Live Discussion with Dr Jen Kanady - 29th April 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 29th April 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 23 Apr 2020 at 7:32 PM
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  • Sleepio Member

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    Graduate

    Hi sikluke, I’ve left you some detailed help on your profile page :)

  • Sleepio Member

    • 29 comments
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    Graduate

    Hi, I seem to be able to get to sleep ok, but I'm struggling to get the waking up time consistent. With the lighter earlier mornings I'm waking even earlier. Would like to have black out curtains but it's not possible during lockdown. I also get very hot from about 4am. Our room gets the sun all afternoon and bakes the bricks and then the heat seems to come through about 4ish. I usually wake up then with my creepy crawly feeling and a hot flush. Is this normal and how do I overcome it? I'm over 70. Thank you.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi senora,
    I’ve left you details about sage leaf tablets that help with my hot flushes. I’ve been on them since last summer and they make a huge difference at night :)
    Kurly

  • Sleepio Member

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    Session 2

    Would love to hear about the impact on sleep and circadian rhythm, if any, of not getting much or any sunlight during the day, and possible solutions if this creates a problem. Thanks!

  • Sleepio Member

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    Graduate

    Hello Dr Kanady, I am getting better sleep now, but I am still taking OTC meds every night and that bothers me. I graduated from the Sleepio course bc my sleep proficiency is 96% but that's with meds. I was really hoping to get off the meds. Right after I started this course is when the whole Covid thing started and my anxiety levels were high so I started taking meds to sleep again. I don't feel like I've reached my goal of good quality sleep without meds. Should I take the course again once things get somewhat back to normal?

  • Sleepio Member

    • 2 comments
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    Graduate

    My sleep problem is mainly that I need 10+ hours of sleep at night and I really struggle with having to wake up for a 9 to 5 lifestyle. People just call me lazy, but I genuinely believe if I had a more flexible working pattern I would cope better. Am I alone in this?

  • Sleepio Member

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    Graduate

    Hi Dr Kanady I'm on my 4th week of the course so in my second week of SR as is to be expected I'm pretty exhausted and finding the day seems to stretch on forever until midnight when l can take the match sticks out of my eyes and collapse into bed. At the moment l am getting just over 3 hours a night,normally waking sometime after 3am then not able to get off again, my get up time is 5am. From reading other posts l know its usual for your sleep to get worse before it gets better but what l am a bit concerned about is i7when l finish the course and still only getting a few hours sleep how will l know how to adjust my sleep restriction in relation to my sleep efficiency etc when things hopefully start to improve
    Thank you Mike

  • Sleepio Member

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    Expert

    Hello Sleepio community! My name is Dr. Jennifer Kanady and I am a clinical and research psychologist with an expertise in sleep. I am here to answer all sleep-related questions for the next 1.5 hours. Excited to get started!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi sikluke,

    Thanks for the great questions. I will answer them in turn.

    Regarding electronic devices: Electronic devices can have a negative impact on sleep for several reasons. First, the light emitted from many electronic devices is bright enough to inhibit release of a hormone called melatonin, which is necessary to prepare the brain and body for sleep. It is also important to note that light has an alerting effect, regardless of spectrum (e.g., blue light), and thus can make initiating sleep more difficult. Second, electronic device content can often be emotionally and cognitively stimulating. Social media, reading emails, and reading the news can all have an arousing effect and as you have learned in Sleepio, we want the brain and body to be relaxed prior to trying to initiate sleep. While a blue light filter is great and may help ameliorate some of the negative effects of device use, it is still generally recommended to abstain from electronic device use in the hour or two before bed. For more detailed information about the impact of electronic devices on sleep, see this Sleepio library article: https://www.sleepio.com/library/article/do-light-emitting-electronic-devices-disrupt-sleep/

    In terms of experiencing nocturnal awakenings when you didn’t before, several things can be contributing to this change. One possible explanation is that sleep changes with age. As we get older, there is a decline in the amount of slow wave sleep we get. Slow wave sleep is the deepest of the sleep stages and is the sleep stage that is hardest to awaken from. Thus, as slow wave sleep declines, the number of nocturnal awakenings may increase. When a person has insomnia, these awakenings can be prolonged and it is generally recommended to apply the techniques used in Sleepio to help reduce the length of these awakenings. E.g., applying the quarter of an hour rule and/or using the cognitive techniques taught in sessions 4 and 5. Other factors that may be increasing nocturnal awakenings are environmental and lifestyle factors. Things like warmer temperatures, new bed partners, increased caffeine and alcohol use can all increase the number of nocturnal awakenings experienced. Tracking behaviors and things in the environment can be helpful for identifying these patterns.

