Live Discussion with Dr Michelle Davis - 31st March 2021

Dr Davis will be hosting a live online discussion here on Wednesday 31st 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 25 Mar 2021 at 4:54 PM
  • 22 comments
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  • Sleepio Member

    • 3 comments
    • 0 helped
    Graduate

    Hi. I’m concerned about week three having to stay up later – I struggle with tiredness in the evenings anyway, and when I’m really tired I get restless legs. If I go to bed with restless legs even more, I’ll never sleep! Any advice for dealing with restless legs? Thanks

  • Sleepio Member

    • 3 comments
    • 1 helped
    Graduate

    Four questions:

    I’m concerned about the QHR, because past experience is that, if I get up in the night, I then wake up more, start to feel hungry, as if it was morning, so then it’s more difficult to go back to sleep and feel really dreadful the next day, whereas, if I just lie in bed, I don’t worry about not sleeping and just drift until I go back to sleep, and feel tired etc the next day, but not as dreadful. I will try the QHR, but I’m worried it will make my mental and physical health worse. Is there any other advice, given this experience of feeling worse?

    Also, there’s lots in the programme about before and during the night, but not about mornings. Given the opportunity, I’ll stay in bed, after I’ve woken for the day, surfing on my phone, eg reading/watching this Sleepio programme. My bed is the most comfortable place in the house, but I know it’s a bad habit and I miss achieving more practical things during the day, which leads to poorer mental and physical health, so I am supposing I must get up when my alarm goes off and not go back to bed, so that bed is only for sleep?

    Also, particularly during the pandemic, when the whole family has been working from home, bedrooms have become used as offices too, so it’s hard to have that dedicated sleep space. There isn’t space to put all our offices elsewhere, particularly when we have meetings which would disturb the others. Is there any way to mitigate this? My teenager prefers to do her homework in her bedroom anyway, which I’m sure is not good for her sleep.

    Will there be guidance on how to achieve deeper sleep? I’ve always been a light sleeper, so am easily woken by my husband getting up in the night, to go to the loo, even though he now sleeps in another room. I was fed up with his snoring and restless movements and light/ noise disturbance from him watching videos/listening to podcasts on his headphones, because of his tinnitus, and he was fed up with me complaining about those or waking him up to stop snoring/jiggling. Ideally, I’d like to share a bed again, but we both need to sleep.

  • Sleepio Member

    • 4 comments
    • 0 helped
    Session 5

    Hi Dr. Davis,

    I've been practicing sleep restriction for a week now. My main sleep problem is frequent awakenings and I don't struggle falling asleep anymore. A typical night now involves me waking up once or twice for 10-30 minutes, it doesn't take me very long to get back to sleep after getting up to practice the QHR. My question is: is it advisable to increase my sleep window to 15 minutes even though I still wake up once or twice a night? I've been averaging ~83-90% sleep efficiency this past week, but I usually find it hard to fill in my sleep diary to an accuracy of 15-30 minutes, so my efficiency could actually have been 90%+ for all of last week, but I'm really not sure. My concern is that increasing my sleep window too soon will have a negative impact on my frequent awakening problem. At the same time I can easily see myself stagnating at 85% only to never increase my sleep window (I usually err on the side of pessimism when filling in my sleep diary).

    I hope that kind of makes sense. Many thanks!

    B

  • Sleepio Member

    • 3 comments
    • 1 helped
    Graduate

    Waking from 3am onwards and then my worries start one after another. Can you give me the best thing to try at that time so that I can fall asleep again. At these times my body is too tired to move. My worries escalate and I end up getting up early.
    Thankyou.

  • Sleepio Member

    • 1 comments
    • 0 helped
    Graduate

    Hi Michelle, I would absolutely love to hear any comforting words you may have for those of us suffering with sleep problems at the moment, and finding it hard to cope.

    I'm 32 years old, doing really well in my job and felt like I had my whole life ahead of me – I was in a great place until sleep became out of reach.

    In reality, I've only had 3-4 weeks of sleep problems, 2 of which have been intense and very low amounts of actual sleep. It started in Nov 2020 for a short sharp week of insomnia before I was put on Mirtazapine which helped tremendously until I started to taper back end of Feb. 3 weeks in my sleep was broken but manageable. This past week I feel I am at square one, and I can't seem to look to a future where I feel well again or able to sleep soundly as I once used to. I want to try and continue without mirtazpine, trying (and not really believing) that things will (must) improve. I get irrational thoughts such as going back on the medication won't work anymore and that I'll use up all options and be left in this nightmare for the rest of my life.

    I'm sorry if that sounds dramatic, but it just feels so hard to struggle with something so natural. Any words of wisdom or kindness may help at this stage.

