Live discussion with Dr John Cape 17th August 2016

Dr Cape will be hosting a live online discussion here on Wednesday 17th August, 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.

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

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Posted 11 Aug 2016 at 2:03 PM
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  • Sleepio Member

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    Graduate

    If you read the introduction it mentions the time of the discussion. It's tonight BST time 7pm. Aug 17th.

  • Sleepio Member

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    Graduate

    hi guys ,i'm mike i've been with the program about 4 weeks. i'm in session 3 completed my schedule and to do list. i think i'm doing pretty good . how do i work them or are they just a guideline? any help would be great thanks. mjs058

  • Sleepio Member

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    Graduate

    Hi,
    I've had some good success with the sleepio programme. I have complex APNEA and use a CPAP every night, so now I fall asleep within 15-30 mins which is a significant improvement from where I was 6 months ago and the anxiety it caused.
    The quality of my sleep in the first half of the night has improved to through using the sleep restriction.
    However now I always wake about 4-4.5hrs after I go to sleep. I wake up continuing whatever I've been dreaming. It's not like I'm thinking about the next day or work or issues around not getting back to sleep (again, sleepio has helped me ban those negative thoughts), but my mind is racing on whatever the dream was about and because I'm so 'wired' I struggle to get back to sleep for about an hour. If I get up, it doesn't help, because it just means I don't get back to sleep until 5-6am which means my alarm goes off at 7 and I feel completely exhausted all day. They're not negative thoughts, or anxiety about my sleeping, but just a waking continuation of whatever dream (good or bad) I happen to be having. It's only after my body calms down can I get back to sleep.
    I understand it seems to be inline with a sleep cycle, but why would I wake up mid-dream. It's not like I'm falling awake or done something to cause me waking up. I go from being asleep to being awake and then my brain prods me that I'm actually awake and have been for the last few minutes.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I can answer this. No gadgets after 9 ( I go to bed at 10 and sleep 10:30). I use a Kindle in bed, but I bought a filter for it and have turned it down to low. Both seemed to help a great deal, but that was part of my sleep schedule.

  • Sleepio Member

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    Expert

    Hello everyone. Welcome to this live session. I look forward to answering your questions and having some discussion. There have been quite a few questions posted earlier so I shall get on with answering them. Let me know if you are on line now and posted a question earlier by posting a quick “Hello I am here, I posted a question earlier” and I shall try and get to that sooner. And if you have just logged on and want to pop a question, go right ahead

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. You ask about use of podcasts to help get back to sleep. From a brief look at the site you mention, the podcast featured is a type of guided meditation. As such it shares features with mindfulness, imagery and autogenic training that are covered in session 5 of the programme. So fine for people to use it as an alternative if they find it works for them. There are advantages in using approaches that you can do in your own mind rather than needing to have to switch on a device like a podcast and rely on an external voice, but this is not critical. Importantly, if still awake with the podcast after 15 minutes, one should get up following the quarter of an hour rule and wait to go back to bed until one is sleepy tired in the same way as the programme recommends when using the other approaches covered in sessions 4 and 5.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Yes, its tough being awake in the middle of the night and unable to get back to sleep. Sessions 4 and 5 of Sleepio, which I think you may not yet have reached, go over various approaches to dealing with thoughts and other distractions that often contribute to difficulty getting back to sleep. As mentioned in my reply to the previous post, while podcasts are not mentioned in Sleepio and there are some disadvantages to them, podcasts for sleep tend to be guided meditations or relaxation and so share features of the approaches that are covered. All approaches to changing sleep habits take time to have effect – you have to practice them over many weeks in order to establish new habits that are conducive to sleep. They are not a quick fix (unfortunately there is no quick fix). You ask about chemical reasons for not sleeping. The initial Sleepio sessions discuss caffeine, alcohol and food (too much or too little) as factors that can interfere with sleep, and certain medical illnesses can interfere (e.g. pain, the hormonal changes at menopause).

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi, sounds like you are having a rough time with a lot of anxiety at night, which as you make clear keeps the body awake. No doubt you are well aware of the approaches in sessions 4 (and 5) for dealing with anxious thoughts. You ask about circumstances where one might shorten the sleep window. If the initial sleep window set by Sleepio was too long (which can happen for example if sleep was unusually good the week when sleep was being monitored to establish the sleep window), then reducing the sleep window is appropriate. But reducing it to less than 5 hours would be inadvisable (and for some people 6 hours).

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for your question about medication. Sleepio is equally effective for people taking sleep medication as for people not on any medication. That sleep recorded in ones sleep diary may have been brought on by medication is not a problem. Switching medications frequently can make it more difficult to establish a consistent sleep pattern so people are advised to work out with their physician a regular sleep medication that suits them best, although sometimes can take time.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Thanks for your really helpful question – can Sleepio work after 23 years on sleeping medication? In brief, yes it can. Sleepio is about establishing sleep habits for yourself that lead to better sleep, whether on medication or not. Some people who, in discussion with their medical practitioner, decide to come off sleeping medication do so before starting the programme, but others wait until they feel their sleep has improved sufficiently following Sleepio (often many months after). And some people just stay on sleeping medication. When coming off sleeping medication, the usual recommendation is to come off very gradually (reducing the dose a very small amount each week), but people should always seek the advice of their doctor as the medications that people are on and their medical and personal circumstances are different.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. You say, when you are not asleep within 30 minutes, you get up and go to the family room couch and relax with progressive relaxation and often fall asleep, then at 2 or 3am wake up and go back to the bedroom where you sleep to the morning. If just occasionally this is fine. The problem if this happens regularly is that instead of a bed-sleep connection being established (which is what good sleepers have and is the aim of Sleepio), a couch–sleep connection becomes established. So better to go back to bed when feeling sleepy tired after progressive relaxation (but not yet asleep).

