Live Discussion with Dr Jen Kanady - 18 September 2019

Dr Kanady will be hosting a live online discussion here on Wednesday 18 September, from 8.00 PM to 9.30 PM British Time or 3.00 PM to 4.30 PM US Eastern Time.

They will discuss as many topics as possible in the hour and a half 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 12 Sep 2019 at 7:51 PM
  • 20 comments
  • 8 helped

Comments

  • Sleepio Member

    • 11 comments
    • 5 helped
    Graduate

    Before I started the programme I read that it was unhelpful to be focusing on how much one had slept, for example with Fitbit etc. Obviously the Sleep diary makes one do exactly that and I think in my case contributes to the focus in the day time on sleep generally, which I have seen on other people's posts is part of the overall problem i.e. that we tend to think and talk about sleep much more than other people. Any suggestions on how to manage this or is it just becuase I am deep in the programme?

  • Sleepio Member

    • 11 comments
    • 3 helped
    Graduate

    I'm on statins and a side effect can be the nightmares and awful dreams which I suffer from. I find I am so full of adrenaline that I have a feeling similar to thinking I'm running out of petrol, or a massive motorway jam on a way to somewhere where I can't be late. I've got an overdue medication review with a pharmacist, which I hope may be better than a fob off with the GP. Do you know if all statins have this side effect? ( not the fob off with the GP) Do you find coming off statins helps with insomnia? The GP said there was no cure for nightmares, told me I was anxious, told me to go to Talking Therapies who won't treat me because I'm dyslexic( I can read and write) but really struggle filling in their GAD7 test. I also had to lie filling in the Sleepio questionairs as it wouldn't let me progress if I couldn't say which catogory I'm in or the timings of sleep events. I've still got filthy sleep hygiene, I'm like an addict to bad sleep habits. I used to sleep really well and am wondering if I should come of the statins.

  • Sleepio Member

    • 2 comments
    • 4 helped
    Session 1

    I've been looking through the community forums but I could not see this specifically mentioned, but may have missed it, in which case apologies. I'd be eternally grateful if Dr Jen or someone else can help me with the below query.

    My sleep issues seem to be closely tied to my general anxiety (like a lot of people i'm sure), but the particular thing I struggle with I don't see many people talking about and am unsure whether it's symptomatic of something else. So I would be interested to hear whether this is 'normal' or common with Insomnia.

    The issue only seems to occur when I'm sleep deprived. Basically I can get myself feeling calm and ready to sleep but every time I am about to nod off or I can start to feel the pull into the next phase of sleep I am jolted awake. Like a jolt back into wide awakeness, sometimes with a surge of anxiety/panic and sometimes without. It's not a hynic jerk, more just in the mind. This will happen over and over again, some nights it can occur literally around hundred times and I don't sleep. This is the thing that is causing me great distress. It only happens when I am overtired, so if I have a bad night the next night this problem starts and so it continues. The only way I have managed to break it thus far is prescription medication. It's horrendous and very frustrating. I just don't see it talked about very often which I find odd. Any advice on this would be massively appreciated.

    Anyone else experience this? Any ideas on best way to solve.

  • Sleepio Member

    • 11 comments
    • 5 helped
    Graduate

    I have been on sleep restriction for over 4 weeks and only managed one increase of quarter of an hour, although i have had better sleep efficiency overall. I wondered how long people typically have to wait to see improvement as I just feel exhausted and finding it hard to stay up until it's my time to go to bed.

  • Sleepio Member

    • 3 comments
    • 1 helped
    Graduate

    Hi. I have just got results of my genetic test and it showed that I cannot sleep because of problems in my genes – slowed down conversion of 5-HTP to melatonin and weak sensitivity of GABA receptors to GABA. I also have a moderate (constant) anxiety and hyperactivity which also have genetic reason not psychological. No meds work for me, I developed a resistance to them (rare case, I am resistant to all of them). Calming herbs of no help either – developed a tolerance as well. I do not sleep at all (6 days in a raw that is for sure). In this condition I cannot implement sleep restriction because I am exhausted both physically and emotionally to say mildly. I live in a hell. I also have schizoaffective bipolar and all doctors thought before the results of my genetic tests that these two conditions are associated but now I can see that it is not necessary. My question is – can SOMEHOW CBT-i help me to sleep at least 3 hours per night on my own? My doctors do not know what to do with my case. Nothing works for me. Maybe because the problem is in genes. I really do not know what to do. For the years of having insomnia I have tried tonns of methods even the most serious and risky one…but no result at all. They show results for other my conditions but not for sleep. Please give me advise about CBT-i. Thank you for your time.

