Live discussion with Dr John Cape - 28th Dec 2016

Dr Cape will be hosting a live online discussion here on Wednesday 28th December, 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 22 Dec 2016 at 4:01 PM
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  • Sleepio Member

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    Graduate

    Hi,
    Do we have to inform the team if we don't follow the restricted sleep window as I am struggling this week to follow it.
    Thank you.

  • Sleepio Member

    • 475 comments
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    in reply to Sleepio Member
    Expert

    I am not sure there are studies specifically of components for the racing mind. Most studies of CBT for insomnia, as the studies of Sleepio, incorporate the range of techniques to maximise effectiveness. If you are interested on the impact of specific techniques I could check with my colleague Simon Kyle who has been researching the impact of individual components. If you are interested more generally in the impact of the whole range of approaches, you could start with the initial Sleepio randomised controlled study in the Journal Sleep, Vol 35, No 6, 2012 (which I think is an open access journal)

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    You say you often wake up feeling like you didn't rest at all. The last user I replied to was saying something similar and you might want to look at my reply to that post. You say “deep sleep” but I think you probably mean more refreshed and restorative sleep. The science of sleep tells us that people have their longest deepest brain wave sleep in the first few hours of sleep, but this is different to what people experience as quality sleep or refreshing/restorative sleep. I see you are just starting on the Sleepio programme. All the techniques of Sleepio help improve sleep efficiency and with more efficient sleep (less time in bed awake) comes better quality sleep. All the best with going through Sleepio and getting more refreshing sleep

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for your suggestion. Good that this helped you so well. It is important to check out what can medically help any physiological/physical reason that interrupts sleep. But when all has been done medically, many people still do get woken up by their physical problem and then, as I am sure you will appreciate, Sleepio can help.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    There can be different reasons for struggling with the restricted sleep window. There can be practical reasons, like taking a trip to another country or school holidays or other things disrupting ones routine which make it difficult to follow the set schedule. Or there may be events in ones personal life which are stressful which make it feel better to postpone for a while following the programme. In these cases people can certainly halt the programme for a time and can contact the team at hello@sleepio.com requesting to halt the programme and to add an extension when they take it up (as some people have paid for fixed term periods). But otherwise there is no need to inform the team. Is there a particular reason it is hard now you would wish to share, or is it that it is just very difficult to stick to which we appreciate it is as it often is really really tough

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. Very helpful that you have identified an overactive mind and negative thoughts as key to your difficulty falling asleep. This should help you making progress. Sessions 4 and 5 with the Prof cover specific techniques for dealing with negative thoughts – some techniques to shift focus from the thoughts, others to directly challenge the thoughts. But the sleep scheduling (sleep restriction and quarter of an hour rule) approaches of session 3 are a very important base for all else that comes after in the Sleepio programme, so do follow these to make sure that the specific later techniques have best chance of success. All the best with it.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Great that Sleepio has helped you with falling asleep at night, although you are still struggling with early waking. Sounds like you are finding this really tough and if you are struggling to make it to the beginning of your sleep window and have even fallen asleep during the day, there clearly must be quite a lot of sleep pressure built up from the nights of not sleeping so well. While a week of this must feel a long time, it can take some time for things to shift and for some people there are critical points of desperate tiredness before a better pattern becomes established. As waking up in the night is common even for good sleepers (although good sleepers almost immediately go back to sleep and so often don't remember they have woken up) the early morning waking may not of itself be significant, but not getting back to sleep again is. And of course the more feeling there is about waking up early, the more difficult it is to get back to sleep which is the plight of the poor sleeper. This as you are aware is the purpose of the various Sleepio techniques you have tried (and may be worth trying again) – to get out of this way of thinking. I remember a post from a Sleepio user that was clicked as “helpful” by the most other users of any, which was that what shifted for her was to no longer care (to no longer worry) if she slept poorly, which is when she started to sleep better. How that change of view happens, I cannot tell and when people have caring or other responsibilities during the day as you describe, it is hard to imagine how people make that shift. But people do and sometimes there are critical points of desperation that may precede it when things could go either way. All the best with it. And one other thing: being so sleepy during the day and especially in the evening it is important to do activating activities to keep awake.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. Yes advice on tapering off temazepam you would need to get from your prescriber to be sure is appropriate to you, although my understanding (which you would need to check with your prescriber) is that the general rules of tapering are the size of decrease of dose (whether to cut up tablets to make a slightly smaller dose where necessary and appropriate rather than just going down to the tablet of the next lowest dose) and whether these happen more gradually/slowly or less slowly. What we can say is that people do equally well with Sleepio whether they are on sleeping medication or not. For those on sleeping medication who have agreed with their prescriber to taper off, some do so after they have finished Sleepio and have well established better sleep, while some do so before or while going through the program. I see you are a graduate so you may have reached a point in the programme where you have established better sleep and now have agreed with your prescriber to come off medication. All the best with it. We are aware from many Sleepio users that withdrawing from benzodiazepine medications like temazepam can be tough.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. Good to hear that you are enjoying the course and your sleep quality has improved. It’s an interesting sleep pattern you describe where you go to sleep OK, then wake up 2.30/3.00 to 5.30, then sleep 5.30 – 6.30. I am wondering what your sleep restriction window is as I would have expected if this was your regular pattern that this might have been set at a length that disrupted this or might yet do so. I am also wondering over the last couple of weeks what you have been doing between 2.30/3.00 and 5.30 – particularly whether you have been using the quarter of an hour rule (getting up after 15 mins and doing something relaxing and only going back to bed when sleepy tired) and what of the approaches covered in session 4 and 5 you have been trying and how these have worked. All these are designed to help with what you have described.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Bright light is primarily a treatment for circadian rhythm disorders, to help with shifting the timing of peoples sleep so that they sleep during the night rather than having a shifted sleep pattern (going to bed and getting up very early or going to bed and getting up very late). There is a brief article in the Sleepio library on this:
    https://www.sleepio.com/library/article/what-is-bright-light-therapy/

