Live Discussion with Dr Jennifer Kanady - 13 January 2021

Dr Kanady will be hosting a live online discussion here on Wednesday 13 January, from 8.00 pm to 9.30 pm British Time or 3.00 pm to 4.30 pm 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 8 Jan 2021 at 12:57 PM
  • 31 comments
  • 10 helped

Comments

Show older comments
  • Sleepio Member

    • 2 comments
    • 0 helped
    Session 1

    Finding it hard to sleep in the early hours. usually awake around 0230 and cannot go back to sleep till 0630. I work for the NHS in the UK in the frontline. Past few months partner noticed clinching of teeth in the middle of sleep. I have no awareness of this. Waking up in the morning tired as If I was in war whole night.

  • Sleepio Member

    • 394 comments
    • 125 helped
    Expert

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

  • Sleepio Member

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

    Finding it hard to sleep in the early hours. usually awake around 0230 and cannot go back to sleep till 0630. I work for the NHS in the UK in the frontline. Past few months partner noticed clinching of teeth in the middle of sleep. I have no awareness of this. Waking up in the morning tired as If I was in war whole night.

  • Sleepio Member

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

    Hi RyanRobust,

    Thanks for reaching out and that sounds really frustrating. A couple of thoughts:

    First, nocturnal awakenings are completely normal and everybody experiences them. Just not everybody is able to remember these awakenings. These awakenings really only become problematic when they cause significant distress or when they are prolonged. It does sound like these awakenings are causing you distress, which I am sorry to hear so let’s talk a bit about what might be contributing to this experience and things you can try.

    Multiple awakenings during the night are sometimes the result of an environment factor (e.g., sleeping with a partner, sleeping with a pet, getting up to use the bathroom). I tend to encourage people to pay attention to what is waking them up at night (if anything, sometimes, these awakenings don’t have a clear environmental cause). Another thing to consider is that multiple nocturnal awakenings may be indicative of a sleep disorder. If you are concerned about these awakenings, I would encourage you to speak to a sleep professional who can provide a proper assessment.

    Further restricting your sleep restriction window is a great thought. Sleep restriction works by increasing sleep pressure, which helps individuals to fall asleep faster and sleep through the night. However, it is important to keep in mind that it is recommended to not restrict the window to below 5-6 hours (depending on health status; 6 hours for those with preexisting physical/mental health conditions). In terms of sleep restriction, some people start to feel worse before feeling better, which is an important thing to keep in mind. Also, if you are feeling dangerously sleepy during the day (e.g., drowsy while driving), the best thing to do is to take a nap to keep you and others around you safe.

    Another thing to keep in mind is that daytime fatigue doesn’t always mean that you aren’t sleeping well at night. Other things can cause fatigue too, for example boredom. Keeping track of how you are feeling and when can help to identify correlates.

    Here are a couple of library articles that you might find useful:

    https://www.sleepio.com/library/article/frequent-awakenings-when-will-they-go-away--/

    https://www.sleepio.com/library/article/staying-asleep-during-the-night/

    Please feel free to reach out with any additional questions and keep us posted!

  • Sleepio Member

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

    Hi Gabeiel,

    I am sorry to hear that. Please see my response to RyanRobust above.

  • Sleepio Member

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

    Hi Jedi1,

    It sounds like you are in good company. Please see my response to RyanRobust above, who is struggling with a similar problem.

    It is also important to note that there are many different ways to think about sleep quality and everybody defines it differently. E.g., how restorative sleep felt, how you feel during the day, how you feel upon awakening, etc. I would be curious to hear how you think about sleep quality to better understand what is going on. I also tend to encourage people to think about sleep as a multidimensional construct as there are many parameters of sleep health (e.g., sleep duration, sleep timing, sleep efficiency, daytime functioning, consistent sleep schedules). Getting bogged down on one aspect of sleep can increase sleep-related anxiety and can exacerbate sleep problems.

    Please feel free to reach back out, wishing you the best of luck!

  • Sleepio Member

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

    Hi Susan Hopeful,

    Thanks for sharing and you are not alone in finding sleep restriction challenging. While sleep restriction is the most powerful intervention for promoting healthy sleep, it is also the most challenging. A couple of thoughts:

    When starting sleep restriction, I usually tell people that things can sometimes feel worse before they start to feel better and that if they can stick with it, things will often improve. However, sleep restriction gets more complicated when working a stressful and high demanding job (e.g., frontline healthcare worker). As a frontline worker during the pandemic, it may not be the best time to start sleep restriction and it may be an intervention you consider trying when the timing is better.

