Live Discussion with Dr Michelle Davis - 14th October 2020

Dr Davis will be hosting a live online discussion here on Wednesday 14th October, from 8.30pm to 10.00pm British Time or 3.30pm to 5.00pm US Eastern Time.

They 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. If there are a lot of questions, they may not be able to answer all in the time available, but will try to answer as many as they can.

Please do note that, as per our guidelines, Dr Davis will not be able to give personal medical advice including those about medication. Their 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 9 Oct 2020 at 4:41 AM
  • 19 comments
  • 5 helped

Comments

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 4

    Hi Dr. Davis,

    I'm currently starting my fourth week of Sleepio. Sleep restriction has been very difficult, as expected. I know it's a proven technique, and am willing to continue with it for that reason, but only if there's a good chance it will work for my situation.

    I'm questioning this because I'm starting to suspect that I might be suffering from depression. Please understand that I'm NOT asking for a depression diagnosis here; my doctor and I are already in discussion about it. What I do hope you can answer is whether Sleepio is effective at treating insomnia for people with depression.

    Is there any research on this? I understand that depression can cause frequent nighttime awakenings that seem to have no other explanation. These seem like the core of my sleep problem right now, and if they are caused by depression, I have to wonder whether sleep restriction can do much to stop them. I would, of course, be thrilled if it could.

    Thanks for your time!

  • Sleepio Member

    • 453 comments
    • 184 helped
    in reply to Sleepio Member
    Graduate

    Hi Megalogue
    Do please check your profile page as I have left you a message ;-)

    Kurly ;)

  • Sleepio Member

    • 52 comments
    • 22 helped
    in reply to Sleepio Member
    Graduate

    Hello Megalogue,

    I can say that doing Sleep Restriction (SR)
    changed the way that I sleep, it made a big improvement to it.

    Doing this course has definitely improved my mood I am a happier and positive person because of it.

    I have left you a message on your profile also.

    LoM.

  • Sleepio Member

    • 3 comments
    • 0 helped
    in reply to Sleepio Member
    Session 4

    Saw it and replied!

  • Sleepio Member

    • 11 comments
    • 0 helped
    Graduate

    Dear Dr Davis,

    My scheduled wake-up time is 5 am, but I'm finding I often wake up 1-2 hours before that; I get up, do relaxing things, but I don't ever feel sleepy again. What should I do?

    Thank you.
    Bev

  • Sleepio Member

    • 3 comments
    • 0 helped
    Session 4

    Hi Dr. Davis,

    I hope it's not a problem that I'm posting another question separate from my first one.

    A while back, my doctor prescribed me generic Ambien, and when I take it, it works wonders. It almost always gives me a solid 5+ hour block of sleep, which is something I can almost never match without medication (at least in this stage of my life). It's such a relief to have it as backup when I go multiple nights in a row with bad insomnia.

    But I've been trying to avoid taking it whenever possible. This is partly because I don't like the idea of being reliant on medication, but also because I'm concerned about how it might interact with the Sleepio course. It occurred to me that using such an effective medication might make Sleepio less effective, since the artificial drowsiness it causes is obscuring my real progress in staying asleep and getting back to sleep.

    I'm not asking for any advice about whether I should take the medication. All I want to know is whether or not, by taking it, I'm “cheating” myself out of the longer-term benefits of Sleepio.

    Thanks!

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 5

    Hello Dr Davis. Please can you help me with the sleep restriction plan. My diary records 8 hours sleep per night (in chunks due to wakening). Sleepio has suggested that I plan for 6.5 hrs per night and therefore wake at 5am. I would normally need to be up for work at 0700 so the plan seems a bit extreme. Please can you help me to work this out? Many thanks in advance. Rachel

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 2

    Hi Doctor,

    Just joined Sleepio and hoping for improvements. What are some of the immediate measures to be taken to ensure that you fall asleep ?

