Live discussion with Dr John Cape - 3rd January 2018

Dr Cape will be hosting a live online discussion here on Wednesday 3rd January, from 7:00pm to 8:30pm British Standard Time or 2:00pm to 3:30pm 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. If there are a lot of questions, he may not be able to answer all in the time available, but will try to answer as many as he can.

Please do note that, as per our guidelines, Dr Cape will not be able to give personal medical advice including those about medication. His replies to questions will be made in such a way as to help as many people as possible who might have similar issues.

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

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Posted 28 Dec 2017 at 5:26 PM
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  • Sleepio Member

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    Session 3

    No worries – happens to the best of us! :)

  • Sleepio Member

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    Expert

    Hi. There may be just a grain a truth in your doctor's advice as there is an echo of it in the Prof's advice to go back to bed only when sleepy tired when out of bed in the middle of the night under the Quarter of an Hour rule. But as all such one line “sage” advice for sleep, it doesn't help with the complexity and severity of insomnia for someone who has been unfortunate enough to experience this for months or years. I hope that you are finding the rationale and range of approaches in the Sleepio programme helpful. If not, do let us know where you are stuck. All the best

  • Sleepio Member

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    In reply to a deleted comment
    Expert

    I am sorry to hear you have had norovirus. Very unpleasant and debilitating. You ask how to record this time in your sleep diary when you have been in bed all the time other than getting up to be sick. We would recommend you skip recording these days and resume when you back up out of bed and trying to establish a regular routine again. I hope that is speedily.

  • Sleepio Member

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    Expert

    Thanks for your understanding. As you are online, is there a question you would like to put?

  • Sleepio Member

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    Expert

    Hi. Good point. You can add tags to your sleep diary to note that you took sleeping medication or drank alcohol and reviewing these over time see a pattern. But it is true the algorithms of the programme do not then pick up these tags – this is something you have to do. In terms of sleeping medication, the evidence is that the self-help CBT approaches for sleep built into the Sleepio programme are as effective for people on medication as those not. Some people on medication choose to complete the programme on medication and then maybe discuss with their prescriber coming off medication later while continuing to use the Sleepio approaches.

  • Sleepio Member

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    Expert

    Good question about whether and how to modify the sleep window if disturbed in the night by children. If this is just occasional and you are not up for long, is probably best not to make any changes. If it is regular and you are up for long periods, then is reasonable to add that time on to your sleep window (so if up for an hour dealing with a sleepless child, then add an hour to your sleep window). The only problem is that recording this hour awake in the sleep diary, the programme will not recognise that this has been because of children and your sleep efficiency will be recorded as lower in same way if you had been awake because of insomnia. One way around this is not to record in the sleep diary this time woken up by the children as time awake. All the best with it

  • Sleepio Member

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    Expert

    You ask whether the quarter of an hour rule would work as well if it was a half an hour rule, as you find the 15 mins very anxiety provoking. I am not aware of research systematically looking at this, although there may be. Quarter of an hour we know from many many studies works and the logic of not extending it is that the more time sleepless in bed, the less easy it will be to re-establish a good bed = sleep connection. But you could experiment and see. Or, you could persist a bit longer with the 15 mins and then try. Let us know how you get on

  • Sleepio Member

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    Expert

    Interesting question about dealing with procrastination – not going to bed even when you have decided it is your bed time. I would be interested in your ideas for dealing with this. There is nothing specifically in Sleepio on this, but (as I see you have just started the programme) you will in due course be set a sleep window and it will be key to stick with this. Generally over nights of having less sleep, sleep debt and sleep drive will increase and you would expect this to motivate most people to get to bed on time. But the procrastination habit can be very strong, so really good you have identified early that this will be an issue for you

  • Sleepio Member

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    Expert

    Hi. It's pretty common for people to take a break from the programme – either a planned break or that it just slips – when they have been travelling or on holiday. When this happens, yes just go back to where you left off. In terms of dark nights and when best to fit the sleep window, it is absolutely fine to change the start time of your sleep window to fit better with the light/dark cycle and/or your routine (and change the end time accordingly so that it is the same length). There is even a way to do this on your schedule. See – https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/

  • Sleepio Member

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    Expert

    You ask for tips for going back to sleep when awake in the middle of the night. I would suggest you review the techniques in sessions 4 and 5 (you can do this from the Library tab). There are quite a few there to try out. Usually people will find one or two that are helpful to them. All the best with it

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Ah… lucky you if rolling over and hugging your pillow works for you!

