Live Discussion with Dr Jen Kanady - 28th October 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 28th 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 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 22 Oct 2020 at 9:49 PM
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  • Sleepio Member

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    Session 2

    How can Biphasic sleep be recorded on the diary? Is Sleepio trying to push people to a 8 hour sleep with no rising/wakefulness period when they may actually be better sleepers with more rest gained in a biphasic pattern?

  • Sleepio Member

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    Session 5

    My normal abysmal sleep pattern has recently deteriorated until in recent weeks I have slipped into the habit of lying awake until 4 or 5am before falling asleep for an average of 4 hours. I believe this is a side effect linked to my taking a very powerful anti cancer drug. I did my first night of sleep restriction last night. I have a 6 hour sleep window from 1am to 7am. During that time I slept for only 1 hr 45 minutes and got up and out of bed at least 6 or 7 times which was difficult to keep doing. I have a few questions: 1) Is this tiny amount of sleep a typical response at the beginning of sleep restriction ? 2) I have 3 Zopiclone tablets (given to me by oncologist) in my drawer and wonder if it would be a good use of them to try and accelerate adaptation to the new sleep window by taking one each night for 3 nights around half an hour before my 1am sleep start time – obviously sticking to the 7am wake up time. Or would that be a negative move ?

  • Sleepio Member

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    in reply to Sleepio Member
    Session 1

    Thanks for this Alison. You comment gave me an idea: I've been on omeprazole (stops stomach acid reflux) for about four years. I checked for info on any relationship between omeprazole and magnesium deficiency and there is a relationship of this with long term use. Might well be a contributing factor (maybe even a significant one). Thanks for your help.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Have left you a message on your profile page ;)
    Kurly 80)

  • Sleepio Member

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    Graduate

    I am in week four of the program. I have experienced to wake up after three hours of sleep, and not get back to sleep. I go into another room and try to relax, but will not be sleepy for the last three hour of my sleep window. I have tried to go back to bed, but had to get up again. Any suggestions on how to go back to sleep? I use the relaxation techniques in the program and the mindfulness approach.

  • Sleepio Member

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    Expert

    Hello Sleepio Community! Welcome to the live expert chat. My name is Jennifer Kanady. I am a clinical psychologist with an expertise in and I am here to answer any and all sleep-related questions for the next 1.5 hours.

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    Hi Walker-J,

    Thanks for the great questions. There are several ways you can approach the early rise time. First, absolutely, you can embrace an earlier rise time if that works for you and your schedule/obligations. It’s important to note that as we get older, our circadian preference -- or what time our biology tells us to go to bed and wake up -- shifts to earlier. Therefore, early morning awakenings or an earlier rise time becomes more common as we age. Now, if these early morning awakenings are causing distress, this is where sleep restriction can be helpful. Shifting to a later bedtime will increase the sleep drive and thus, will often increase the likelihood of sleeping past the 4:15 rise time. For those who want to shift to a later rise time, in addition to sleep restriction, it’s also important to pay attention to light and darkness cues. Make sure you expose yourself to bright light when you want to be awake and alert and darkness when you want to be asleep.

    In terms of sleep stages, we do tend to get the majority of our deep sleep (stage 3 slow wave sleep) during the first half of the night. Our sleep becomes lighter as the night progresses.

    Finally, a couple of concluding thoughts about wearable devices (e.g., Fitbit). While these devices can be helpful for calling attention to sleep, it’s also important to avoid hyper-focusing on the output. The accuracy of these devices, especially for capturing different sleep stages, hasn’t been well established. Also, for some, overly focusing on the wearable device output can cause more stress and anxiety about sleep, which can perpetuate sleep problems.

    Please feel free to reach back out with any questions!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Tabs,

    Thanks for reaching out and that situation can certainly be tricky. The quarter of an hour rule (QHR), which is introduced in session 3, is the idea that you should get out of bed if you are unable to fall asleep or return to sleep in ~15 minutes. Our brains are very good at making associations. So when we toss and turn in bed or stare at the ceiling, 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 of sleep. Getting out of bed after being awake for approximately 15 minutes is a great way to strengthen the bed-sleep connection.

    Now the important thing to note is that the technique indicates approximately 15 minutes. This does not need to be exact and it is really up to the individual to decide when it makes sense to get out of bed. If you are wide awake, it probably makes sense to get out of bed after ~15 minutes. If you are drifting in and out of sleep and feel like you are on the verge of dozing, then maybe staying in bed for a few more minutes makes sense. It is also important to note that the first sleep stage -- stage 1 sleep -- is the transitional sleep stage between wakefulness and sleep. It is also the lightest of sleep stages and often, individuals report not being asleep when they were in stage 1 sleep. So the state of drifting off and being awake probably includes some stage 1 sleep.