    In my case, mind is ON as if somebody has switched it ON. How to turn that off ?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 2

    Hi Doctor,

    I've been having trouble falling asleep for a longggggg time. Recently I found that taking melatonin helps me fall asleep relatively easily, but the effect disappears as soon as I stop melatonin. I wonder, is it okay to take it long-term?

    Thanks a lot!

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    HI Dr I have suffered with my sleep for many years now i would say about 10 years maybe a little longer, it use to be that I could never fall asleep and would lie there for hours trying , some nights just being awake all night. now it has changed. I seem to fall asleep ok now but find i wake after a couple of hours and can never fall back to sleep. Why would it change in that way.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    HI Dr I have suffered with my sleep for many years now i would say about 10 years maybe a little longer, it use to be that I could never fall asleep and would lie there for hours trying , some nights just being awake all night. now it has changed. I seem to fall asleep ok now but find i wake after a couple of hours and can never fall back to sleep. Why would it change in that way.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    HI Dr I have suffered with my sleep for many years now i would say about 10 years maybe a little longer, it use to be that I could never fall asleep and would lie there for hours trying , some nights just being awake all night. now it has changed. I seem to fall asleep ok now but find i wake after a couple of hours and can never fall back to sleep. Why would it change in that way.

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi Megalogue,

    Thanks for the great (and very clear!) question.

    First, you’re definitely not alone in experiencing sleep restriction as very difficult! I definitely understand wanting to have some reassurance that sleep restriction will be helpful in order to stick with it. Some general thoughts are below, though it’s important to remember everyone is different, and your doctor will be the most helpful person in deciding what treatments are best for both your mood and sleep.

    Depression and sleep have a huge overlap and a bidirectional relationship, wherein not getting enough sleep can impact mood, and low mood can lead to sleep problems. Low mood can definitely cause sleep problems, including frequent awakenings.

    Due to this overlap, we sometimes see that treating one problem can benefit the other (e.g., focusing on improving sleep can reduce symptoms of depression, and focusing on improving mood can improve sleep).

    The research literature on cognitive behavioral therapy for insomnia (CBTi; which includes sleep restriction as a core component) indicates that CBTi can be helpful for improving sleep in individuals who are also experiencing depression, and there is some evidence that there may be mood benefits to improving sleep.

    These research articles may be of interest:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227711/
    https://academic.oup.com/sleep/article/31/4/489/2454177

    I also see that some Sleepio community members have posted below about their experiences with mood and Sleepio – it may be helpful to search the community boards to learn about the experience others have had with sleep restriction and depression.

    I hope this information is useful, and wish you the best with whatever decisions you make.

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi Bev,

    Great question. There are two general recommendations for waking up too early:

    First, we typically recommend paying close attention to lighting conditions (both before bed, but also when waking up too early). Exposure to bright light upon awakening can have a stimulating effect on the brain, which makes it difficult to fall back asleep. Experimenting with different relaxing activities and making sure to do them in low light conditions can be helpful.

    Next, if someone has experimented with their activities upon awakening and still is not feeling sleepy again, shifting the sleep window (i.e., experimenting with different bedtimes) can also be helpful. We all have different circadian preferences, or different times we prefer to go to bed and wake up. As an example, as we age, our circadian preference tends to shift earlier. One thing that can be helpful for some with early morning awakenings is to shift the sleep schedule earlier.

    I hope this is helpful, and hope you find something that works for you!

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi Megalogue,

    No worries, multiple questions are fine! :)

    Our typical response to this question is that you do not need to change your medication in order to use Sleepio (i.e., we see that people can benefit from Sleepio while taking medication).

    To answer your question more specifically, however, there’s not a large amount of research on the effects of combining cognitive behavioral therapy (CBT) approaches for insomnia (such as Sleepio) with medication. One research study (linked below) indicated that medication may be beneficial early on, but reduce the benefit of CBT long-term; however, this is far from conclusive and there is still more work to be done to understand the effects of combining sleep medication and therapy.

    https://jamanetwork.com/journals/jama/articlepdf/183931/joc90042_2005_2015.pdf

    Due to this, my general suggestions would be to continue to experiment with your medication (with the support of your doctor) as you have been doing, and to consider searching the Sleepio community to learn about the experiences of others who have used medication and Sleepio in combination.

