Live Discussion with Dr Jen Kanady - 24th June 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 24th June 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.

To do this

On PC hit CTRL and R keys or the F5 key
On Mac hit CMD and R

Posted 18 Jun 2020 at 1:43 AM
  • 23 comments
  • 7 helped

Comments

Show older comments
  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 1

    I sleep through the night like a rock, so I think, but how do I know for sure if it's restorative sleep, since I never feel refreshed when I wake up? I sleep deepest and best during that 4 am to 7 am timeframe, which happens to be the timeframe that I need to be waking up within, depending on the day. How do I change my sleep cycle to be sleepier at night and more refreshed up waking in the early morning? I then have to make up for missed sleep on weekends by sleeping in until 10 am or so.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Session 1

    How to deal with Perimenopause Insomnia and if a sleep programme is beneficial and how it can work alongside HRT?

  • Sleepio Member

    • 8 comments
    • 0 helped
    Graduate

    I am in the first week of Sleep Restriction and need some words of encouragement to keep going. I'm finding it really hard.

  • Sleepio Member

    • 1 comments
    • 1 helped
    in reply to Sleepio Member
    Session 2

    I only started yesterday so it’s all still relatively new to me as well but please keep up with it even though you are finding it hard because the positives would be any improvement in you’re sleep you can do this x

  • Sleepio Member

    • 453 comments
    • 181 helped
    in reply to Sleepio Member
    Graduate

    Hi LillyBet, I’ve left you a very encouraging reply on your profile page in answer to your message on the rolling banner 8))
    Kurly :)

  • Sleepio Member

    • 453 comments
    • 181 helped
    in reply to Sleepio Member
    Graduate

    Hiya Tiffany, I have left you a welcome message too!
    Kurly :)

  • Sleepio Member

    • 376 comments
    • 120 helped
    Expert

    Hello Sleepio community! I am back to answer any and all sleep-related questions for the next 1.5 hours.

  • Sleepio Member

    • 8 comments
    • 0 helped
    Graduate

    Thank you, this is my first time here so I am not sure how it works. My question is what is the difference between sleep quantity and sleep quality and does quality always trump quantity? Is so, why?

  • Sleepio Member

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

    Hi Hanna88,

    Thanks for your message. Making some assumptions here, but I believe that you are asking about the relationship between tinnitus, visual snow, and sleep. As I am sure you already know, individuals with tinnitus may experience difficulty falling asleep and may experience reduced sleep quality. Some preliminary research shows that treatment of tinnitus can help with sleep problems. Early research also demonstrates that cognitive and behavioral techniques for sleep (similar to what is taught in Sleepio) are helpful for improving sleep in individuals with hearing impairment, including tinnitus. Anecdotally, I worked with a lot of Veterans with tinnitus and many of them reported that white noise (e.g., a fan) was helpful for falling asleep at night.

    Here is a community thread about tinnitus in case of interest:

    https://www.sleepio.com/community/discussion/tinnitus/

    In terms of visual snow and sleep, unfortunately, this is not an area that I know very well. I took a dive into Pubmed and there doesn’t seem to be much research in this area. My general recommendation would be to speak to your doctor about any concerns.

    Please feel free to reach back out and let us know how you are doing.

  • Sleepio Member

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

    Welcome LillyBet! I wanted to give a brief explanation for how the live chats work before answering your question. Sleepio members can post questions to this thread either during the live chat or beforehand. The live expert -- in this case me -- then answers the questions in turn. I will respond to your questions after responding to those questions above yours. Hope this helps and happy to have you!

  • Sleepio Member

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

    Hi Josh,

    Thanks for reaching out and these are great questions and insights!

    First of all, congratulations on putting in all this great hard work. Sleep restriction can be very challenging and I am happy to hear that your sleep has been consolidated and that your sleep efficiency has been high. Well done!

    In terms of your questions, I have a couple of thoughts:

    1. Your interpretation of the Prof’s advice is absolutely correct. Generally, individuals should not get into bed before feeling sleepy. So the bedtime, or threshold time as the Prof likes to call it, is the earliest you should get into bed. If you don’t feel sleepy at bedtime (or threshold time), then the rule of thumb is to go to bed once feeling sleepy (and that is fine if it is after the prescribed bedtime).

    2. Generally, the recommendation is to keep the rise time static and consistent. The reason for this is that our circadian rhythms -- an important process for regulating sleep and wake -- function best under regular conditions. Regular rise times are one of the best ways to map the circadian rhythms onto the 24-hour day. When we vary our rise times (e.g., sleep in on the weekends), what we are essentially doing is jetlagging ourselves. In other words, our brains aren’t able to learn when we are supposed to be awake and when we are supposed to be asleep. So the rule of thumb is to keep those rise times consistent. If you have to wake up for work at a certain time (e.g., 6:30 AM), then my suggestion would be to make this the rise time.

