Live discussion with Dr John Cape - 26th October 2016

Dr Cape will be hosting a live online discussion here on Wednesday 26th 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.

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Posted 20 Oct 2016 at 12:00 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Dreaming is an absolutely normal part of sleep. There are characteristic brain patterns when people dream (so called REM sleep) and throughout the night everybody has dreams, more as the night goes on after an initial period of dreamless sleep. But people vary enormously in whether they remember their dreams. If people are waking up more in the night and/or sleeping fitfully, they may remember their dreams more (when people don't wake up or go quickly back to sleep there isn’t sufficient time to consolidate the dream into memory). Fitful sleep can also lead to some confusion between whether the dream is real or not as people go in and out of a dream. Does this answer your question?

  • Sleepio Member

    • 3 comments
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    Graduate

    Many thanks for your reply about timing. I'll do as you suggest.

    Thank you,
    Julia

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Good to hear that your sleep is improved and you have come off sleeping meds and are pleased with this. But that 2-3 times a week after a year you still only sleep 3-4 hours is a lot. Continued occasional sleep onset insomnia after this period of time is not uncommon, and especially after stressful events, but it sounds from what you describe that you are awake a long time. I can imagine lying awake on these occasions must be very frustrating, but as you will appreciate frustration of course is activating and hinders sleep. So tricky as frustration about lack of sleep is an important driver of poor sleep. And keeping getting out of bed at such times following the quarter of an hour rule is hard work over a long time (and also following some of the other recommended approaches in Sleepio for when people are lying awake). But this is the essence of chronic sleep problems that the longer people have experienced them the more frustrated naturally people feel and the harder it can be to persist with following the techniques that can be helpful. But clearly you have done well getting this far and must have put in a lot to achieve this, so you must have a lot of determination. So we would expect that keeping up what got you to this point and reviewing all the approaches in Sleepio to check there isn’t something additional that could help would bring further progress. All the best with it.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    All the best with it and do come back with any further questions in future. There is a live expert session every Wednesday

  • Sleepio Member

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    Graduate

    Ok great, thanks. I'm finding Sleepio brilliant so far – it's making a real difference already and I am only in week 3.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Wow. You have had a long time of struggling with sleep. Good your severe sleep apnea was diagnosed and that you have done well with the CPAP. But after a long time, even if sleep apnea originally contributed to someone’s waking up and sleep maintenance insomnia, a sleep pattern can be so well entrenched that it continues after successful treatment of the sleep apnea. You say you are 2 weeks into sleep restriction which is very early days for anyone, but especially for anyone with a very long term well established sleep problem. In terms of your specific questions, Sleepio as you know recommends getting out of bed if awake for over 15 minutes and not going back to bed until sleepy tired. You mention having a racing mind at such times and the later sessions of Sleepio, which you may not have yet reached, cover different approaches that can be helpful for a racing mind. But also, if people don't feel sleepy tired after an hour or two, it would certainly be reasonable to go back anyway to bed and see if sleep comes (and get up again if not asleep within another 15 minutes). We do not advise on medication, as this is a discussion people need to have with their prescriber. Sleepio works equally well for people taking and not taking sleep medication. But sleep restriction works by creating sleep pressure in night following nights where people have been relatively sleep deprived from following the sleep restriction protocol. So the nights of even worse sleep during sleep restriction are useful. In terms of your query about medical use marijuana this again is a medical prescribing issue, but there is some evidence that marijuana like alcohol is ultimately more of a problem for sleep than helpful.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for your question. People with chronic pain commonly have sleep problems as I expect you know. Anything that activates the body can wake people up and interfere with sleep, and pain is a serious activator. Waking up in the night of itself is not a problem for sleep (mini awakenings throughout the night are normal and many good sleepers will have frequent times of being wider awake). It is not getting back to sleep relatively quickly that is a problem and this is where the pain and how people think and react around the pain can come together and drive sleep problems. So finding strategies to manage pain at night so it is least interfering has some similarities to finding strategies to deal with day time pain in order to get on with life despite the pain. In terms of the approaches in Sleepio, people with chronic pain sometimes find the sleep restriction and bed-sleep connection approaches covered by the Prof in session 3 particularly tricky for their pain so, even these are the most powerful approaches in changing sleep, if they find this to be the case there can be modifications made to these. But the approaches covered in sessions 4 and 5 people with chronic pain may find overlap with approaches they have found useful in managing day time pain so can be in a better position to put these into effect than others. All the best with the program.