    If sleep restriction feels overwhelming at this time, one idea is to start by keeping a regular sleep/wake schedule (i.e., going to bed and waking up at the same time every day, even the weekends). This helps to stabilize the circadian rhythms, which is important for sleep health and daytime functioning. From there, you could then consider restricting the sleep window to the actual amount of time you spend sleeping. Again, there is no “one size fits all” approach and it is up to the user to figure out what makes the most sense.

    Another option is to try sleep compression. Sleep compression involves 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 it again. It’s most important to pay attention to how you are feeling during the day (e.g., how alert/wakeful you are) rather than the number of hours. 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.

    Here is a library article that you might find useful:

    https://www.sleepio.com/library/article/i-cant-commit-to-the-course-for-practical-reasons/

    Ultimately, Sleepio is a self-help program and it is up to the individual to figure out the best way to apply the interventions in a way that makes sense to them. Happy to help brainstorm more as needed.

    Also, a big thank you to you and all frontline healthcare workers!

    Keep us posted!

  • Sleepio Member

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

    Hi again Gabeiel,

    Oof, that sounds really frustrating. I see that you are on session 2, which means that you have a lot of evidence-based techniques to look forward to in the upcoming sessions.

    For example, during session 3, you will be introduced to sleep restriction. Sleep restriction is an intervention that reduces the amount of time spent in bed to the amount of time spent asleep. The reason that sleep restriction works is that it increases sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night. Sleep restriction also works by stabilizing circadian rhythms -- an important process for promoting healthy sleep -- by encouraging you to maintain a regular sleep/wake schedule. Sleep restriction is one of the most powerful interventions in the sleep toolbox, but is also one of the most challenging. As you get into sleep restriction, please don’t hesitate to reach out to the Sleepio community with any questions or for support.

    Another intervention you will be introduced to is called the Quarter-of-an-hour rule or QHR. Our brains are very good at making associations and when we read, watch television, or toss and turn in bed, 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 for sleep. The QHR is based on that principle. QHR asks you to get out of bed if you are unable to fall asleep or return to sleep within 15 minutes. When out of bed, the idea is to do something relaxing in dim light or dark conditions, and only return to bed once feeling sleepy. The QHR is a great way to capitalize on that conditioned bed-sleep response!

    Also, only getting good sleep every other day can sometimes lead to sleep-related worry, which can exacerbate sleep problems. During sessions 4 and 5 you will learn techniques to help combat sleep-related thoughts, beliefs, and worries, which can also help to improve sleep.

    Please keep us posted about how things progress!

  • Sleepio Member

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

    Hi Olma,

    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 it is possible to confuse sleep for wakefulness.

    Also, I am sorry to hear that you are experiencing sleep-related worry. Revisiting the techniques taught during sessions 4 and 5 can be helpful for individuals whose thoughts are keeping them up at night.

    Thanks for reaching out.

  • Sleepio Member

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

    Hi SleepyJC,

    Please see my response to Olma above. Also, I see that you are on session 3. During session 3, you learned about the quarter of an hour rule (QHR). The QHR encourages people to get out of bed if awake for more than ~15 minutes. Our brains are very good at making associations and when we experience anxiety in bed, we are teaching our brains that the bed is a place for wakefulness and arousal. Instead, we want our brains to learn that the bed is a place for sleep. The QHR is based on that principle. QHR asks you to get out of bed if you are unable to fall asleep or return to sleep within 15 minutes. When out of bed, the idea is to do something relaxing in dim light or dark conditions, and only return to bed once feeling sleepy. The QHR is a great way to capitalize on that conditioned bed-sleep response!

    Also, during sessions 4 and 5, you will learn some evidence-based techniques for coping with sleep-related worries. One technique that I really like is scheduled worry time. The idea behind this technique is that you spend the same 20 minutes, in the same place, everyday worrying and problem solving. Let’s say that 12-12:20 PM is the “scheduled worry time.” During those 20 minutes, you write down as many worries and solutions as possible. Then, once those 20 minutes are up, worry time is over. If worries start creeping in at night, you can say, “nope, I already worried about that earlier” or, “nope, I have time set aside to worry about that tomorrow.” Eventually over time, your brain will learn that there is a dedicated place and time for worrying and worries will start to interfere with sleep less.

