Live discussion with Dr John Cape - 14th September 2016

Dr Cape will be hosting a live online discussion here on Wednesday 14th September, from 7:00pm to 8:15pm British Standard Time or 2:00pm to 3:15pm US Eastern Standard Time.

He 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.

Please do note that, as per our guidelines, Dr Cape will not be able to give personal medical advice. His 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 8 Sep 2016 at 8:52 PM
  • 36 comments
  • 4 helped

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  • Sleepio Member

    • 6 comments
    • 0 helped
    Session 2

    What kind of material is generally considered best for sleep? I've tried novels but any dark, restless, or distressed experiences feel difficult to work through. I also have no idea how long I sleep for. The only solution is to find the most soporific material and be hopeful that I will feel the relaxed state I sometimes experience after reading around 6 – 8 pages and prime myself to stop.

    Some say reading old books helps, others boring material. Whilst I realise this may depend from person to person, I read all day for a living and am prone to anxiety, so I am hopeful that there may be some general ideas about what sort of book occurs to you for people in my sort of position, coming off addiction to sleeping pills (and books). Then this may help me find what to look for in my vast collection (I have discarded nearly all possible books as they are too challenging, easy/non-'escapist' or too have too many dark elements) or elsewhere.

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    Hi Dr Cape,

    I've regressed with my sleep a bit recently and have noticed when trying to sleep and after applying the QHR that I generally do nod off then awaken almost immediately or 5 minutes later. Something in my psyche is almost self sabotaging going to sleep here. Once asleep I have no problem but its this initial period. Any techniques you recommend here?

    Mindfulness training has helped a lot with previous anxiety problems. Jolting awake is causing restlessness now which is feeding the problem. I don't fear getting through the next day just the physical act of trying to sleep. Perhaps paradoxical thinking is a good technique to try here?

    Cheers,

    Steve

  • Sleepio Member

    • 5 comments
    • 2 helped
    in reply to Sleepio Member
    Graduate

    I know how you feel as I'v had the same problem for years. I just lay awake, I'm not thinking about anything at all something just doesn't click to make me go to sleep. For about 17 years I was either on Xanax or sleeping pills just to make me sleep, then I did restriction therepy. For the first week I hardly slept at all, but I gradually started sleeping without any meds. A couple of months have gone by and things are a lot better so don't give up. Although my sleeping is not perfect, I have good and bad nights but all in all things are much much better. I'm convinced that something gets blocked in my brain, i even have a strange feeling in my heard as if something is being forced to work, but no doctor has ever been able to explain that. So don't give up the course will help you in time!!

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    Hello everyone. Welcome to this live session. I look forward to answering your questions and having some discussion. There have been quite a few questions posted earlier so I shall get on with answering them. Let me know if you are on line now and posted a question earlier by posting a quick “Hello I am here, I posted a question earlier” and I shall try and get to that sooner. And if you have just logged on and want to pop a question, go right ahead

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Your post about songs playing randomly in your head I see has got quite a response from others. This happens commonly enough that they have a name for such songs you cannot get out of your head – “earworms” – and there is beginning to be research on how to block them for people who find this distressing. So you are not alone – nothing abnormal in this at all!

  • Sleepio Member

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

    Good you asked your question about sex, sleep and the Sleepio programme. It is a question that I am surprised doesn't come up more often – maybe as people feel slightly embarrassed to raise it. When filling out your sleep diary for Sleepio, do not count the time having sex as time in bed. If having sex before going to sleep, record time when you went to bed in the diary as the time when sex ended. As such, the sleep window starts when sex has ended. Similarly, for people who have sex in the morning and then get out of bed after having sex, record the time getting up in your diary as the time sex started. These two work for most circumstances, but not for having sex in middle of the night when people have slept before sex and go on sleeping after – there isn’t a way to easily fill out your sleep diary in Sleepio to adjust for this.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for your two questions.
    (1) It is fine to read after your other pre-bed tasks before you go to bed if this helps you get to a sleepy state
    (2) The purpose of setting the sleep restriction window is to create pressure to compress all sleep into this “time in bed” window. This changes sleep patterns over time so that people go to sleep more quickly and stay asleep and/or go back to sleep more quickly if they wake up in the night. The sleep window advised by the Sleepio programme is calculated to optimize the sleep window for each person doing the programme based on their current sleep. Lengthening the sleep window in the way your post suggests would mean the sleep window was longer than optimal and less likely to be effective.

