Live Discussion with Dr Michelle Davis - 24th March 2021

Dr Davis will be hosting a live online discussion here on Wednesday 24th March, 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 19 Mar 2021 at 5:20 PM
  • 26 comments
  • 5 helped

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  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Good morning Dr. Davis.
    Can you help with my problem please?
    I have finished the 7 weeks of the program and will be continuing as this gives good evidence to work with.
    One thing that has become apparent is the evidence that when I have a very poor night's sleep this coincides with very high readings from my COPAP machine of an AHI figure in excess of the 30 score that I understand is considered severe. The other day the AHI figure was 43.8. My previous highest score was 38.
    Is there any evidence that a high AHI score is accompanied with a poor night's sleep. What can be done to help me in with this issue?

  • Sleepio Member

    • 4 comments
    • 0 helped
    Session 5

    Hi,

    I'm wondering whether restricting the act of lying down during the day would serve as effective Stimulus Control Therapy. I.e. is it efficacious to restrict lying down (whilst reading on the sofa for example) to increase the bed-sleep connection?

  • Sleepio Member

    • 9 comments
    • 5 helped
    Graduate

    I’m in week 3 and so far it seems my sleeping is now even worse. Previous to this week I would go to bed at 10 and often wake around 3 (and not be able to go back to sleep)..now I’m going to bed at 11:30 and have still woken at 3 in 2 out of the last 3 nights (and not able to ever return to sleep), although I’ve also had a night where I did sleep until 5. Also,I have no problem initially falling asleep and have a very hard time staying awake until my bedtime.

    Any ideas in what I should be doing differently? Is what I’m experiencing common during the first week of SR?

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    Hi. I’m in my second week and have seen comments about the QHR. I can lay awake in my mind for a couple of hours during the night with a busy head, but if someone were to look at me they would think I was asleep. I never lay wide awake with my eyes open. Will the QHR apply in this case? I find it really hard to open my eyes as they are so tired. I even get up for a wee just squinting through one eye! I feel that getting up will wake me even more if that makes sense.

  • Sleepio Member

    • 64 comments
    • 18 helped
    Graduate

    I have a comment about time zones for my fellow Sleepios who are now on Daylight savings time. 8:30 GMT is 4:30 EDT. I think the U.K. is not yet on summer time. So I think today’s session starts at 4:30 EDT. It is currently 1:34 EDT.

  • Sleepio Member

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

    Hi Hantshoney,
    I’m sorry to hear you’re struggling with nightly nightmares, that can be very scary and upsetting. I think it can be helpful to remember that in times of stress, our dreams can become more intense and distressing (i.e., nightmares). A recent study examining the impact of COVID-19 indicated that people are reporting more nightmares during this time (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560506/ for this article).

    The contents of Sleepio won’t specifically target nightmares, however, there is research indicating that cognitive and behavioral approaches (like Sleepio) can lead to a reduction in nightmares (likely via general sleep improvement). My general advice would be to try to focus on stress reduction, and remember that this may be a temporary occurrence. Other things that have been helpful to others are to limit alcohol consumption before bed.

    If you find that these nightmares are recurring outside of times of stress, don’t resolve on their own, or are causing you lots of distress, I would recommend speaking to a doctor who may be able to provide you with behavioral interventions or medications that target nightmares specifically.

    I hope this is helpful and I hope your nightmares improve soon.

  • Sleepio Member

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

    Hi sleeplessinEDH,

    Thanks for the question. The answer will depend on both personal preference, and perhaps a bit of experimentation to see what works best for you. Per the QHR guidelines, getting out of bed is the appropriate action, but after that, it will be up to you to decide what works best for you during that time. The two viable options are 1) engage in a non-stimulating activity in low light conditions and see if you get sleepy enough again to return to bed (noting that you may not, since it’s so close to your wake time), or 2) start your day a bit earlier.

    As I alluded to earlier, this may take some experimentation. You might try option 1 and see if you are able to get sleepy enough to fall back asleep and if not, try option 2. Ultimately, it will be important to try to stick to the same rise time each day, so this may mean you need to adjust your bedtime slightly (i.e., shift it slightly later) if you find that 5:15 is too early for you to consistently wake up.

    I hope this is helpful information!

  • Sleepio Member

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

    Hi plorl,

    Thanks for the question. These guidelines are meant to be general in nature (and flexible per your preferences and what works best for you). The intended verbiage there is to try to eat at least 3 hours before bed (i.e., try not to eat in the 3 hour window before bed).

  • Sleepio Member

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

    Hi TiredMum1,

    Thanks for the questions.

    Regarding irritable bladder, this can definitely be tricky (and a common problem). It’s good to hear that you’re able to go back to sleep immediately. 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 to 1) not reduce your daily amount of 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 (which I’m sure you are doing!). If you find that you’re having trouble getting back to sleep or that the awakenings are very distressing, the best option would be to speak to your about potential solutions.

    Regarding external noise, a solution that has been helpful for some is to experiment with white noise (e.g., a fan, a white noise machine), which can help mask sounds. Others have found that sound-proofing their bedroom (with double-glazing, heavy curtains, carpets or rugs, or even wall insulation) can help drown out noise. It may also be helpful to know that it is possible to learn to tolerate, or desensitize yourself, to external sounds. Many people learn to sleep under a flight path, or with a newborn, for example. Sometimes, it’s not just the noise that causes the problem, but the thoughts that people tend to have about the noise that causes a lot of the problem. If you find yourself having thoughts like “I can’t handle this” or “this will never get better” when you are awakened by a loud noise, it may be useful to try challenging (or reframing) those thoughts. For example, a slight shift in thinking can look like reminding yourself, “this is difficult, but I am trying different strategies for overcoming it”. This can have a big impact on how the noise affects you. The less you are distressed by the noise, the less of a negative impact it will have on your sleep, and the less distressing the noise will become. Though environmental changes are likely your best bet, keep in mind that it is possible to break this cycle of noises causing distress that impacts your sleep by practicing accepting it, rather than fighting against it, to try to develop a more neutral, less distressing emotional response to the noises.