  • Sleepio Member

    • 9 comments
    • 4 helped
    Graduate

    I have been doing the Sleepio programme since March.
    Overall I think there has been significant benefit-mainly that if I wake during the night, I can usually get back to sleep again.
    However, I still wake after 4 house of sleep, even when I'm very tired.
    Any suggestions as to how to stop that happening? Should I go back to more severe sleep restriction?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 4

    Hi, I'm on week 1 of the programme and am a shift work. I have been doing night shifts only for the last 6 months however am going back onto mixed shifts in the next month. What is the best way to adjust between day and night shift, especially when coming off night shift and going back onto a normal night sleeping schedule. For example, tonight I am working 2130-0700, after working 0900-2100 over the weekend. My plan is to have a nap this afternoon, then possibly only a few hours sleep in the morning and get up at lunch time. Is this the right thing to be doing?

  • Sleepio Member

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

    Good morning. On occasions I have a similar experience although not as acute as you. I find it's best to just accept that I'm not going to sleep and I get up. I read or just sit in a dark room. I find it breaks the pattern, almost like breaking the circuit in my brain and generally even after 20 minutes or so I fall asleep when I return to bed. Hope this helps.

  • Sleepio Member

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

    Good morning. I posted a reply then hit the Flagged tab by mistake and deleted it! I'm new to the programme.

  • Sleepio Member

    • 9 comments
    • 1 helped
    Graduate

    Hi Dr Kanady.
    Another anxiety question again i'm afraid. I have been suffering with anxiety and panic attacks for over a year and have had CBT which has almost stopped my panic but the anxiety is still there although much reduced but it turned into insomnia from May this year.
    I'm on a waiting list for a second round of CBT for my anxiety. My sleep has improved from were it was in May but i still wake several times and sometimes i get very little sleep some nights but my SE doesn't often go below 60% and is 80-90 sometimes so thats good.

    Last weeks Q&A session somebody asked about frequent waking and the Dr gave possible reasons for this and one was anxiety. So my question is Are people like me only going to go so far with sleep improvement until the anxiety is dealt with?. A lot of the techniques for better sleep work well but it's only been since i've worked on my anxiety that sleep has improved. But it still overtakes my nights sometimes but i feel i have a long way and lot of bad nights to go. Should i just accept that this for now as good as it gets?

    thanks.

  • Sleepio Member

    • 388 comments
    • 122 helped
    Expert

    Hello everybody. My name is Jennifer Kanady and I am a clinical and research psychologist trained in sleep. I am here to answer any and all sleep-related questions for the next 1.5 hours.

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Glisglis,

    Thank you for the great question. Sleep diaries can be a conundrum for this exact reason. On the one hand, sleep diaries are an important aspect of the Sleepio program because they are essential for establishing the sleep window and for monitoring progress. On the other hand, filling out the diaries can also be a source of anxiety for some individuals. My suggestion for completing the sleep diaries is to provide your best guess estimates upon awakening in the morning. The sleep diaries do not need to be exact and are instead supposed to be a measure of your subjective sleep experience. The idea is that you can spend 3 minutes filling out the diary and then not think about it for the rest of the day.

    For graduates of the program who find sleep diaries to be a significant source of anxiety, another option is to bypass the diaries all together. For this option, individuals would adjust their sleep window based on a reflection of the previous week of sleep. If you feel like you slept well, you could move your bedtime 15 minutes earlier. If you feel like you could have slept better, maybe keep the sleep window the same or move your bedtime 15 minutes later. Ultimately it is recommended that individuals find a way to apply Sleepio skills in a way that works best for them.

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Napcat,

    I’m sorry to hear that you are struggling with nightmares. Unfortunately, I am unable to provide any recommendations about medication use and suggest that you consult your primary physician before making any changes to medications.

    A couple of additional thoughts:

    (1) There are some evidence-based treatments for nightmares, including psychosocial treatment (e.g., imagery rehearsal therapy and/or CBT-I). See this paper for a review:
    http://jcsm.aasm.org/viewabstract.aspx?pid=29826.

    (2) Skilled clinicians should be able to adapt psychosocial treatments to your specific needs (e.g., completing the GAD-7 orally).

    (3) It’s great that you are able to acknowledge your problems with sleep hygiene. Revisiting the sleep hygiene skills and other skills learned in Sleepio may be another way to help get your sleep back on track.

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi GiJones,

    This sounds really frustrating. Unfortunately, it is difficult for me to know what is causing these “jolts”. One possible explanation is that these experiences are caused by transitioning into REM sleep. REM sleep is characterized by something called muscle atonia -- essentially, your muscles become paralyzed during REM sleep so you don’t act out your dreams. Some people experience twitches, jolts, or jerks during this transitional sleep state. Further, when you are sleep deprived, you tend to experience REM rebound. Meaning, you tend to get more REM sleep than usual. This could help explain why you experience these jolts more during sleep deprived states. There are also sleep disorders that are characterized by jerking/jolting. For example, there is a type of sleep disorder called restless leg syndrome. Restless leg syndrome 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.