    Looking forward to hearing about how things progress.

  • Sleepio Member

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

    Hi Jazzy Lady,

    These are some really great questions. I will respond inturn:

    1. Sleep restriction works for both difficulty falling asleep and difficulty maintaining sleep (e.g., waking up in the middle of the night or too early in the morning). Sleep restriction works for two reasons. First, by compressing the sleep window, sleep restriction increases sleep pressure -- our brain and body’s need for sleep -- making it easier to fall asleep and stay asleep at night. Second, sleep restriction stabilizes circadian rhythms, which is an important process for regulating sleep. Our circadian rhythms function best under stable, regular conditions. Regular rise times is 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.

    Now for those with early morning awakenings, one thing to be mindful of is individual circadian preferences. Everybody has a different circadian preference due to differences in biology. Some people are “early birds” and their brains tell them to get up early and some people are “night owls” who prefer to stay up late. For those individuals who are “early birds” (and experience early morning awakenings), shifting the sleep schedule earlier might help. Consider playing around with the timing of your sleep to figure out what works best for you. Also, it is important to pay attention to light and darkness cues in your environment. The rule of thumb is to maintain dim light conditions when you want to be asleep and bright light conditions when you want to be awake.

    2. Another great question and it really depends on the individual. The light from television can be alerting enough to make returning to sleep more difficult so experimenting with blue light glasses is a great idea. Another thing to keep in mind is that some individuals find television to be really engaging and as such, that may not be the best activity to do in the middle of the night. In terms of what to do when getting out of bed, I encourage individuals to experiment and figure out what works best for them (because it is not a one-size fits all approach).

    3. Light has an alerting effect and therefore it is important to maintain dim light/dark conditions when you want to be asleep.

    Thanks for asking!

  • Sleepio Member

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

    Hi Lucy,

    Thanks for your words of support and encouragement. Wishing you the best of luck with your job search (and of course, wishing you happy and healthy sleep!).

  • Sleepio Member

    • 13 comments
    • 2 helped
    Graduate

    Hello….
    Will you please explain“sleep quality”?
    Thanks!

  • Sleepio Member

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

    Hi Claira,

    Thank you for sharing and I am glad to hear that all of your hard work is paying off. As you and others know, sleep restriction can be quite challenging and requires commitment. Stories like yours are very encouraging and are helpful for providing support for those who are struggling. I also like how you adapted sleep restriction in a way that made sense for you! I am happy to hear that you reached your sleep-related goals.

  • Sleepio Member

    • 6 comments
    • 2 helped
    Graduate

    Hello

    Can you advise on early waking and how to structure my sleep window please? I now go to bed later to try to over ride the early waking but it hasn't changed anything and I'm still waking earlier than I would like/need (and getting out of bed to help keep my sleep efficiency high). But this also means that I'm getting less sleep and then tired during the day etc. I've just had my review with the Prof and I've got another 15 mins but I can only use this to go to bed earlier which will only make things worse?

    Many thanks

  • Sleepio Member

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

    Hi Standardpoodlemom,

    Thanks for the questions. Like many things, sleep exhibits a bidirectional relationship with pain. That is, the more pain you experience, the worse you sleep and the worse you sleep, the more pain you experience. The good news is that this cycle can be broken and improving sleep can help reduce experiences of pain. Interestingly, research suggests that cognitive and behavioral therapy for insomnia is effective for reducing insomnia for those with comorbid pain and for some, may improve pain-related functioning (if interested, here is a 2014 review of the literature: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248667/).

    In terms of your questions:

    (1) Sleepio is a self-help program and it is up to the individual to figure out how to apply the techniques in a way that makes sense for them. Given that sleep restriction is one of the most powerful interventions introduced, I generally encourage folks to experiment to figure out how best to apply the intervention. For example, keeping a consistent sleep/wake schedule rather than restricting time in bed (see my response to Susan Hopeful above for some more ideas/details).

