Live Discussion with Dr Michelle Davis - 21st April 2021

Dr Davis will be hosting a live online discussion here on Wednesday 21st April, 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 16 Apr 2021 at 8:10 PM
  • 20 comments
  • 3 helped

Comments

  • Sleepio Member

    • 13 comments
    • 5 helped
    Graduate

    Could you please discuss how we go about easing off the program?. I am now sleeping most nights in a block of 5-6 hrs after starting Sleepio about a year ago. Is the regimented wake up time, the quarter hour rule etc… things that I now have to live with forever?. I'm not confident enough that I will continue sleep if I let it ease.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    What is classified as “good sleep”?

  • Sleepio Member

    • 5 comments
    • 0 helped
    Graduate

    Could you cover the 1/4 hr rule
    Am really struggling with it as it feels like it is making a v anxious sleep/bed association

  • Sleepio Member

    • 4 comments
    • 3 helped
    Graduate

    Hello,
    Last week I asked you about troubles I was having with repeated wakings an hour or so before my scheduled time to get up. You suggested moving my schedule earlier which surprised me. I thought you would have suggested going to bed later rather than earlier.

    Could you please explain the reasoning around this?

  • Sleepio Member

    • 24 comments
    • 17 helped
    Graduate

    Dear Dr Davis,
    I finished the set programme a few weeks ago, and would be grateful for a bit of advice about the best way forward.
    My sleep problems are to do with anxiety over getting to sleep. I found that sleep restriction caused a big spike in my anxiety, to the extent that I couldn’t sleep at all. I would get out of bed after 20 minutes, following the QHR, and be awake for the rest of the night. After a couple such nights I got straight to sleep out of sheer exhaustion, and then the cycle started again. I never once managed to get to sleep following the QHR, and so the association between bed and anxiety built up even further.
    I decided to put sleep to restriction to one side, and focused just on the thought-related techniques. These have definitely helped, and I feel encouraged about that. I am however still getting intermittent spells of sleepless nights. I guess it is too soon to know whether their frequency might diminish as I get more practised at the cognitive techniques.
    I am not sure whether to carry on down this path (just focusing on the cognitive exercises), or to have another go at sleep restriction. I am concerned about getting another big spike in anxiety if I try again, but also know that sleep restriction is the most solid form of intervention, and feel a little bit as though I have failed at it.
    Do you have any advice for someone in my position? I appreciate that you can’t give definitive advice on this, and that it is probably up to me to decide. Thank you.

  • Sleepio Member

    • 6 comments
    • 0 helped
    Graduate

    My sleep has definitely improved overall although I dont think I will ever be great sleeper but my question is, when life is stable my sleep tends not to be too bad but when I have acute stress, which i have a lot of because of family concerns my sleep just nosedives. I have tried mindfulness, journaling and other relaxiatiom techniques but I still find myself either not being able to get to sleep easily or waking up and not being able to sleep as my mind is plagued with very real worries. Do you have any ideas on how to still a worried mind. I do try to simply tell myself that bedtime is sleep time not worry time but it doesn't always work. Thank you.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Is the live discussion on zoom or how do you connect to it?

  • Sleepio Member

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

    Hi Alison,

    Congratulations on completing the Sleepio program and noticing more consolidated sleep – it sounds like you really put the techniques into practice and are continuing to. That takes a lot of effort and willpower!

    “Life after Sleepio” can look a lot different for different people. Some people ease some of the strict recommendations, and others stick with the program long term. Accordingly, it will be up to you to decide what works best and it may take experimentation (i.e., if you do start to flex some of the restrictions, do you notice your sleep worsening? If you try this and do see a decline, you can always go back to the techniques).

    However, my general advice is to try not to slip back into old habits that may worsen sleep. Our circadian rhythms play a very important role in regulating our sleep, and they love regularity and routine. Keeping a regular sleep schedule (even on the weekends!) is a great way to continue to promote healthy sleep. It will be a balance to figure out what works best for you in terms of sticking to healthy sleep habits and routines, but not being so stringent that you’re distressed by it. That said, if it doesn’t feel like you are getting enough sleep currently, the general suggestion would be to continue gradually increasing the sleep window every week.

    I hope this is helpful. One suggestion is to try searching the community board (or posting yourself!) to see if/how other graduates have changed their sleep habits after completing the program.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Just started the restricted sleep regime and had a headache all day, could not easily concentrate at work and felt grumpy and short tempered. It took all my strength to control this,
    Should I lengthen the time a bit fixed for sleep more?

