Live discussion with Dr John Cape 29th June 2016

Dr Cape will be hosting a live online discussion here on Wednesday 29th June, 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 23 Jun 2016 at 11:52 AM
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  • Sleepio Member

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    Expert

    You ask if it is normal that sleep goes up and down – that week 4 was really good then week 5 bad again. Yes, absolutely normal. Progress is almost never steady all the way. A series of poor nights of sleep after a series of good nights is the norm. The key thing for dealing with the poor nights again is not to get alarmed or too worried about them as alarm/worry of course can interfere with sleep on future nights. So see them as part of the normal cycle of recovery. Good sleepers can have occasional series of bad nights too, but they don't get worried that this means the next night is going to be bad too and so the next night is usually fine.

  • Sleepio Member

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    Expert

    1.30/2.00am is quite a late time to bed. Have you always been a late to bed person? Generally shifting the sleep window very gradually back works. So going to bed 5 mins earlier (say at 1.45am) and getting up 5 mins earlier for a few nights then 5 mins earlier still (say at 1.40am), then another 5 mins (at 1.35am) etc etc. But for some people who are “night owls” it is more tricky.

  • Sleepio Member

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    Expert

    A really interesting issue you raise that, ever since neck surgery some years ago, you wake after 2-3 hours with physical discomfort and then have restless sleep for the rest of the night. Pain and a variety of medical problems can lead to interrupted sleep and inevitably this is tough for people to deal with. But people do seem to vary in how they manage this and this may be to do with their thoughts and reactions to being woken up by their pain and discomfort, some people finding this more of a wearisome burden than others which then affects their sleep and sleep quality. Session 4 of the Sleepio program covers thoughts and thoughts around being woken and restless in the night are one type of thought that the “thought checker” introduced in that session can be used to check.

  • Sleepio Member

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    Expert

    Yes, listen to PR before going to bed

  • Sleepio Member

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    Graduate

    Yes I have always been a night owl. 1/30/200am was the time the Prof told me to go to bed.

  • Sleepio Member

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    Expert

    The advice about increasing the sleep window, which I think is what you mean by core sleep time, is to do this when sleep efficiency in the current window is averaging 90% (sleep efficiency is % of time in bed that one is asleep). The Sleepio programme calculates users average sleep efficiency and the Prof informs them when sleep efficiency over the previous week has averaged over 90% and says they can increase their sleep window by 15 minutes (some people may decide not to as they are happy with their current sleep window). Increasing the sleep window before sleep efficiency is averaging 90% is likely to lead to the disruption, as you rightly say. People vary in how long (how many weeks) it takes them to reach 90% sleep efficiency and get the 15 minute extension. The length of time varies for many reasons, including the length of sleep window they have been set at the start. And for some people, the increase ins sleep efficiency is sufficient and they don't increase their sleep window.
    See also this Sleepio Library article on sleep efficiency:
    https://www.sleepio.com/library/article/sleep-efficiency-in-depth/

  • Sleepio Member

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    Expert

    While being an early bird or a night owl for many people is not a major problem and they can adjust their lives and routines to work around it, for some people where this is more extreme this can be more of an issue. This Sleepio Library article discusses the extreme night owl version
    https://www.sleepio.com/library/article/what-is-delayed-sleep-phase-disorder/

  • Sleepio Member

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    Expert

    Your description that “a switch suddenly goes off in your head that you won't be able to sleep”, as sleep time approaches, is a great description of the central difficulty for people with long-term sleep problems. Rather than the good sleepers bed = sleep association, long-term poor sleepers have a bedtime = awake/wont be able to sleep association. And as you so rightly say, this becomes a self-fulfilling prophecy. I appreciate from previous posts that you have tried different approaches to shift that mindset. One rather radical approach for this mindset is the so called “paradoxical intention” approach. This is, instead of approaching bed with the intention of sleeping (but unfortunate belief/conviction one will not), one approaches bedtime with the intention of NOT sleeping and does all one can to not sleep. If effective, this sort of turns the mindset on its head, by setting up a completely different mindset.

  • Sleepio Member

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    Expert

    Hi . So you have two questions. The first is about having very good and very bad weeks. This, as I replied to an earlier post this evening, is normal in making progress to re-establishing a firm better sleep pattern. It is normal too at times even for good sleepers. Accepting this, being patient and not getting upset about the bad nights is important in maintaining progress, as too much upset and concern will make sleep more difficult. In terms of your second question, there is a Sleepio community discussion forum on this, although I don't think it is currently active:
    https://www.sleepio.com/community/discussion/sleeping-with-your-bed-partner/
    An aspect of being woken up by a bed partner’s moving a lot (or snoring) is the same as any other reason that people get woken up in the night (crying baby, noises on the street, having to go to the toilet). It is how one reacts to this. Thoughts that this means I wont get back to sleep will make it more difficult to get back to sleep. Using the Sleepio thought checker to check out thoughts about being woken up can be useful

  • Sleepio Member

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    Expert

    Good question about quality of sleep vs more hours of sleep. Improving sleep efficiency (being asleep more of the time when one is in bed so that sleep is more concentrated) improves sleep quality (people feeling they have had a good night’s sleep). Indeed it improves sleep quality more than having more hours sleep. This is one of the reasons why sleep efficiency is the key measure of sleep that Sleepio focuses on. All the best with the program.