    Thank you,
    Emma

  • Sleepio Member

    • 9 comments
    • 5 helped
    Graduate

    Hi Dr Davis,

    I’m in week 4 of the program and am really struggling. My sleep window is 6.1/2 hrs of which I’m probably sleeping between 5 and 5.5 hrs (which I know is more than many). Problem is that I feel I am way more sleep deprived now, barely functional most days now (I’m not working so there are no issues there). My efficiency is decent most days now Due to restricted time in bed but since I can’t even stay asleep until my wake up time I don’t see how I can increase my sleep time anytime soon. I also find it incredibly difficult to stay awake until my go to bed time (But I’m doing it mostly…although I did go to bed earlier at least once). Any ideas or words of wisdom? I generally do sleep uninterrupted for 5 or so hours but unfortunately I can’t function at all on that little sleep.

  • Sleepio Member

    • 3 comments
    • 1 helped
    Session 2

    I worry about keeping my husband up with my snoring this affects my sleep

  • Sleepio Member

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

    Hi MohamedAli10,

    Deep sleep (or stages 3-4 of the sleep cycle, also known as slow-wave sleep or SWS) typically up approximately 20% of the night and REM sleep typically takes up 20-25% of sleep. However, it’s important to know that these percentages vary widely between individuals. Specifically, deep sleep really varies across the lifespan, where we see that as we age, we have a smaller percentage of deep sleep. REM sleep can also vary depending on an individual’s biological need for sleep.

    I think you might find this Sleepio Expert Article to be interesting and informative:
    https://www.sleepio.com/articles/sleep-science/what-is-sleep/

    Thanks for the question!

  • Sleepio Member

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

    Hi Kazd,

    Great question. Menopause can definitely have an impact on sleep for many people (though not all).

    The hormonal changes that occur during the transition to menopause can cause many women to experience hot flashes and night sweats, which can lead to waking during the night and/or difficulty falling asleep. Additionally changes in mood (i.e., increases in anxiety, stress, and irritability, as well as low mood) can impact sleep, due to the close relation between sleep and our emotions. Research does suggest that menopause can have a negative impact on sleep quality. The good news is that these problems tend to stabilize over time as hormone levels stabilize.

    There are many techniques to try to reduce the impact of menopause on sleep, which are outlined in this Sleepio library article:
    https://www.sleepio.com/library/article/menopause-and-sleep/

    Additionally, here are a few more articles on the impact of menopause (and hormones more broadly) on sleep:

    https://www.sleepio.com/library/article/menopause-and-sleep-problems/

    https://www.sleepio.com/library/article/hormones-and-sleep-a-two-way-street/

    I hope this information is useful!

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    Hi Dr Davis,

    What's the best way to treat getting ill whilst on sleep restriction?

    Usually I find it best to sleep / rest as much as possible whilst getting better, but this can mess with the sleep schedule. Should I sleep elsewhere outside of hours, or pause sleep restriction until better? And if paused, should I then restart sleep restriction completely, or start from where I left off?

    Many thanks

  • Sleepio Member

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

    Hi JT567,

    The restless legs sounds really frustrating and difficult! You’re not alone in feeling concerned about week 3 – this is definitely the most difficult part of the program, but also the most powerful technique! You may experience difficulty sleeping during the early stages of sleep restriction, but that is actually very common – things tend to get a little bit more difficult before they get a lot better, so I hope you are able to hang in there.

    In terms of the restless legs, it’s difficult to provide advice on how to manage them without more information (as there could be several different causes).

    You may want to speak to your medical provider to determine the cause in order to inform what treatment will work best. There are a few different types of sleep disorders that can cause a sensation of restless legs – for example, restless leg syndrome is characterized by an uncontrollable urge to move your legs during periods of rest or immobility, while periodic limb movement syndrome is characterized by muscle jerks or twitches throughout the night or when trying to fall asleep. Generally, it is recommended that individuals consult with a medical professional if these experiences are causing significant discomfort or distress.

    Generally treatment for these types of issues consists of medication and lifestyle changes (e.g., avoiding caffeine, alcohol, and nicotine use, and getting regular exercise). For more information about restless leg syndrome, please check out this Sleepio article:

    https://www.sleepio.com/library/article/what-is-restless-legs-syndrome-rls/

    Additionally, this community discussion about restless legs may also have some useful tips and information:

    https://www.sleepio.com/community/discussion/does-restless-leg-syndrome-keep-or-wake-you-up-dur/

    I do want to point out that research has demonstrated that the cognitive and behavioral techniques used in Sleepio are helpful for treating insomnia in individuals with restless leg syndrome and other sleep disorders. However, if you are using the Sleepio interventions and are still struggling with sleep, you may require more personalized care. Again, your doctor or a sleep specialist will be able to provide you with more personalized advice.

    Hope this helps!

  • Sleepio Member

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

    Hi Daisy66,

    Thanks for the questions.

