Live Discussion with Dr Kirsty Horne - 6th November

Dr Horne will be hosting a live online discussion here on Wednesday 6th November 7pm-8pm (GMT).

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Posted 31 Oct 2013 at 3:49 PM
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  • Sleepio Member

    • 2 comments
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    Graduate

    Hello
    I am on week 3 of the program and am looking for suggestions on how to try and get my sleep back on track after working night shifts. I am a nurse and work mostly 12 hr day shifts but every 3 weeks I do a set of 3 12hr night shifts (7pm to 7am). I do fairly well with getting adequate sleep during the day when I am night shifts but often will struggle to get back to a pattern where I can resume sleeping through the night.

    For instances I am wondering what to do on the morning of my last night shift. If I sleep during the day, I will have trouble getting to sleep that night. Wondering if I should severely limit the amount of sleep I get on that last morning so I will be sleepy that night, although that sometimes does not work.

    Anyway any suggestions would be great.
    thanks
    Carrie

  • Sleepio Member

    • 258 comments
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    Graduate

    Hello Again, Dr. Horne,

    Well, it's a new ballgame as they say. I like others just started the SR last night and see what a huge change this is in lifestyle. No matter what it does for sleep, adjusting to it will be a very big task.

    I echo the sentiments of one of our colleagues who says she didn't get sleepy enough to return to bed. I had the same experience, so I did not return to bed. That meant that my SE was 100% (!), and I felt a little better because I didn't toss and turn or become anxious in bed, but had just three hours of sleep. That was kind of scary! So, I feel apprehensive about this process.

    I understand that one night does not an experiment make. So let's see how tired I am later this day and how it goes for the next week. Avoiding the wakefulness and anxiety in bed will motivate me to keep doing this. If I am able to return to sleep and sleep another one to two hours, then I will be able to say that I have managed to make this work.

    I can experiment with upping the dose of my sleep aid and see what that does, and will ask my doctor about this. It's a non prescription supplement that contains phenibut as its most likely sleep aid.

    Do you have a PhD, or or are you another kind of doctor? Reason I ask is just to know your background, and I don't have any preconceived notion about what the title means. Credentials just tell us what sort of training you had.

  • Sleepio Member

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    Graduate

    Dear Dr. Horne,
    I dread going to bed and I dread getting out of bed. Once I'm up and going I'm fine. Do you have any suggestions of positive reinforcement statements that I can tell myself to help with this? Since one statement may not work for me several rephrasings or ways of looking at things are helpful to me. Thanks for any help that you can provide.
    -datagatherer Oct. 30, 2013

    Usually at night, it's simply that I override myself about the need to get to bed. I'm not good at wrapping things up or relaxing. It's a general feeling of avoidance. Why bother. It's peaceful being up late with no-one to bother me.
    In the morning, I'm not looking forward to the day. I usually don't. Bed is warm, safe, and cozy. There's no conflict in bed. To me, what difference does it matter if I get up right away or whenever. I feel no rush to face the day. It will still be there.

    Another thought is that its time to go to bed and I haven't relaxed and unwound yet. I really want to and so I do, which gets me off schedule.
    Please help me counter these thoughts and provide positive affirmations to replace with healthier thoughts.
    Thanks,
    datagatherer

  • Sleepio Member

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    Graduate

    Good evening everyone, let’s get started…

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Sarahukulele, thanks for your question and sorry to hear things are so difficult for you just now. I hope you are getting some help with the anxiety and low mood- if not it might be worth asking your GP to refer you for some talking therapy. Also, I wonder if you have any other support from friends or a cancer/pain support group? Social support is an important protective factor. I’m glad to hear the pain is improving with the supplements and medication- hopefully this should help your sleep. How have you found the relaxation and mindfulness exercises? These can be very helpful for people suffering from stress/ anxiety. With regards to your sleep window, have you just started SR? This is a very important part of the programme and is vital to break the pattern of poor sleep, build sleep pressure and develop a strong bed sleep connection. How late have you been sleeping until? If you sleep later, you will have less sleep pressure at your threshold time, meaning you will either have difficulty falling asleep or difficulty maintaining sleep- hence the pattern will continue- you will end up being awake through the night, then tired in the morning and sleeping later or napping through the day. It is a very difficult cycle to break but it is so important that you persevere with it. Are you lying in your bed awake for 3 hours or are you implementing the QHR? This is another very important part of the programme as it helps develop a strong connection between bed and sleep. If your pain is making things more difficult, I would ensure you have a room set up for QHR and ensure it is comfortable and relaxing for you. Also, try to use the thought checker and relaxation techniques to relax your body and mind through the day and night. Finally, you must try to rise at your set rise time and avoid napping through the day to break the cycle of poor sleep- you can rest and relax through the day (if your schedule allows) and try to pace your activities if possible. If you feel it would be dangerous not to nap during the day (e.g. if you are driving) then limit any naps to 15 minutes. Use caffeinated drinks, activity, fresh air and daylight to keep alert through the day. Hope this help and good luck with it. Don’t forget to use the community for support.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Ewa, I am not sure what might be causing your sweats. If the GP thinks they are panic attacks then I would recommend continuing to work with your CBT therapist on ways of reducing physical symptoms of anxiety and challenging any negative cognitions (both during the day and night). I also suggested last week trying to cool your room down with a fan or opening a window for a while prior to retiring to bed. Try to also ensure you are as relaxed as possible prior to sleep onset and wind down in the evening.

