Live Discussion with Dr Michelle Davis - 28th July 2021

Dr Davis will be hosting a live online discussion here on Wednesday 28th July, 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 23 Jul 2021 at 9:28 PM
  • 12 comments
  • 2 helped

Comments

  • Sleepio Member

    • 20 comments
    • 1 helped
    Graduate

    On most nights I do not have problems falling asleep but I have problems waking up 3-4am with inability to fall back asleep almost every night. I'm not sure though if I fall asleep or not. I try to estimate the 15 minutes but sometimes couple hours goes by without me knowing it. Sometimes when I'm doing this, I have dreams or I'm told that I snore, so I think I must've been sleeping? Other times I think it could possibly not have been 2-3 hours so I suspect I may be dozing or in/out of sleep? Nonetheless, I'm always very tired.

  • Sleepio Member

    • 2 comments
    • 0 helped
    Session 5

    Hi,

    I just started sleep restricting and I was wondering what should I do if I'm feeling under the weather. If sick, should I sleep in or keep restricting?

    Thanks!

  • Sleepio Member

    • 3 comments
    • 1 helped
    in reply to Sleepio Member
    Graduate

    kmins I just read your post & felt I could have written it myself!

    Like you I'm not always sure if I have actually dozed off again after waking around 4am. I also think its been 15 minutes then find 2 hours have gone. I'm not generally tossing and turning, just lying there still, so I think maybe I do get some light sleep sometimes, but it can't be proper sleep as I still feel very tired when this happens.

    Sometimes I also feel like I have a really groggy thick head, I can't get back to sleep but also don't feel awake up enough to get out of bed.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Session 5

    been working with the plan for several weeks havent seen much improvement other than the lack off sleepless nights. is this as good as it gets?

  • Sleepio Member

    • 20 comments
    • 1 helped
    Graduate

    Sleepysue, thanks for your message. Let’s hope the doctor will be able to advise us as I’m sure it’s a very common problem. Thanks for helping me see I’m not alone in this.

  • Sleepio Member

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

    Hi kmins,

    Thanks for the question – it’s one we get a lot, and it looks like others in the chat have had a similar experience.

    Regarding being unsure if you’re asleep or not – this is a really common experience. Research indicates that we are, in general, pretty bad at estimating time, and particularly bad at estimating the time we’ve been awake versus asleep. Light stages of sleep versus wakefulness are some of the hardest to differentiate. However, getting the time exactly right (and understanding exactly how long we were awake versus asleep) isn’t necessary, and can even be counterproductive. For example, if someone is looking at a clock or very worried about how much time they’ve been awake versus asleep, this can add to anxiety around sleep and actually make things a bit worse. My general advice is to not focus on getting a precise estimate (and not even looking at the clock when in bed to check to see if your estimates are accurate), but instead to focus on getting out of bed when you’re not sleepy. If you find yourself awake and you can’t fall back asleep, get out of bed. It doesn’t have to be perfect, and not knowing what happened in the middle of the night is a good indicator that you were likely asleep for a good portion of that time. Your best guess is likely to be fine. It’s worth remembering that insomnia is considered a subjective disorder – it’s based on self-reported judgments of sleep quality – and therefore, your subjective estimate of sleep will best capture your insomnia.

    Regarding the early waking, this is also a common experience and can be really tricky. Sometimes it’s biological – we all have different circadian rhythms, and some people are more likely than others to experience early awakenings. There are a few different options that you might try experimenting with:

    1. It is sometimes helpful to shift the bedtime later (i.e., keep the same sleep window, but push the entire window back). This will increase the need for sleep (i.e., make you more sleepy), which may make it more likely to sleep past your typical early morning wake up time.

    2. Another option is to experiment with leaning into the early awakening, and shift the bed time earlier to account for the earlier rise time (again, keeping the same sleep window, but shifting it earlier).

    Experimenting with these strategies may be helpful. As a final tip, research suggests that light conditions can have a really important effect on our circadian rhythm, and we can use this fact to leverage light to our advantage. For example, making sure you’re in dim lighting conditions near bed time, and getting bright light exposure first thing upon waking.

    I hope this information is useful – here’s a link to a community discussion that discusses this issue and how other people have managed the same problem:

    https://www.sleepio.com/community/discussion/early-awakening/

    Best of luck!

  • Sleepio Member

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

    Hi ICan’tGetNoSleep,

    This is a great question, and one that we get a lot – thanks for posting it!

    In general, we tend to recommend sticking to sleep restriction guidelines as strictly as possible – this is the best way to see big improvements in sleep. However, when someone is sick, it is definitely a good practice to apply some leniency, particularly because sleep is really important for our immune functioning and recovery. My general advice is to allow for extra time in bed when sick, and then get back to the recommended window once healthy. Another tip is to keep filling out the sleep diary as usual – the extra time in bed will likely influence adjustments to your sleep restriction window, but you can return to sleep restriction once you’re feeling healthy again. You can also add custom tags to your sleep diary to keep track of days that you were feeling sick.

    I hope this helps, and best of luck with the sleep restriction!

