Live discussion with Dr John Cape - 26th August

Dr Cape will be hosting a live online discussion here on Wednesday 26th August 7pm-8.30pm BST.

He will discuss as many topics as possible in the hour and a half and, as always, you’re welcome to ask any questions at all about sleep or the Sleepio program. Please do note however that, as per our guidelines, Dr Cape won’t be able to give highly specific medical advice. He will however try to help as best as she can!

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

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Posted 20 Aug 2015 at 12:48 PM
  • 52 comments
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  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Good question about being sleepy tired, going to bed and then being immediately wide awake. Others this evening have posted the same question. A key finding from behavioural sleep science is that while for good sleepers the bed is a cue for sleep (the body responds by sleeping), for poor sleepers the bed is paradoxically a cue for wakefulness (the body responds by becoming alert). Changing this pattern is central to the CBT approaches in the Sleepio program. As any behavioural habit, it takes time to change. Interesting point you make about “trying to do sleep restriction”. Sometimes starting Sleepio or any approach to helping sleep heightens awareness about what is happening to your sleep pattern and paradoxically at first can add to the bed = wakefulness connection

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Mc510
    This Library article sets out how Sleepio calculates sleep efficiency https://www.sleepio.com/library/article/how-is-my-sleep-efficiency-calculated/. As anniem has posted, it is the time you are asleep divided by the total time from when you went to bed to when you finally get up. As a short hand this is often described as time asleep divided by time in bed, but as you say this can be misleading

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Good to hear the Sleepio community discussion on tinnitus was helpful

  • Sleepio Member

    • 11 comments
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    Graduate

    I've graduated but am still suffering from my main sleep problem, namely waking up after four hours and having difficulty getting back to sleep in my bed (I _can _get back to sleep on the couch, however). It seems to not matter how tired I am when I go to sleep; four hours seems like sufficient sleep that I will have difficulty getting back to sleep, but certainly not enough for me to feel human the next day. I recall when “sleep training” my then-young children, one book advised that if a child has a consistent middle-of-the-night waking issue, that what you should do is intentionally wake the child up 60 minutes before that time, when they're still in a deep sleep cycle, and then let them fall back asleep again and, the theory goes, not wake up in between sleep cycles. Does this make sense for adults and is it something that I should try? I'm really running out of any other solutions for my intractable middle-of-the-night insomnia.

  • Sleepio Member

    • 7 comments
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    Graduate

    So by just going to bed heightens my awareness and causes me to be more awake. In other words it amplifies the situation. When I am on the sofa I am not trying to get to sleep and so sleep comes naturally? How can I transfer this natural ability to the bed?

  • Sleepio Member

    • 12 comments
    • 1 helped
    Graduate

    Hello – I'm here too :)

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Great to hear that your sleep is better. Your question about whether to wait till you have finished the course and your sleep is stable before coming off medication or to do so while doing the course is a common one. There is a Sleepio community discussion on doing the course while on medication you might want to check out and contribute to: https://www.sleepio.com/community/discussion/using-medication-while-doing-the-sleepio-course/. In my view if you haven't changed your medication regimen so far (I see you are half way through the Profs initial 6 sessions of the course) then it is probably better to wait at least until the end of these 6 sessions. Yes, you may well find that as you wean off medication that your sleep will become more disturbed temporarily again, but the key to the Sleepio program is that you can go on using the techniques you have learned to get back on track. It won't be going back to the beginning, but getting back on track. It would be sensible to get the advice of your prescriber about weaning/reduction regimens and timing as well. All the best with it

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi loriloo
    I see two graduates (anniem and sleepsound) have already replied to your post. You are still early in the program. As they say the program does address your concerns in recommendations about a wind down regime before bed. And you will also learn about the importance of sticking with a consistent going to bed and getting up time. So do stick with it. But if in a couple of weeks you still feel your concerns are not being addressed by Sleepio, do post again

  • Sleepio Member

    • 12 comments
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    in reply to Sleepio Member
    Graduate

    Many thanks!

    Then I will continue like this – have the same length of sleep each night, and try to keep the difference low.

    Any other techniques that can be useful in the transission days (friday and sunday)?

