Live Discussion with Dr Kirsty Horne - 18th December

Dr Horne will be hosting a live online discussion here on Wednesday 18th December 7pm-8pm (GMT).

She will discuss as many topics as possible in the hour, starting with the most popular questions with answers being given in a way to give the most benefit to the general Community.

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Posted 12 Dec 2013 at 2:20 PM
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  • Sleepio Member

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    Graduate

    Quite a few questions posted already. I'll have a read through these just now and then start answering them as best I can.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Mushmellowstar

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Evone63, as Angief commented, it would be helpful to have a bit more info regarding what you would specifically like help with. How often does your grandchild stay over? Is she expected to sleep in a room alone? How old is she? How does having her sleeping in the bed with you impact upon your sleep? etc

  • Sleepio Member

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    Graduate

    Thanks Angie, more information is always helpful so we know exactly what the issues and specific questions are.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Mushmellowstar, sleep restriction does help to build sleep pressure but also helps to consolidate sleep and increase sleep efficiency (the % of time spent asleep whilst in bed). Do you sleep for a solid 4 hour block in a night? Or is it lots of little bits of sleep with awakenings in between them? Do you have a mixture of good and bad nights? Do you nap during the day at all? Do you have a good sleep pattern? Who instructed you on the use of SR in the past? Was it part of a programme you were following or were you using it as a stand-alone therapy? Everyone's experience is different and I'm not sure exactly how you implemented it in the past; however, staying awake for 3 days straight seems very unusual.

    Sleep restriction is explained more in session 3. Basically, the aim is to limit time spent in bed in an attempt to 'squash up' all the little bits of sleep into a solid block of sleep in bed and then to gradually 'grow it' bigger (quality then quantity). It first involves recording in a sleep diary and calculating average nightly sleep duration. The aim, then, is to obtain this average each night. This goal is achieved by setting rising time as an “anchor” each day and delaying going to bed until a “threshold time,” which permits this designated amount of sleep. Thus, the sleep period is reduced and sleep efficiency is likely to increase. The permitted “sleep window” can then be titrated week by week in 15-minute increments in response to sleep efficiency improvements. Sleep restriction is now a core element in all CBT programmes for poor sleep. That's why it is an important part of this Sleepio course too! Although it appears at first to be counter-intuitive and can also be challenging to implement consistently, many leading researchers and clinicians believe that sleep restriction is perhaps the most effective CBT component.

  • Sleepio Member

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    Graduate

    Dr. Kirsty, I sometimes sleep for solid blocks, but more frequently wake up every night 1 1/2-2hrs and can't get back to sleep. I self taught myself SR in the past and I set my SW and was up for 3 days straight. When my sleep time came I just couldn't fall asleep. For 3 days. That is why I am confused about the whole sleep pressure thing. With insomnia as bad as I have you would think I would have an insurmountable amount of sleep pressure.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    In response to your second question, I am a Clinical Psychologist and use a bio-psychosocial approach to understand and help people with mental health and sleep difficulties. I believe that biological, psychological and social factors are all very much connected and that altering one of these areas has an impact on the others. The cause of sleep difficulties might vary between individuals; however, it is rarely purely biological or psychological- rather, a mixture of both. Insomnia might have been started in some individuals by biological changes or stressful life events, however, it can then cause bad (behavioural) habits to develop (e.g. going to bed too early, napping during the day, spending long periods of time awake in bed etc.) and can create anxiety about sleeping (or not sleeping), which can make the problem worse- hence a vicious cycle develops. It sounds like you recognise that you have developed a fear of not sleeping. CBT is the most widely recommended, evidenced-based, non-pharmacological treatment for insomnia and will therefore be helpful for in overcoming your sleep difficulties and fear of sleeping. Remember to use the community for support. Good luck.

  • Sleepio Member

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    Graduate

    Hi, it sounds like you do not have a good sleep pattern. The Sleepio programme should help reset your sleep pattern and develop a more consolidated sleep. The programme is about a lot more than sleep restriction and sleep pressure- there are many more components to it that will help you improve your sleep. I see no reason it would not work for you if you follow the programme. Take it one week at a time and try not to rush ahead.