    In summary, I encourage individuals to play around with the QHR rule and figure out how to best apply it in a way that makes sense for them.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Nur14,

    Thanks for reaching out and please see my response to Tabs above. To summarize, the QHR is not supposed to be exact and 15 minutes is an estimate and jumping off point. 20 minutes make more sense for some individuals, especially if sleep onset is right around the corner.

    For those who take longer to fall asleep, it is also important to remember that you shouldn’t get into bed before you feel sleepy (and once you reach session 3, you shouldn’t get into bed before your prescribed bedtime or threshold time). This will help to increase the likelihood of falling asleep faster.

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    Hi again Walker-J. I respond to the questions in the thread in the order they are received. I responded to your question a few minutes ago. Hope this helps!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Zoh,

    Thanks for the thoughtful questions. I wanted to start by saying that in this context, I am unable to provide medical advice. For specific medical questions, I recommend that you speak to your healthcare provider. That being said, I can speak to your questions more broadly.

    (1) Sleep restriction. While sleep restriction is one of the most powerful interventions for sleep, it can also be the most challenging. For individuals with medical conditions, the general recommendation is to not restrict the sleep window to below 6 hours. Another thing that is also helpful to note is that these interventions do invite creativity. For example, the Prof talks about the importance of keeping the bed for sleep and sex only. However, some individuals have mobility issues, chronic pain, and/or difficulty getting out of bed. In those cases, I typically recommend keeping one side of the bed for wake and the other side of the bed for sleep. One option is to approach sleep restriction in a similar way. E.g., restrict the window to 6 hours, and outside the window, make sure to spend time on the “awake” side of the bed.

    (2) Great question about chronotype. Sleepio doesn’t explicitly address chronotype or circadian preference. I am glad to hear you’ve done some reading on your own. My general recommendation is that individuals establish their sleep restriction window based on their chronotype. E.g., if you are a night owl, then having a later bedtime and rise time probably makes the most sense.

    (3) How long does it take for sleep restriction to work? Unfortunately, there is not a definitive answer to this question. Some people see improvements in a week or two, whereas others see benefits after several weeks/months. Generally, the better you are able to stick to the window, the faster you see improvements. However, there are exceptions to this rule and everybody responds differently.

    Please keep us posted about how things are going and best of luck!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Paul101,

    Welcome to Sleepio and thanks for reaching out!

    That sounds incredibly frustrating. It is clear from your description as well as what you have tried that you have done a lot of researching on your own, well done! Unfortunately, the research on hypnagogic jerks is limited. There are some lifestyle factors that can worsen this experience, including caffeine/stimulant use, sleep deprivation, stress, and exercising too close to bedtime.

    It sounds like you are already doing a lot of great work around the hypnagogic jerks such as limiting caffeine use and challenging negative thoughts about the jerks as they arise. Keep up the great work! As stress also contributes to hypnagogic jerks, engaging in stress management during the day may also be helpful. For example, exercising (but making sure it is earlier in the day), and engaging in activities that are relaxing and enjoyable. Also, developing a winddown routine in the hour before bed is a great way to promote relaxation and prepare the brain and body for sleep.

    The cognitive and behavioral strategies introduced in Sleepio don’t target hypnagogic jerks explicitly. However, they can help improve the quality of sleep, which can decrease the presence of these jerks.

    It also sounds like some other Sleepio members have provided some advice and insight as well.

    If this continues to be a concern, my general recommendation would be to speak to a healthcare professional.

    Keep us posted!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi katecelyn,

    That can be so frustrating to see progress one night and then have things slip the next night. In terms of your question, there are a couple of things to keep in mind.

    Everybody experiences the occasional bad night of sleep, even healthy sleepers. It is inevitable. Just because you have a few nights of poor sleep doesn’t mean that your sleep problem is returning. I like to remind people of this, especially those with a history of sleep problems, because if you start to worry about sleep, it can perpetuate the sleep problem and make things worse.

    That being said, for those who experience poor sleep regularly, then experimenting with the sleep restriction window can be helpful. Reducing the window again by 15 minutes can increase the sleep drive, which in turn, may improve sleep quality.