  • Sleepio Member

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    Expert

    Thanks for the question. There was an earlier post about difficulty/procrastination getting to bed and yours is the flip side – difficulty getting up. The way you say you are recording this in the sleep diary sounds correct and will mean that your sleep efficiency is low as all the time in bed after your alarm has gone off (and which you nicely describe as being in a sort of stupor) is recorded as time awake in bed. In terms of what to do, some people have circadian rhythms where they are naturally late to bed and late to get up and a later sleep window (say going to bed at 2.30 am rather than 12.00am) may suit them better as this means they get up more easily at end of their sleep window. If this could be you, then it could be worth trying this. If not, then is tricky – some people try to find something to reward themselves for getting up on time

  • Sleepio Member

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    Expert

    Hi. Thanks for your honest and clear post. It is important and helpful to be as clear as you have been about the struggles with the programme and doubts that it is going to be of any help. Many if not most people don't find immediate improvement over the first few weeks of the programme and almost nobody goes through it without problems. And this is especially the case where people have had problems with sleep over many many years. Changing well established albeit unhelpful patterns of sleep and replacing them with more helpful patterns takes time and also is not smooth – improvements are followed by set backs in which people get disheartened and can feel that they will never improve and it can be hard to get back on track. So thanks for making this so clear in your post as I am sure your experience will be shared by many people reading your post. Please do let us know how you get on. Thank you

  • Sleepio Member

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    Expert

    PS I meant also to pick up on depression and sleep problems. The scientific evidence has caught up with what people who have suffered both have know all along – that sleeplessness causes depression as well as depression causing sleeplessness. It's a hard mixture. Good to hear you are working on it from all angles

  • Sleepio Member

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    Expert

    Sorry again to have missed the session time today which has meant there hasn't been the opportunity for a live chat. But I hope these replies to your pre-posted questions are of some help. Thank you to all of you who have posted for your interesting questions. All best for 2018

  • Sleepio Member

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    Expert

    Hi, I have just noticed I missed your post about non- restorative sleep. For most people, the approaches in Sleepio improve quality of sleep as well as efficiency and amount of sleep. The improvements in sleep quality are often delayed – so sleep efficiency improves before people experience their sleep as better quality. But there are a few people who sleep very well but never feel rested. For some of these few this is linked with chronic fatigue syndrome (ME), but for others of these few it is not clear why and sleep scientists and researchers are still trying to understand this and how best to help.

  • Sleepio Member

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    Graduate

    Hi, thanks for your reply!

    As far as ideas go: Well, I've already automated my day planning as much as possible by combining Trello with a Python script that pre-populates it with a template, and I've even included timing details for my evening routine, which has it spoon feed me “at what time I need to do this or that” to make it to bed comfortably on time. Right now, the struggle is disconnecting from online time-wasters to go brush my teeth and be done with it. It's too easy to hit up “just one more youtube video.” :)

    I'm thinking I could do things like find chrome extensions that make it really inconvenient to access any kind of social media after say 8pm.

    I'm also thinking of flipping things so that bedtime activities like brushing my teeth are done as soon as I get home, before I have time to even sit down. That would lower the barrier of entry. One way or the other, I'll have this issue solved this month. That's the goal anyway. :)

  • Sleepio Member

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    in reply to Sleepio Member
    Session 3

    Hi tzsebe,

    I would be super interested to hear how you get on, and about any successful tools/methods that you implement.

    I suffer from hugely from procrastination before bed, and find myself sitting up for hours past my planned bedtime just wasting time on the internet or faffing around. It's worse when my boyfriend is away for work, and not here to tell me it's sleeptime – left to my own devices I have zero discipline.

    Probably down to 10+ years of chronic insomnia and an unhealthy relationship with bed/sleep. Insomnia is frustrating & lonely but also insanely boring, and I dread just lying in bed waiting for something to happen!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for sharing your ideas. Clever that you have identified a key issue (checking social media) that contributes to your not going to bed on time. That puts you ahead of the game in being able to come up with a solution that will work for you as I see you are well on your way to doing. Working out what are the key barriers /issues for oneself is likely to be several 100% more effective than generic suggestions

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hey fyko,

    Hah I know exactly how you feel. It's nice to know I'm not the only one on here with this challenge. I suspect it's a pretty massive group of people, actually. :)

    I'll bring up whatever breakthroughs I might have while focusing on this this month. While I'm all for discipline and grit, I'm also all for setting things up to require the minimal amount of discipline. Ideally, the thing you have to do is the thing that's the easiest and most desirable at the time you have to do it.

    Amusingly, one thing that's made at least a small difference is keeping my floss at my desk, and not in the bathroom. I can floss without even getting off my butt, and once I've got that going, it's easier/more natural to get up and brush lol

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