  • Sleepio Member

    • 341 comments
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    in reply to Sleepio Member
    Graduate

    Hi Maria24, thanks for your question and sorry you are finding SR so difficult. It is not easy- I'm sure the other members can share their experiences also, but it is very important to persevere with it, as it is a very important part of the course. Would there be any way you could 'pause' this part of the course until a better time- perhaps a holiday from work? It's difficult to say how long it takes to work as everyone is different. Also, if you are struggling to implement it every night, it may take a little longer and you will continue to wake through the night due to a weak bed-sleep connection or not having enough 'pressure' for sleep at bed time. How long was your sleep window to start with and did you reach 90% sleep efficiency during the first week? If so, you are permitted to extend your sleep window by 15 minutes- either by going to bed earlier or getting up later. The idea is to build sleep pressure and develop a strong bed-sleep connection. We want to squash up all the bits of sleep into a consolidated block initially and then to gradually grow it bigger. Although some people find it very difficult, it does work and you should begin to notice improvements to your sleep soon. I would encourage you to continue with the other aspects of the course also- particularly the thought checker, relaxation and mindfulness techniques, as it sounds like you are feeling a bit stressed and low about your sleep and the impact it is having just now. Trying to get some fresh air, get out into the daylight and keeping active during the day can help with daytime tiredness, as can a caffeinated drink, provided it is not too close to bed time. Good luck and don't forget to use the community for support also.

  • Sleepio Member

    • 341 comments
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    in reply to Sleepio Member
    Graduate

    Hi Maria, I think I have answered your questions in my previous reply. You can also look in the library, in session 3, under sleep restriction for more info and see Dr Kyle's article https://www.sleepio.com/library/article/frequent-awakenings-when-will-they-go-away--/
    It's also useful to note that it is common to feel very sleepy in the post-lunch period (2- 4pm, give or take an hour, or so for individual variability). Sleepiness increases naturally as a result of a signal from our biological clock. This is why road traffic accidents peak around this time too. This period is sometimes referred to as the 'mid-afternoon slump' and is the reason people in some countries have a siesta in the afternoon. Eating well, having a snack (e.g. fruit) in the afternoon and staying well hydrated can also help you feel less tired and more alert.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Megan, thanks for your question. Well done with persevering with many of the Sleepio techniques, which seem to have worked for you for a period of time. It's important to have realistic expectations, in that you might always have an occasional 'bad' night- even good sleepers have bad nights at times. It sounds like these are increasing for you just now and you are starting to experience the 'pendulum' effect again. I wonder if you are under increased stress just now or if there have been any changes in your life, your health, your diet or your routine lately that might be impacting upon your sleep? I think it's really important to try and stay awake after the 'bad' nights until your bedtime in order to prevent the pendulum effect starting again and build sleep pressure for the following night's sleep. I would avoid going to bed unless you are sleepy tired- this will weaken the association between bed and sleep. This may mean not going to bed until the early hours of the morning, being very tired the following day but remaining awake until your threshold time- by which point you should definitely be sleepy enough to sleep! Try staying active, getting some fresh air, having a caffeinated drink etc. in order to get through the very tired stage over lunch time. I would also encourage you to re-visit the cognitive techniques (challenging any negative sleep- related thoughts and giving up any concern or effort to sleep). Hope this helps and good luck!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Clairebear, we cycle through different kinds of sleep every night- both light and deep sleep as well as REM (dreaming) sleep. Sticking to the Sleepio techniques should help you to get a more refreshing, good quality of sleep with fewer awakenings throughout the night. I'm sure stress can contribute to disturbed and un-refreshing sleep, so, yes, trying to stay physically and mentally relaxed can help. Other lifestyle factors like exercise and diet can also affect sleep and might be worth thinking about. Using the bed only for sleep and developing a strong association with bed sleep by implementing QHR and SR also help improve sleep. Also, thinking about whether the bedroom is conducive to good sleep might be worthwhile (temperature, light, noise etc.) and continuing to implement the cognitive techniques should help.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Wonder Woman, well done for taking steps to come off your sleeping medication- unfortunately rebound insomnia is a common problem when attempting to do so. I think continuing with Sleepio will help re-set your sleep pattern and teach you useful techniques to cope with disturbed sleep etc., so I would recommend continuing with it and using the community for support.