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

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Senora,

    Thanks for reaching out. Early morning awakenings can be quite tricky and frustrating. Great idea about the black out curtains and agreed, lockdown has certainly complicated things. Some other ideas for blocking out the light that you may already have access to at home (and may already have considered) include hanging a dark sheet or comforter to block the light or using an eye mask.

    Thanks for your question about feeling hot in the morning. Increases in body temperature in the early morning hours is common. Our core body temperature changes throughout the night. More specifically, our core body temperature drops in preparation for sleep and starts to rise in the early morning hours in preparation for wake. Other things that can also contribute to increases in body temperature include hormonal changes, drinking alcohol before bed, and environmental factors (e.g., wearing too many clothes, having a heavy comforter).

    Another thing to consider is that as we get older, our circadian preference -- that is when our brain/body wants to be awake and asleep -- changes. As we enter into older age, there is often a shift in circadian preference towards a morningness circadian preference. People will report going to bed earlier and waking up earlier than they did in years past. The extreme version of this is called advanced sleep phase. For those individuals who struggle with early morning awakenings often, I typically recommend playing around with the sleep schedule. Shifting the sleep schedule forward (i.e., going to be earlier and getting up earlier) can sometimes help eliminate waking before the intended rise time.

    Please feel free to follow-up with any additional questions.

  • Sleepio Member

    • 10 comments
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    Graduate

    HI Dr Kanady,
    I am just coming up to completing my first week of the course, due to have second session with the Prof tomorrow. Obviously my general sleep pattern is poor and a few years ago I was diagnosed with FND giving me dysphasia , GAD and reaonably mild restless legs syndrome. Iam now off all meds except stroke ones and have coped with poor sleep for a vey long time by having a few nights poor sleep and getting so tired I get a good one. Part of my habit is to drink wine when I a desperate for sleep about 2 /3 nights a week.
    Since starting on the course my sleep has plummeted and I guess I am now thinking about sleep even more. My restless legs has been irritating most nights and it is now coming up to a night to allow myself a wine o clock!
    Major guilt trip! Any advice ? I know its early in the course and I have a lot to learn , but Ihave tried most things already, reading, meditation, yoga for restless legs etc and nothing seems to work.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Autogoat,

    Thanks for the great question. As you mentioned circadian rhythms in your question, it sounds like you are already aware of the importance of sunlight for entraining circadian rhythms. Circadian rhythms are very responsive to things in our environment and sunlight is one of the strongest alerting cues; sunlight lets our circadian rhythms know that it is time to be awake and active!

    Sunlight exposure can be limited for a number of reasons. For example, many of us are limiting our time outdoors due to lockdown, “stay at home,” and “shelter in place” as a result of COVID-19. Even if we aren’t able to go outside as often as we like, sunlight exposure through windows is strong enough to have a beneficial effect on circadian rhythms. Other causes of limited sunlight exposure include things like shift work or living in places with limited daylight during certain times of year. My general recommendation for these cases is to invest in a light box. Light boxes mimic the sunlight and also have an alerting effect on the brain/body.

    Keep us posted !

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Jeaniveytx,

    Thanks for reaching out.

    COVID-19 is on everybody’s minds right now and worries about health, finances, and the general uncertainty of the situation is causing many people to struggle with things like anxiety and sleep. I am sorry to hear that this has been your situation. But I am also happy to hear that you successfully completed the Sleepio program and are getting better sleep. Unfortunately, I am unable to provide advice about medication use and recommend that you consult a medical professional for guidance about tapering use. What I can speak to, however, is the benefit of the skills taught in Sleepio. When people stop taking sleep medications (OTC or prescription), sometimes there can be a “rebound” in insomnia symptoms (i.e., insomnia symptoms can get worse). Reapplying the skills taught in Sleepio can be helpful for getting sleep back on track. Generally, it is up to the individual to figure out if they want to retake the Sleepio course or if they want to apply the skills independently. Some people prefer the structure of the course whereas others prefer to reapply the skills on their own. Only you know what will work best for you!

    Please feel free to reach back out to let us know how you are doing and/or if you have any additional questions.

  • Sleepio Member

    • 2 comments
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    Graduate

    Hi. During my periods of wakefulness (middle of the night or early awakening), I sometimes feel like I drifted into a brief light sleep (because I had dreams) but that even during that sleep I was feeling frustrated because I could not sleep! Is that possible? What is that all about? Thanks.

