Live Discussion with Dr Jen Kanady - 7th April 2021

Dr Kanady will be hosting a live online discussion here on Wednesday 7th April 2021, 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 1 Apr 2021 at 2:34 AM
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  • Sleepio Member

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    Session 4

    I don't understand why it's recommended to watch TV instead of reading. It has kept me up for 2 days i've been watching TV until 30 minutes before bed time like sleepio has recommended and i have not felt sleepy or tired at night time. Is watching TV actually beneficial? It's not recommended by any sleep doctors or other doctors i've talked to.

  • Sleepio Member

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    Expert

    Hello Sleepio Community and welcome to the live expert chat!

    My name is Dr. Jennifer Kanady. I am a clinical psychologist with an expertise in sleep and the treatment of sleep disorders. I am here for the next 1.5 hours to answer any and all sleep-related questions.

    For those of you new to the chat, the way that it works is that I answer the questions in the order in which they were received. Feel free to add your questions to the queue.

    Looking forward to digging in!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Hobbit78,

    Thanks for reaching out and for the great question. It looks like you are pretty early in the Sleepio program and a lot of this will be covered in future sessions. In particular, session 3 will likely be of interest. During session 3 you will learn about sleep restriction and the quarter of an hour rule (QHR).

    Sleep restriction is a powerful sleep intervention that limits time in bed to the actual amount of time spent asleep and then increases time in bed each week as sleep improves. Sleep restriction works because it capitalizes on the two processes that regulate sleep: (1) process S (our sleep drive) and (2) process C (our circadian rhythm).

    The QHR is based on the principle of stimulus control and the fact that our brains are very good at making associations. QHR encourages individuals to get out of bed if unable to fall asleep or return to sleep within about 15 minutes. The idea here is that you don’t want to spend a bunch of time in bed because the brain will start to learn that the bed is a place for wakefulness (remember, our brains are very good at making associations) when instead we want our brains to learn that the bed is a place for sleep. When getting out of bed during QHR, it’s important to maintain dark/dim light conditions and do activities that are relaxing/sleepiness-promoting.

    I am sorry to hear that you are struggling during the day. Some things that can help to combat fatigue/sleepiness are exposing oneself to bright light (ideally sunlight) and exercise. Also, if you are feeling sleepy during situations that can potentially be dangerous (e.g., driving), the recommendation is to take a nap until the sleepiness subsides.

    For consistent excessive daytime sleepiness, the general recommendation is to speak to a doctor who will be able to diagnose any potential sleep problems and/or offer more personalized advice.

    Keep us posted about how things are going!

  • Sleepio Member

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    Graduate

    Hi Jennifer,
    Sleep/bed connection please. I follow the guidelines on this very carefully (barely go into the bedroom during the day never touch the bed) and consistently over the last 6 weeks or so. However it remains that I find it much harder falling back to sleep in my bed (after waking in the middle of the night) than I do in any over bed/sofa of the house.

    Keen to know why this is – my theory is making my bed so sacred inadvertently makes it a pressurized environment.

    Also why is it a problem for me to use another bed or the sofa to sleep on if it's easier for me to fall asleep there?

    Many thanks!!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi jamesmccloskey3,

    Early morning awakenings (i.e., waking up before intended without being able to return to sleep) can be tough. People often report that it is difficult to return to sleep during these awakenings, which makes sense given that the sleep drive is low (our sleep drive is our biological need for sleep that increases the longer we are awake and decreases during sleep). Some things that can be helpful during these awakenings is reducing exposure to light and limiting activity (e.g., avoiding things that have an alerting effect). I also sometimes encourage experimenting with the sleep schedule. Everybody has a different circadian preference and some individuals are morning people; e.g., their circadian rhythm tells them to get into bed and wake up early. Sometimes shifting the schedule forward (e.g., going to bed an hour earlier) can be helpful for these awakenings as well.

    Please feel free to reach back out with additional questions.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi abalach,

    With pre-bedtime activities, it is not a one-size fits all approach. The general rule of thumb is that you want to avoid any activities that are too stimulating and any activities that involve bright light. Watching television before bed can impact different people in different ways. For some, it’s a nice, passive activity that can be a good way to wind down before trying to fall asleep. And certainly, decreasing light exposure from the TV can also be helpful (e.g., reducing the brightness of the TV, electronic device). For others, the TV can be too stimulating and is not suitable as a pre-bedtime activity. I generally tell people to experiment with what works best for them. E.g., try watching TV before bed for a few nights and see how you sleep vs. doing something else before bed. It’s a nice opportunity for some creative problem solving!