  • Sleepio Member

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

    Hi who123*

    Great question. Due to the fact that we all differ in the amount of sleep we need (and that factors like age and stage of life can all impact our sleep quantity), we typically do not focus as much on the number of hours of sleep as a definition of “good sleep”. Instead, some more helpful ways to classify good sleep are 1) daytime functioning (e.g., how rested or refreshed someone feels during the day) and 2) sleep efficiency (i.e., the amount of time spent in bed asleep versus awake). I tend to emphasize daytime functioning over sleep efficiency, as people often fixate on the numbers which can be counterproductive (i.e., cause anxiety about whether the sleep efficiency score is high enough). If someone generally feels alert and well-rested, and does not have difficulty with daytime functioning (i.e., concentration problems, difficulties with fatigue or staying awake, etc.), they likely are getting “good sleep”.

    I hope this answers your questions! If you’d like more information on sleep cycles and “deep sleep”, this article may be helpful:

    https://www.sleepio.com/library/article/deep-sleep/

  • Sleepio Member

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

    Hi emilyhall,

    Thanks for the question. This is a tricky technique for many, so you’re not alone in struggling with it.

    The science behind the quarter-hour rule is that our brain forms associations between certain activities and emotions and specific contexts. For example, if you always eat dinner in front of the television, you may find yourself getting hungry when you watch tv outside of dinner time – your brain will have formed a connection between the context (being in front of the tv) and the activity (eating). The same is true for the bed as a context. The more we are awake while in bed, the stronger the connection between the context (being in bed) and the activity (being awake). Given that many people experience anxiety when they are unable to sleep, staying in bed while awake and anxious can also build a connection between being in bed and being anxious. Though getting out of bed can be very challenging, the purpose is to dissociate the relationship between being in bed and being awake (and/or anxious). If you are awake and anxious, it is better to do this outside of the bed. This way, each time you are in bed and asleep, you’re strengthening the bed-sleep connection. This is a process that takes time to start working, but many people find that it is worth the struggle.

    That said, you will be the best judge as to whether or not the quarter-hour rule is working for you (or whether to implement it at all).

    Here are some articles that go more into depth that you may find useful:

    https://www.sleepio.com/library/article/the-bed-sleep-connection-the-science/
    https://www.sleepio.com/library/article/the-quarter-of-an-hour-rule-putting-it-into-practi/
    https://www.sleepio.com/library/article/the-quarter-of-an-hour-rule-the-science/
    https://www.sleepio.com/library/article/the-quarter-of-an-hour-rule-just-isnt-for-me/

    It may also be helpful to hear from others on the community board regarding how they coped with the quarter-hour rule, and whether they found it was beneficial.

    Hope this is helpful!

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Than you. I functioned better last week when I was not limiting my hours of sleep so much. I know that the aim will be to get continuous sleep and less interrupted sleep therefore better quality but it is limiting my concentration levels for critical work. Can I take one day out of the week so that I can recover from the limited time in bed?

  • Sleepio Member

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

    Hi Shirley Ann,

    Happy to clarify. Everybody has a different circadian preference in terms of sleep timing. For some, going to bed earlier and waking up earlier (when that's an option) can be helpful for combatting early morning awakenings. For others, going to bed later can be helpful for encouraging a later rise time. If the desired outcome is to wake up later, you might try going to bed later (e.g., practicing sleep restriction, which Dr. Kanady also mentioned as an option) to see if that helps. If that doesn't help, experimenting with the timing may be helpful.

    Hope that helps!

  • Sleepio Member

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

    Hi Ellenyork,

    Congratulations on finishing the program and thanks for the great question. I’m sorry to hear you had so much trouble with sleep restriction, and the modifications you made sound very reasonable. Thanks for noting that I can’t give definitive advice :) but I can give some general recommendations that you can decide whether or not to implement.

    You’re correct that if you want to improve your sleep further sleep restriction is a very solid option for how to do so. It may be that, now that you’ve got some experience with those cognitive strategies (with get more effective over time as you get more skilled with using them), you may now be more prepared to tackle it than you were in the past. The thing about anxiety is that it tends to keep going when we avoid experiencing it. When we allow ourselves to experience anxiety repeatedly, without doing anything to avoid it, we teach our brains an important lesson that we can handle the situation at hand, and the anxiety tends to go down on its own. This is what’s known as “habituation” – as we repeatedly engage in an activity that makes us anxious, the anxiety tends to die down on it’s own. You may find that if you do decide to try it again and you still have anxiety, if you allow it to be present and persist with trying the sleep restriction, it will get better on its own over time. If you find that the anxiety is too much for you to handle on your own, it may be helpful to work with a professional who can give you more tools for managing it.