  • Sleepio Member

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    Expert

    Hi. I am not sure from your question whether you mean that find it difficult to get out of bed after 15 minutes of being awake (in line with the quarter-of-an-hour rule) or if you mean that you have difficulty getting out of bed in the morning to go to work as you have slept so poorly. Could you clarify?

  • Sleepio Member

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    Expert

    Welcome to the Sleepio course. The problem you describe of random things running through your head when you are in bed is certainly one that the course is designed to help with. I see another user has helpfully indicated a part of the course where this is directly addressed, but all the earlier course sessions and approaches will be relevant to this also and are important for this specific approach mentioned to have the best chance of being helpful. So do follow through the Profs sessions as set out.

  • Sleepio Member

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    Expert

    Hi. From what you say your sleep window has only just been increased by 15 minutes and these first 2 nights with the new window, you have woken ½ hour earlier so overall getting less sleep. It is not uncommon that increases in the sleep window lead to some temporary blips. The change and expectations can disrupt the better sleep pattern that had been established prior to the change. On the whole one would expect things to settle down if not making too much of the blip (if someone gets worried and upset about the blip, then this can affect sleep and make it worse). For some people, if there is a significant disruption for many nights, it can be useful to go back to the previous short sleep window for a time.

  • Sleepio Member

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    Graduate

    both

  • Sleepio Member

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    Expert

    So knowing that you have work or responsibilities the next day, you don't sleep, but other times you are fine. In sessions 4 and 5 of the course there are various techniques for dealing with thoughts that keep people awake and these include awareness and thoughts about the next day, including the troublesome thought that “I must sleep as I have to work tomorrow” which is one that can really make it difficult to sleep. But all the earlier sessions and approaches are relevant and important too and build on each other. All the best with it.

  • Sleepio Member

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    Expert

    OK, so both getting out of bed after quarter of an hour not sleeping and in the morning are hard. I can appreciate this. It is hard when you have slept poorly to drag yourself out of bed after 15 mins as this is what the Prof says helps, when your body is screaming out “I just need more sleep”. And then again in the morning. The one thing to hang on to at such times, although I appreciate it is hard, is that the less sleep one has had one night, the greater the sleep pressure built up for the next night. The whole purpose of the Sleeoio techniques is to get out of the pattern of staying more in bed when not sleeping, through a period of feeling even worse, to re-establish the more natural easier sleep pattern.

  • Sleepio Member

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    Expert

    Hi again.You say you don't nap now during the day when tired, which is great, but when instead you read you find yourself dozing. Yes, getting up and going outside or doing anything active and energising that keeps you from dozing is good. Realising that being tired, but keeping awake means that the sleep pressure will be building powerfully and making it that much easier to sleep at bedtime can be an incentive to keep active and awake

  • Sleepio Member

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    Expert

    You say you wake up at the same times in the middle of the night and ask about how to reprogram your body clock. Now it could be that the times you wake up are times in the natural pattern of sleep where sleep is light. Brief awakenings which people are not fully aware of or don't remember is part of the natural sleep cycle. So it may be that it is not the sleep programming that is the main problem. For some people at these natural times in the sleep cycle, rather than going straight back to sleep stay, they become fully awake and have difficulty getting back to sleep. So for such people the main problem is not that they wake up but that they do not go immediately back to sleep. So all the approaches in Sleepio for dealing with not getting back to sleep, including dealing with thoughts about being awake in the night, are relevant for helping with this.

    In relation to your question about GABA, I am now aware of the clinical data you refer to and this is not my area of expertise. In Sleepio we focus on the science and approaches that people can use to self manage sleep problems and improve their sleep, which can be used ad are effective with or without prescribed or non prescription sleep aids

  • Sleepio Member

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    Expert

    Thanks for your observation. Obstructive Sleep Apnoea can indeed be a serious condition. The screening questions in Sleepio are designed to pick up if this might be an issue and alert people to this. As the Sleepio program is used by people in different countries around the world it is not possible to give guidance as to exactly what medical professional people should consult as medical systems vary from country to country. But we shall certainly look again at what is said in the program. Thank you again for alerting us and I hope you find Sleepio useful

  • Sleepio Member

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    Expert

    We have come too the end of our time for today. Thank you for your interesting questions and comments. Do come back with further questions and comments for the next live session (again on Wednesday pm US EST, evening UK time)

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