Live discussion with Dr John Cape - 11th March

Dr Cape will be hosting a live online discussion here on Wednesday 11th March 7pm-8:30pm GMT.

He will discuss as many topics as possible in the hour and a half, starting with the most popular questions with answers being given in a way to give the most benefit to the general Community.

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Posted 6 Mar 2015 at 10:00 AM
  • 20 comments
  • 11 helped

Comments

  • Sleepio Member

    • 435 comments
    • 248 helped
    Graduate

    As we are approaching the spring equinox, I'm sure there are lots of members who are concerned about how the clocks going forward will affect their sleep. Can you give us your advice on dealing with the time shift?

  • Sleepio Member

    • 15 comments
    • 8 helped
    Graduate

    Hi, Dr. Cape –

    Last week several of us had questions about how sleep efficiency is calculated. Dr. Creanor said she'd ask the clinical/technical team and let us know. Since Dr. Creanor is not on this week, I'll ask the question again, in case you can answer.

    I (and others) sometimes (or even often) go to bed later than allowed and/or get up earlier than allowed because I don't feel sleepy enough to be in bed. Sleepio uses actual time in bed rather than sleep window time to calculate sleep efficiency. The concern is that this method may lead to the sleep window's being increased when maybe it shouldn't be.

    For example: My sleep window is 1:00 to 6:00 (5 hours). If I go to bed at 1:00, fall asleep within 5 minues, wake up at 5:00, decide after 1/4 hour that I'm not sleepy enough to go back to sleep, and get out of bed, Sleepio says my sleep efficiency is over 90%. However, I've slept less than 80% of the sleep window. If this sleep pattern continues (or even happens only, say, every other night) for the week, my efficiency for the week will be >90% and 15 minutes will be added to my sleep window. But I may have slept only 80-85% of the time allowed for the week.

    It makes sense to me that the sleep window should be increased when you cannot get enough sleep within your current window to feel rested. In the example above, I don't need a bigger sleep window in order to get more sleep – I need to sleep more of the time that I'm allowed.

    Can you explain why the efficiency calculation is based on actual time in bed? Most programs I've read about do use actual time in bed, but there's at least one sleep expert in the US (Dr. Michael Perlis) who advocates using sleep window time.

  • Sleepio Member

    • 48 comments
    • 12 helped
    Graduate

    Hello Dr. Cape,

    I'm sure that my question has no answer, but I would like to know how to cope when my partner, who has recently fractured his wrist in more than one place, is up and down all night? My sleep has deteriorated to nearly an all-time low and I am feeling quite depressed to be awakened repeatedly by my partner when I am struggling so much myself! I know that this sounds very unfeeling, but I have my own pain problems at night to deal with and my spouse is able to quickly fall asleep again when he wakes and I am not. We have no spare room to move into, and our sofa is “apartment length” so is impossible to stretch out on downstairs. I am feeling overwhelmed … and exhausted.

    I'm sure that I will just have to deal with it, but I am back to waking up between 7 to 20+ times a night and am finding it very hard to go to work in the morning, let alone stay positive. I feel very defeated. My hypervigilance has come back in spades, as every small movement from my husband wakes me with great concern for his well-being and I feel helpless to shut it off again in case he needs my help.

    Flick
    xoxo

  • Sleepio Member

    • 184 comments
    • 89 helped
    Graduate

    Hi Dr. Cape,

    I would like to know your opinion -- if once a week or so I keep the same sleep window amount of time, but change my bed time or wake up time by one hour, does this impact the effectiveness of the SR? I did that once this past week because of needing to get up for work two hours early, plus the hour of the U.S. Day Light Savings time clock shift forward. I went to bed an hour early but kept my 7 hour window. The next night, I was exhausted so went to bed an hour early but kept the 7 hour window. Now I'm back to my regular schedule. It didn't seem to have a negative effect on my sleep restriction. I was wondering, for the long term, if once a week (like on a weekend) we shift forward or back one hour, but keep the SW the same, how big of a problem is this?