    (2) Similar to what I said to Jedi1 above, there are many different ways to think about sleep quality and everybody defines it differently. E.g., how restorative sleep felt, how you feel during the day, how you feel upon awakening, etc. I would be curious to hear how you think about sleep quality to better understand what is going on. I also tend to encourage people to think about sleep as a multidimensional construct as there are many parameters of sleep health (e.g., sleep duration, sleep timing, sleep efficiency, daytime functioning, consistent sleep schedules). Getting bogged down on one aspect of sleep can increase sleep-related anxiety and can exacerbate sleep problems. It’s also important to note that feeling crappy during the day doesn’t necessarily mean you didn’t sleep well the night before. Many things can impact our mood and energy levels. Keeping track of what you are feeling and when can help to identify potential correlates, which can further aid in problem solving.

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

  • Sleepio Member

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

    Hi DMS007,

    I want to start by thanking you for your work as a frontline worker. I imagine that your job is very stressful and as we all know, stress is closely related to sleep. The more stressed we feel, the worse we sleep and the worse we sleep, the more stressed we feel. It can feel like a vicious and frustrating cycle, but the good news is that this cycle can be broken and improving sleep can reduce stress and improve mental health. I see that you are on session 1, which means that you have a lot of evidence-based skills to look forward to in upcoming sessions. I outlined what to expect over the next several weeks in my response to Gabeiel above, which I have pasted below for your reference:

    During session 3, you will be introduced to sleep restriction. Sleep restriction is an intervention that reduces the amount of time spent in bed to the amount of time spent asleep. The reason that sleep restriction works is that it increases sleep pressure -- your brain/body’s need for sleep -- making it easier to initiate and maintain sleep at night. Sleep restriction also works by stabilizing circadian rhythms -- an important process for promoting healthy sleep -- by encouraging you to maintain a regular sleep/wake schedule. Sleep restriction is one of the most powerful interventions in the sleep toolbox, but is also one of the most challenging. As you get into sleep restriction, please don’t hesitate to reach out to the Sleepio community with any questions or for support.

    Another intervention you will be introduced to is called the Quarter-of-an-hour rule or QHR. Our brains are very good at making associations and when we read, watch television, or toss and turn in bed, 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 for sleep. The QHR is based on that principle. QHR asks you to get out of bed if you are unable to fall asleep or return to sleep within 15 minutes. When out of bed, the idea is to do something relaxing in dim light or dark conditions, and only return to bed once feeling sleepy. The QHR is a great way to capitalize on that conditioned bed-sleep response!

    During sessions 4 and 5 you will learn techniques to help combat sleep-related thoughts, beliefs, and worries, which can also help to improve sleep. One technique that I really like is scheduled worry time. The idea behind this technique is that you spend the same 20 minutes, in the same place, everyday worrying and problem solving. Let’s say that 12-12:20 PM is the “scheduled worry time.” During those 20 minutes, you write down as many worries and solutions as possible. Then, once those 20 minutes are up, worry time is over. If worries start creeping in at night, you can say, “nope, I already worried about that earlier” or, “nope, I have time set aside to worry about that tomorrow.” Eventually over time, your brain will learn that there is a dedicated place and time for worrying and worries will start to interfere with sleep less.

    Please keep us posted about how things are going.

  • Sleepio Member

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

    Hi Jazzy Lady,

    Sleep quality is a subjective term and everybody defines it differently. E.g., how restorative sleep felt, how you feel during the day, how you feel upon awakening, how much deep sleep you got, etc. I generally recommend that people define sleep quality in a way that makes sense for them and that is associated with their sleep-related goals.

  • Sleepio Member

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

    Hi Very tired mum,

    I really appreciate your creative problem solving here. Certainly going to bed later is one way to encourage sleeping in later and may be useful for some. For others, leaning into the early morning awakenings and scheduling the sleep window around them can be useful (e.g., getting into bed earlier and waking up earlier). I generally recommend that people experiment with the timing of the sleep window to find what works best for them. It is also important to note that sleep restriction is not an immediate fix and for some it takes a few weeks to months to notice improvements in sleep. Finally, for those with early morning awakenings, it’s important to be mindful of light/darkness cues and to make sure the environment is dark during those early morning hours to decrease levels of alertness.

  • Sleepio Member

    • 394 comments
    • 125 helped
    Expert

    Signing off now. Thanks for the great questions and discussions. Please keep the conversation going by joining our next live expert chat on Wednesday, January 20th. Wishing everybody happy and healthy sleep!

Return to top