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    You ask whether hardly ever dreaming means that you do not sleep deep enough. Dreaming occurs not in the deeper stages of sleep, but in a phase when the brain is more active (called REM sleep). People who report they do not dream do have REM sleep, but they do not wake up enough during or after REM sleep to fix their dreams in memory or they subsequently forget they had a dream. People vary a lot in how much they remember dreams, but REM sleep is universal. From your post it sounds like what sleep you have you do not feel to be good quality and do not experience as refreshing. For some people quality of sleep, rather than difficulty falling or staying asleep, is the biggest problem and one that Sleepio is designed to help with.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Blue light probably affects sleep through inhibiting the production of melatonin (a naturally occurring hormone in the body that helps regulate sleep). An article in the Sleepio library says a bit more about this: https://www.sleepio.com/library/article/the-importance-of-the-sleeping-environment/.
    I don't know of any research that gives evidence of a time before going to bed to reduce exposure to blue light, but probably advisable to stop using the computer at least half an hour before starting your wind down routine before going to bed. I see another user has suggested no gadgets an hour before going to bed which makes sense and works out about the same.

    Daytime napping reduces sleep pressure so is not advisable for people with sleep problems. Session 3 of Sleepio will go into this in more detail.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    You ask about whether to do progressive relaxation (PR) before going to bed or in bed. I can see it might be confusing as both are possible. In the first instance, PR is useful before going to bed as part of a wind down routine. For people who wake up in the night and have difficulty getting back to sleep, it is possible to do PR (as also the imagining and other approaches) in bed, but if not back to sleep after 15 mins, then people should get up following the quarter of an hour (QHR) rule. PR can also be done when people have got up following the QHR, which may help them become sleepy tired and ready to go back to bed.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Congratulations on reaching 90% sleep efficiency for several weeks. You ask, with being about to end your access to Sleepio, how to maintain and consolidate your progress. Yes, in the first instance continuing with the approaches you have been using and that have helped is exactly what to do. Over time, people can feel they have come to a point that their better sleep habits are well established and they no longer feel the need to actively follow the approaches. If they subsequently have a bad night or run of bad nights (even good sleepers have these at times), they then go back to the Sleepio approaches that previously helped to make sure they get back on track and don't slip back (a few bad nights doesn't mean one is slipping back, but worrying about the bad nights can interfere with sleep and cause further bad nights leading to a worsening spiral; going back to the familiar approaches that helped before acts as prevention). All the best!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi. Congratulations about coming to the end of the programme. Sounds like you are taking the opportunity of the live session to set up a clear schedule for yourself and make a commitment to sticking with it. This is a really good way to end and set yourself up to continue to make progress. The schedule you set out looks really good. But all of us have difficulty sticking with things we decide to do even when we know they are good for us. So maybe plan also for what will help you stick to the schedule. Some people set an alarm or similar device to prompt them to start their routine. Some people tell a friend about what they are committing to and ask the friend to check on them. Some people set up a reward system to reward/treat themselves when they do stick to their schedule. And I expect there are ideas you can come up with – you know yourself best! All the very best with it.

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Hi. You say you are at session 3 and have completed your schedule and to do list and ask what next. Great you have done that. What you should now do is follow the schedule and do the things on your to do list. Sleepio works by helping people to reset their sleeping habits to habits that will bring on sleep naturally. The schedule and to do list are all things that are pro sleep – things that if you do regularly they will help sleep come naturally. At times it may not be possible to follow exactly your schedule – various work or social activities may mean that you have to do something a bit different. But the more consistently you follow your schedule and do the things on your to do list, the more progress people are likely to make.

  • Sleepio Member

    • 230 comments
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    in reply to Sleepio Member
    Expert

    Good to hear you have had success with the programme in getting to sleep, especially given you are on CPAP for OSA. Impressive. Interesting to hear about your waking up now after 4 hours or so and your mind racing with the dream you woke up with. More REM (dream) sleep occurs later in the sleep cycle so it is not surprising that after 4-5 hours that you wake up in midst of a dream. It may be this is a transition phase in your progress that you shift out of naturally, but the imagery approach covered in session 5 of the programme is one that could be useful for this (substituting the imagery suggested for that of the dream) or to use the mindfulness approach. If you needed to be reminded of these, you can go to the Library and click the Session 5 button and you will find them there.

  • Sleepio Member

    • 230 comments
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    Expert

    Time to end for today. Thanks for all your questions and to those of you who pitched in with some helpful suggestions in reply. Next live discussion will be next Wednesday as usual

  • Sleepio Member

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    in reply to Sleepio Member
    Session 3

    Thank you! This is very helpful that you have found some measure of success with doing this.
    Jonathan

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