    Hope this helps!

  • Sleepio Member

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

    Hi Rose,

    Great question, thanks for asking it.

    There is some research to support that this month of fasting can have an impact on sleep cycle (not only because our meal timing can impact our circadian rhythms, but also because many people make changes in lifestyle and habits during Ramadan).

    My general recommendations would be to try to keep regular hours during this time (i.e., going to bed and getting up at approximately the same time each day), avoid caffeine in the evenings, and to get regular exercise (not too close to bedtime as it may impact your sleep). As to how to resume your usual sleep, immediately trying to return to your previous sleep schedule OR slowing working your way back to your previous schedule (by slowly adjusting your sleep window) are both viable options. One tip when trying to readjust after Ramadan is to remember that bright light boosts alertness. Light alarm clocks and light boxes that mimic the sun’s spectrum and intensity can help to reset wake cycles.

    You might also try making a post on the Sleepio community to see how others have dealt with sleep disruptions due to Ramadan.

    I hope this is helpful!

  • Sleepio Member

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

    Hi SleepingWellPlease,

    Thanks for the question. Though not covered as specifically within the Sleepio program, we do have a sleep guide specifically for shift workers on how to apply/adjust the program recommendations while doing shift work.

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

    This guide also references some of the research literature in this area.

    Hope this helps!

  • Sleepio Member

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

    Hi DPS,

    In general, this is a question best suited for your doctor, who will be best able to help you with your sleep apnea (as sleep apnea is not covered in Sleepio, and your doctor will be in the best position to help you determine whether your AHI scores are too high. My only general advice here would be that you may want to speak to your doctor about the machine (e.g., the machine, the fit of the mouthpiece, etc.) to ensure that its functioning properly.

    Best of luck!

  • Sleepio Member

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

    Hi bhonan,

    I don’t think there is research investigating whether this works, but in general I would say it’s a very nice idea and worth experimenting with! Anything you can do to strengthen the bed-sleep connection (and this seems like a potential way) is generally in line with Sleepio’s recommendations.

    Great question and nice idea!

  • Sleepio Member

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

    Hi again. :)

    It is not at all uncommon to experiencing worsening sleep with the onset of sleep restriction – you’re certainly not alone – and this is actually an indicator that it seems to be working. The fact that you’re having a hard time staying awake until your bedtime indicates that your sleep drive is high. Over time, you should find that your sleep will gradually become more consolidated (i.e., less unbroken). If you find that you continue to wake up way too early or are unable to stay awake until your, you might consider whether minor adjustments to your sleep schedule (i.e., shifting the window forwards or backwards by 30 minutes) are helpful to be more in line with your natural rhythms.

    This is definitely a challenging time, but it does tend to get a bit worse before it gets better. Please feel free to check back in with how it’s going!

    Great job sticking with it!

  • Sleepio Member

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

    Hi JT567,

    Great question. Technically, the QHR should apply any time you are awake (even if your eyes are closed). The purpose of the QHR is to associate being in bed with being asleep. Getting up likely will wake you up a bit more, but it will help build the bed-sleep connection, which is an extremely important piece of the program.

    Hope this helps!

  • Sleepio Member

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

    Thanks for the comment! I've informed our team in case the timing information on the website is incorrect.

  • Sleepio Member

    • 3 comments
    • 2 helped
    Graduate

    Should I import Fitbit data or should I adjust it to match my experience? My Fitbit says I am awake 8+ times a night, some 30 secs. I don’t remember most of these awakenings so wonder if I should adjust what I enter in sleep diary to reflect what I remember?

  • Sleepio Member

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

    Dear Dr Davis,

    Thank you for your reply.

    I was referred to this website by my GP. I had just completed a sleep study at Papworth Hospital. They referred me to another sleep help website, but my GP preferred I use this one.

    Papworth Hospital first said that my CPAP machine was faulty and gave me a new one and replaced my mask. Over the next weeks I recorded the AHI and PB scores and I was not surprised to see that it had made no difference and the relationship between poor sleep and high AHI scores was still apparent.
    When I did the sleep study at Papworth, the day of the study I had a relatively ok night's sleep so of course this did not produce the evidence I needed to prove my point of view and the evidence I have collected seems to no have any value.

    I am sorry to be a bit blunt here but this is how I currently see things –

    I have produced considerable evidence to show that my poor sleep coincides with a high sleep score but NOBODY seems to want to listen. All that happens is everyone seems focused on referring me to anyone so that they do not have to pick-up and take responsibility to guide me out of this maze.

  • Sleepio Member

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

    Dear Dr Libby,

    After conducting research, Fitbit's are generally unreliable for tracking sleep accurately. I did use mine, however, I understand that I am not waking up that amount for more than a few seconds. I decided just to relax about it and rely on my sleep efficiency score in Sleepio.

    I hope this helps,

    Sleep Well Please

  • Sleepio Member

    • 2 comments
    • 3 helped
    Session 2

    Hi, I struggle to get to sleep but also to stay asleep. I can wake anything upto 10 times a night. I wake up feeling groggy and like i havent slept. This is also causing me to fall asleep during the day. I really struggle to stay awake during the day.

    Any advise please

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