Live discussion with Dr John Cape - 19th October 2016

Dr Cape will be hosting a live online discussion here on Wednesday 19th October, 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.

To keep up with new comments as they are posted you will need to refresh this discussion page.

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Posted 13 Oct 2016 at 4:00 PM
  • 30 comments
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  • Sleepio Member

    • 302 comments
    • 72 helped
    in reply to Sleepio Member
    Expert

    Hi. Great that you have stuck with the sleep restriction and are getting 2-3 nights in a row with sleep efficiency of >90%, and feel great about it, even if this is followed by a bad night. Better nights followed by worse nights is the most common pattern of progress – it is very rare that people progress evenly. You ask how long it typically takes for someone to consistently achieve a reasonable sleep efficiency night after night. You are right that this is difficult to answer as people vary and it also varies according to the initial sleep window people are set. Generally I would say it is weeks to months. But a key aspect is how people think about the less good nights and lack of consistent progress. If they think about them as a big disappointment, then this risks driving further bad nights. If they take them in their stride, with thoughts like “there will be bad nights, but that doesn't mean anything especial” then this helps continued progress.

  • Sleepio Member

    • 302 comments
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    in reply to Sleepio Member
    Expert

    Good to hear that your sleep pattern has been improving steadily. Yes, holidays and other changes affecting sleep routines can disrupt improvement in sleep, but they also very often do not. So the first thing is to have an open mind about what will occur. In terms of your question about sleeping medication, the Sleepio program works whether people use sleeping medication or not. Use of sleeping medication does not affect helpfulness of the program. All the best for your holiday!

  • Sleepio Member

    • 302 comments
    • 72 helped
    in reply to Sleepio Member
    Expert

    Hi, you ask about whether there are types of sleeping medication that are OK for someone with obstructive sleep apnea to take. I am afraid this is not within our expertise, and anyway would be something that would need an individual recommendation from your doctor/prescriber who would know the details of your medical history. The approaches used in the Sleepio program can be used alongside CPAP, but as you indicate take a bit of time to help improve sleep. I appreciate that it is very tough to carry on with responsibilities when feeling exhausted through poor sleep and, as such, it is natural to want something quickly to help. But over the next few weeks you will be introduced to a set of tools that help most people, and many find even from the beginning that it helps to feel that they have started on program to help and are learning things that will help. All the best with it and do come back next week and post how you are getting on.

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 1

    How do I listen to the live event?

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 1

    First time. Is there not an audio, just written comments to questions?

  • Sleepio Member

    • 302 comments
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    in reply to Sleepio Member
    Expert

    Hi. I see you have just started Sleepio and are asking about the Profs advice about lifestyle and sleep and particularly about exercise in the evening. There is evidence that aerobic exercise too close to bedtime can lead to difficulties getting to sleep – https://www.sleepio.com/library/article/exercise-and-sleep/. This is why the Prof suggests avoiding exercise in the evening. But for some people this will not be a problem or not if 4-5 hours before bedtime. So while Sleepio recommends everything that is known to help, if exercise is important to you and 6pm is the time you can fit it in, then this could just be something you experiment with and see if there is any difference in time falling asleep between when you have exercised in the early evening and when you have not. Anything else in particular about the Profs advice about lifestyle and sleep that you were unsure about?

  • Sleepio Member

    • 302 comments
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    in reply to Sleepio Member
    Expert

    Welcome. It is just written posted questions and answers. No audio. Some people post in advance and pick up the reply later. For those who are able to post live, it gives opportunity for an interactive chat. So far today, you are the only person who has posted live. With Sleepio users living in different time zones – Australia, Europe, North America – is hard for many to post live

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 1

    OK, no problem, I am new to the research study and just learning your systems. Do you have a specific book or online resource on CBTi that you like to recommend?

  • Sleepio Member

    • 302 comments
    • 72 helped
    in reply to Sleepio Member
    Expert

    Hi. You indicate you suffer from non-restorative sleep. I am curious as to what you mean by this (what your sleep pattern is) and whether this is something you have had diagnosed by a sleep specialist. From what you say you are sleeping very poorly in alls sorts of ways. I am also wondering about what sleep window for sleep restriction you were initially set by the Prof as you indicate that you have reduced it and now sleep from 12 – 7.30, which suggests you now have a 7.5 hour sleep window. But as you say you only sleep 4.5 hours, I would have anticipated you would have been set a shorter sleep window. Generally, the right sleep window, sticking with this, getting out of bed after 15 minutes not sleeping under the quarter-an-hour rule and only going back to bed when feeling sleepy tired, drive sleep pattern changes that lead to more consistent and restorative sleep. If you are not able to answer now, I shall be doing the live sleep session at the same time next Wednesday so post into that and I shall respond then.

