Live Discussion with Dr Michelle Davis - 17th June 2020

Dr Davis will be hosting a live online discussion here on Wednesday 17th June, 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 12 Jun 2020 at 7:04 AM
  • 15 comments
  • 1 helped

Comments

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    Question about staying awake before bedtime during sleep restriction phase – finding this really tough. Conflict with trying to relax before bed and finding relaxing activities sending me to sleep an hour or more before I should be going to bed. Big struggle to stay awake.
    My main sleep issue has been staying asleep not getting to sleep and sleep restriction is REALLY working (but can't wait to get an earlier bedtime and more total sleep).

  • Sleepio Member

    • 2 comments
    • 1 helped
    Graduate

    Hi Dr. Davis,
    I am in a kind of catch 22 situation. I have been attempting to implement SR for two weeks now and am between session 4 and 5. I am committed to this program and I am willing to endure sleep deprivation if it will fix my sleep. My issue is that I get migraine headaches that are triggered when I don't get enough sleep. I am already working with a doctor about this and we have determined through my headache log that sleep deprivation and stress are the triggers for migraines for me. For this reason, he wants me to fix my sleep problem instead of putting me on migraine prevention medicine that has other health side effects.

    If I use the sleep window suggested to me by the Professor, it triggers a lot of anxiety for me about sleep because I am stressed I wont get enough sleep, and sometimes I do not sleep at all on those nights, and end up with a migraine the next day from sleep deprivation, my migraines are severe. This is compounded by the fact that I am a mom of small children who I need to care for in the mornings when my husband goes to work. So it affects the whole family when I am unable to function. So, what I have done is relax my sleep window considerably to reduce the anxiety I feel about sleep – although I still have my original sleep problems this way, sleep anxiety, it's not worse, but not better either. I realize relaxing my sleep window is contrary to the recommendations of the program and I'm not squeezing my sleep so I am concerned that I will lose the benefits of the program.

    I am waking up at the same time and going to bed at the same time, and following the QHR, and the wind down routine. I am also trying to learn to practice the CBT techniques I just learned in session 4. But I am not restricting my sleep window. I will say that most of my sleep issues do revolve around worries about my sleep and therefore not able to relax and sleep. I am tired enough to sleep but my brain gets in the way.

    What should I do? Will I still benefit from the Sleepio program without implementing SR?
    OR should I push through with SR even though it will cause a lot of disruption to my family and migraines?

    I have to fix the sleep to fix the migraines, but if I have to lose sleep to fix the sleep then this makes the migraines worse…
    Your advice would be appreciated.
    Thank you so much,
    Laura C.

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    Hi Dr Davis

    I have at least partially some similarities with Laura C above, I am getting migraine headaches that completely wipe me out for between 1 and 2 days. They appear to be triggered by the sleep restriction but it is completely random when I get them.

    At the moment I am on SR from about 11.00 to 4.45 I think and I do stick to that, if slightly later such as 11.15 I will get up at 5.00. I am waking always no later than 4.15 ish, sometimes 3 ish though.

    This is my second attempt at Sleepio, the first last October. That worked for a while but then I had onset insomnia again so I have started again.

    I have had to use Zopiclone, half at a time then I will drop to a quarter then none like I did last time.

    It is the migraine headaches that I need to deal with and I do not seem to get them if sleep is better. However I can get a 3ish wakeup and not get a migraine, I am assuming it is the build up over a few nights that causes them to trigger. Headache tablets such as anadin and paracetamol do nothing for them, only sleep will get rid of them.

    I am not sure if I should mention the migraine issue to my GP or is it a waste of time when I am fairly sure it is the sleep restriction. I never used to have them in the past.