    3. How to adjust the sleep window? That is a tricky one and one that I often encourage people to play around with. I think your intuition is a good one. If your sleep efficiency is high, then the Prof is going to give you the opportunity to move your bedtime earlier. However, if you are already staying up later than your prescribed bedtime, then it probably doesn’t make sense to move up further. Generally, it is recommended that shifts to the sleep schedule be made gradually and 15 minute increments are generally best. So if you are going to bed around 12:30 AM comfortably and are sleeping well through the night, maybe try going to bed at 12:15 AM the next week.

    A couple of additional thoughts:

    1. Let’s talk a little bit about sleep inertia. Sleep is not an on-off process. E.g., it’s not like a light switch. Just like it takes us time to fall asleep at night, it also takes some time for us to wake up in the morning. Those initial feelings of grogginess upon awakening and that urge to return to sleep are totally normal and are to be expected. It is something called sleep inertia, which is the transitional state between sleep and wake. This is all to say that feeling groggy upon awakening and wanting to return to sleep doesn’t necessarily mean that you didn’t get enough sleep or good sleep, it just means that your brain needs an opportunity to wake up. Some of the best ways to push through sleep inertia is to get out of bed immediately (don’t snooze!), expose yourself to bright light, and splash some cold water on your face.

    2. To help facilitate sleepiness at night, try to establish a winddown routine. Ideally, the winddown routine should involve relaxing activities, should not involve the use of electronics, and should be done in dim light conditions. Bonus points if you do the same thing every night before bed! That is a great way to teach your brain that bedtime is coming soon.

    Keep us posted about how things are going.

  • Sleepio Member

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

    Hi G12345,

    I am sorry to hear that you are still experiencing insomnia symptoms. It must be frustrating to put in so much good work and to see little improvement. Before jumping into some potential ideas, I wanted to take time to note that Sleepio is a self-help program and may not be suitable for everybody. Some individuals may require more personalized one-on-one care. If you have implemented all the Sleepio techniques and are still struggling with sleep, I would recommend speaking to your doctor about other options.

    And now, a couple of thoughts related to your experience:

    1. It may be worth noting that sleep restriction is often anxiety-provoking for a lot of people, but for some it is especially worrisome. In those cases, an alternative to sleep restriction 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.

    2. I am curious if you are engaging with the relaxation techniques in bed? Our brain is very good at making associations and thus, it is important to try to keep the bed and the bedroom for the S’s -- sleep and sex only. For some, even engaging in relaxation techniques in bed can teach the brain that the bed is a place for wakefulness (which is the opposite of what we want!). Maybe try experimenting with doing relaxations outside the bed (if you aren't already doing that).

    3. This one may be obvious and you may already be doing it, but another thought is to pay attention to what is waking you up at night (if anything). Do you have to get up to use the bathroom? Is a bed partner or pet waking you up? Ambient light? Do you drink alcohol close to bedtime? Are you waking up because you are hot? I know you said you have good sleep hygiene, but there may be things in your environment or lifestyle that are interfering with your sleep. Sometimes small changes to the environment or lifestyle can significantly improve sleep.

    Wishing you the best of luck and thanks for reaching out!

  • Sleepio Member

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

    Hi nN duermo,

    Thanks for reaching out. It sounds like some of the information that I provided to Josh may be relevant for you as well. For convenience, I will paraphrase some of that content here and will add some additional thoughts:

    1. Let’s talk a little bit about sleep inertia. Sleep is not an on-off process. Just like it takes us time to fall asleep at night, it also takes some time for us to wake up in the morning. Those initial feelings of grogginess upon awakening and that urge to return to sleep are totally normal and are to be expected. It is something called sleep inertia, which is the transitional state between sleep and wake. This is all to say that feeling groggy upon awakening and wanting to return to sleep doesn’t necessarily mean that you didn’t get enough sleep or good sleep, it just means that your brain needs an opportunity to wake up. Some of the best ways to push through sleep inertia is to get out of bed immediately (don’t snooze), expose yourself to bright light, and splash some cold water on your face. In terms of knowing whether you received decent sleep, I would wait until the hour or two after waking to see how refreshed you feel (i.e., not immediately upon awakening).