  • Sleepio Member

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

    Hi. Good to hear that your sleep improved with Sleepio, although recently it has got worse again. A set back, after improvement is the most common pattern – it is rare that people report a steady improvement without set backs. The set backs often occur after a change of schedule or change in circumstance or event in peoples lives (as perhaps the return after holiday you describe), although equally often can occur “out of the blue” without any obvious change. The key to maintaining progress is not having no set backs, but learning to take set backs in ones stride and getting back on track after a set back. Seeing a set back as normal and reviewing and putting into practice the Sleepio techniques that were helpful previously gets people back on track smoothly. Getting worried and alarmed about a set back activates the body (which can lead to a variety of bodily changes and sensations that occur with bodily arousal) and can bring back all the old worrying thoughts about sleep leading to a vicious cycle that aggravates the set back. I am always pleased when set backs occur, because it gives people the opportunity to learn that these are normal and they can get over the set back and back on track. And the more times this has happened, the more set backs they have got over, the easier it is to see the set back for what it is – just a temporary set back – and not something to be worried about.

  • Sleepio Member

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

    Hi. I am sorry you felt the Prof’s description in the first session or two missed the key experience for you of what it is like when you are awake at night. Peoples personal experiences when awake and unable to sleep are different and the “racing thoughts” the Prof describes, although many people identify with this, is not the experience of others. And from what you say, you may well feel that you have in hand the sleep hygiene and sleep environment approaches covered by the Prof in session 2. I note a graduate of the Sleepio course has replied to your post with how her experience was similar to yours and how the sleep restriction approaches of Sleepio were slowly slowly helpful for her and she encourages you to hang on and not give up. Sleep restriction is introduced by the Prof in session 3 of the course. It for many is the most powerful approach (possibly uniquely powerful for people who do not identify troubling thoughts when awake at night) but also the one that can be difficult to stick with. And key is sticking with it over quite a long period of time despite initially feeling it may be making things worse or at least not better. Do come back and post in a future live session (every Wednesday) if you get to this point in the programme and continue to feel the Prof is not addressing your problems

  • Sleepio Member

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

    Hi, you ask if it is OK to do the Sleepio programme at the same time as light therapy using a light box. Yes, absolutely. How are you using the light box and how are you finding it?

  • Sleepio Member

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

    Thanks for sharing your experience

  • Sleepio Member

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

    Hi. Thanks for your interesting and detailed question. I am assuming from various things you say that you live in the UK. In the UK, most NHS sleep clinics are for a single specific sleep disorder called Obstructive Sleep Apnoea and are based in the respiratory medicine departments of hospitals. They do not deal with insomnia disorder, which is the most common form of insomnia (insomnia just meaning problems with insufficient or unsatisfactory sleep) or with other specific sleep disorders such as Sleep Phase Disorders (longstanding patterns of needing to sleep early or late), Narcolepsy (falling asleep during the day without warning), Restless Legs Syndrome and Parasomnias (e.g. sleep walking and nightmares). Complicating the picture is that there has been a recent change in diagnostic classification systems and the most common form of insomnia is now termed “insomnia disorder” and seen as a diagnosis in its own right whereas previously a distinction was made between “primary insomnia” and “secondary insomnia” with secondary insomnia being seen as something caused by another disorder such as depression and anxiety. This distinction has been for some time considered unhelpful by sleep experts as there is as much evidence that insomnia can cause depression and anxiety as vice-versa. So it is not surprising that different excellent GPs give different opinions about the same sleep problem. We are not in a position in Sleepio to advise on individual circumstances, but from what you describe you might want to look into literature on Delayed Sleep Phase Disorder. There is a Sleepio Library article on this:
    https://www.sleepio.com/library/article/what-is-delayed-sleep-phase-disorder/
    The CBT for insomnia approaches included in the Sleepio programme have been most extensively researched and found to be effective for people with insomnia disorder although there is research also on CBT with other sleep disorders. Sleepio is designed to help people adopt approaches to their sleep problems which have been found by CBT to be helpful.