    Additionally, another possibility is to try sleep compression, which can be a good alternative for those who feel especially anxious about sleep restriction. Sleep compression involves gradually decreasing the sleep window rather than gradually increasing the sleep window. For example, if you are sleeping 5 hours, but are spending 8 hours in bed, you gradually decrease the sleep window by 15-20 minutes per week until you see a sleep efficiency of above 90%. E.g., week 1, your sleep window is 7.75 hours, week 2 your sleep window is 7.5 hours, week 3 your sleep window is 7.25 hours … and so on. Once you achieve the 90% sleep efficiency, you can either keep your sleep window as is or start to gradually increase it again. If you go this route, it’s most important to pay attention to how you are feeling during the day (e.g., how alert/wakeful you are) rather than the number of hours (as the number of hours needed for sleep can differ between people).

    I hope this is helpful!

  • Sleepio Member

    • 24 comments
    • 17 helped
    Graduate

    Thanks so much for the comprehensive advice, and this is certainly very helpful.

  • Sleepio Member

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

    Hi Jacq,

    Thanks for the question and the problem you describe is not at all uncommon. Stress and sleep have a bidirectional relationship, meaning they are highly connected – if we are stressed, our sleep suffers, and if we sleep poorly, we feel more stressed. The good news is that managing our stressors during the daytime can have a positive effect on our sleep (meaning there are strategies you can use throughout the day to reduce your overall stress level, rather than just trying to cope with the stress you feel at night with a worried mind). It sounds like you are engaging in some of these activities (mindfulness, journaling, relaxation techniques), which is great! Two additional strategies that people often find to be helpful are exercise and a technique called worry time. Exercise has been demonstrated through research to have a really powerful impact on both sleep and stress. Getting in some regular exercise, with light to moderate intensity, at least 3 times a week, is a great way to manage stress. It will be important not to do this too close to bedtime so it doesn’t interfere with your sleep.

    Additionally, worry time is another powerful technique for managing worries. The idea behind this technique is similar to the bed-sleep connection in that it takes advantage of the fact that our brains build connections between certain contexts (e.g., being in bed) and activities/emotions (worrying). The idea is to schedule about 20 minutes a day where you (in the same place and time, each day) spend time focusing on your worries. This can look like focusing specifically on one problem (and maybe problem solving), or simply cycling through worries in your mind. Then, once those 20 minutes are up, worry time is over. If worries start creeping in at night, you can say, “nope, I already worried about that earlier” or, “nope, I have time set aside to worry about that tomorrow, and I'll be more effective at problem solving during that time than I will be now, when it's time for sleep.” Over time, your brain will learn that there is a dedicated place and time for worrying and worries will start to interfere with sleep less. This technique does take time and practice to start working, but it can be highly beneficial for worrying.

    Hope these are helpful suggestions!

  • Sleepio Member

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

    Hi who123*

    I saw you asked a question about the live discussion – I am currently live and responding to the questions in order (i.e., there’s no zoom, it is all chat-based).

    Regarding your question about sleep restriction, this is not at all uncommon when first starting sleep restriction (especially on the first night). There is a transition period where at first, things can start to get a bit worse before they start to improve. Many people notice “side effects” of sleep restriction, like fatigue, headaches, irritability, etc. Over time, sleep restriction will become less difficult as your body starts to adjust to the new schedule. You will be the best person to decide whether or not the experiences you’re having are tolerable (i.e., whether you should keep engaging in sleep restriction, or lengthen your time), but my general advice is to try to stick with it and see how it improves over time, as the difficulties you’re describing do not appear to be uncommon.

    Here’s an article you may find insightful: https://www.sleepio.com/library/article/i-cant-put-sleep-restriction-into-action-right-now/

    Hope this is helpful!

  • Sleepio Member

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

    It's generally advised to stick to the same schedule every day (as our circadian rhythms thrive on consistency), but again, you'll be the best judge as to whether or not you will be able to tolerate the difficulties that sleep restriction can cause in the beginning (which do tend to go away with time). I hope the article I posted in the last response gives you some good insight to make the decision.

  • Sleepio Member

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

    No problem, so glad to hear it was helpful! Feel free to keep us posted on how it's going.

  • Sleepio Member

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

    Thank you so much for your reply.

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