Live Discussion with Dr Jen Kanady - 18th December 2019

Dr Kanady will be hosting a live online discussion here on Wednesday 18th December, 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 14 Dec 2019 at 1:29 AM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Cprez,

    Don't worry about it. Flagged comments go to our user happiness team. If they see that there is nothing wrong with the comment, then no action will be taken. Thanks for letting us know.

  • Sleepio Member

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    Expert

    Hi Jim43,

    Thanks for your questions. Problems with temperature can be very frustrating and can certainly impact your sleep. It is difficult to know what is causing you to feel very hot in the middle of the night. Some common culprits include a hot environment, hormonal changes, and alcohol use. My general recommendations for regulating temperature include leaving a window open, wearing less clothing to bed, having layers on the bed (e.g., a sheet and a comforter) so you can remove a layer if feeling warm, and avoiding alcohol use before bed.

    If these strategies don’t work and feeling hot continues to interfere with sleep, my general recommendation is to speak to a doctor about this issue.

  • Sleepio Member

    • 5 comments
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    Session 3

    There do seem to be a number of questions here with similar issues. ie those of us who are very early wakers and wake after 3, 4 or 5 hours sleep and don't return to sleep. Sleep restriction therefore can't get at our symptoms as sleep restriction isn't recommended for less than 5 hour block. Because we feel terrible on this amount of sleep it is clearly no that we only need 3 4 or 5 hours sleep a night. Sleep efficiency therefore isn;t a useful yardstick to measure improvement. In my experience over years, getting out of bed earlier hasn't led to longer duration of sleep. Does Sleepio have further techniques to address this pattern?

  • Sleepio Member

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    Expert

    Hi again DanLevs,

    Exactly. The QHR and sleep diary are supposed to be best guess estimates. No need to watch the clock for exact numbers, especially if that increases anxiety.

  • Sleepio Member

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    Expert

    Hi pmyerscough,

    The cycle you are describing is quite common. Not sleeping well can lead to anxiety about not sleeping and anxiety about not sleeping leads to poorer sleep. It can be a vicious, frustrating cycle!

    The cognitive strategies introduced in sessions 4 and 5 can be helpful for breaking this vicious cycle. One example of a cognitive strategy includes challenging unhelpful thoughts about sleep. For example, if you are having the thought, “I am never going to be able to function tomorrow because of my sleep” you can try to think about this in a more balanced manner. For instance, “I have been able to function off little sleep before.” Or, “if I don’t sleep well tonight, it’s more likely that I will sleep well tomorrow.”

    Another thing to remember is that it is important to get out of bed during these awakenings. Spending time awake in bed teaches your brain that the bed is a place for wakefulness. Instead, we want the brain to learn that the bed is a place for sleep.

    Hope this helps. Feel free to reach back out.

  • Sleepio Member

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    Expert

    Thanks, DanLevs. Please see my response to your earlier question.

  • Sleepio Member

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    Expert

    Hi Ant W,

    It sounds like you are doing a lot of really great things. I am happy to hear that you are doing in-person CBT and it sounds like you have done a lot of really great work with Sleepio.

    Unfortunately, early morning awakenings are sometimes challenging to treat due to differences in biology. Some people are predisposed to be early risers and for these cases, I generally recommend that the individual move their sleep schedule earlier.

    However, it sounds like this has been a fairly recent problem for you. Other techniques that can help with early morning awakenings is sleep restriction and the quarter of an hour rule. Staying awake later can help with sleeping in later. It is also important to get out of bed during these awakenings so the brain doesn't make an association between the bed and wakefulness. Also, making sure that you maintain dim light conditions during these awakenings may be helpful.

    Finally, for anxiety during these awakenings, I generally recommend revisiting the cognitive strategies introduced in sessions 4 and 5. For example, progressive muscle relaxation might be a good way to reduce tension and increase the likelihood of sleep.

    Best of luck and let me know if you have any additional questions.

  • Sleepio Member

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    Graduate

    Thank you for your response. I used to sleep 8+ hours before I started having sleep issues 2 years ago. I do think I am an early riser, but I also think I need more sleep than what I am averaging currently which is around 4 hours. My energy is also very low during the day. I will try to move my sleep window so I go to bed a bit earlier and wake up earlier. It's just frustrating waking up in the middle of the night without any reason (I sleep in a dark, cool room with a fan on and there is no noise) after being asleep 3 hours and feeling fully awake… I do practice good sleep hygiene so low lights at night, not watching tv before going to bed etc. Also my sleep efficiency is very high, because I follow the rules and don't stay in bed, which makes it look better than how I am actually doing. Thanks again for your time!

  • Sleepio Member

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    Expert

    Hi SarahSam,

    Stress can have a significant impact on sleep and it sounds like you are dealing with a lot.

    Sleep restriction is a very effective tool for improving sleep. However, for some individuals, sleep restriction increases stress and can have the opposite effect. Therefore, sleep restriction is not a good fit for everyone. For those individuals who find sleep restriction to be stressful, I generally recommend a technique called sleep compression. Sleep compression works by gradually decreasing your sleep window until you reach the amount of time you are spending sleeping. For example, if you spend 8 hours in bed, but are only sleeping 6, for the first week, you can reduce your time in bed to 7.5 hours. The second week, you can reduce your time in bed to 7 hours. The third week, 6.5 hours. You continue to move in that manner until you receive a sleep efficiency of 90%. Once you receive that sleep efficiency, you can increase your sleep window gradually again.