  • Sleepio Member

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

    Hi Sleepysue29,

    Since you posted about having a similar experience to kmins, I’ve pasted my response to their questions below -- hope this helps:

    --

    Regarding being unsure if you’re asleep or not – this is a really common experience. Research indicates that we are, in general, pretty bad at estimating time, and particularly bad at estimating the time we’ve been awake versus asleep. However, getting the time exactly right (and understanding exactly how long we were awake versus asleep) isn’t necessary, and can even be counterproductive. For example, if someone is looking at a clock or very worried about how much time they’ve been awake versus asleep, this can add to anxiety around sleep and actually make things a bit worse. My general advice is to not focus on getting a precise estimate (and not even looking at the clock when in bed to check to see if your estimates are accurate), but instead to focus on getting out of bed when you’re not sleepy. If you find yourself awake and you can’t fall back asleep, get out of bed. It doesn’t have to be perfect, and not knowing what happened in the middle of the night is a good indicator that you were likely asleep for a good portion of that time. Your best guess is likely to be fine. It’s worth remembering that insomnia is considered a subjective disorder – it’s based on self-reported judgments of sleep quality – and therefore, your subjective estimate of sleep will best capture your insomnia.

    Regarding the early waking, this is also a common experience and can be really tricky. Sometimes it’s biological – we all have different circadian rhythms, and some people are more likely than others to experience early awakenings. There are a few different options that you might try experimenting with:

    1. It is sometimes helpful to shift the bedtime later (i.e., keep the same sleep window, but push the entire window back). This will increase the need for sleep (i.e., make you more sleepy), which may make it more likely to sleep past your typical early morning wake up time.

    2. Another option is to experiment with leaning into the early awakening, and shift the bed time earlier to account for the earlier rise time (again, keeping the same sleep window, but shifting it earlier).

    Experimenting with these strategies may be helpful. As a final tip, research suggests that light conditions can have a really important effect on our circadian rhythm, and we can use this fact to leverage light to our advantage. For example, making sure you’re in dim lighting conditions near bed time, and getting bright light exposure first thing upon waking.

    I hope this information is useful – here’s a link to a community discussion that discusses this issue and how other people have managed the same problem:
    https://www.sleepio.com/community/discussion/early-awakening/

    --

    Best of luck!

  • Sleepio Member

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

    Hi clp899,

    Thanks for the question. I’m glad you’ve had a lack of sleepless nights – that seems like a success if this is something you were struggling with in the past – but sorry to hear that you haven’t seen much improvement in other areas.

    It’s difficult to say what you should expect without knowing more about what problems you’re still experiencing, but in general, as people continue applying sleep restriction, the quarter hour rule, and good general sleep hygiene, they should continue to notice improvements in their sleep quality and daytime functioning over time. If your problem is with daytime functioning (i.e., if you’ve found that your sleep has improved for several weeks yet still feel very fatigued), it may be important to check with your doctor about whether there may be another cause for the fatigue.

    If your problem is with sleep itself, unfortunately, there’s no good answer to the question “how long does it take sleep restriction to start working?”. For some, it works immediately, but more often, it can take several weeks for the sleep drive and circadian rhythm to adjust.

    It looks like you are on week 5 of the program, and have been implementing sleep restriction for a few weeks. My general advice is to stick with strict implementation of sleep restriction (along with the quarter hour rule and general good sleep hygiene) for several weeks to see its full benefit.

    I hope this is helpful!

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    Dear Michelle,
    I hope you are well
    I’ve been sleeping restricting for a while. I started a new job 6 weeks ago (traveling to work).
    Before the job, I was waking up at 8 pm and going to bed at midnight. My sleep and energy levels were good. I felt rested. I gradually adjusted my sleep schedule to waking up at 6:50 am and going to bed at 23:40 pm. I feel extremely exhausted and my energy levels are not getting any better. I don’t feel rested and have body aches and headaches every day. I have also gained a lot of weight during lockdown.
    Also, every Sunday night I only get 2 hours of sleep and then the rest of my week is even more exhausting.
    Is there anything you could suggest, please?
    Thank you

  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    *sorry I meant to say I was waking up at 8 am

  • Sleepio Member

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

    Hi sannaj,

    Thanks for the question and sorry to hear you've been having such a difficult time.

    A few things come to mind in response to your post. First, there can sometimes be a circadian misalignment between jobs and circadian preference (i.e., everyone has a unique circadian rhythm or preference – a tendency to prefer going to bed late and waking up late, or vice versa). It could be that you're having some trouble adjusting to the new job schedule. One thing that can help with adjusting the circadian rhythm are paying close attention to light exposure (e.g., getting bright sunlight exposure early in the morning, and keeping dim conditions in the evening).

    It could also be possible that a major life change (like a new job) could be creating some stress that is contributing to poor sleep. Even if a change is a “good” change, it is still a change that can have an impact on our stress levels. Making sure you're getting some moderate intensity exercise at least 3 times a week can go a really long way toward reducing stress levels (and as a side benefit, improving sleep). It would be interesting to know if there is something happening on Sundays that contributes to your poor sleep on this day – perhaps concern about starting the work week? If you find that you are having a lot of stress related to this change (or due to other reasons) and that you're unable to manage it on your own with self care strategies like exercise, you may want to speak to a doctor.

    Finally, you mentioned that during lockdown you've gained weight, and described some other difficulties (body aches, headaches) that may be related to sleep loss, but may also be due to other sources (e.g., stress, depression, a medical condition). It may be helpful to speak with your doctor to determine if something else may be causing these issues, and how you might manage.

    I hope this is helpful, and I hope you find some relief soon!

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