Live Discussion with Dr John Cape - 16th March 2016

Dr Cape will be hosting a live online discussion here on Wednesday 16th March, from 8:15pm until 9.45pm GMT.

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 10 Mar 2016 at 4:57 PM
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  • Sleepio Member

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    Expert

    Hi Ronald
    Sorry to hear this. No approach is always successful. There can be aspects of the nature of someone’s sleep problem or their life circumstances or way they are trying to set about putting the Sleepio techniques into action that mean they don’t make the kind of progress that they would wish for. But for sleep to be worse than before starting Sleepio, not just for a short time but for a while is unusual. I know you have posted before and your posts have always been thoughtful and interesting, but each about something slightly different. This may not be relevant to you, but when people feel desperate about sleep they can understandably be ever looking for the one thing, the one tweak that will make the difference. But of course it is repeatedly doing the same routine that helps sleep rather than always slightly changing the routine. Does this ring any bells? Do come back at me with your thoughts

  • Sleepio Member

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    Expert

    Hi Nickymal
    Having enough food to last over the night is important in maintaining sleep. Generally the recommendation is to go to bed having eaten enough, but not too much – https://www.sleepio.com/library/article/diet-and-sleep/. So what people eat can certainly affect sleep and it works the other way round too – being sleep deprived can increase hunger and the amount people eat.

  • Sleepio Member

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    Graduate

    Would you agree that sleep restriction is only a short-term solution? For example, if my sleep goals are to improve my energy and ability to get through my work, and if, say, my optimal sleep window is 7 hours, then a sleep window of 5 hours will not be enough to achieve my goals.

  • Sleepio Member

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    Expert

    Hi again Nickymal
    Great post about how when you wake in the night you get into a panic with thoughts that it will be awful to get through the next day’s work with little sleep and so you take a sleeping pill. This is a perfect example of how the mind works to keep you awake. You are now getting to the sessions in the Sleepio programme where the Prof goes over different ways of dealing with thoughts (and images) that keep people awake and techniques for dealing with these in addition to the quarter of an hour rule which the Prof will already have covered with you. Let us know how you get on with these.

  • Sleepio Member

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    Graduate

    Hi Dr,
    Nicely said. I can relate to what you said in a constructive way: I have a workout routine that I've been following for decades. Any changes I've made have been made slowly and have built on the original routine and the principles behind them. Thank you.

  • Sleepio Member

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    Expert

    Hi again
    Yes the ultimate purpose of sleep restriction is to re-establish a good sleep pattern, not something one would go on doing for ever. So the logic as you know is that, say starting with a 5 hour sleep window, once your are sleeping through most of that 5 hours (sleep efficiency 90% or more) the sleep window is increased by 15 mins and then when the person is sleeping through 90% of that five and a quarter hours it is increased again by another 15 mins and so on. If sleep efficiency doesn't improve enough to trigger the 15 mins extension of the sleep window, there can be different reasons. One might be what one might call technical – that in fact the person is mostly sleeping through the sleep window, but it doesn't quite trigger the algorithm in Sleepio to extend the sleep window. Then it can be appropriate for the person to override the algorithm and increase the sleep window by 15 mins. Other reasons will apply when the person is consistently quite a bit off 90% sleep efficiency. What sorts of sleep efficiency are you clocking?

  • Sleepio Member

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    Expert

    Hello to you from Brazil. Good to hear you have found out about the Sleepio programme. I see you have just started the programme, so welcome. The Sleepio programme is effective both for people who are taking sleeping pills and for people who are not taking sleeping pills. Some people who are on sleeping pills and complete the Sleepio programme decide with their doctors to try and come off sleeping pills and see if they can maintain good sleep without pills using the techniques in the Sleepio programme. Others decide to continue on sleeping pills. It is an individual decision. The scientific evidence is that sleeping pills are very good for helping with short-term insomnia, but for long-term sleep difficulties cognitive behavioural treatment approaches to insomnia provide a more lasting solution as people learn approaches to manage their own sleep. It is these cognitive behavioural approaches that are what are used in the Sleepio programme. I wish you all the best with going through the Sleepio programme and do come back and post in further Wednesday live session with any further questions you have .

  • Sleepio Member

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    Expert

    Hi Clara
    As it turns out we discussed recently reviewing what is known about the accuracy of different commercial trackers and writing this up for Sleepio members. We haven’t done this yet, so I cannot answer your specific question. But some aspects of measurement like stage/type of sleep are more difficult for trackers to detect accurately as these trackers of course use body movement to estimate type of sleep and not brain activity which is what characterizes the different stages of sleep. I guess I would reframe your question and ask what you experience that doesn't feel satisfactory about sleep as in the end it is the subjective experience of being satisfied with sleep that is important. Is it that, although you sleep 7 hours, it does not feel refreshing sleep?

