Live Discussion with Dr Kirsty Horne - 20th November

Dr Horne will be hosting a live online discussion here on Wednesday 20th November 7pm-8pm (GMT).

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Posted 14 Nov 2013 at 1:30 PM
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  • Sleepio Member

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    Graduate

    “Hello again, Dr. Horne,” as the Professor says. Here's my latest news. I am near the end of week 4 and see that while I am having some success with these intrusive thoughts, I don't seem to have a system for when to use them. So far, it's been more experimental on my part.

    Clearly, thoughts about planning, the future and the past, and anxiety about sleeping are all going on and here it will help the others as well as me if you say more about this.

    Planning thoughts don't arise that much now, and I am not sure why. I don't think meditation has a lot to do with it as I have always practiced meditation when I could not sleep. The schedule does force me to put the day to rest rather than just going to bed right away and maybe that helps a bit. The best thing for me is just to get out of bed before I start to ruminate about this, hence the QHR.

    Thinking about the past and the future can also be alarming. Sometimes I have dreams about this. I know from my meditation practice that there is no past and no future, just right now. So, maybe these thoughts are not that important for causing me not to sleep. I do practice thought blocking when just about any unwanted thought pops into my head, even though I will not learn more about it until this week (5). I tell myself to Stop!

    Finally, there's my anxiety about not getting enough sleep. I am aware of this so it's the most real of the three intrusive thoughts for me right now. I see that paradoxical thinking is called for here. That's rather difficult to introduce as there is not much guidance about it either in the library or by the community. But I think I “get it” that when these thoughts arise while I am in bed, I tell myself that the best way to deal with them is to get out of bed, rather than stay in bed and ruminate about it. I also have used humor to try to tell myself to lighten up. If that's it, then I am doing it.

    The numbers I have don't show a lot of progress but the lessening of these intrusive thoughts says otherwise. Also, I am not taking any sleep aids, so that gives me the chance to see more clearly what CBT is doing.

  • Sleepio Member

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    Graduate

    Dear Doc,
    Re. SE. My sleep is sound for 5 to 6 hrs. Then on wakening at 5 am I try a med. tape in bed & continue deep relaxation. Then I continue relaxing & feel this is beneficial. I feel my body needs this. I am not ever aware of worrying in bed at this stage about sleep & accept I have had 5 hrs restorative sleep & then enjoy relaxing. How long should I allow this to go on, & should I really be getting up sooner? I may lie there after meditating for more than an hour.

  • Sleepio Member

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    Graduate

    Good evening everyone, welcome to tonight's expert session!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi paulineapark, thanks for your very interesting question. You are not alone in this 'menstrual insomnia'. According to a 2007 National Sleep Foundation poll, 33% of women said their sleep was disturbed during their menstrual cycles. This is attributed to rising and falling levels of the hormones oestrogen and progesterone, which regulate the menstrual cycle. These hormones can affect a woman's ability to fall and stay asleep -- as well as influence the quality of her sleep. Unfortunately, there is not a great deal you can do to prevent this disturbed sleep- however, using the Sleepio techniques should help (challenge any negative sleep-related cognitions, use relaxation and meditation and try to keep your bedroom environment and routine conducive to good sleep- including avoiding alcohol and exercising regularly). It might also help to try and plan your activities around this phase if you expect poor sleep (e.g. scheduling activities that are less demanding or scheduling things for a time of the day that you might feel more refreshed). I hope this helps.