    Let us know what ends up working best for you!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi M,

    Thanks for reaching out and it sounds like you have made some really great progress (a 90% sleep efficiency, congratulations!). Though, I am sorry to hear that you are at times struggling during the day.

    I have a couple of thoughts that might be helpful:

    It looks like you are only on week 2 of sleep restriction. Sleep restriction works by increasing the sleep drive. Therefore, experiencing daytime sleepiness during the first several weeks is to be expected. In fact, I often tell people that it means that sleep restriction is working! As the sleep window increases and the brain and body adjusts, for many, that sleepiness will begin to reside.

    Insufficient sleep is not the only thing that can cause daytime sleepiness or fatigue. For example, boredom can be a common culprit! Some things that can be helpful for mitigating daytime sleepiness/fatigue include exposing oneself to bright light (preferably sunlight) and exercise.

    Sometimes the timing of sleep can be a contributing factor. If possible, it may be helpful to experiment with the timing of sleep (e.g., shifting the sleep schedule earlier) for combatting things like evening sleepiness.

    Finally, a couple of concluding thoughts about applications that measure sleep. While these applications can be helpful for calling attention to sleep, it’s also important not to hyperfocus 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 output can cause more stress and anxiety about sleep, which can perpetuate sleep problems.

    Congratulations on all your hard work and please do reach out with any additional questions and/or let us know how things are going.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Dee,

    Thanks for reaching out with some really interesting questions. Our sleep is regulated by two processes: (1) process S (our sleep drive) and (2) Process C (our circadian rhythm). Circadian rhythms are rhythms that occur naturally in our body and follow a roughly 24-hour period. One thing that is important to understand about circadian rhythms is that they are very responsive to cues in our environment. In particular, cues of light and darkness. Light (especially sunlight) has an alerting effect whereas dark or dim light conditions has a sedating effect and triggers the release of melatonin (an important hormone for preparing the brain and body for sleep). Therefore, sunlight certainly has an impact on sleep. And in fact, regular early morning bright light exposure can be really helpful for mapping circadian rhythms onto the 24 hour day and promoting healthy sleep. Ideally, the early morning bright light exposure would be sunlight, but given that you are a lark, the sun may not be up during those early morning hours. So turning on lights in your home and/or investing in a light box can be a helpful replacement for sunlight.

    Pasted below is a review article that you might find to be helpful:

    https://www.sciencedirect.com/science/article/abs/pii/S1087079215001136

    Also, I am unaware of any research demonstrating an association between sunlight exposure and dream recollection.

    Finally, thanks for your kind words about Sleepio and the importance of sleep. Here’s hoping that you find the program to be helpful and please reach out with any additional questions.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Sue Law,

    Unfortunately, it’s hard for me to speak to what may be going on, but am glad to hear that you have discussed it with your GP. I am unable to provide diagnoses or medical advice, but can speak to this experience more generally.

    One thing that comes to mind is restless leg syndrome. Restless leg syndrome is a disorder typically characterized by an unpleasant sensation in the legs and a strong urge to move the legs. This sensation is usually more intense during periods of rest/relaxation. Another thing that comes to mind is that during REM sleep, our muscles paralyze (something called muscle atonia; the hypothesized function of muscle atonia is so that we don’t act out our dreams). During sleep stage transitions, some people experience jerks/movements in the outer extremities.

    For more specific information about your experience, I would suggest speaking to your doctor who can make a referral to a sleep specialist.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Farshad,

    Great question. I see that you are on session 1. During session 3, the Prof will teach you some more about sleep efficiency and how to adjust the sleep window. In general, if you have a sleep efficiency of over 90%, then you can increase your sleep window by 20 minutes or so for one week. If your sleep efficiency continues to be high the next week, you can again increase the sleep window by about 20 minutes. The idea is that you keep doing this until you reach your optimal sleep window; a sleep window that yields and high sleep efficiency and enough sleep.

    Looking forward to you getting to session 3 and learning more about this technique. Keep us posted!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Emily/Jennifer – can i tag on to this question please?

    Could you also explain sleep efficiency within sleep restriction. Is the efficiency rating based on time asleep Vs time awake as opposed to time asleep Vs time in bed.