    Thanks

    Dave

  • Sleepio Member

    • 2 comments
    • 1 helped
    Session 5

    Hi Dr Davis

    I wonder if you could give any advice on the appropriate sleep window start time for someone who usually gets to sleep reasonably well but then wakes after 5 hours and can’t get back to sleep. If I go to bed at 11 I usually wake at 4 and if I go to bed at 12 I wake at 5. I’m not managing to go back to sleep after that but I’m still very tired. Is this set amount of time I’m sleeping likely to change with sleep restriction and start to extend? Also I would prefer to wake at some point after 6 ultimately, so would I be better going to bed nearer 1am then hopefully waking at 6 and then once I have the appropriate efficiency trying to bring my bedtime forward to extend my sleep time ie is it better to set the wake time that I ultimately want and then work backwards for the going to bed time?
    Thanks
    Kirkers

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    Hi Dr Davis

    As well as my post above regarding migraines. I have exactly the same issue as Kirkers, if I go at 11.00 I wake at 4ish and do not go back to sleep, probably because I am up at 5.00. It seems to be conditioned now due to the sleep restriction, mine is slightly different in that if I went after 11.00 maybe 11.30 it would still be a 4 ish wake up at best. I do get the occasional earlier wake up maybe 3 ish.
    Thanks

    Dave

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Hi Dr Davis
    I have just had Session 5. My sleep has deteriorated over the last week or so mainly because I now find it difficult to get to sleep whereas before the problem was waking up in the night. I find it very hard to stop dozing at my previous bedtime of 2300. When I finally go to bed at about 0030 I feel wide awake. I get up again and read for about 1-2 hours then seem to get to sleep. Would I be better going to bed when I feel dozy but getting up even earlier? I have tried some of the exercises on the App but does not seem to help. I am not sure how one called 'I am worrying about my sleep' works since it suggests you look at a mark on wall or ceiling which is difficult in a dark room. In the course it did imply you tried this exercise with the light on but then if you do fall asleep the light is on?? I often wear an eye mask. I have established through another study I have a very poor visual imagination so that is not an option.

  • Sleepio Member

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

    Hi Cait8,

    Thanks for the question and for sharing your experience. It’s not uncommon to fall asleep during the wind-down routine, particularly during sleep restriction.

    When people are struggling to stay awake until their bedtime, I typically have two suggestions --

    The first is to adjust the wind-down routine to actually engage in less relaxing activities to make it less likely that you’ll fall asleep. For example, if you’re reading on the couch, move to a less comfortable chair. If you’re listening to an audiobook, try walking around the room while you do so. Other ideas are to engage in a conversation with someone else (either in your home or via phone), or do some light housework – anything you can do that isn’t overly stimulating, but will keep you awake until bedtime.

    The second suggestion is to shift your sleep schedule a bit earlier – but this would also require shifting the rise time as well so that the length of the sleep window stays consistent. For example, if your sleep window is 1:00AM to 7:00AM, switching to 12:30AM to 6:30AM.

    It may take some experimentation with either of these ideas to find a solution that works best for you!

    Hope this is helpful.

  • Sleepio Member

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

    Hi Laura,

    Thanks for your question. I recommend speaking to your doctor or a medical professional about this – they will be in the best position to help you decide whether or not to engage in sleep restriction and how to manage migraines. I won’t be able to give more specific advice on that.

    I can let you know that many people use the Sleepio program without implementing sleep restriction and find the other aspects of the program (e.g., sleep hygiene, the quarter hour rule, maintaining a consistent sleep/wake schedule) very helpful. Some people opt to – instead of using sleep restriction – keep a consistent sleep/wake time, adjusting the window until they find something that works for them (not necessarily restricting the sleep window). You can manually adjust your sleep window in line with your preferences and needs.

    I’ve pasted below a link to an article that explains how to manually adjust your sleep window, should you decide to do so.

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

    Overall, the recommendations in Sleepio are meant to be implemented in a way that works best for you and your unique health/lifestyle situations, and the input of a medical professional is always suggested for questions about whether Sleepio is appropriate.

    Hope this is helpful!

  • Sleepio Member

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

    Hi Kirkers,

    Thanks for the question!

    This may take some experimentation, but yes, you’re correct that it’s generally best to use the wake time as an anchor (i.e., what you suggested regarding working backwards to choose your sleep time). If your desired wake time is 6:00AM, then using that as the anchor, the initial bedtime would likely be around 1:00AM (the suggested sleep window in Sleepio will never be shorter than 5 hours). As your sleep becomes more consolidated (i.e., you’re sleeping through the night), the bedtime can be gradually (i.e., in 30 minute increments) moved earlier and earlier.