  • Sleepio Member

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    Expert

    Hi nic1982
    Sorry to hear that you have had such a terrible time with sleep and anxiety over the last month or so. The good news is that recent sleep problems (those that have gone on a month or two) are generally much easier to get over than sleep problems that have gone on months or years. This is becuase it is only over a longer period of time that unhelpful sleep habits become more fixed and harder to change. It is very common to have difficulty sleeping as a result of illness and anxiety, but usually sleep improves when people recover from illness and/or have less to be anxious about. If someone becomes very anxious about their sleep, this is when they are at risk of developing a longer term sleep problem as the anxiety activates the body and keeps people awake. All this and the techniques for getting back on track with sleep are in the Sleepio programme which I see you have only recently started. The key techniques are in sessions 3 – 5. All the best with it.

  • Sleepio Member

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    Expert

    Hi
    No reason the Sleepio programme should not be helpful for peri-menopausal problems. Hormonal changes are one of many things that can disturb sleep leading to increased night time wakings. What makes the differences between the many people who go through the menopause without any significant concerns about sleep and those who develop sleep problems is what happens when the person wakes in the night. If they become preoccupied and concerned that they wont sleep again, these thoughts paradoxically activate the body and make it more difficult to sleep leading to development of a sleep problem. The techniques the Prof covers in sessions 4 and 5 can be useful for these sort of thoughts. If it is other kinds of issues that concern you about hormones, the menopause and sleep do post back.

  • Sleepio Member

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    Expert

    Hi Pegs212
    Sleep habits usually take time to change, unless sleep difficulties have been very recent as in my answer to a previous post. For people who have had sleep problems for longer, it takes time to re-establish better sleep habits. When I say ‘habits’, that is the whole pattern of how someone thinks, acts, feels and how their body operates around sleep. I can see you have not yet started session 3 which is when the most effective but difficult element of the Sleepio programme is introduced. All the best with it and do post again in one of the Wednesday weekly live sessions if you feel this or another question you have still needs answering

  • Sleepio Member

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    Expert

    Hi sailorgirl
    You ask about your eyes being tired and seeing less well and wondering if these are related and a consequence of sleep restriction. Certainly being tired can lead to people feeling they can focus less well, which is presumably how the expression “bleary-eyed” came about. Are you seeing progress with sleep efficiency in your sleep restriction?

  • Sleepio Member

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    Expert

    Hi zippi
    Great you had good sleep for so many years. I am sure some Sleepio members will envy you that, although now you appreciate the misery that poor sleep can bring. You describe an interesting rather specific thing that keeps you awake. Although you describe it as linked with anxiety, the fact that it is triggered by a bodily sensation is similar to an issue for sleep for a number of people. A particularly clear example is pain – being unable to get to sleep or back to sleep because of pain. And the more conscious and focused the person is on the pain, the more awake they become. Various techniques the Prof covers in session 4 and 5 are designed to refocus attention and are particularly useful for people who focusing on troubling bodily sensations keeps awake. Try them out and find one that you find most useful and keep practising it when awake and aware of the sensation at night until it becomes a habit.

  • Sleepio Member

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    Graduate

    Hi Dr,
    Thank you for confirming my understanding of sleep restriction, its role and how to adjust it.
    My SE last week was 51%, about where it was when I started. However, I did an analysis of the 16 days where my SE was 90% or greater. I discovered that 14 days (87.5%) my sleep window was 5 hours, and 2 days (12.%%) my sleep window was more than 5 hours. In addition while I’ve had more than a few days when my SE was 0%, only once did I have three consecutive days when my SE was 0% and on those days my sleep window was more than 5 hours. So based on my experience, while SR does not guarantee SE, it is practically a prerequisite.

  • Sleepio Member

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    Expert

    Hi again
    Sounds like your sleep window has changed over time then from 5 hours to more than 5 hours – is that right? What is it now?

  • Sleepio Member

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    Expert

    OK, time for end of the live session. Thanks for all your interesting questions. All the best!

  • Sleepio Member

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    Graduate

    Hi Dr,
    That's true, but you make it sound better than it is. Frankly, I've been inconsistent, the worst thing I could do. Last night my sleep window was 6 hours and my SE was 0%. Tonight I plan to return to 5 hours, which means awakening at 4:45am for the day.

  • Sleepio Member

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    Graduate

    This was good so far as it goes, but I had to fly to Australia (from UK) at a day's notice for my mother's funeral and then back again a week later, so preparation beforehand was a no go. I have now been back 10 days. Of necessity I have been a bit lax with my sleep window (to prevent divorce or murder!) and I am now ready to “get back to it”. My sleep diary is not looking good. Advice on what to do when everything has gone belly up would be good. Do you go back to square one on the sleep window or go back to where you left off?

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Per Dr. John Cape, sleep restriction, say starting with a 5 hour sleep window, will help re-establish a good sleep pattern. That said, I did just that last night and scored a SE of 0%. My only solace is that after two or three literally sleepless nights I will finally collapse due to sleep pressure.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks Ronald. Smaller window it is. Sorry about your lack of sleep last night and hope you don't have to have another couple of 0% SE before you get something reasonable. I am feeling quite impressed with my 46% last night now.

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