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    Hello everyone. Welcome to this live session. This is your time for questions about sleep and the Sleepio programme. There have been a few questions in advance. But anyone have a live question they want to ask first?

  • Sleepio Member

    • 6 comments
    • 1 helped
    Graduate

    Hi Dr John Cape!
    Do you have any tips for those of us that sleep in the same bed as another person, to avoid to disturb their sleep as little as possible while we are going through the sleep restriction part of the course?

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi Marie Elaine

    Good question about what best to do when the clocks go forward for Summer daylight savings time. Community members from the USA can maybe tell us their experience as their clock change was last Sunday. In the UK it will not be until the last Sunday in March.

    My main advice is to make sure to keep the same length of sleep window on the night of the clock change. So if your sleep window length is currently 6 hours, from midnight to 6.00am, then keep it 6 hours over that night of transition (which say might mean going to bed at midnight “old time” and getting up at 7.00am “new time” or going to bed at 11pm “old time” and getting up at 6.00am “new time”)

    Beyond this, what is best will depend on the individual and the pattern of your sleep problem. If you have a problem keeping awake until the start of your sleep window and/or sleeping to the end of your sleep window (quite a few people mentioned this in last week’s expert session with Dr Vicki Creanor), then you will probably welcome the clock shifting forward as the new shifted time may suit you better. However, if getting to sleep is your biggest problem and you are worried about in effect going to bed an hour earlier, you could phase the change in your sleep window to the new time (so, in the above example, for a few days have a sleep window of 12.30am – 6.30am “new time” before shifting back to midnight – 6.00am). Is that clear?

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi tinytiranid

    Yes, this is one to consider and discuss with your bed partner when you start sleep restriction. There is a community discussion headed something like “sleeping with your bed partner” where people give their experiences and tips. Initially sleeping in a different room or bed can be helpful.

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi kt80rep

    Dr Creanor and I followed this up with the Sleepio technical team. You and others are quite correct that the current algorithm for extending the sleep window is based solely on whether you hit 90% sleep efficiency. It does not take into account your actual previous sleep window time. This can lead to what you and others report that, if you consistently get out of bed for the day before the end of your sleep window, you can hit 90% SE on the algorithm and have your sleep window extended even though your time in bed is less than 90% of your sleep.

    We agree that this is not ideal and an algorithm that also takes account of the actual existing sleep window and time in bed would be better. But this turns out to be a fairly major engineering change. In the mean time, where this happens and is unhelpful, as you describe, then better to stick with the old sleep window. As a general principle, if you really feel that the length of a sleep window created by Sleepio is not working for you, you should adjust your window to what you feel is a more achievable length (although you will not be able to make this change on your Sleepio schedule – see Library article on How to shift your sleep window).

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi Flick

    How upsetting this must be for both you and your partner. It is a shame that the easiest way to deal with this – sleeping in separate rooms or at least beds – is not possible for you.

    My one angle on this for you to consider is your thoughts when you are woken up. You say that when you are woken up by his small movements you have great concern for his well-being and worry in case he needs your help. Thoughts like that would certainly keep me awake in your circumstances. Have you put these thoughts under the microscope of the thought-checker? In terms of accuracy, have you checked directly with your husband or his doctor/physician about his wellbeing and whether he needs help from you in middle of the night?

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi CaterpillarD

    Keeping to the same sleep window is recommended. An occasional change can be OK and may be appropriate and needed for reasons such as you describe – work and adapting to Day Light Savings time (see also my reply to Marie Elaine above). But more than an occasional change, even if you keep to the same sleep window duration (7 hours in your case) can be disruptive. The purpose of having a set time for the sleep window is to establish a good reliable sleep routine. Once sleep is reliable, then making changes shouldn’t be a problem.

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    I have now replied to all the questions posted before today's live session. We have plenty of time for further questions.

  • Sleepio Member

    • 47 comments
    • 17 helped
    Graduate

    Dr. Cape,

    Greetings from Arizona – where it is an unseasonably warm 90 degrees.