  • Sleepio Member

    • 341 comments
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    in reply to Sleepio Member
    Graduate

    Hi Ewa, you would address the panic at night in the exact same way as you do during the day- identifying triggers, recognising and challenging any negative thoughts, using abdominal breathing and relaxing your body. I'm glad to hear it's going well during the day. Any thoughts on why you struggle to implement the same techniques at night? Remember to use the thought checker and paradoxical thinking (giving up any concern about being awake and giving up any effort to sleep).

  • Sleepio Member

    • 5 comments
    • 1 helped
    in reply to Sleepio Member
    Graduate

    Thank you. I have postponed it at the moment as I am overseas for 6 weeks but hope to continue when I get home, but shall have to start again from the very beginning with the reduction of medication as I simply couldn't sustain it with a very taxing work load!

  • Sleepio Member

    • 341 comments
    • 25 helped
    in reply to Sleepio Member
    Graduate

    Hi Carrie, this is a very difficult situation and not easy to resolve I'm afraid. With shift workers doing the same shift pattern continually it's a little easier but changing from one to another is very difficult. I would suggest sleeping on the last morning but, as you say, limiting this sleep so that you are still sleepy at bed time. Try to keep the room as dark and quiet as you can during sleep times and try to get as much daylight and fresh air as possible upon awakening- keep active during the time you are meant to be awake if you can and use wind down techniques and relaxation in the evening when it's approaching bed time (which might be later than usual for the first night). Try to then have a set rise and bed time for the days following to get back into a routine. Hope this helps.

  • Sleepio Member

    • 341 comments
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    in reply to Sleepio Member
    Graduate

    best of luck with it!

  • Sleepio Member

    • 341 comments
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    in reply to Sleepio Member
    Graduate

    Hi Caliman, thanks for sharing your experience with us- I always find it useful and I’m sure others do too. It sounds like you are keeping an open mind and seeing this as an experiment, which is great- a really good place to be. I’ll be interested to hear how you are doing by the end of this week also. With regards to my title- I am a Clinical Psychologist. I have a BSc (Hons) in Psychology, an MSc and a Doctorate in Clinical Psychology. You can read a bit about the experts clicking on ‘Sleepio Experts’ at the bottom of the page.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Carrie, you can also have a look at Dr Kyle's article in the library: https://www.sleepio.com/library/article/shift-work-and-sleep/

  • Sleepio Member

    • 341 comments
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    in reply to Sleepio Member
    Graduate

    Hello again datagatherer, I’m not entirely sure that’s it’s positive affirmations you require. Firstly, I would advise not going to bed at night until you are ‘sleepy tired’ anyway, not just because it’s bed time. If you are not sleepy then don’t go to bed and if you enjoy staying up late, relaxing in peace, then this also sounds fine. I’m wondering if you have a schedule that requires you to be up for a certain time or if you are able to sleep in as late as you like? It sounds like you are saying you do not need to be up at a set time? Also, I wonder if you experience conflict during the day, which causes stress? and perhaps don’t have many enjoyable/ meaningful activities to look forward to? If this is the case, I can see why you might prefer to stay in bed at times. Could you look at introducing more of a schedule and structured activities to your day? In particular, building in things you enjoy and things that give you a sense of achievement? With regards to positive statements- all I can suggest based on what you have told me would be to remind yourself that 1. bed is warm, safe and cosy and 2. That you are always fine once you are up and going. Can you find time to relax during the day at all or only at night?

  • Sleepio Member

    • 341 comments
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    Graduate

    Any more questions in the last 10 minutes?

  • Sleepio Member

    • 341 comments
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    Graduate

    Well, thanks for all your questions everyone and sleep well.

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