    Thanks

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Raquel21,

    I get this question a lot and a lot of people experience heightened sleep problems during perimenopause and menopause. Sleep is certainly closely related to our hormones and changes to hormones can impact sleep. As can stressors and behavioral factors. The good news is that Sleepio addresses a lot of different factors that maintain sleep problems. Also, research has shown that the cognitive and behavioral techniques introduced in
    Sleepio are helpful for individuals in perimenopause and menopause.

    Here is an article talking about the relationship between perimenopause and sleep: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185248/

    Here is a research study demonstrating the benefits of cognitive and behavioral techniques for those in perimenopause with insomnia symptoms: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2522398

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Emilyhall,

    Happy to explain. Sleep efficiency is essentially a variable that tells you how efficiently you are using your sleep time. It is calculated by dividing total sleep time (the amount of time you are spending asleep) by time in bed (the amount of time you are spending in bed). A sleep efficiency above 85-90% is generally considered to be healthy. The importance of sleep efficiency will be much more clear in session 3. The Prof will use your sleep efficiency to determine your personalized sleep window for sleep restriction (one of the most, if not the most, powerful sleep intervention). Sleep efficiency will also be used to adjust your sleep window from week to week.

    As you progress through the program, please don’t hesitate to reach out with any additional questions.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Bigcheesewheel,

    Please see my response to abalach above because it is similar to your question. To reiterate: with pre-bedtime activities, it is not a one-size fits all approach. The general rule of thumb is that you want to avoid any activities that are too stimulating and any activities that involve bright light. Watching television before bed can impact different people in different ways. For some, it’s a nice, passive activity that can be a good way to wind down before trying to fall asleep. For others, the TV can be too stimulating and is not suitable as a pre-bedtime activity. I generally tell people to experiment with what works best for them. E.g., try watching TV before bed for a few nights and see how you sleep vs. doing something else before bed. It’s a nice opportunity for some creative problem solving! If you find that watching television before bed makes falling asleep harder, then it may be worth experimenting with other activities that are more relaxing.

    Let us know what ends up working best for you!

  • Sleepio Member

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

    Hi Add Ham,

    This is really great insight on your part. While the cognitive and behavioral techniques are helpful and can reduce insomnia symptoms, for some, they can provide an additional layer of pressure/stress/anxiety. Sometimes, adhering to these guidelines too strictly can add a layer of anxiety that can exacerbate sleep problems. Anecdotally, I have seen this with sleep restriction, sleep diaries, and the bed-sleep connection. In these cases, my general recommendation is to encourage self-compassion and flexibility (e.g., don’t get too bogged down in the strict recommendations and allow yourself room to experiment). Also, the idea behind keeping sleep in bed (and not the couch) is to again strengthen that bed/sleep connection. But perhaps experiment a bit and figure out what works best for you (e.g., if you are able to sleep in both your bed and the couch without issue, that is probably okay).

    Keep us posted and let us know what you find works best for you!

  • Sleepio Member

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

    I cant sleep without the use of some alcohol or sleeping aid and i feel terrible the next morning, what can i do

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Kim22,

    I am sorry to hear that you are finding it difficult to sleep without alcohol or a sleep aid. Unfortunately, I am unable to provide medical advice. Your doctor will be able to best advice you on how to appropriately and safely taper medication use. In terms of alcohol use before bed, the relationship between alcohol and sleep is a tricky one because while alcohol helps us to fall asleep faster, once the alcohol metabolizes, it leads to lighter and more fragmented sleep. Therefore, the general rule of thumb is to avoid alcohol use in the 3-4 hours before bedtime. For some, once reducing alcohol use, sleep problems can start to get worse before feeling better. The cognitive and behavioral techniques introduced in Sleepio have been found to be helpful for those who are abstaining from alcohol. However, it is not a one-size fits all and some individuals may require more personalized care. Again, speaking to your doctor may be helpful.

    Keep us posted!

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    Hi Jennifer,

    One more quick Q if there's time (and thanks for your previous reply):

    Could you also explain sleep efficiency within sleep restriction. Is the efficiency rating based on time asleep Vs time awake as opposed to time asleep Vs time in bed.

  • Sleepio Member

    • 376 comments
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    in reply to Sleepio Member
    Expert

    Hi Add Ham,

    It's based on the second. Time asleep / Time in bed. E.g., if you spend 10 hours in bed, but are only sleeping 8 hours, your sleep efficiency will be 80%.

  • Sleepio Member

    • 376 comments
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    Expert

    OK, signing off now. Thanks everybody for the great questions and please do take advantage of our next live expert chat next week.

    Happy sleeping!

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