    If you need to manually adjust your sleep window to suit your preferences, below are instructions for doing so.

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

    Hope this is helpful information!

  • Sleepio Member

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

    Hi Dave,

    Thanks for the questions.

    Echoing my recommendation to Laura above, it is important to mention the migraine issue to your GP to determine whether sleep restriction is appropriate given your migraines.

    I’ll also paste my response to Laura here re: whether Sleepio can be done without sleep restriction:

    ---

    I can let you know that many people use the Sleepio program without implementing sleep restriction and find the other aspects of the program (e.g., sleep hygiene, the quarter hour rule, maintaining a consistent sleep/wake schedule) very helpful. Some people opt to keep a consistent sleep/wake time, adjusting the window until they find something that works for them (though not necessarily restricting the sleep window too much). You can manually adjust your sleep window in line with your preferences and needs.

    I’ve pasted below a link to an article that explains how to manually adjust your sleep window, should you decide to do so.

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

    ---

    Finally, I saw your other comment re: waking up too early, and (if you are to continue doing sleep restriction per your GP's recommendation) my general advice is to use the wake time as an anchor. For example, If your desired wake time is 5:00AM, then using that as the anchor, the initial bedtime would likely be around 12:00AM (the suggested sleep window in Sleepio will never be shorter than 5 hours). As your sleep becomes more consolidated (i.e., you’re sleeping through the night), the bedtime can be gradually (i.e., in 30 minute increments) moved earlier and earlier.

    Overall, the recommendations in Sleepio are meant to be implemented in a way that works best for you and your unique health/lifestyle situations, and the input of a medical professional is always suggested for questions about whether Sleepio is appropriate.

    Hope this helps!

  • Sleepio Member

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

    Hello,

    Sorry you’re having this problem! I’ve notified our User Happiness team and they will be reaching out to you today – they aim to respond within 24 hours. I hope it gets resolved soon!

  • Sleepio Member

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

    Hi Tef1,

    Thanks for the question. Sorry to hear your sleep has worsened over the last week. A few general thoughts here –

    I usually encourage people who hare having trouble with falling asleep to play around with the sleep schedule a bit to find what works best for them by experimenting with the sleep window (i.e., shifting it later or earlier by 30 minutes or so to find the sweet spot for you). I’ve pasted below a link to an article that explains how to manually adjust your sleep window, should you decide to do so.

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

    Second, the exercises suggested in the Sleepio program are ideally meant to be done outside of the bed (i.e., getting out of bed and practicing the relaxation exercises in another area until you get sleepy). You're absolutely right about the light – you always want to be in dark/dim lighting conditions when waking up in the middle of the night because light has an alerting effect. So getting out of bed, sitting elsewhere, and trying the mark on the wall technique in very dim lighting might be one strategy – but experimenting with what works best for you is going to be key here. Some people find that a breathing or relaxation exercise works best, others prefer to listen to music or an audiobook until they start to get sleepy – the point is to do something non-stimulating and even boring.

    Hope this is helpful!

  • Sleepio Member

    • 4 comments
    • 0 helped
    in reply to Sleepio Member
    Graduate

    Hello

    Thank you. I will play around with that

    Another query please. I am not sure how sleep quality on the sleep diary is calculated. I found the definition of Sleep efficiency

  • Sleepio Member

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

    Hi TEF1,

    Sleep quality on the sleep diary is a self-rated assessment (i.e., how well you think you slept), on a 5-point scale from “very poor” (0) to “very good” (5). The sleep quality metric for the week averaged across your available sleep diaries for that week (i.e., your average rating). For example, if your average sleep quality is a 3, your sleep quality for the week would be “Fair”.

    Sleep efficiency (which it sounds like you already found!) is the total sleep time divided by the total time in bed.

    Hope this helps!

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Thank you. I thought it was something the computer calculated.

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