Live Discussion with Dr Jen Kanady - 30 September 2020

Dr Kanady will be hosting a live online discussion here on Wednesday 30th September, 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.

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 27 Sep 2020 at 9:10 PM
  • 12 comments
  • 3 helped

Comments

  • Sleepio Member

    • 13 comments
    • 5 helped
    Graduate

    I'd love some advice about when its OK to take the offered extra 15 mins, my SE is in the 80s but Im worried I will slip back to waking up in the night if I extend any further. Any times for when I can be confident to try and stretch my window would be great,
    Thank you
    Alison

  • Sleepio Member

    • 13 comments
    • 5 helped
    Graduate

    My apologies Dr Kanady, I have just found your answer to this question from the discussion a couple of weeks ago. I thought I had missed out because I couldn't log on at the actual live time of your session, until I realised the discussion is still available!
    As you can see I am still struggling with the same question, however. My SE is the same 11-6 and I am getting 6-6.5 hours every night, which is hugely better than when I joined sleepio. I am still tired and would love a bit longer sleeping but because my SE is in the 80s every week I've left it the same for five weeks now…should I dare moving it early to 10:45 and see if I can adjust and then get more sleep?
    Thanks so much for your support and expert advice
    Alison

  • Sleepio Member

    • 12 comments
    • 0 helped
    Graduate

    Good evening, Dr. Kanady,
    I have a question, I am in my third week and using a Fitbit since the second week.
    I see that there are differences between what the device measures, in terms of total sleep time, number of awakenings and time awake during the night and what I think happens during the night.
    In the morning when I record my data I usually correct it in the sleep diary based on the fact that the previous two weeks, the data was recorded without the watch, but I do not know if I should leave it as it appears on the Fitbit.
    How should I best record it?
    Thank you very much,
    Stroop.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    I'd like to point out a couple of flaws in the follow-up program – it only tracks sleep efficiency when suggesting an increase my sleep window. It does not take into account that my average sleep time is way below the existing window. I do refuse the window increase, but the follow-up reviews after finishing the program are detached from reality this way.

    Similarly, it does not account for the wide deviation in sleep times. My sleep times go like 4-8-4-7-2-12 hrs over a week, which isn't normal, but is ignored.

  • Sleepio Member

    • 386 comments
    • 120 helped
    Expert

    Hello all and welcome to the live expert chat. I am Dr. Jennifer Kanady. I am a clinical psychologist with an expertise in sleep. I am here for the next 1.5 hours to answer any and all sleep-related questions.

  • Sleepio Member

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

    Hi Alison,

    Thanks for your question. I am glad that you figured out that you can access the chat even if you can't attend live (i.e., when I am online and answering questions).

    Great question regarding when to increase your sleep window and I am glad you were able to see my answer from a couple of weeks ago.

    To reiterate, the general rule of thumb is to keep your sleep window the same if you haven't achieved a sleep efficiency of greater than 85-90%. That being said, there is always room for experimentation. Adding 15 minutes to the sleep window and seeing what happens to sleep sounds like a great experiment. If you add 15 minutes and your sleep efficiency remains high, you can keep the window the same or experiment with adding another 15 minutes. If your sleep efficiency decreases significantly, you may want to consider decreasing the window by 15 minutes. I generally encourage people to play around and see what works for them.

    Also, it's important to keep in mind that everybody has a different sleep need. While we often hear that we should be getting 8 hours of sleep each night, this is just an average and some people need more sleep and some people need less. Therefore, it's also important to pay attention to how you are feeling during the day. If you feel good during the day, then you may not need to increase your window any further.

    Please feel free to reach back out with any additional questions. And keep us posted about how the experimentation goes!

  • Sleepio Member

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

    Hi Stroop,

    I love that you asked this question. Insomnia is a disorder that is characterized by subjective sleep problems. Therefore, I generally encourage people to use their subjective experience to fill out the sleep diaries (rather than a commercial device like the Fitbit). Therefore, I think modifying the sleep diaries based on your subjective experience is a great approach.