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Wow. You are having a really hard time in your first week of sleep restriction. People vary in their response. Someone who posted and I replied to earlier slept through their sleep window on the first three nights of sleep restriction – something I can see right now you are yearning for. But some like you have a really hard time. The one good thing that can be said about the lack of seep in this first week is that it builds the sleep pressure which eventually will drive the sleep into the regular sleep window. So stick with it. You are not on your own. If you have checked out the Sleepio community discussion fora you will have found this is the single toughest issue with the program for people and yet the one that brings the biggest gain

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    My only advice about techniques for the transition days between weekdays and weekends is (1) use the same wind down routine for each (2) try not to assume it will be difficult as the difference is small and any difficulty could be created because of your thoughts/anticipation that it will be a problem (as always easier said than done; if we could control our thoughts just like that life would be easy!)

  • Sleepio Member

    • 12 comments
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    in reply to Sleepio Member
    Graduate

    I concur. The first week with Sleep Restriction was tough, but it was also liberating to 1) have more time relaxing, and 2) a more efficient sleep.

    Be patient , my fellow colleguage :)

  • Sleepio Member

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

    You say you don't go to bed because you aren't sleepy and sit up on your computer. Yes, you won't make progress like this. I see you are at session 5. Three important things for you to do are (1) make sure you turn off your computer at least an hour before the time for you to go to bed (the time for going to bed set in your sleep window) (2) make sure you do go to bed at the time of your sleep window (3) if you do get out of bed in the night as you cannot sleep (as recommended in the quarter of an hour rule) do not go back on your computer. If you still find you cannot tear yourself away form your computer, then get a friend to help you by phoning or encouraging you in other ways to do this

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Hi LauraM
    So you are now able to sleep pretty well through the night if you sleep in the spare bedroom, but if you sleep in your regular bedroom you wake up and have difficulty getting back to sleep because you are convinced your partners movements will prevent you from getting back to sleep or will wake you up again. Is that right? Creating a good bed-sleep connection in one place (the spare bedroom) does not always transfer to another (your shared bedroom). What I would recommend is that you stick with one bedroom or the other rather than constantly move from one to the other. If you have established a good sleep pattern in the spare bedroom, then move to your shared bedroom and stick to it, knowing that your sleep will be disrupted again at first. There is a community discussion on sleep problems and sharing a bed you could look at for ideas: https://www.sleepio.com/community/discussion/sleeping-with-your-bed-partner/. You might also want to check out again approaches for dealing with “heightened awareness thoughts” (session 4) as your anticipation and awareness of your partner’s movements is an example of this type of thought. All the best with it

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Hi. I like the way you put it that you have been making progress with “sleep deprivation”. I know you meant sleep restriction, but sometimes doing sleep restriction can feel like sleep deprivation so you are spot on there! It's OK for you to take occasional sleep medication in the way you describe. Better not to if you can as it then builds up the sleep pressure for you to be more likely to sleep the next night without the need for medication. But OK if you do.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Good you are sleeping now through the night. The only general rule about weaning off sleeping medication is to do so gradually, cutting up tablets into halves and quarters as needed. It is sensible to get advice from your prescriber as well. All the best with it

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    You say you are getting to sleep more easily and sleeping through better but waking up early at 4.30am. Have you always been an early waker – some people are and for them a sleep pattern of going to bed early and getting up early suits? You asked about age. Yes, with age less sleep is needed, but not particularly waking early. What is your sleep window and how many hours of sleep are you averaging a night at the moment?

  • Sleepio Member

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

    Sounds tough trying to keep awake in your wind down time. For some people shifting their sleep window to start earlier can be helpful (e.g. going to bed at 11 and getting up at 6, rather than going to bed at 12 and getting up at 7). For others it is a case of walking or doing activating things to keep awake. The problem of then going to bed and find yourself wide awake is one a few other people have posted about today and I commented on earlier. It takes time and a lot of guts to shift behavioural patterns. All the best with it

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Great to hear that your sleep improved substantially on the course and that you have succeeded in reducing zopiclone to just a quarter of a tablet a night. What you have found is common, that weaning off sleep medication leads to a temporary blip in sleep. For some people the final reductions in dose are the most difficult, even though the absolute reduction in dose may be smaller. In terms of what you should do, it is a question of sticking with what has worked for you in getting to this point. So, yes, the quarter of an hour rule.

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    We have come to the end of the live session tonight. Thanks for all your great questions. I think I have managed to reply to everyone, but if I have missed you or you have further questions do post a question next week. If you can make it live, that's best as it allows for clarification and dialogue, but appreciate that is not always possible with people being in different time zones from Australasia to Europe to the Americas. All the best

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