    It is important to note that Sleepio is a self help program and it is up to the user to figure out how to apply sleep restriction in a way that works for them.

  • Sleepio Member

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    Expert

    Hi Brainalert,

    Please see my response to your earlier question about the rationale for sleep restriction.

    The sleep restriction window should never be less than 5-6 hours of sleep, depending on medical and mental health conditions. For those individuals getting less than five hours of sleep, sleep restriction likely won't decrease the amount of sleep received. E.g., sleep restriction won't increase the sleep drive.

    However, sleep restriction can still be helpful as sleep restriction also: (a) limits the bed to sleep only and (b) stabilizes the circadian rhythm by maintaining a regular sleep/wake schedule.

    Sleep restriction is definitely not a one size fits all intervention. Ultimately, it is up to the user to figure out how sleep restriction works best for them.

  • Sleepio Member

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    Expert

    Hi Brainalert,

    Yes. All previous chats are available in the “community” Sleepio tab.

  • Sleepio Member

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    Expert

    Hi DanLevs,

    Yes, one of the goals of sleep restriction is to stay up later, thereby increasing the sleep drive and supporting consolidated sleep. For individuals who feel anxious about staying up later, I generally recommend playing around with the sleep window (while maintaining a sleep window based off of total sleep time) or revisiting the cognitive strategies introduced during sessions 4 and 5.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    This issue comes up frequently for people who are working on their sleep. Our typical recommendation for those who are traveling is to do your best to stick to the sleep schedule and quarter of an hour rule- we realize that this is not always possible, but try as much as you can!

    Ultimately, if you can’t stick to the sleep window, you can always get back on track when you return.

    Here’s an article about this very topic and decision making about whether to continue with sleep restriction while traveling.

    https://www.sleepio.com/library/article/im-going-on-holiday-should-i-stop-the-sleepio-cour/

    And, in case it’s applicable, here is a Sleepio guide for managing jet lag:
    https://www.sleepio.com/articles/jetlag/the-science-of-jet-lag/

    Hope this information is helpful and enjoy your trip!

  • Sleepio Member

    • 8 comments
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    in reply to Sleepio Member
    Graduate

    Thanks Dr, I am adhering strictly to SR and QHR (although I admit I'm probably bad at estimating the quarter hour). Unfortunately I'm waking about an hour beforehand, which means 15 minutes in bed, x amount of time in the spare room meditating, then more time in bed, by which point I've got very little time to get back to sleep. The timeline seems to render the whole exercise pointless. Do you have any other tips?

    I think I got into this habit of early awakening due to waking up a bit early, dreading work (toxic place, bullying), and clock watching until it was time to get up. I think this gradually fed into my depression until I was waking up earlier and earlier and not getting back to sleep at all. I've since left where I was working, so maybe it's a case of just waiting it out and keeping up my CBT for depression.

  • Sleepio Member

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    Expert

    In addition to sleep restriction, other tools that will be introduced in Sleepio include the quarter of an hour rule (getting out of bed when awake for more than 15 minutes) and cognitive strategies which can be helpful for combating sleep-related anxiety and stress. The cognitive strategies will be introduced in sessions 4 and 5. Here is an article about cognitive strategies: https://www.sleepio.com/library/article/cognitive-techniques-in-depth/

  • Sleepio Member

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    Graduate

    I’m logging off now for relaxation time but just wanted to say thanks – this has been great!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi again inrain,

    It sounds like you are doing a lot of really great things! Keep up the great work! Unfortunately, the amount of time it takes to see an improvement in sleep varies from person to person. So it may take several weeks before you start to see your sleep change.

    Also, for individuals who are applying all Sleepio techniques but still struggle with their sleep, I generally recommend speaking to a medical professional. Some individuals require more intensive care than a self-help program. Also, a medical professional can be helpful for diagnosing other sleep disorders (e.g., sleep apnea).

    Please feel free to reach back out with any further questions.

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Ant W,

    It sounds like you are applying the Sleepio skills beautifully. As you may already know, there is a very close relationship between sleep and depression. The good news is that as sleep improves, depression tends to improve and as depression improves, sleep tends to improve. It may be the case that as you continue to work with your CBT provider, you will see improvements in your sleep. Also, for those in mental health treatment, it is generally recommended that individuals speak to their mental health providers about how to incorporate Sleepio into their current treatment plan.

    Wishing you all the best.

  • Sleepio Member

    • 394 comments
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    Expert

    Signing off now. Thank you for all the great questions. For any lingering questions, please take advantage of our next live expert chat. Happy sleeping and happy holidays!

  • Sleepio Member

    • 17 comments
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    in reply to Sleepio Member
    Graduate

    Thanks. I have started to be more determined in getting out of bed. However, it does seem to actually, if anything, reduce the chance of me getting back to sleep that night because I don't get sleepy again when I get up a do something like reading. I just feel increasingly ill, with a worsening headache. For instance, on Thursday night I awoke at 4am and got out of bed at 4:20am and read for an hour before going back to bed and meditating till 7am (in the hope that I'd drift off but didn't) when I got up. I took several co-codamol to reduce my headache but I felt awful and highly sleep deprived all day. Last night I slept wonderfully though :-). I'll persist for a few weeks to see if I can remove the association of wakefulness with bed.

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