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. As well as my previous response, you might be interested in this article in the Sleepio library as you say you have fibromyalgia: https://www.sleepio.com/library/article/fibromyalgia/.
    I see that you have only recently started on Sleepio so there is a lot of information and techniques to come and from session 3 you will be working to a regular sleep schedule worked out individually for you from your sleep diary information

  • Sleepio Member

    • 475 comments
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    in reply to Sleepio Member
    Expert

    I am not up to date on the genetics of sleep, but most things are influenced by our genetic make up including our personality. There may be a specific genetic component in circadian rhythms: whether one is more of an early morning ‘lark’ or a late ‘night owl’. I note you said your father was an early morning person, so it may be that you have a similar pattern and it suits you to be in bed early and up early. Key to chronic insomnia is a cycle of habits and thoughts around sleep that maintain the insomnia and this is what Sleepio sets out to help people to change. In terms of your comment about sleep efficiency improving, but not total sleep time, in general sleep efficiency (and reduced wakefulness in bed) and sleep quality are what improve more with Sleepio (and with CBT for insomnia) than total sleep time.

  • Sleepio Member

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    Expert

    I am not an expert on CPAP for obstructive sleep apnoea, but believe there is some research on what helps people tolerate the mask. I shall check this out and get back to you if I find anything useful, although this might not be for a couple of weeks. But it could be, as it looks like you are on to already, that some of the approaches covered in sessions 4 and 5 of Sleepio like mindfulness, imagery or thought blocking could be helpful.

  • Sleepio Member

    • 11 comments
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    Graduate

    Many thanks for the e mail. I'm sorry if I said I had Fibromyalgia I certainly meant I do not have this condition. Just goes to show that I do need the help with sleep as I'm not functioning as I should. Thanks anyway as I can definitely use the second article.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Interesting question. There is a specific sleep syndrome called Restless Legs Syndrome. This Sleepio article describes it:
    https://www.sleepio.com/library/article/what-is-restless-legs-syndrome-rls/
    Does this fit with your experience? If so, it might be something to get a medical opinion on

  • Sleepio Member

    • 475 comments
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    Expert

    OK. There have been a lot of interesting posts tonight which I wanted to reply to so have gone over time. It's been a good evening discussion. So thanks all for your posts which everyone benefits from. We shall be back as usual next Wednesday. A Happy New Year to all in advance

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Sorry! My error. I was scanning posts too quickly towards the end of the session. All best with the programme ahead and do post again in future

  • Sleepio Member

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    Graduate

    Easily done. No problem. Thanks for your help.

  • Sleepio Member

    • 10 comments
    • 1 helped
    in reply to Sleepio Member
    Graduate

    Hi

    The problem I have is getting back to sleep and I find tat the relaxation techniques do not work for me,as thinking about what I have to do next makes me more awake.Are there different relaxation techniques?

  • Sleepio Member

    • 475 comments
    • 101 helped
    in reply to Sleepio Member
    Expert

    Hi. Autogenic training, imagery and mindfulness are alternative approaches to progressive relaxation for getting back to sleep. Thought blocking is a simple technique quite a few people find helpful. All these can be reviewed by going to the Library tab on the home page and then looking under sessions 4 and 5. MP3 audio files to help with imagery and autogenic training can be downloaded from going to the case file tab and the to 'downloads'. All the best with it

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