  • Sleepio Member

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    Graduate

    Hi Philip1957, thanks for your question and sorry to hear you have only seen slight improvement so far. Have you noticed any changes in the time it takes you to fall asleep, to the number of awakenings you have through the night or to the quality of sleep you experience? Generally, you can expect to see improvements in quality of sleep before quantity. It's still early days also and it can take time for changes to occur, particularly if you have had a sleep problem for a long time. I would advise you to continue with QHR, so that you are not spending lengthy periods of time in bed awake- as this would decrease your sleep
    efficiency and weaken the association between bed and sleep. If you are concerned about your body not getting enough rest, then try to rest during QHR or during the day. Are you getting less total sleep just now than you were prior to starting Sleepio? Are you napping at all during the day? If so, try to avoid this as it will decrease sleep pressure, making it more difficult to sleep at night. Finally, yes, I would advise you to record your final rise time in your sleep diary- if you are sleeping 90% of the time you spend in bed, this is good news. If this continues for a week, you are permitted to increase time in bed by 15 minutes. I hope you start to sleep a little longer soon.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Cybersal, I can't see a question from you, sorry!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Megan, thanks for your question. I'm glad to hear you are sleeping well at present and glad to hear you have decided to join the rest of your family on holiday in February. Please try not to worry too much about what may or may not happen in the future. Worrying about what your sleep will be like can create anxiety, which could impact negatively upon your sleep. You can use the thought checker, relaxation and mindfulness techniques to help decrease anxiety related to these thoughts. Remember, even good sleepers occasionally have bad nights where they don't sleep well, but generally people do cope okay the following day, even on little sleep. Even if your sleep is disturbed for a night or two on holiday, you now have the knowledge and skills to 'fix' it upon returning home- it would not mean you had taken a backward step. Ultimately, it's is the decision of you and your GP whether you start using sleeping tablets again, however, it sounds like there is no real need for you to do so at present. Even if you do not sleep well on holiday, you could try to rest and relax during the day and just try to enjoy yourself as best as you can and reinstate good sleep habits upon returning home.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Marmalade, 15-20 minutes is fine (quarter of an hour is just approximate- we don't want you timing it or looking at the clock as this can create further anxiety and impact upon your ability to sleep). I think watching TV is okay as long as it's not too stimulating.

  • Sleepio Member

    • 7 comments
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    Graduate

    Dr Kirsty thanks for reply. In relation to quarter of an hour does one just approximate the time themselves without looking at the clock?

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi mushmellowstar, in response to your third query, I believe light therapy can be effective for circadian rhythm sleep disorders; however, there is no strong evidence that this works for insomnia. Some studies have found it can be beneficial to use light therapy in combination with CBT for insomnia when there is a severe difficulty getting to sleep every night or a severe difficulty rising every morning. I commented on the use of light boxes in the expert session on 4th December- you might want to have a look. Also, you might find Professor Espie's article in the library on light therapy useful: https://www.sleepio.com/library/article/what-is-bright-light-therapy/
    It is worth mentioning that light boxes are not generally available through the NHS and I believe they are expensive to purchase. You might find it helpful to open the curtains as soon as you rise, sit near a window and get outdoors (although this will obviously be more effective in the summer months).

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Yes Marmalade, that's correct. I would advise trying not to look at the clock through the night- a rough estimate is fine (if it feels like it has been approximately quarter of an hour you have been awake in bed).

  • Sleepio Member

    • 344 comments
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    Graduate

    Thanks, Dr. Kirsty!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks for your reply and advice Dr Kirsty. No, I'm not napping during the day. Since starting Sleepio I am at least getting a minimum of 3 hours sleep every night, so that's an improvement, as I had been getting only 1h30 some nights, just a couple of weeks ago. I will make sure to persist with QHR.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Philip, it sounds like things are improving then. A lot of people think by restricting time spent in bed, they will be getting even less sleep- which is why many people find it difficult. However, as you have found yourself, despite spending less overall time in bed whilst undertaking the programme, you are actually sleeping for twice as long as you were and so, your body is actually getting more rest than it was. It just takes time, but be patient and try to stick with it and you will continue to see improvements and to then feel better during the day as a result. Best of luck.

  • Sleepio Member

    • 341 comments
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    Graduate

    that's us finished for tonight, thanks to everyone who contributed and have a lovely Christmas and New Year everyone!

  • Sleepio Member

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    in reply to Sleepio Member
    Session 5

    My granddaughter sleep with me 4 nights a week she is 2 years old and will not sleep with no one but me she goes to bed a About 9:30 pm she sleep all over the bed and if I get up and she don't feel me she wakes up and start crying her mother is going to be off and month and work on getting her to sleep alone I am praying that it will help

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