  • Sleepio Member

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    Graduate

    I'm in my second week of sleep restriction. As you've alluded to above, I'm generally sleeping fewer hours a night than before I started the restriction (and was already very tired then). Sometimes I'm so tired I feel unwell and exhausted – last Saturday I went back to bed for three hours, as I felt I wouldn't be able to function properly during the day if I stuck to the sleep window (6.5 hours). I know this disrupts the pattern-forming of sleep restriction. Do you have any comments?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    How long do you need to have Sleepio as a major focus before it becomes an automatic habit? You ask a really good question. It depends of course on how entrenched a person’s previous poor sleep habits were, how consistent they follow the Sleepio procedures and various specific aspects of their sleep problems and circumstances. But in general new habits take months to become automatic even if there is no pre-existing contradictory habit to unlearn first. So generally we would suggest people continue to focus on the programme until they feel their sleep is consistently improved and then experiment with varying where this suits their life (e.g. not necessarily always sticking with the same sleep window). I hope this helps

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Sorry to hear you have suffered from insomnia for so long. Laying awake for hours in bed is awful and, as you will find out going through the Sleepio programme, actually unhelpful for sleep. Stress and all sorts of things can be the start of insomnia, but our modern understanding of insomnia is that what keeps it going is a cycle of sleep habits and ways of thinking about sleep and thoughts when trying to sleep that paradoxically keep people awake when they are trying their hardest to sleep. It is breaking this cycle and developing better sleep habits that leads to change. The Sleepio programme incorporates what is known about changing sleep habits in a way that people can make the changes themselves supported by the programme and, where people want additional support, from the Sleepio online community discussion groups. All the best with it.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks very much for raising this. It is really tough feeling exhausted with lack of sleep and then starting sleep restriction having even less sleep. So it is no surprise that people find it difficult always to stick strictly to the program and end up staying in bed longer than their sleep window or going to bed in the day. It’s great when people admit this is happening – I suspect this happens much more than people generally acknowledge. So thank you. We are but human, not superhuman. However, in the end the more people manage to stick to the sleep schedule/window set out by the Prof, the quicker and more solid will be their progress. There can be occasions when some aspect of the sleep window set or sleep restriction itself may not suit someone, but this is unusual. If you feel this might be the case for you, let us know and why.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thank you very much for your encouragement. It's actually helpful just reading that it's common to get less sleep initially with the sleep window, and that other people also find the restriction tough. It's also helpful having confirmation of my assumption that the restricted sleep makes us so tired that we ultimately (hopefully) start sleeping better, and that it's acceptable to go back to bed after an hour of up-in-the-night even if not sleep tired, to see if sleep comes.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Yes, hormonal disturbance can trigger sleep problems. But what keeps them going is more often what you nicely describe as the anxiety about sleep keeping you awake. In terms of your specific question as to whether to postpone the program until your toddler son’s sleep improves or continue nonetheless, this is really up to you. If you continue, you would just include the time awake dealing with your son in your sleep diary as part of the your time awake in the night. Many people have issues that require them to wake up in the night and the question then becomes getting back to sleep after being woken up, which is a key part of what Sleepio addresses. The realities that wake people up (in your case your son, but maybe also something hormonal) cannot be avoided, but these can then trigger the anxiety about getting back to sleep that you describe. If you do decide to postpone the program for a while, contact the customer services team on hello@sleepio.com so they know and extend your subscription as needed.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Good that you have found it helpful. Thanks for letting us know.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. I am afraid I don't know if ITP is associated with sleep problems and, if so, in what way. You would need to ask your medical specialist. Many chronic health problems are associated with poor sleep. The most common reason for this is that some aspect of the medical illness activates or alerts the body and wakes people up. This can then lead to more significant sleep problems as people become worried about not sleeping, in which case both the body and the worry or the sleep habits that people get into to try to sleep combine to keep people awake. There is a lot of evidence that the kind of approaches included in Sleepio can help people who have insomnia associated with chronic physical illness. All the best with the program.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    You ask about falling asleep with the TV on. There are two aspects of this. First the light from the TV can interfere with the circadian (day-night) brain mechanisms that regulate sleep. The second, for someone who is dependent on having the TV on in order to fall asleep, is that it becomes a crutch which if not available for some reason means that the person is unable to sleep. In effect the person has developed a TV-sleep connection instead of a bed-sleep connection. So these are the reasons the Prof recommends keeping the TV out of the bedroom. I would not say this is absolutely essential, but certainly advisable.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. You ask if some people will always need sleep medication. In terms of our current scientific understanding, there is no reason why this should be the case. But some people do find it useful to go on taking medication and Sleepio is equally effective for people taking sleeping medication as it is for people not on medication.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Sleepio advises abstinence from alcohol in the evening because of its effects on sleep – https://www.sleepio.com/library/article/alcohol-and-sleep/. But this doesn't mean that for every person or for all time this is necessary. So while we would recommend this, you could experiment with this yourself. Good luck and let us know how you get on!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. I am not quite sure what you mean by hyper-vigilance. Sounds like you are the look out for something, but what? And does this occur during the day as well as the night? My guess is that some of the approaches covered in sessions 4 and 5 of Sleepio may address directly what you describe, but these need to build on a solid foundation of sleep schedule changes as set out in session 3. Do come back with further information about what exactly you mean. For some people hyper-vigilance during the day and night can be associated with traumatic events that they have experienced and they may need specific help for this.

  • Sleepio Member

    • 302 comments
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    Expert

    We have reached the end of our time for today. I think I have got back to everyone who has posted a question but, if not, I apologise and do post again next Wednesday. Thanks for asking your questions and sharing your experience. We all learn from this – myself included.

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