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi SleepioTime,

    Great question. Sleep need varies from person to person. I am sure that we have all heard that we should be getting 8 hours of sleep at night. However, that 8 hours is actually an average. The truth of the matter is that some people may need closer to 6 hours whereas others may need closer to 10. To figure out sleep need, my general recommendation is to track sleep and daytime functioning to figure out how much sleep is needed for feeling your best. For individuals who like data and experiments, I also sometimes recommend conducting a mini experiment of sorts. E.g., sleep 8 hours one night and 10 hours a different night and note functioning the next day (e.g., energy levels, concentration). Experiments like these are also helpful for figuring out sleep need.

    For individuals who are sleeping a lot but still feel sleepy during the day, the general recommendation is to consult a medical professional to determine if there is an underlying sleep disorder.

    Hope this helps, thanks again SleepioTime!

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi Mike,

    Thanks for the great question. You are in the thick of it and you are absolutely right! Sleep restriction can be one of the most challenging aspects of the Sleepio course for this exact reason. For some, sleep will start to get worse before it starts to get better. I usually tell people that if they are feeling sleepy during the day, that means it’s working! The science behind sleep restriction is to increase the sleep drive -- or need for sleep -- so that initiating and maintaining sleep is easier. Sometimes it takes the brain/body time to adjust so getting through the first couple of (sometimes challenging!) weeks is key. Keep up the amazing work!

    In terms of your question, there are a couple of options. First, when you complete the Sleepio course, you can still have check in “sessions” with the Prof. During these abbreviated sessions, the Prof checks in with you about your sleep diary and adjusts your sleep window accordingly. You have the option of doing this for weeks and this may be one way to achieve your optimal sleep window with support. Another option is adjusting the sleep schedule independently. The idea is very similar to what you will be doing in the Sleepio course. Continue keeping a sleep diary and if 90% sleep efficiency is achieved, increase the sleep window by 15 minutes. Now how do you know when to stop increasing the sleep window? My general recommendation is to pay attention to two things. First, pay attention to daytime functioning. If energy levels are high and you are feeling good during the day, you may have reached your optimal window. The second thing to pay attention to is whether sleep gets worse. This may be an indication that you increased your window too far.

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

  • Sleepio Member

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

    Hi Iris helen,

    Thanks for reaching out and that sounds really frustrating. For some with sleep problems, focusing on sleep (e.g., starting the Sleepio program) can make sleep problems worse before sleep problems start to get better. I am sorry to hear that has been your experience. The good news is that the Prof will start to teach you different skills to improve sleep starting in session 2. And session 3 is where things get really interesting with the introduction of sleep restriction and the quarter of an hour rule!

    For sleep disorders such as restless leg syndrome, the general recommendation is to consult a medical professional. It sounds like you have spoken to your doctor about this diagnosis already, which is great. Additionally, some behavioral techniques that have been shown to be helpful for RLS symptoms include limiting caffeine use, increasing exercise, and relaxation techniques such as progressive muscle relaxation.

    The relationship between alcohol and sleep is complicated and unfortunately, alcohol has a negative impact on sleep. While alcohol may help us to fall asleep faster, it leads to lighter and more fragmented sleep once the alcohol has metabolized. The general rule of thumb is to avoid alcohol use 3-4 hours before bed.

    As you are pretty early in the program, please do reach back out if you don’t see any improvement in your sleep in the next couple of weeks. We are here to help!

  • Sleepio Member

    • 11 comments
    • 1 helped
    Graduate

    Hi Dr Kanady
    Thank you for a very comprehensive answer to my questions, l'm reassured and a lot more confident now l understand the logic behind Sleep Restriction, it all makes sense

  • Sleepio Member

    • 394 comments
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    in reply to Sleepio Member
    Expert

    Hi stengelfoot,

    Sleep can be so strange sometimes, can’t it? Great question. During sleep we pass through different sleep stages and move from lighter sleep stages to deep sleep. Sometimes it is difficult to tell the difference between light sleep and wakefulness. Also, there is a phenomenon called sleep state misperception where individuals believe they were awake when in fact they were asleep. So to answer your question, yes this is possible.

    Thanks for reaching out.

  • Sleepio Member

    • 394 comments
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    Expert

    Thanks for the great live expert session today! As usual, you had some really great questions. For any lingering questions, please take advantage of our next live expert chat next Wednesday.

    As an aside, Professor Colin Espie, one of the founders of Sleepio, is looking for your feedback on several Sleepio features. You can find these threads here: https://www.sleepio.com/community/topic/feedback-to-team/ . For those of you that have time, we would love to hear your thoughts on the Sleepio community, live expert chats, the case file, the sleep diaries, and the Sleepio library. Your input will help us to make this program even better.

    Signing off now. Wishing you all happy and healthy sleep!

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