Live Discussion with Dr Michelle Davis - 20th May 2020

Dr Davis will be hosting a live online discussion here on Wednesday 20th May, 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 14 May 2020 at 9:28 PM
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  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 2

    I am currently furghloughed from work, and as a chef, have a great opportunity to fix my patterns so have now begin this course. My only concern being that when I return to work, I will return to working shifts and late nights 4 or 5 times a week. How can I stop myself slipping back into bad habits?

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 3

    Hello!

    I just finished my 1st session, and I am here because I'm having trouble staying asleep at night. I recently started eating healthier and drinking a LOT of water, and the frequent trips to the restroom are what's waking me up. Do you have any suggestions to help with this without decreasing my daily water intake? I thought it would get better as my body became used to it, but it's been 9 weeks without much change.

    Thank you!

  • Sleepio Member

    • 11 comments
    • 4 helped
    Graduate

    Dear Dr Davis,

    I often wake up in the middle of the night (usually after about 3/4 hours) and though I try to do the various recommended activities (short stroll, read a dull book, listen to calming radio, muscle relaxation, meditation) I can almost never get back to sleep. Even if I'm fairly relaxed, the tiredness just does not come, or only comes by the time it's nearly time to get up again.

    What can I do about this?

  • Sleepio Member

    • 3 comments
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    Graduate

    Hi!

    How can I attend the expert session?

    Where is it hosted?

  • Sleepio Member

    • 242 comments
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    in reply to Sleepio Member
    Expert

    Hi Alexic0023,

    Thanks for the question and congratulations on being a Sleepio graduate.

    I’ve pulled together some general advice for calculating a sleep window, though it’s important to note that ultimately it will be up to you how to implement this information in a way that works best for you.

    First, I just want to let you know that it’s very common to wake up in the night – in fact, everyone does at some times throughout the night, they just often don’t remember it. Awakenings are only considered problematic if they are prolonged or causing significant distress.

    That said, in general, it is recommended to never reduce the sleep window to less than 5 hours, or less than 6 hours for those with medical or mental health concerns. The sleep window should be based on how much the individual is sleeping, rather than how long the person is in bed -- in other words, total time in bed, minus how long it took to fall asleep and/or the estimated time of awakenings.

    The sleep diaries can be used to account for fragmented sleep, but it’s important to remember that these estimates don’t need to be exact – taking a best guess is fine. For those who are experiencing multiple, shorter awakenings, it is often recommended to just guess at the total length of time awake during the night (rather than trying to capture the duration of each awakening). Either way you choose to do it, these should be subtracted from the total time in bed (minus time to fall asleep) to estimate a sleep window.

    I hope this is helpful information! If you need additional information or assistance, your medical provider will be the best person to contact for this.

  • Sleepio Member

    • 242 comments
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    in reply to Sleepio Member
    Expert

    Hi Mr beaver,

    Thanks for the question. It is generally recommended to try to guess at these things, rather than looking at the clock or paying too much attention to whether you were “fully” awake or not. The general rule would be to lean towards getting up and trying to follow the rule, rather than not.

    However, this is something you can experiment with! Sometimes I suggest trying to stick more rigidly to the rules for a week and seeing if it makes a difference to your sleep. If so, stick with it!

    My only other suggestion would be to try not to look at the clock – your best guess at the time is good enough, and looking at the clock can create stress and anxiety, which then interferes with sleep.

    Here’s an article by Dr. Colin Espie, co-founder of Sleepio, which discusses more specifics on how to implement the QHR:

    https://www.sleepio.com/library/article/the-quarter-of-an-hour-rule-putting-it-into-practi/

    Hope this is helpful!

  • Sleepio Member

    • 242 comments
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    in reply to Sleepio Member
    Expert

    Hi njees,

    Thanks for your question. I'm sorry to hear you've had a rough time with sleep and depression.

    There is some literature looking at sleep deprivation and/or partial sleep deprivation as a form of treatment for insomnia; however, this research is not definitive.

    You may be aware of this, but I want to highlight some definitions: sleep deprivation is the lack of opportunity to sleep, while insomnia (or sleep problems) involves having the opportunity to sleep, but being unable to. Sleepio is designed to help with sleep problems, and does not use sleep deprivation to do so.

    The Sleepio program instead utilizes sleep restriction, which limits the time in bed to the actual amount of time spent asleep. While you may get less sleep as a result, the sleep lost accrued should be fairly minor and temporary (e.g., we never recommend a sleep restriction window of less than 5-6 hours). While Sleepio tends to be effective for most common sleep problems, we always recommend checking with your doctor if you're unsure if it's a good fit for you.

    I’m glad that you’ve noticed an improvement in your mood and are no longer feeling suicidal. If this changes, please reach out to your doctor or a medical professional (or, in urgent situations call a helpline or go to your nearest emergency services).

    I hope this information is helpful and best of luck!

