activities in dim light or dark conditions.

    (3) Another thing that may be helpful is not leaving the bedroom. Sometimes moving to another room leads to a lot of activity and possibly, associated alertness. Setting up pillows on the floor of the bedroom might be a good way to keep the bed for sleep only, while reducing the amount of movement in the early morning hours.

    (4) Finally, one thing that might be helpful to pay attention to is your sleep schedule. All of us have different circadian preferences -- that is, different times we prefer to go to bed and wake up. When we get older, our circadian preference tends to shift earlier. One thing that can be helpful for some with early morning awakenings is to shift the sleep schedule earlier. I generally encourage people to play around with their sleep schedule until they find one that works for them.

    Please keep us posted about how things are going!

  • Sleepio Member

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

    Hi Chris,

    Thanks for reaching out. Sleep restriction can be very challenging and you are definitely in the thick of it. But while sleep restriction is challenging, it is one of the most powerful (if not the most powerful) tools in your sleep toolbox. Unfortunately, for some, things can feel worse before they start to get better. My general rule of thumb is to stick to the sleep restriction window as much as possible. If individuals can push through the first couple of weeks, things tend to get easier. Some additional thoughts to your questions:

    (1) Really interesting observation! One explanation may be that shifts in sleep schedules can cause sleepiness/tiredness and other symptoms. When we shift our sleep schedules, what we are essentially doing is jet-lagging 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. That’s one of the reasons why it is important to try to keep a regular sleep/wake schedule, even on the weekends.

    (2) Another explanation might be that you slept “too much.” Sounds silly, I know. But there is such a thing as both too little and too much sleep. Following a night of extended sleep, some people may actually feel more sleepy and fatigued the next day.

    I must say, I love that you are collecting data and conducting mini-experiments. Correlations such as the one you described are great ways to recognize patterns -- both good and bad!

    Keep us posted!

  • Sleepio Member

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

    Hi Gayathri,

    Thanks for the questions and that does sound frustrating. It sounds like you are already doing some creative problem solving around this issue. A couple of thoughts:

    (1) I think your idea of adding 15 minutes to the rise time instead of the bedtime is a great thing to experiment with. Everybody has a different circadian preference. That is why some people are “night owls” and others are “morning larks.” One possibility is that you may be more of a night owl, so staying up later and getting up later may be a better fit for you.

    (2) Another thing I generally recommend is paying attention to light cues during the hour or two before bed. Light has an alerting effect (and blocks the release of melatonin) so it’s important to maintain dim light conditions to prepare the brain and body for sleep. Winddown routines that don’t involve the use of electronics may also be helpful for increasing sleepiness before bed.

    (3) It sounds like you have been at sleep restriction for a few weeks now. At some point, you will reach your optimal sleep window. In other words, you won’t need to add 15 minutes to your schedule. I usually tell people that two things can inform whether they have reached their optimal window: (1) Has their sleep problem returned? If it is taking significantly longer to fall asleep or return to sleep at night, that may mean that the window was increased too far. In these cases, you may want to keep the sleep window the same or decrease the window by 15 minutes. (2) How are they feeling during the day? If a person is feeling energized and is functioning well during the day, that is another sign that the optimal sleep window may have been reached.

    I generally recommend experimenting to find what works best for you. Let us know how it goes!

  • Sleepio Member

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

    Thanks Ccat,

    Please see my response to JudeD above. To summarize briefly, the first stage of sleep is a very light sleep stage and it is very easy to be woken up shortly after falling asleep. Also, great job paying attention to external stimuli that may be contributing to these awakenings. Keeping the bedroom quiet, dark, and fur-baby-free are all great ways to help prevent awakenings.

  • Sleepio Member

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

    Hi Luce Jeanne,

    Thanks for reaching out and for the context. It sounds like you have been struggling with some significant sleep challenges, I am sorry to hear that. I want to start by saying that unfortunately, I am unable to provide medical advice. For changes in medication (e.g., starting to take medication again), it is recommended that you speak to your doctor.

    Now the good news is that you haven’t started Sleepio session 3 yet. During session 3, you will be introduced to two powerful techniques. The first is sleep restriction. Sleep restriction is an intervention that reduces the amount of time spent in bed to the amount of time spent asleep. Sleep restriction works by increasing sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night. It is one of the most powerful interventions in the sleep toolbox, but is also one of the most challenging. As you get into sleep restriction, please don’t hesitate to reach out to the Sleepio community with any questions or for support.

    The second intervention you will be introduced to is called the quarter-of-an-hour rule or QHR. Our brains are very good at making associations and when we read, watch television, or toss and turn in bed, we are teaching our brains that the bed is a place for wakefulness. Instead, we want our brains to learn that the bed is a place for sleep. The QHR is based on that principle. QHR asks you to get out of bed if you are unable to fall asleep or return to sleep within 15 minutes. When out of bed, the idea is to do something relaxing in dim light or dark conditions, and only return to bed once feeling sleepy. The QHR is a great way to capitalize on that desired conditioned bed-sleep response!

    Please circle back next week if you have any additional questions.

  • Sleepio Member

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

    Hi stroop,

    Distinguishing between hypnopompic hallucinations, nightmares, and delusions can be quite challenging. While I am happy to provide you with definitions of each, I want to encourage you to speak to your doctor about any medical questions. Also, as I am sure you know, Sleepio is intended to target poor sleep, but not psychotic symptoms. For mental health concerns, it is recommended that you speak to a mental health professional.

    In terms of the three experiences you described (and it sounds like you may already be familiar with these definitions):

    Hypnopompic hallucinations occur when transitioning from REM sleep to wakefulness. REM sleep is the sleep stage associated with dreaming and during REM sleep our muscles paralyze to prevent us from acting out our dreams. Sometimes these REM features can carry over, which lead to hypnopompic hallucinations.

    Nightmares typically occur during REM sleep and are defined as dreams with scary, explicit, or unsettling content.

    Delusions are defined as beliefs that are maintained despite objectively not being true.

    All three can be very distressing and they can be difficult to tease apart. For better clarity on this, I would recommend speaking to a doctor.

    Thanks for reaching out, stroop.

  • Sleepio Member

    • 394 comments
    • 123 helped
    Expert

    Thanks for the great questions. Signing off now. For any outstanding questions, please utilize the next live expert chat on Wednesday, September 23rd.

    Happy sleeping!

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