    First, I have found the program to be very helpful and encourage my fellow community members to follow the basics and lead a healthy lifestyle that includes good nutrition and exercise.

    I once had a Dr. tell me that chronic insomnia is not really curable and can only be “managed” like other chronic disease. Has that been your experience?

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi glider guy

    Wow that is warm for early March.

    Great to hear you have found the Sleepio programme so helpful. As to your question, yes when someone has had insomnia for a long time then it is a chronic problem. Viewing it as something you are going to need to keep an eye on for a long time after you have established a good sleep pattern is sensible. Temporary periods of difficulty with sleep are common for everyone, but if you have had insomnia for a long time and improved such “normal” blips can knock you off balance as you are inclined to see these as the old insomnia returning which can risk being a self-fulfilling prophecy if you go back to the old thoughts.

    By the way, as we started today with a query about daylight savings time, I read somewhere that there is no daylight savings time change in Arizona – is that so?

  • Sleepio Member

    • 184 comments
    • 89 helped
    Graduate

    Hi Dr. Cape, thanks for addressing the questions related to calculating sleep efficiency effectively using the diary. What I have started doing (and I want to verify this would be appropriate,) even if I were to start my day an hour before my SW wake up time, I note that hour as simply time awake within the SW. The final question of what time I finally got out of bed I would just note as the end of my SW (even if I had been out of bed an hour.) That way the sleep efficiency would be calculated correctly. SLEEPIO could technically just phrase the last diary questions differently.

  • Sleepio Member

    • 47 comments
    • 17 helped
    Graduate

    That is true – We are the only state that does not follow the time change. There are some areas in Indiana and on the Navajo Nation that don't follow either. It is so hot here in the summer that the last thing we want is to have the evening extend to 9 or 9:30.

    We once had an editorial in the newspaper in support the decision because “We did not need another hour of daylight”. As if that is something that can be legislated. I think the writer probably lost his job and wound up at FOX news.

    Thanks for answering the question

  • Sleepio Member

    • 230 comments
    • 44 helped
    in reply to Sleepio Member
    Expert

    Hi CaterpillarD

    Just checking I have got this right. Are you referring to my answer to kt80rep? If so, just to be clear, Sleepio does calculate your sleep efficiency correctly if you answer the sleep diary questions as set out. The problem with the algorithm is not about the calculation of sleep efficiency, but about when your sleep window gets extended.

    Although its now 8.30pm GMT I shall hang on a few minutes so you can get back to me if I have misunderstood you

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    OK. Thanks everyone for your contributions today

  • Sleepio Member

    • 25 comments
    • 7 helped
    Graduate

    Hello Dr Cape, I am on week 4 of the course, and I am finding it rewarding in many unexpected ways! Over and above the improvement and empowerment in my sleep life, it is teaching me a lot about real possibilities for changing habits and attitudes. And I continue to be surprised and delighted by finding myself with more hours in the day because I'm not wasting them by lying in bed battling with sleep.

    However, I am struggling with this: My SW is 5 hours 45 minutes, and I do wonder how necessary it is to keep the SR going for several weeks before getting a 'normal' 7 or 8 hours. Or is 'normal' a fiction? IS there any way of knowing how much sleep I, as an individual, actually need? I am mostly sleeping straight through now, which is a big improvement, and I keep losing track of the reason for the 5.5. hours – saying to myself “ I often used to get 8 hours sleep', am I punishing myself for nothing. And I'm not sure how Sleepio arrived at the 5.5. hours in the first place. I had had a particularly severe bout of bad nights (2 – 3 sleep for a few days) – which drive me to find Sleepio, but they weren't the norm.

  • Sleepio Member

    • 15 comments
    • 8 helped
    in reply to Sleepio Member
    Graduate

    Thanks for your reply. I figured Sleepio used actual time in bed because it was easier to program. Users just need to know the limitations of this metric and how and when to manually adjust their sleep window.

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