    Hope this is helpful!

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi Dr Snooze (great username!).

    The Sleepio program does often recommend a length of 6.5 hours for starting sleep restriction. The reasons for restricting (or reducing) the window of time that you’re in bed can be found here:

    https://www.sleepio.com/library/article/sleep-restriction-the-science/

    and some guidelines for sleep restriction can be found here:

    https://www.sleepio.com/library/article/sleep-restriction-putting-it-into-practice/

    It’s important to remember that everyone is different, and we know that people have different circadian preferences (e.g., some “morning larks” prefer to wake up earlier, while other “night owls” prefer to stay up later). To account for these preferences, you are able to manually shift your sleep window to a time that works best for you (i.e., you could move your bedtime later and wake up a bit later). The recommended length of the window is based on your current sleep and what we know works best for most people; however, if you find that this length of time is too extreme, you can also opt for a longer sleep window by manually changing your sleep window.

    Instructions for how to adjust your sleep window can be found here:

    https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/

    I hope this is helpful, and best of luck with sleep restriction!

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi MiaAma,

    Thanks for the question.

    I can confirm that the effects of melatonin require you to continue taking it (i.e., there is no benefit after you stop taking it, as you have observed). However, whether or not it is okay or safe to take long-term is a question for your doctor or medical provider, who (having your medical history) will be in a much better position to determine whether or not melatonin is safe for you.

    I hope you will find that Sleepio is helpful and that you don’t require a sleep aid, but everyone is different!

    Welcome to Sleepio and congrats on getting started!

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi Jinglebells,

    Thanks for the great question. Unfortunately, I won’t have a clear answer for you as sleep is impacted by so many various factors that there could be a number of different reasons for this (or multiple different reasons!).

    I’ve outlined below a number of different factors that can impact our sleep (and the specific type of sleep problems people may experience), but it’s by no means comprehensive:
    Changes in physical activity
    Changes in daily routine (this can be especially impacted by COVID)
    Changes in light exposure at different times of the day
    Changes in diet
    Hormonal changes
    Changes in lifestyle or stressors
    Environmental changes (e.g., noise)

    Luckily, sleep restriction has been shown to be helpful regardless of whether the problem is difficulty falling asleep or waking up too early. I see that you’re in session 4, so you’re likely just getting started with sleep restriction. I hope you find that it’s helpful!

  • Sleepio Member

    • 242 comments
    • 53 helped
    in reply to Sleepio Member
    Expert

    Hi dynamite_subs,

    Thanks for the question. Welcome to Sleepio!

    The sleep hygiene techniques that are presented in session 1 are often good for cleaning up any bad habits that might be leading to poor sleep.

    If you’ve tried these, or already doing them, there are many other strategies (which are presented later in Sleepio) which may be helpful. You noted feeling as though your mind is “switched on” – this is addressed in sessions 4 and 5, which talk about the impact of thoughts and/or stress and anxiety on sleep. One of the most important takeaways from these sessions is that worrying about sleep (or worrying about the fact that we’re worrying, or that our thoughts are racing), actually makes the worrying (and sleep problems!) worse. It may seem counterintuitive, but not worrying so much about ensuring that you fall asleep can actually help you fall asleep more easily. There are some techniques you can do before bed (for example, relaxation exercises) that can be helpful for reducing mental chatter, but above all, worrying too much about this is likely to have the opposite effect.

    The strategies in Sleepio are not a quick fix, and unfortunately take some time and practice to see the full benefit. The pay-off is that once people do see benefit from these techniques, they tend to notice that the benefits are long-term. It might be helpful to think of it as a long-term investment – putting in some hard work and experiencing some initial discomfort in order to see a long-term improvements.

    Hope this is helpful, and best of luck with the program.

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