  • Sleepio Member

    • 242 comments
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    in reply to Sleepio Member
    Expert

    Hi Suellalan,

    I’m glad you’ve made some huge gains and thanks for the great question. It sounds like you have good instincts here around what may be causing the issue, but that you may be having some trouble implementing some of the things you know will be helpful?

    My general advice would be that experimentation is often extremely helpful. Experimenting with different bedtime routines (e.g., not letting yourself lie down or sit on the sofa at all before bed and trying out a different pre-bed location and activity) may help you land on something that allows you to wind down without accidentally falling asleep.

    Here's an article by Dr. Colin Espie, one of the co-founders of Sleepio, on the wind-down routine before bed:

    https://www.sleepio.com/library/article/before-bed-the-wind-down-routine/

    As far as the QHR and keeping the bed for sleep only – these are the best ways to develop a healthy sleep habit, as you stated, but how perfectly individuals are able to stick to them is often related to how unhappy they are with their current sleep, and how much benefit they see when they do stick to them. I would typically caution against trying to get the perfect amount of sleep, and instead focus on daytime functioning.

    I’m glad you are finding that continuing to check in with the program is keeping you accountable – wishing you the best!

  • Sleepio Member

    • 4 comments
    • 2 helped
    Graduate

    Hi Dr Davies,

    I have been doing the Sleepio course for one week and started week 2 today. I have been prescribed Zopiclone by my GP but I only have 14 days of tablets. I have been taking half a tablet but not every day. Unfortunately when I don't take a tablet it is taking me 3 or 4 hours to actually fall asleep and then I don't always stay asleep either. I want to come off the tablets but I find if I don't take them I simply do not get enough sleep and end up exhausted the next day. If I take the pills then my sleep is OK and I record that in the sleep diary. My concern is that if my sleep diary is showing that I have good night's sleep with the pills then my usual (bad) sleep pattern will not be accurately recorded and the programme may not help my actual sleep problem. Do you have any advice?

    Thank you.

  • Sleepio Member

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

    Hi Sikluke,

    Glad to hear you’re falling asleep easier, though you find yourself waking up early. It’s hard to say what is causing the early awakenings without having more information, but I have some general guidance.

    First, it can be really helpful to experiment here. If someone continuously wakes up early, I would check whether this time is an acceptable one – if so, this time can be the new regular wake time. To account for it, the person would gradually shift their bedtime earlier by 15 minutes per week. I would recommend against shifting the bedtime earlier by an hour all at once because that could lead to difficulties falling asleep – a slow shift toward earlier bedtime is recommended. If sleep problems get worse after shifting the bedtime, this means the bedtime may have been shifted too far, and should be shifted a bit later.

    This will take some experimentation and patience on your end, but if you continue to wake up early and this time is not acceptable for you, it may be worth checking with your doctor to try to get more specific recommendations based on your medical information.

    I hope this is helpful!

  • Sleepio Member

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

    Hi Moxie,

    Thanks for the question. Typically we find that sleep quality improves alongside sleep efficiency, as more efficient sleep indicates less disruption to the natural cycling of sleep stages. However, I’ve highlighted a few points below that I hope will be helpful in finding something that works for you (whether that’s Sleepio, or another solution!).

    First, Sleepio does not address active dreaming specifically, but it’s important to know that stress can increase active dreams. The current situation is a stressful one, so it would make sense for many to be experiencing active dreams during this time. For stress management, I would typically recommend experimenting with relaxation techniques or cognitive techniques (these are introduced in sessions 4 and 5 of Sleepio) for stress reduction. Some moderate intensity exercise (not too close to bedtime) can also be extremely helpful for stress reduction.

    Sleepio does address nocturnal awakenings, but it’s also important to note that everybody wakes up throughout the night – we often just don’t remember them. Nocturnal awakenings are considered a problem when they are prolonged (i.e., more than 15 minutes in duration) and causing a lot of distress.

    I also want to highlight that Sleepio may not be a good fit for everyone, and some people require more personalized care (e.g., the support of a medical professional). If you continue to experience difficulties or feel that the Sleepio self-help program is not enough, you may want to reach out to your doctor or medical provider.

    I hope this information is helpful!

  • Sleepio Member

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

    Hi Heather,

    Thanks for the question and I’m glad you’re trying to figure out how to sort out your sleep again after some success in the past. First I just want to say that it’s not at all uncommon to experience problems with sleep when making a lifestyle change like retirement. You also didn’t state your age, but it is common for us to get less sleep as we age, which could also be a factor.

    I can give some general advice below, but ultimately if you completed the Sleepio program and are using all the skills, but still struggling with sleep, you may want to consider speaking to your doctor about more personalized care.

    First, I want to give a word of caution about wearable devices. The accuracy of these devices is not well-established, so I recommend taking their output with a grain of salt. You mentioned noticing you are not feeling great during the day – this (i.e., daytime functioning) is the most important indicator of sleep quality.