    A couple of things to keep in mind about commercial wearable devices: (1) the accuracy of these devices is questionable and accuracy tends to decrease as sleep becomes more disturbed. E.g., commercial devices may do a good job estimating total sleep time in healthy sleepers. But as sleep becomes more disturbed (e.g., increased nocturnal awakenings), the device estimates become less accurate and may over or underestimate sleep. (2) While I think that it's great that these devices point to the importance of sleep, it's also important not to get too bogged down in the numbers. Hyperfocusing on device output can make individuals more anxious about sleep and can perpetuate any ongoing sleep problems.

    Thanks for asking such a great question!

  • Sleepio Member

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

    Hi Evgenii,

    Thanks for flagging these points. Sleep efficiency is one marker of sleep quality/sleep health and there are other parameters of sleep quality -- or sleep health -- as well (e.g., total sleep time). Also, sleep efficiency is calculated as an average and doesn't account for variations in efficiency across the week.

    If you feel like the program isn't adjusting your sleep window appropriately, my general recommendation is to experiment with a sleep window that works best for you (for example, see my response to Alison above). Maybe try keeping the sleep window the same or adding/subtracting 15 minutes to see how it impacts your sleep. When experimenting, it is also important to keep in mind that another important aspect of the sleep window is establishing a regular bedtime and rise time. Our circadian rhythms -- an important process for regulating our sleep -- love regularity. When we vary our bedtimes and rise times significantly, our circadian rhythms become confused as to when we are supposed to be awake and when we are supposed to be asleep. Keeping a consistent sleep schedule is another way to promote healthy sleep.

    Thanks again Evgenii. Comments like these are helpful for further improving upon the program.

  • Sleepio Member

    • 8 comments
    • 0 helped
    Graduate

    Hi Dr Kandy,
    I am just wondering how long I should continue. I have no problem falling asleep when I go to bed initially. But every night without fail I wake up after about 4 hours. Following the QHR I get out of bed after about 15 minutes. Despite feeling calm, I never feel sleepy again in the middle of the night, no matter what I do. After about 40 minutes of quiet time (usually meditating) in total darkness, I go back to bed. Sometimes, after about another hour of tossing and turning, I eventually doze or sleep very fitfully until my alarm goes off in the morning. However, for the last 2 nights, I have not managed to fall back to sleep at all. Any advice would be very welcome. I understand that strictly speaking I should get out of bed for a second and third time if I do not fall back to sleep within the 15 mins. However this would prevent my getting any sleep at all after the 4 hours. Is this what I should do? Is it safe?

  • Sleepio Member

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

    Hi G123456

    That is really frustrating. Nocturnal awakenings/early morning 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:

    Keep up the good work! As you noted, 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! For those concerned about missing sleep opportunity when getting out of bed, I usually like to mention this motto, “If not tonight, then tomorrow night.” The idea is that if you sleep poorly on 1-2 nights, it is more likely that you will get good sleep on subsequent nights.

    Sometimes gauging sleepiness can be challenging. When implementing the QHR rule, if you don't “feel” sleepy after some time, there is no harm experimenting with getting back into bed to see if you can fall back asleep. But the general rule of thumb is to get back out of bed if unable to return to sleep in 15-20 minutes for the reasons highlighted above.

    I love that you practice meditation during these awakenings in complete darkness. Such a great middle of the night activity. 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 in the early morning hours.

    Finally, one thing that might be helpful to pay attention to is your sleep schedule. All of us have different circadian preferences -- that is, different times we prefer to go to bed and wake up. When we get older, our circadian preference tends to shift earlier. One thing that can be helpful for some with nocturnal/early morning awakenings is to shift the sleep schedule earlier.

    Also, it sounds like you are struggling with getting enough sleep. One thing that is important to note is that if you feel excessively sleepy while engaging in a potentially dangerous situation (e.g., driving), the best thing you can do is to take a nap until the sleepiness subsides. It is important that you keep yourself and others around you safe!

    Please keep us posted about how things are going!

  • Sleepio Member

    • 386 comments
    • 120 helped
    Expert

    Signing off now. Thanks for the great questions and please feel free to check in with our expert next Wednesday. Wishing everybody happy and healthy sleep.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Have only just found access to this, thanks very much for it, my questions are being answered via the postings of others. Dr Kanady has some very good tips.

Return to top