  • Sleepio Member

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

    You ask about the difference between white noise and pink noise and effects on sleep. I have to confess to never having heard of pink noise before and have had to google it to find that like white noise it is a type of sound that occurs at all frequencies (frequency = pitch), but the loudness of the noise at each frequency is more uniform compared to white noise (white noise sounds more high pitched). White noise is used to mask sounds, so that against a background of white noise one would be less likely to hear sounds that interrupt sleep (e.g. noise of traffic or music outside) or they would sound less loud. As such white sound and pink sound could be useful for people whose sleep is affected/interrupted by noise. But maybe you have come across research I am unaware of?

  • Sleepio Member

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

    Good to hear the course has helped you feel less anxious about your sleep pattern. You ask if all the necessary phases of sleep can occur even if sleep is broken. Briefly – yes. Broken sleep for some people is common because of their circumstances, for example mothers of infants. Sleep can feel less satisfactory and refreshing, but as long as people are not sleep deprived overall it is not a problem in terms of health. And if people are too sleep deprived, then sleep pressure builds to such an extent that they sleep (unless they are forcibly being kept awake as under torture – which is why sleep deprivation feels like a torture). Historically in cold climates, people would get up to move to warm up then go back to bed rather than sleeping through, so uninterrupted sleep is not necessary. Even good sleepers have micro-awakenings throughout the night which they don't remember.

  • Sleepio Member

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

    Hi, thanks for your really good question about the risk of nodding off before start of your sleep window. Doing things to activate the body (e.g. walking about the room, rather than relaxing and wind down activities which promote sleep) will help delay sleep. But shifting the sleep window to earlier (say 11pm – 5am instead of 11.30pm – 5.30am for a 6 hour window) is an alternative for people who consider this would work better for them. If you do fall asleep on the couch, do just as you set out in your post – go directly to bed when you wake up from the couch and get up at your pre-set time.

  • Sleepio Member

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

    You ask whether cutting out both alcohol and sleep aids together may be too much of a challenge. The Sleepio programme is as effective for people using prescribed sleep medication or non-prescribed sleep aids as it is for people not using any medication/sleep aids. So people should not feel under any pressure to feel they need to change sleep medication/aids when going through the Sleepio programme (and for prescribed sleeping medication they should seek advice of their doctor). The complications of alcohol (and nicotine) for a good sleep pattern are well established which is why the Prof discusses these as a priority in the initial sessions of the programme.

  • Sleepio Member

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

    Hi again. You ask about what kind of reading material is most helpful for sleep. You hit the nail on the head when you say it is whatever is most soporific for each individual. So this is going to be an individual thing rather than one type of book for everyone. For some people, no form of reading may be helpful in promoting sleepiness and other relaxing activities are what are most helpful to them as part of their wind down routine. But this is a question you could post in one of the General Discussion fora in the Sleepio Community and see what others find helpful.

  • Sleepio Member

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

    Hi. You describe going quickly back to sleep when back in bed after applying the quarter of an hour rule (QHR), but then waking up again in a jolt after a few minutes. You say mindfulness has helped you with other problems. If so, then it makes sense to use mindfulness when you do wake up quickly in a jolt. As I recall it is session 5 when the Prof discusses use of mindfulness which you have either just reached or is next up.

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    Thanks for all your posts. Next expert session will be next Wednesday. All best with continuing to work on your Sleepio to do lists

  • Sleepio Member

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

    I try to use my lightbox for 15-20 minutes around 10-15 minutes after waking. I feel brighter after a dose of light especially as it is getting dark in the mornings. I think it is early days yet (I have been using it for less than a week), as I haven't seen any improvement in my sleep.

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