    Next I want to point out that you’re absolutely right that sleep and anxiety are closely related. When we don’t sleep well, we feel anxious, and when we are anxious – we don’t sleep well. I’m sorry that you’re experiencing this. There are things you can do to manage stress and anxiety (e.g., moderate intensity exercises – not too close to bedtime, the cognitive and relaxation techniques in sessions 4 and 5) that may be helpful.

    I hope this is useful, and hope you find what works best for you!

  • Sleepio Member

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

    Hi OPH,

    Thanks for the question. This is a difficult time, but I’m glad you are viewing it as a good opportunity to work on your sleep.

    It will likely take some experimentation when returning to work to adjust your sleeping schedule to find what works best for you, but in general we recommend sticking to the sleep hygiene techniques (e.g., using the bed for sleep only, getting out of bed if awake for more than a quarter hour, not napping) as closely as possible, given that it will be difficult to stick to a consistent sleep/wake time.

    Sleepio has guide specifically for shift work and sleep, which may be a helpful for resource for thinking through what adjustments you will need to make when returning to work.

    https://www.sleepio.com/articles/shiftwork/

    I hope that during this time you find that your sleep improves and that will motivate you to stick with those techniques that you find most helpful.

  • Sleepio Member

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

    Hi Sgamble,

    Great question! A few points here – first is that waking up during the night is not necessarily a problem, unless someone is having a lot of trouble getting back to sleep, or the awakenings are causing a lot of distress. We all wake up several times throughout the night, we often just don’t remember it!

    That said, some general recommendations regarding water intake are to 1) not reduce amount of daily water intake, but try to consume it earlier in the day (rather than before bedtime), and 2) make sure to use the bathroom immediately before bed.

    I hope this information is useful, and good luck with the rest of the program!

  • Sleepio Member

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

    Hi Rheum,

    Thanks for the question. A few general pieces of advice are below:

    I often don’t recommend strolling or walking, because even low effort activity can increase alertness.

    It is typically recommended to make sure that these activities are done in dim light conditions, as bright light can increase wakefulness.

    Similar, it’s important to make sure these activities (e.g., the relaxation and music) aren’t being done in bed, as it’s important to try to capitalize on the sleep-bed connection by trying to only be sleeping while in bed.

    Finally, it’s important to remember that relaxation exercise don’t promote sleep, they promote relaxation (which can be helpful for achieving sleep). Sometimes we put too much pressure on relaxing exercises (e.g., getting frustrated when they don’t lead to sleep), which can make them less relaxing.

    I hope these general tips are helpful, and I hope you find something that works for you! If experimenting on your own doesn’t seem to be working, you can always consult your doctor for help.

  • Sleepio Member

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

    Hi Lucfig,

    I am answering questions as they come in, if you would like to post one here.

    Thanks!

  • Sleepio Member

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

    Hi Eileen 1401,

    Thanks for the question and welcome to Sleepio. Ultimately, you and your doctor will need to decide how to manage your sleep when it comes to medication (and whether or not you should take it) and dosage. You do not need to change your medication in order to use Sleepio, and many have used Sleepio successfully while taking sleep medication.

    Here’s a community conversation around using medication while doing Sleepio that may be a helpful resource:

    https://www.sleepio.com/community/discussion/using-medication-while-doing-the-sleepio-course/

    In terms of your sleep diary, we don’t recommend any changes to the sleep diary to account for medication use. If you’d like, you can manually add tags to your sleep diary to demarcate days on which you used medication, if you’d like to track it. Information for how to do that is below:

    https://www.sleepio.com/library/article/how-to-use-the-sleep-diary-tagging-system/

    Hope this is helpful!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Dr. Davis!

    Oh, I thought it was a video discussion.

    Thank you…

  • Sleepio Member

    • 2 comments
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    in reply to Sleepio Member
    Graduate

    Thanks for the advice Dr Davis,

    The last week is the first time I have worn a wearable device as I was always reluctant to analyse my sleep that way. I do however really struggle to function well on the days where I have poor quality sleep.

    Although I don't fully awake during the night I feel that my sleep is light and I don't get the deep refreshing sleep unless I am absolutely exhausted.

    Prior to this current spell of poor sleep my problem was mainly falling asleep and waking early but I always felt I had some restorative sleep. At the moment I feel as if I only get restorative sleep every few days.

    I do admit that I am feeling more anxious about sleep than I ever have and I'm working on the techniques from the sessions.

  • Sleepio Member

    • 242 comments
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    in reply to Sleepio Member
    Expert

    Glad to hear you're working on the techniques. If you find that your anxiety (about sleep or in general) is overwhelming, I'd encourage you to reach out to a doctor for assistance – there are lots of strategies for managing stress that can be very helpful.

    Best of luck!

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