Live discussion with Dr John Cape - 29th July

Dr Cape will be hosting a live online discussion here on Wednesday 29th July 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!

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Posted 23 Jul 2015 at 3:31 PM
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  • Sleepio Member

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    Graduate

    I have another question…or two:

    I live abroad and often go away and have to adapt to a time change or even just a routine change. Depending on the context, it is sometimes just unsociable for me to take myself off to bed at the time I should on this programme. Will my next few days away this weekend throw everything out again or would it be better to put the programme aside for that time…?

    Also, this is a very different question, is it ever possible for us under-slept folks to actually become the kinds of sleepers who just clock off whenever they want (oh how I would love that!) or, in general, have you seen that people like us have to follow a very strict routine to have any hope of sleeping well…?

    Thank you Doc!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi RAAC

    Three good questions:
    1) With only the one room and kitchen, then inevitably you will and have to use that room for other things than sleep. This shouldn't be a problem. But at night, when you cannot sleep and get up after quarter of an hour, do leave this room and go to the kitchen
    2) The quarter of an hour rule is not meant to be a clock watching exercise. If clock watching you wont get to sleep! So, yes, if you are feeling sleepy tired and reach the 15 minutes, stay in bed as you might go to sleep in some further few minutes. But if you find yourself getting into a habit of extending it and not getting to sleep, you might need to review this as this wouldn't be helpful
    3) There could be different reasons why you feel exhausted after even after 6-7 hours of good sleep including that you might be someone who needs more sleep. Even with knowing more about your sleep pattern and history, it might be difficult to work out. At the early stage you are at with the programme, I would suggest taking a wait and see approach as to what happens with this as your sleep improves under the programme

    All the best and do come back tonight or another week with any further questions you might have

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi stuckers

    Falling asleep quickly, but then waking after a short time, feeling wide awake and having difficulty getting back to sleep is certainly a not uncommon problem. The most effective method for dealing with this is also the toughest to do consistently – getting up after quarter of an hour, going if possible to another room, and doing something unstimulating until you feel sleepy-tired when you can go back to bed; but might need to get up again if after another quarter of an hour you are not asleep. This so called Quarter of an Hour Rule (QHR) can be hard to implement consistently, but it is effective. Using a relaxation technique in the time after getting up after quarter of an hour is helpful for some people. You might want to look at the library articles and community discussion threads on the Quarter of an Hour Rule which give ideas for putting it into practice. The various cognitive strategies covered in session 4 and 5 may also be useful for you (remember you can always go back and look at these under the library tab)

  • Sleepio Member

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    Expert

    Hi loridori

    I am interested that you seem to have quite a long sleep window (7 hrs 15 mins) for having just started the programme and waking up after 5 1/2 hours. What was your pattern before you started the programme? But, yes, when you wake up and are still awake after 15 mins, then you should get up and move to another room until you are sleepy tired (the quarter of an hour rule). People who wake up close to the end of their sleep window often, understandably, find this hard to do feeling frustrated about having to get up when it is not that long before they would need to get up anyway. But the whole purpose of this is to strengthen the connection between bed and sleep and staying in bed when awake and tossing and turning is counterproductive to this

  • Sleepio Member

    • 21 comments
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    Graduate

    Hi thank you, I made a mistake my window is 6 quarter hours, from 12 – 6:15

    thank you

  • Sleepio Member

    • 4 comments
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    Graduate

    Thank you very much for the answers to my first three questions Dr. Cape. They are precise and very useful indeed.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Blodwen

    Sorry you could not join for the live chat as I can sense the frustration of all that you have tried and continuing to have so little consistent sleep and it would have been good to chat and see if there is anything subtle that we could work out about your sleep pattern and approach. As I can see you appreciate, the longer and more established a pattern, the longer it takes to change. I doubt that you are missing the point and clearly have taken to heart the message to try and take calmly and not care about the constant nights of poor sleep. But this is an enormously difficult and paradoxical feat to achieve, with potential to trip up (thoughts like “why cannot I be calm”). But if there are even very small gains in sleep, then welcome them. Very small steps repeated over time can amount to significant gains. All the very best

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    OK, loridori, that makes more sense. But also waking up at 5.30 so close to 6.15 is exactly what I was saying about it being all the harder then to get up and go to another room.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi again

    Best stick to the programme in terms of using the same length of sleep window and techniques, but where you place that sleep window in the new time zone (or routine) will vary depending on how long you are away/in the new time zone. If the plan is to be there some time (more than a few days) then as far as possible just use the same time in the new time zone for your sleep window. If only a few days, then you won't have time to adapt and there are advantages in sticking to the times back at home.

    Yes, some people certainly to get to a point where they would say they now sleep naturally and no longer see themselves as following the programme it get good sleep. But everyones sleep is at one time or another disrupted and if you have had sleep problems in the past then it can be useful at this time to go back tp applying the programme

  • Sleepio Member

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    Expert

    Hi TOM ZAR

    Good question. What you are struggling with is what many people struggle with when they start sleep restriction. Keeping to your sleep window is critical – you can shift it by for example going to bed regularly at 11 rather than 12, but you need to stick with the length of the window that the programme calculates as appropriate for you based on your sleep diary. This does mean that if you don't sleep during your sleep window, then you will often have less sleep in the night than your average before you started the programme. The next day will often be a real struggle and you indicate it is when you have gone back to work that you are struggling. But keeping to the sleep window even when you haven’t slept means that your lack of sleep builds up sleep pressure which makes it more likely that the next night or night after you will sleep through the night. And when you have slept through the night on successive nights (so when you sleep efficiency has been over 90%) then the programme lengthens your sleep window. Good luck with it.