  • Sleepio Member

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    Graduate

    Hi Anne, we would always advise speaking to your GP or medical practitioner on medication issues. Dr Kennan gave some excellent advice in relation to taking sleeping tablets whilst undertaking the Sleepio course in last week's expert session- you might find it helpful to take a look at that. If your medication is causing anxiety (and therefore making your sleep more disturbed), then it might be worth speaking to your GP about the best way to reduce or discontinue with it. Good luck.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Peanutboy, welcome to Sleepio. I'm afraid there's no way of calculating sleep quality- it's just a subjective estimate of how you perceive your quality of sleep to be. Thinking about how long it took you to initiate sleep, how many awakenings you had in the night, how long you were awake for during the night and how rested/ refreshed you feel upon awakening in the morning should give you some ideas of the quality of your sleep. I hope you notice some improvements soon.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hello again Ewa, sorry to hear you are still struggling. I hope you are noticing some improvements- if even to the anxiety/ panic during the day. Yes, I think we agreed during previous sessions that in your case it would be advisable to remain in bed and use relaxation techniques rather than getting up if this is creating excessive anxiety. Also, as your cardiologist advised you to remain in bed, we did not want to contradict this advice. Do your GP or cardiologist know why you are sweating like this? Are you using the thought checker (challenging any negative thoughts about the impact of not being able to sleep etc) and paradoxical thinking (giving up any effort to sleep or any concern about being awake- as you feel you are about to fall asleep, try to gently keep yourself awake for a little longer). I hope your sleep difficulties improve soon. Well done for persevering with the programme.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hello Dina, welcome to Sleepio and sorry to hear you are not sleeping well and feeling exhausted just now- you have come to the right place and should start to see improvements in your sleep over the coming weeks! You will learn more about the Thought Checker in session 4. Basically, it helps you to firstly, become more aware of negative automatic thoughts (thoughts that might pop in and out of your head and have a negative impact upon your emotions) and then to challenge them and learn ways of replacing them with more balanced, helpful thoughts. If you can manage this, you should feel less anxious and therefore be more able to sleep. For example, the automatic thought, “I am never going to get to sleep and I won't be able to concentrate at all tomorrow”, is likely to create anxiety and make it more difficult to initiate sleep. By challenging this thought (examining the evidence for and against it), and replacing it with a more helpful, balanced thought, e.g. “I always get at least a couple of hours sleep and I have managed on only a few hours in the past” you should feel more relaxed and therefore more able to drift off to sleep. As with everything on the course, the thought checker takes practice and will only work if it is fully committed to and worked on to the best of your ability. Good luck.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Caliman, thanks for sharing your experiences with us. It sounds like you have been doing really well and have really been trying to use the cognitive techniques and QHR to help overcome your sleep problem. I am really pleased you are having some success in reducing intrusive thoughts and that you are giving the CBT a go without the use of sleeping aids. I think it is a case of using your own judgement and trying different techniques to see what works best for you. The type of thoughts you mention having are all very common and as you have discovered, some might be more problematic than others. I would agree that winding down in the evening and ‘putting the day to rest’ (as well as keeping a pen and piece of paper next to the bed to quickly jot down any other planning/ problem solving thoughts that might pop into your head whilst in bed) are the most helpful techniques in dealing with planning thoughts. The QHR helps as you are physically removing any thoughts, worry, frustration, anxiety and wakefulness from the bedroom environment- thereby increasing the association between bed and sleep and decreasing any other negative associations you might have developed with your bed (you are literally taking the thoughts elsewhere and keeping your bed as a place for sleeping). You say thinking about the past and future can be alarming- but then contradict yourself a bit to say they are not important in contributing to your sleep difficulties- do they seem to cause you anxiety or other unpleasant emotions? If so, mindfulness techniques are helpful, or if necessary, possibly even seeking more help in the form of talking therapy (thoughts about the future can also be dealt with as part of your ‘putting the day to rest’ or using problem solving techniques during the day or early evening). Thought blocking can be a helpful technique to use for trivial thoughts or if your mind is racing from one thought to another. Rather than trying to stop thinking (which doesn’t work- e.g. if I were to tell you not to think of a pink elephant- what happens?), the idea is to focus on the word “The” (a meaningless word that fills up that short-term memory store and stops anything else getting in). It's best to actually articulate the word “the”, that is mouth it, but don't say it out loud, because this is particularly helpful at suppressing other material from entering your mind. Finally, in relation to your anxiety about getting to sleep (or not), you can use the thought checker to challenge these type of thoughts (see my reply to Dina above). Paradoxical thinking can also be helpful for these types of thoughts, as can autogenic relaxation, mindfulness techniques and guided imagery. Paradoxical thinking is discussed by Professor Espie in the library (https://www.sleepio.com/library/article/paradoxical-thinking/). The idea is to give up any concern about being awake and give up any effort to sleep. You should try to enjoy being awake- maybe even think of all the advantages of being awake through the night (e.g. the peace, quiet, hearing noises or seeing things outside that others might not see, time to rest/ relax etc.). When you feel like you are about to fall asleep, gently try to stay awake for a little longer. If you can do this and give up the effort to sleep, you should automatically feel less frustrated and drift off to sleep before you know it. Sleep should be a natural process and when you apply excessive effort, you are interfering with that natural process; hence paradoxical thinking is a useful technique for people who try too hard to sleep. A very long answer I know, but hopefully it will be of some help to you and others. All the best and keep up the good work!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Pierrette, I'm pleased to hear you are getting a good solid block of sleep. I would encourage you to get up out of bed when you wake up in the morning- perhaps going elsewhere to do meditation and relaxation. If you are spending time in bed awake, you will be weakening the connection between bed and sleep and decreasing your sleep efficiency. Are you happy with wakening at 5am? If you feel this is too early, perhaps you could experiment with a later bed time? Also, are you continuing to extend your sleep window or do you feel that 5-6 hours is enough sleep for you?