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

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Glisglis,

    Unfortunately, there is no exact answer to this question. The amount of time it takes to adjust to the new window differs from person to person.

    I also want to acknowledge that the beginning part of sleep restriction is hard! What I like to tell people is that if they feel exhausted and are struggling to stay awake until their bedtime, that actually means that sleep restriction is working! Sleep restriction is meant to increase your sleep drive -- your need for sleep -- thus making it easier to fall asleep and stay asleep at night. It’s also great to hear that you are seeing improvements in your sleep efficiency. This is another indication that sleep restriction is doing what it’s supposed to. I imagine that the more you stick to your sleep window, the more improvements you will see.

    Keep up the good work!

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Lenochka09,

    Thanks for your questions. It seems like you are dealing with a lot and I am sorry to hear that this is impacting your sleep as well. 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 current treatment plan. Sleep problems can certainly exacerbate symptoms associated with schizoaffective and bipolar disorder so it’s great that you are thinking about how to target and treat your sleep problems.

    A couple of additional thoughts:

    While genes certainly predispose us to developing certain conditions, the good news is that genes are not the entire story. Our environment and our behaviors also influence how we feel and how we sleep. Thus, even though we can’t change our genetic makeup, research shows that making changes to things like behaviors, environment, and lifestyle can lead to significant improvements in mood and in sleep.

    While sleep restriction can be a powerful tool for a lot of people, it is not for everybody. If an individual struggles to implement sleep restriction, I generally recommend that they instead try to maintain a regular sleep/wake schedule. Maintaining a regular bedtime, rise time, meal times, and exercise times is key for stabilizing our circadian rhythms. Having regular and stable circadian rhythms can help with things like anxiety, depression, stress, and sleep and wake.

    In terms of anxiety, the Sleepio program has a lot of great skills for managing anxiety symptoms that interfere with sleep. Revisiting the skills from session 4 and session 5 may be helpful for alleviating anxiety symptoms.

    To summarize, there are certainly aspects of Sleepio that may be helpful for treating sleep disturbance in the context of a mental heath condition. However, the general recommendation is that individuals work with their mental health provider or other physician on how to incorporate Sleepio or other sleep treatments into their current treatment plan.

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Dory2,

    I am happy to hear that you have had success with the Sleepio program.

    Waking up in the middle of the night is actually to be expected! Everybody wakes up in the middle of the night, but not everybody is able to remember those awakenings. When nocturnal awakenings become problematic is when the awakenings last for 30 minutes or longer and/or when these awakenings are causing significant daytime impairment/distress.

    Sleep restriction is one of the best ways to reduce nocturnal awakenings. Reducing time in bed increases the sleep drive and makes it more likely that a person will sleep through the night. However, if nocturnal awakenings are not causing significant distress, then sleep restriction may be unnecessary. For safety reasons, it is also generally recommended that an individual not decrease their sleep window to under 5 hours to avoid significant daytime sleepiness the following day.

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Chunky Punk,

    Great question. We actually have a guide for shift work because sleep problems are so common among shift workers. You can access that guide here:

    https://www.sleepio.com/articles/shiftwork/shift-work-and-sleep-intro/

    It includes several things you can do before, during, and after your shifts that can help make the transition.

    To specifically answer your question about whether you should take a nap – this is your decision. One thing you might want to think about is the function and outcomes of a nap. A nap might make you less sleepy in the moment. However, it may be more difficult to get to sleep the next time you try, because naps reduce your sleep drive. That said, you will be the best judge of whether you need to take a nap if you are too sleepy to be able to function at work.

    I want to let you know that many shift workers have successfully completed the program and “Graduates” often share tips and advice in the online community (you can try searching there for “shift” and “shift work” to see their posts).

    Check out the shift work sleep guide and the boards and feel free to check back in with us next time if you have further questions!

  • Sleepio Member

    • 388 comments
    • 122 helped
    in reply to Sleepio Member
    Expert

    Hi Eddie06,

    Thank you for expressing your concerns and bringing up the role of anxiety in sleep.

    To reiterate what you and I have talked about before: 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.

    It sounds like you are targeting your sleep and anxiety in a great way -- you are engaging in evidence-based treatment for both! The good news is that there is no “as good as it gets.” The amount of improvement seen following CBT will vary from person to person. The best advice I can give is to keep up the good work. Engaging in evidence-based treatment for sleep and anxiety is a great way to see an improvement in both!

    Please feel free to reach out with any additional questions.

  • Sleepio Member

    • 388 comments
    • 122 helped
    Expert

    Signing off now. A big thank you for all the great questions today. For any lingering sleep questions, please visit our next live expert chat next Wednesday. Happy sleeping to all!

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