  • Sleepio Member

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    Expert

    Hi littleums

    You say that one of your problems is waking up after 5 hours and you wondered if this could be because of low blood sugar/need for food or need to go to the bathroom. Both are possibilities. The library article on diet and sleep gives recommendations about meals and snacks – https://www.sleepio.com/library/article/diet-and-sleep/ – so it is worth having a look at that. Needing to go to the bathroom in the middle of the night is common and for many people changes in bladder function with age mean that this happens more frequently. If I understand correctly what you mean when you wonder if this is a Pavlovian thing, yes it is possible that you have got in a habit of going to the bathroom at a certain time at night rather than “needing” to, but it is also possible that this is physiological. My question to you is whether you get back to sleep quickly after these regular wakenings and going to the bathroom, or if you struggle to get back to sleep?

  • Sleepio Member

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    Expert

    Hi Geojude

    I am really pleased you brought this up. It's very common when people have been doing well with the programme to find themselves going backwards. Often (but not always) they can identify some change that has triggered them slipping back (as possibly for you the vacation). It takes time for any new habit to become firmly established and a new/better sleep pattern is no different. The old habit can quickly pop back. The key thing though I want to pick out of your post is about being “back at square one”. You are definitely not back at square one because at square one you had not done the Sleepio programme and made the improvements you did. You have a new sleep pattern, but have temporarily slipped from it into older habits. Going back to what you did before in the programme to make progress with your sleep, reapplying all the principles and techniques, should get you quickly back on track

  • Sleepio Member

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    Expert

    Hi promovideo

    For people who have no problems with sleep, having a nap during the day is fine. For people with sleep problems it is not recommended as every nap reduces sleep pressure so when it comes to night/regular bedtime there is insufficient sleep pressure which adds to difficulties with sleep.

    By polyphasic sleep, I assume you mean a regular practice of sleeping at different times rather than having one long period of sleep at night. All evidence is that this runs against the human body’s natural tendency for sleep and while in some circumstances (e.g. military service) this may be necessary for short periods, it is not a practice than anyone wants to or should continue for long

    All the best

  • Sleepio Member

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    Graduate

    Dear Dr. Cape . Recently I have red somewhere in regard the sleep duration and continuity : “Eight hours is healthy but no one gets that or plans for it; plan for at least five 90 minute cycles which provides 7.5 hours.” Since this is not in accordance the sleepio recommendations , I am wondering what your comments will be?

  • Sleepio Member

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    Expert

    Hi Jesukamarie

    It is better you get out of bed to do your email rather than do it in bed when you wake up. Using your bed just to sleep strengthens the bed-sleep connection and so helps sleep. But, yes, if you do stay in bed to do email before waking up then you should enter the time you get up as the time after finishing your email when you get out of bed and this will decrease your recorded sleep efficiency

    I do not know about the accuracy of Jawbone and in particular about its assessment of different stages of sleep. I shall check with colleagues and get back to you. There is also a community discussion forum on jawbone you could check -https://www.sleepio.com/community/discussion/jawbone-up/. There is nothing specifically to do to change the pattern of types/stages of sleep. These unfold in a typical pattern naturally over the course of the night and dependent on your sleep debt going to sleep (i.e how sleep deprived you are). You might want to look at the library articles on deep sleep and REM sleep.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Aaron87

    I understand you posted your query a few weeks ago on another forum. At the time you had just started sleep restriction, but see you have now graduated. Congratulations. I would be interested to hear how you have got on. You said before starting the programme you would have several awakenings at night, but most of the time you were able to go back to sleep almost immediately or within 5/10 minutes unless you had something to do the day after in which case you usually could not get back to sleep at all. Mini-awakenings at night are common, often barely registered or remembered. The key problem as you indicated is when thoughts about the next day came to mind in these mini awakenings. Strategies for dealing with such thoughts about the next day are covered in later sessions of the programme and I would be interested to hear if you found these helpful.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Dear Dragan

    There is no set number of hours of sleep that is right for everyone. As any other biological characteristic, people vary in how much sleep is right/best for them. I am not sure what is meant by five 90 minute cycles, but this could be similar to the idea about polyphasic sleep that I replied earlier about to promo video.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi darbydoo

    I am interested to hear that your sleep problems started following you reducing sugar in your diet. You say this was a recent (5 weeks ago) major dietary change, so there could be a period of the body adjusting after. As the library article on diet and sleep indicates – https://www.sleepio.com/library/article/diet-and-sleep/ – the digestive system continues to operate at night and will signal a need for food and so trigger awakening if it considers there to be a dietary lack. Usually this will be because of a real lack of nutrition, which is why going to bed hungry is not a good idea (best to have a evening meal supper, but not too late as it is also not a good idea to go to sleep with too full a stomach). But following a major dietary change there could be a period where the body continues to crave sugar despite this not being necessary for good nutrition. One would expect the body to adjust to the new diet after not too long and no longer trigger awakenings, but like many things that might initially trigger poor sleep, even when the initial trigger has resolved, a pattern of insomnia can remain as a result of the body and thoughts having got into an unsatisfactory sleep pattern. The Sleepio programme is designed to help this dysfunctional sleep pattern.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi PetyaG

    Good to hear that you have made some progress already. That must feel good. You should stick with the sleep window you have been given, but if you find that generally you are sleepy tired and ready for bed before the start of your sleep window (for example at 11 when your sleep window starts at 12), then it can be helpful to shift your sleep window to start regularly at 11 but it needs to last the same length of time so you will need to get up an hour earlier. This link shows you how technically you can alter this on your own Sleepio programme – https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/
    If this isn't clear or you have a further question, do post to next week's expert live session

  • Sleepio Member

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    Expert

    I think I have managed to reply to everyones posts, but if not then do post to next week's live session. Thanks for all your excellent questions and comments

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