  • Sleepio Member

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    Graduate

    I think most of the questions so far were posted in advance of the session. Is there anyone online just now who would like to ask a question?

  • Sleepio Member

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    Graduate

    Gosh, it's very quiet tonight!

  • Sleepio Member

    • 341 comments
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    Graduate

    I wonder if anyone's sleep has changed as a result of the cold weather? It must be difficult implementing QHR in a cold house! Having a blanket, slippers, dressing gown, hot water bottle and perhaps a little heater all ready might help. Setting your heating to come on for a while during the night and early in the morning might also make it easier.

  • Sleepio Member

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    Graduate

    Another 10 minutes left to go if there are any other questions anyone would like answered?

  • Sleepio Member

    • 341 comments
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    Graduate

    5 minutes left? Is there anyone else here?

  • Sleepio Member

    • 1692 comments
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    Graduate

    Great answers!

  • Sleepio Member

    • 341 comments
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    Graduate

    Okay, that's us out of time for tonight. Perhaps the quiet session is a sign that many of you are sleeping well? Hopefully the replies I have given tonight will be of some help, thanks for your questions and good night.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks Angief! I felt like I was having a conversation with myself there! 'See' you in a fortnight. Dr Espie will be doing the expert session next week.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    “Bang On!,” says the professor, when we answer a question correctly. You are absolutely correct in your thoughts about the challenge of getting out of a warm bed in the dark and cold early morning hours. I am sure that many of us deal with this now. Jim aka Cali-man.

  • Sleepio Member

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    • 63 helped
    in reply to Sleepio Member
    Graduate

    Hello Again, Dr. Horne. Here's a brief reply to your very detailed response to my many questions about the various “tools” we have been given. Thanks for taking the time to reply in this much detail.

    For me, anxiety about getting to sleep, about having to get out of bed and do something so that sleep will come, is my biggest challenge. That's why I really appreciate the way you have framed this in a positive way, for example, looking at the QHR as a way to quickly remove this anxiety and wakefulness from the bedroom. Or looking at being awake in the night as a plus, where I get to experience things that others are unable to experience. Like seeing the full moon shining its light through my window. If paradoxical thinking can help me “reframe” the way I look at this, then I will focus on it. I will practice this tonight and the nights that follow.

    Right now I am not sure about the choices I made about what I should do during this wakeful time. I am wondering if I need to try something other than meditation or progressive relaxation.

    I think a big reason for my anxiety is the fact that once I am awake in the middle of the night, I don't seem to get sleepy enough to return to the bed. If it's due to my concern about being awake or effort required to return to sleep, then maybe paradoxical thinking can help me. I have always felt that this inability to return to sleep is something that is not going to go away, but maybe if I relax about it and try not to give it so much weight, I might be pleasantly surprised. (That's glass half full thinking.)

    Sleep Well.
    Time for Dinner Here.
    Jim aka Cali-Man



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