    Please follow-up with us next week and let us know how things are going.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Isilsartari,

    Thanks for your question. There is a dip in our circadian rhythms during the early afternoon hours (usually referred to as the post-lunch dip), suggesting that there may be a biological underpinning to afternoon naps. Also, there is a ton of research demonstrating the benefits of napping for things like attention and memory, productivity, and mood.

    Unfortunately, the recommendations for napping differ depending on whether you are a good sleeper or poor sleeper. For good sleepers, taking an afternoon nap shouldn’t be a problem and in some cases, may be preferable/recommended. However, for poor sleepers, taking an afternoon nap depletes the sleep drive (our need for sleep), making it harder to fall asleep or stay asleep that night. That is why the recommendation for those who struggle with sleep is to avoid daytime naps. And when it’s not possible to avoid daytime naps, to limit napping to earlier in the day and to 30 minutes.

    You can record naps on the sleep diary with the sleep diary tag.

    Thanks again for the question.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Harbord,

    Thanks for reaching out and I really appreciate your thoughtfulness in your approach to the sleep restriction window. Unfortunately, in this context, I am unable to provide medical advice and recommend speaking to your doctor about specific medical questions. Especially those questions related to medication use. That being said, I am happy to speak to your questions more generally.

    In terms of the adjustment to sleep restriction, everybody has a different experience. I usually tell people that things tend to get worse before they get better and that if they can stick with it, things will often improve. However, sleep restriction does get more complicated when also struggling with a medical condition. If you are concerned about sleep restriction or the amount of sleep you are getting, my recommendation would be to speak with your doctor. Of note, CBT-I has been used successfully with individuals with cancer. However, these studies have typically used 1:1 care. Sleepio is a self-help program and the efficacy of Sleepio has not been examined in individuals with cancer. Therefore, my general recommendation is to speak to a healthcare provider about whether Sleepio may be a good fit for your particular needs.

    Unfortunately, I am not able to provide any recommendations about medication use. Your prescribing physician will be in the best position to answer these questions.

    Wishing you all the best and please keep us posted as helpful.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi CharlotteP,

    That is really frustrating. 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. 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! I am so happy to hear that you are getting out of bed during these awakenings.

    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 relax and practice mindfulness. One thing I like to remind people is to make sure to engage in QHR relaxing 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 possible 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 during nocturnal awakenings.

    Please keep us posted about how things are going!

  • Sleepio Member

    • 5 comments
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    in reply to Sleepio Member
    Graduate

    Thank you very much for your replies to my questions. It is very helpful.

    So far, I've had to cheat in that I've been going to bed at Sleepio's recommended time, but I don't set an alarm. So if I'm asleep when my recommended wake-up time passes, I stay asleep. For the time being, I see that as the only way of being able to manage my symptoms as reasonably as possible, although I appreciate that suddenly having your sleep time halved can be hard for anybody, ill or not. During this experience, though, I am increasingly getting the sense that I'm getting cortisol spikes every couple of hours or so, thus I probably need to keep chipping away at this with multiple approaches. Tricky…

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Great, Zoh. Glad to hear that it is helpful. It sounds like you are doing a lot of creative problem solving and sometimes success involves some trial and error. Keeping my fingers crossed that your tenacity pays off! And of course, please continue to use the Sleepio community for additional support.

  • Sleepio Member

    • 376 comments
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    Expert

    Thanks everybody for the lively discussion and thoughtful questions. I am signing off now. For any outstanding sleep questions, please take advantage of our live expert chat next week.

    Happy sleeping!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Paul, as you might have seen I posted about the same issue this week – i am also new to sleepio, and immediately scoured the site for hypnagogic jerk solutions on arrival. However, what has really helped me since I posted my question a few days ago has been realising that hypnagogic jerks are very normal and that the issue is not the jerks themselves but the fact that I have become sensitised to them and nervous of them. Since I realised that my brain doesn't need to be on red alert for hypnic jerks, that they are a normal part of falling asleep, and that a good sleeper would just fall straight back to sleep afterwards without necessarily even realising it had happened, I have been far more relaxed and obviously therefore sleeping a lot better. I have stopped thinking “I can't believe it has just happened AGAIN and I will probably never sleep again in my WHOLE LIFE”, and tend to just think oh yes there's another one and fall back to sleep. I am obviously a sleepio novice so apologies if this is very unhelpful, but it was my own answer to myself about whether or not the site could help or be relevant to my problem – I think it can! Good luck! It's good to know I'm not alone!

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