Live discussion with Dr John Cape - 2nd March 2016

Dr Cape will be hosting a live online discussion here on Wednesday 2nd March 2016, 7pm-8.30pm BST

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 25 Feb 2016 at 4:31 PM
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  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Hi nic1982
    Welcome to Sleepio. I see you have just started the program. Is your insomnia, which you say started after taking Flagyl, just recent or have you had it some time?

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Hi Rolling waves
    You describe shifting your sleep window to 10.30 – 5.00 from 11.30 – 6.00 as you previously would go to bed 9.30 – 10 and had been struggling to stay awake. Shifting the timing of your sleep window in this way so it fits your own sleep pattern, but making sure to keep it the same length, is absolutely fine. In fact there are even some instructions on how you can do this in your online schedule:
    https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/
    In terms of you finding you wake up at 4.30am in the first instance as has been your custom is not surprising, but sticking with it and using the quarter of an hour rule as in your later post is exactly what is recommended.

  • Sleepio Member

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    Expert

    Hi again Rolling waves
    In terms of your further question about what sort of activity to do when you have got up under the quarter of an hour rule, it is quiet relaxing and not energising activities that are recommended. Key is not to expect a miracle – it would be surprising if the first times you did this you were sleepy tired after 15 mins and went straight back to sleep when you return to bed. If it was as easy as this, you wouldn't need to be doing Sleepio. It may be many times of getting up for 15 mins, going back t bed and up again over many days before it begins to click into place. If when you are up for the 15 mins you are eagerly waiting and on the alert for when you are going to be sleepy tired, it will never happen. But of course at first it is hard not to be on the alert like this

  • Sleepio Member

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    Graduate

    Hello
    I am here, I posted a question earlier. I hope you have time to comment.
    Thanks!
    Cotr

  • Sleepio Member

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    Expert

    Hi Cotr
    Wow, you describe perfectly what happens when the bed-sleep connection has completely broken down and been replaced by a bed-wakefulness connection. I assume from your post that at beginning of your night, you are continuing to fall asleep on the sofa before transferring to bed; but now in addition you wake up and cannot get back to sleep even when trying to get back to sleep on the sofa first. For anyone whose bed-sleep connection has been replaced with a sofa-sleep connection (even if they don't always fall asleep on the sofa) we would recommend they go back to first principles and not fall asleep on the sofa but go to bed and not the sofa at beginning of the night and persevere with getting up after quarter of an hour, going back to bed, getting up again after a quarter of an hour, going back to bed, getting up after quarter of an hour and so on and so on until sleep in bed happens (probably at first just for a few minutes, followed by getting up after quarter of an hour etc etc). An extremely tough regime but necessary to change an extremely strong habit.

  • Sleepio Member

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    Graduate

    The last two nights I had a SE of 80. The reason it wasn't higher is that I didn't wake up for the day with my alarm, but went back to bed for about an hour; I simply needed more sleep. (5 hrs. is not enough.) Tonight I plan to go to bed at 11:30 pm (but only if I'm sleepy tired) instead of 11:45 pm in the hope of getting a little more sleep and of increasing my SE. Does this make sense to you?

  • Sleepio Member

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    Expert

    Hi Magsy
    You ask if you should delay moving on to session 5 as your sleep has been interrupted a lot by a bad cough and you think this means that you haven't shown the benefit from sleep restriction. Sorry to hear you have been suffering. Whether to delay the next session of Sleepio when some illness or life event has intervened is a personal decision – there is no right or wrong, the programme works equally well if you postpone or go ahead as long as you are continuing to practice the techniques (including seep restriction) that have been covered by the program so far. The fact that you note you have had 2 nights of 90% sleep efficiency in the 2 weeks under the circumstances is good and great that you sound on the whole optimistic about building on this when your cough is better. All the best with it

  • Sleepio Member

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    Graduate

    I've had problems getting to sleep and early wakening and periods of mild anxiety/depression on and off since my wife died a few years ago. I've been prescribed and am taking Sertraline and have done for about 11 months now. I'm in week 6 of Sleepio and my sleep efficiency has gone up from 50% to 85%. My question is what impact does Setraline have on ability to sleep and what impact might it have as I begin to come off it.