  • Sleepio Member

    • 302 comments
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    in reply to Sleepio Member
    Expert

    The Sleepio program is self-contained and the Prof covers all that is needed in the sessions. There is a Sleepio Library with various articles about sleep and improving sleep that you can access via the Library tab. Not all Library articles are available immediately – some are only accessible when you reach the session in the program where the relevant aspect is covered. Good luck with it

  • Sleepio Member

    • 302 comments
    • 72 helped
    Expert

    Any other questions? I am here till 3.30 pm EST (8.30 pm BST)

  • Sleepio Member

    • 5 comments
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    Graduate

    I have a sleep window of 5 1/2 hours from 11pm. I'm currently 10 days into SR and sleeping for somewhere between 3 and 4 hours. I'm pretty tired during the day but in the main coping well. My problem is driving. On a motorway or straight dual carriageway I'm nodding off, however hard I try not to. This is clearly dangerous. I wondered if you have any advice? I know that it takes time for SR to work, but I'm wondering how long I'm going to have to avoid motorway standard roads – which is not easy for me!

  • Sleepio Member

    • 302 comments
    • 72 helped
    in reply to Sleepio Member
    Expert

    Really good you asked this. Driving when tired can certainly be dangerous. If you cannot avoid driving for longer distances or on motorways (e.g. need to drive for your work), we would advise a longer sleep window (say 6 or 6.5 hours) or skipping sleep restriction completely. This is not ideal, as SR starting with a challenging sleep window that creates adequate sleep pressure is considered to be the single most impactful approach to improving sleep. But safety is more important than anything and the other approaches in the Sleepio program are also impactful and there are plenty of people who for different reasons it is not recommended do SR who have still been helped by the programme. Thanks again for posting this

  • Sleepio Member

    • 302 comments
    • 72 helped
    Expert

    Thanks for your posts. Next live session will be same time next Wednesday and I shall be answering questions again then

  • Sleepio Member

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

    Thanks for your reply Dr. Cape.,

    I think my question didn't come through properly, I couldn't see anything in your reply about it or at the link you posted.

    To reiterate: I do not have difficulty getting to sleep, I don't want advice about that.

    My problem is that I tend to wake up about 5 hours after going to sleep and sometimes cannot return to sleep. So, to reiterate, my questions are:

    I've been adjusting aspects of my life to get better sleep, but some of these are a pain. In particular, avoiding exercise in the evenings.

    – Generally: which general sleep advice is less important or unimportant for waking many hours after sleep
    – Is exercise at 6pm really likely to be an issue for this, given that I go to sleep fine at 11pm? (I don't feel I've observed it being a problem, rather I feel it helps shed nervous tension from the day)

    Thanks for taking another look at this!
    Niall :-)

  • Sleepio Member

    • 302 comments
    • 72 helped
    in reply to Sleepio Member
    Expert

    Thanks for following up my reply. Sorry, I clearly didn't take in that in your original post you said you don't have difficulty falling off to sleep – your difficulty is waking up after 5 hours. Most of the approaches in Sleepio are relevant for helping people who either have difficulty getting to sleep or wake up and have difficulty getting back to sleep (or both). This is true of the Profs advice about most aspects of lifestyle in the second session (so alcohol, diet, smoking, caffeine). Avoidance of exercise in the house prior to bedtime is primarily an issue for people who have difficulty getting to sleep or who tend to wake up shortly after going to sleep and cannot get back to sleep; but for everybody exercise very close to bedtime would be inadvisable as it would interfere with creating a good wind down routine. But, as indicated above, the key approaches in Sleepio are equally relevant whether peoples difficulty is getting to sleep, maintaining sleep or both. So the sleep restriction and sleep-bed connection (quarter of an hour rule) approaches you will come to in session 3 and the various approaches in sessions 4 and 5 to managing when lying awake are relevant for both.

  • Sleepio Member

    • 17 comments
    • 3 helped
    Graduate

    I seem to “catch” insomnia if someone I know tells me they are staying up late or if I even read on my facebook that someone is having trouble sleeping.

    thus, I am wary of reading this message board, as it may just give me new ideas / ways to have this problem.

    I didn't even ever have trouble getting out of bed til I went to college and a friend says she likes to go to bed when she is stressed and get comfort under the covers. a little while later, I started doing that too.

    should I not read this message board if I think it will put me at risk of exacerbating my situation? is there some other way around it to help me stop “picking up” people's behaviors?

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 3

    Thank you Dr. Cape!

    Sounds like right before sleep is inadvisable, but e.g. 4-5 hours before could be right for me.

    Thanks also for the extra info,
    Niall :-)

  • Sleepio Member

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

    Thank you! Sorry I have just read this.

  • Sleepio Member

    • 12 comments
    • 1 helped
    Graduate

    I am halfway through week 3 with the sleep deprivation. I am using a Fitbit, and it is showing that I am restless for more than 50% of the night, so my SE is not very good.
    Does anyone know how accurate a Fitbit is? I tried to read back in previous posts, but can't really find an answer to my question.
    It does reflect the fact that I do not feel rested and always feel very fatigued.
    But still I am wondering as we cycle through the 4 stages of sleep, whether the Fitbit will indicate that we are restless when we are just in a normal lighter stage of sleep.
    I guess, I do not know what my data should look like for a good night's sleep. I can imagine how i would feel though. Hoping I can get there.

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