    2. Sleeping in on the weekend is so tricky and can sometimes do more harm than good! Generally, the recommendation is to keep rise times static and consistent. The reason for this is that our circadian rhythms -- an important process for regulating sleep and wake -- function best under regular conditions. When we vary our rise times (e.g., sleep in on the weekends), what we are essentially doing is jetlagging ourselves. In other words, our brains aren’t able to learn when we are supposed to be awake and when we are supposed to be asleep. Maintaining a regular rise time is one of the most powerful things to do for healthy sleep. So, if you have to wake up for work at a certain time, then the suggestion would be to make this your rise time every day.

    3. Pay attention to light and darkness in your environment. Darkness is a great signal to the brain that we should be asleep and light is a good signal that it is time to be awake and alert.

    In case of interest, I have pasted some additional reading information below:

    https://www.sleepio.com/library/article/the-pro-sleep-schedule-in-depth/

    https://www.sleepio.com/library/article/what-accounts-for-unrefreshing-sleep-/

    Wishing you the best!

  • Sleepio Member

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

    Hi Shazza2811,

    Thanks for the great question. As I am sure you can attest to, individuals going through menopause or perimenopause can experience heightened sleep problems or sleep problems for the first time. It can all feel very frustrating! For specific questions about how to manage sleep during perimenopause, your best resource will be your doctor.

    That being said, a couple of additional comments.

    1. Research has demonstrated that evidence-based cognitive and behavioral techniques (similar to what are taught in Sleepio) are effective at reducing sleep problems in perimenopausal and menopausal individuals.
    2. Cognitive behavioral techniques (e.g., techniques taught in Sleepio) can be used safely in conjunction with hormone replacement therapy. But again, your doctor will be your best resource for any concerns.

    For additional reading on sleep and menopause, please check out this helpful Sleepio article:

    https://www.sleepio.com/library/article/menopause-and-sleep/

    Thanks for reaching out!

  • Sleepio Member

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

    Oh boy, LillyBet, you are certainly in the thick of it! Sleep restriction is one of the most challenging Sleepio interventions, but is also the most powerful. Sleep restriction works by increasing sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night.

    For some, sleep restriction can be especially challenging, especially during the first couple of weeks. Given the increase in sleep pressure, some individuals may feel worse before they start to feel better (I usually describe it as a “shock to the system”). However, I like to remind people that if they feel sleepy during the day, that means it’s working! That is exactly what we want to happen! Generally, if individuals are able to stick to sleep restriction for a few weeks, things start to get much better and sleep starts to become much more consolidated.

    Please don’t hesitate to reach out for additional support as needed! Congratulations on making it this far!

  • Sleepio Member

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

    Welcome Tiffany20 and thanks for the words of encouragement! Please don't hesitate to reach out with questions or for support as you progress through the Sleepio program.

  • Sleepio Member

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

    Hey again LillyBet and thanks for the great question.

    Sleep quantity is essentially how much sleep you get (e.g., 6 hours, 7 hours, 8 hours). Sleep quality generally refers to a myriad of different components including how consolidated sleep is (sleep efficiency), how restorative sleep is, and how you feel during the day.

    I would say that both are important. How much sleep we get, how consolidated our sleep is, and how much deep sleep we get are all important for our functioning, health, and wellbeing. I wouldn't necessarily prioritize one or the other.

    Now that being said, I know you mentioned that you are just getting started with sleep restriction. Sleep restriction works by restricting time in bed to the actual amount of time spent asleep. Then, gradually the sleep window is increased over several weeks. So sleep restriction first focuses on improving sleep efficiency (e.g., consolidation of sleep) and then focuses on increasing sleep duration (e.g., sleep quantity). This may seem counterintuitive, but research shows that it works! Sleep restriction not only increases sleep pressure as I mentioned earlier, but it also stabilizes circadian rhythms and reassociates the bed with sleep.

    Thanks for all the great questions today!

  • Sleepio Member

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

    Oh, and as a follow-up, here is a Sleepio article that you might find to be useful:

    https://www.sleepio.com/library/article/what-accounts-for-unrefreshing-sleep-/

  • Sleepio Member

    • 376 comments
    • 120 helped
    Expert

    Signing off now. Thanks everyone for all the great questions. For any lingering questions, please check out our next live expert chat on Wednesday.

    Happy and healthy sleeping!

  • Sleepio Member

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

    Hi Dr Kanady,
    Thank you for suggesting sleep compression, I will certainly try it. Also, yes, I do practice the relaxation techniques in bed in the hope that I might fall back asleep. I will try waiting until I get up. I don't think there is any obvious reason I wake up after 3 hours. Thank you again for your help.

Return to top