  • Sleepio Member

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    Graduate

    Thanks for your reply. I have a lot of anxiety when I wake at night, obsessing about what time it is etc. I feel pretty helpless at this point. I think that this anxiety makes everything so much worse. Do you any tips how to reverse this anxiety (meditation and progressive muscle relax) does not help. Or should I expect that SR and QHR would still work at some point even though I am so anxious?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Ronald
    Can I just clarify what happened these last 2 nights? Are you saying to slept through your sleep window (say 11.45 – 4.45), but rather than getting up at 4.45 you stayed in bed so that your time in bed was much longer than 5 hours and some of the time after end of your sleep window you were awake so that you sleep efficiency was 80% but actually you were mostly asleep during your sleep window? If so and this is happening repeatedly, then there are circumstances like this when it can make sense to increase the length of ones sleep window because the sleep efficiency calculations, while correct, aren't capturing that one actually slept through ones sleep window

  • Sleepio Member

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    Expert

    Hi Islander
    Great to hear that your sleep efficiency has increased from 50% to 85%. You ask about the antidepressant Sertraline and sleep. Antidepressants can help sleep but also sometimes interfere with sleep – it depends on the antidepressant and the person. Which is the case for you, you would need to ask your doctor, but in truth it can be hard for a doctor to know. But in terms of the approaches covered in Sleepio, they work effectively whether people are on an antidepressant or not and whether people continue to take antidepressants or have decided with their doctor to withdraw from them. If an antidepressant has helped sleep, then there may be some greater difficulty sleeping when withdrawing, but the Sleepio techniques can still help. For anyone considering stopping taking antidepressants it is important to discuss this with their doctor, both to be clear this is medically best but also to plan how to stop them

  • Sleepio Member

    • 44 comments
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    Graduate

    Great questions. Both times my alarm went off at 5AM and both times I went back to bed, once until 5:45AM and once until 6AM. In my diary I entered these times for my final awaking and when got out of bed for day, respectively. I also entered 0 for number of times I woke up during the night. Perhaps I should have recorded that I woke up once during the night at 5AM and fell asleep 15 minutes later and that my final awakening time and my getting out of bed time were the same. My SE would then have been 90 or so.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi again Cotr
    Yes I can imagine you must feel very anxious and desperate when awake in the middle of the night and clock watching. It is worth trying again the various techniques that you would have tried before and that will be covered in later sessions, even if they didn't help before. They may not help again, but they might. If they don't, then in the end, the biological drive for sleep will trump even the worst anxiety, but that is after so many anxious, desparate exhausting night time hours. The courage and determination that is needed for some people to stick with the programme despite how anxious and exhausted they feel always humbles me

  • Sleepio Member

    • 12 comments
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    Graduate

    Thanks for your comments. I would certainly discuss any plan to withdraw from Setraline with my doctor, but I don't think I'll be doing it until I've had a period of settled sleep in case it does impact my sleep. It was my doctor who recommended a CBT approach to improving my mood and my sleep.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Stables
    You ask about best techniques for dealing with night time anxiety, but I would like to pick up first what you posted that for a while your sleep improves but then is terrible again. Sleep getting better, but then worse again is the normal pattern of improvement. Being cool with this pattern and not getting becoming preoccupied with thoughts that things are going downhill again (which drives anxiety which can then interfere with sleep) is a really important step in progress. In terms of techniques, any of the techniques covered in Sleepio can be helpful (you can revise them by going to the Library and they will be there session by session in the left column under Sleep Basics). If there was one or more that were helpful when you went through the programme, then try these first

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Hi again Nic1982
    You must not be on live. The reason I asked earlier in this session how long you have had insomnia, is that sleep being badly disrupted in the short term can happen for a lot of reasons. For most people things settle down pretty quickly after the cause of the sleep disruption stops. But for some people, the worry and anxiety about not sleeping ends up keeping them literally awake and ends up causing a longer term insomnia. In terms of your question about sleeping medications, this is a question you would need to ask your doctor as Sleepio is not a medical advisory service. But the techniques in Sleepio work as effectively for people on sleeping medication as for those not on medication. I see you have just started the Sleepio course – keep with it and the Prof will over the course go over a variety of approaches that have been found scientifically to help with sleep

  • Sleepio Member

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

    Hi again Ronald
    Thanks for clarifying. The way you entered your sleep diary is correct. It's just that the clever algorithms that are in the Sleepio programme and adjust the sleep window when someone is consistently achieving an average of 90% sleep efficiency, are not clever enough to spot that someone has done something unusual. In these cases it is appropriate to trump the algorithms, but it is sensible and really helpful for others (and the Sleepio team) to check it out as you have done in the live session

  • Sleepio Member

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

    Sounds a wise approach. And good to hear that you have a doctor who advised a CBT approach.

  • Sleepio Member

    • 230 comments
    • 44 helped
    Expert

    I realise we have gone over time. I was too absorbed in answering your great questions that I didn't realise the time. Thanks for all your helpful contributions. If you feel something wasn't answered sufficiently or have further questions, do not hesitate to post a comment or do into the live session next week

  • Sleepio Member

    • 6 comments
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    in reply to Sleepio Member
    Session 2

    Hi doctor,
    I went trough some stomach problems ( amebiasis) and took 2 cycles of antibiotics.
    After 1 st cycle I lost the ability to sleep and it is now 2 weeks. I am going to a neurologist who gave me Midazolam and xanax 0.25 before sleeping but this gave me only 4-5 h of sleep not all nights….
    My case is normal? People sleeping very well get stressed and completely unable to sleep @ any time of the day and night without pills….? I am getting anxious about it is not helping

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