    In terms of the QHR, it can sometimes feel a bit worse in the beginning as your brain and body adjust to the new routine; however, it is a very important part of the process in order to build the bed-sleep connection. While laying in bed can definitely feel easier, it is actually maintaining the sleep problem by forming a connection with the state of being awake while also being in bed. I generally advise folks to try it – the extra stress in the beginning tends to pay off. Regarding your second question – yes, you should get out of bed at your rise time and only return to bed to go to sleep. Preserving the bed for sleep and sex only is crucial to forming an association between being in bed and being asleep.

    Here are some articles describing why the QHR is so important and useful:

    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-just-isnt-for-me/

    https://www.sleepio.com/library/article/the-quarter-of-an-hour-rule-the-science/

    https://www.sleepio.com/library/article/the-bed-sleep-connection-the-science/

    Regarding working from home and limited space – you’re definitely not alone there! Though it’s not ideal for sleep, there are some things that you won’t be able to get around if you have limited space. My general advice would be to try to stay out of the bed specifically and do what you can to separate the desk area from the bed area – creating different “zones” of work and sleep. Some have done this by facing the desk away from the bed, or using a room divider.

    Here’s an article on the impact of the sleeping environment on sleep:

    https://www.sleepio.com/library/article/the-importance-of-the-sleeping-environment/

    For your final question, both the QHR and sleep restriction (which it looks like you’re about to start!) are both powerful tools for achieving deeper sleep. Sharing a bed with a partner can be really difficult! I’ve posted a few articles and discussions below that describe how to mitigate some of the difficulties with being a light sleeper and sharing a bed:

    https://www.sleepio.com/library/article/poor-sleepers-impact-on-their-bed-partners/
    https://www.sleepio.com/community/discussion/coping-with-noise/

    https://www.sleepio.com/community/discussion/how-can-you-minimise-the-effect-of-your-insomnia-o/

    https://www.sleepio.com/community/discussion/sleeping-with-your-bed-partner/

    Hope this is helpful!

  • Sleepio Member

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

    Hi bhonan,

    Thanks for the question. My general advice in situations like these is to experiment – you might try increasing your sleep window and seeing if your awakenings increase – if so, you could return to your previous schedule (or build your sleep window out even more slowly). It’s also sometimes helpful to remember that waking up during the night is normal and to be expected – everyone wakes up sometimes during the night, even if they don’t remember it. If the awakenings are short in duration and easy to fall back asleep (which it sounds like yours are), and if they are not causing significant difficulties in daytime functioning, they are generally to be expected.

    Great job sticking with sleep restriction which can be difficult! Good to hear you’re not struggling to fall asleep, and I hope you continue to see improvements!

  • Sleepio Member

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

    I’m sorry to hear about the difficulties you’re having with worrying early in the morning. My general advice for this kind of situation is two-fold. First, during session 3, you learned about the quarter of an hour rule (QHR), which encourages people to get out of bed if awake for more than 15 minutes. The reason this rule is so crucial is because our brains are very good at forming associations – when we experience anxiety in bed, we are teaching our brains that the bed is a place for wakefulness and arousal. This builds the connection between being in bed and being anxious, so that the act of being in bed itself can lead to worry and anxiety. Instead, we want our brains to learn that the bed is a place for sleep. The QHR is based on that principle – it’s really important to get out of bed (though as you noted, it can feel very difficult!), then out of bed, do something relaxing in dim light or dark conditions, and only return to bed once feeling sleepy. The QHR is a great way to start to condition a bed-sleep connection (versus a bed-worry connection!).

    Second, during sessions 4 and 5, you will learn some evidence-based techniques for coping with sleep-related worries. I think the technique that is most helpful for the situation you describe is one called scheduled worry time. This technique is something you do during the day to reduce worrying at night. The idea is to schedule 20 minutes a day in the same time and place, every day, to devote to worrying and/or problem solving. During those 20 minutes, you can either cycle through the worries (as you’re currently doing in bed), or try to write down as many worries and solutions as possible. 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.” Eventually (over time), your brain will learn that there is a dedicated time and place for worrying and you’ll find yourself worrying less in the wee hours. This is a technique that takes practice and time to get skillful at, so please don’t be discouraged if it doesn’t help the first time you try it!

    Here are some Sleepio articles and a community discussion that may be helpful:
    https://www.sleepio.com/library/article/cognitive-techniques-in-depth/

    https://www.sleepio.com/library/article/challenging-your-thoughts/

    https://www.sleepio.com/community/discussion/meditation-and-relaxation-techniques/

    Hope this is helpful.

  • Sleepio Member

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

    Hi Emma,

    I’m so sorry to hear that you’ve had such a difficult time with sleep recently. It can feel extremely isolating and scary to go through the experience of not being able to sleep. I think many people don’t realize quite how psychologically difficult and distressing it can be until they have experienced it themselves. That being said, I do have a few thoughts that I hope can be of some comfort to you.

    The first is that it may be helpful to acknowledge what a difficult time this is for the world as a whole. You didn’t mention any external circumstances that may be driving problems with sleep, but on the whole, we are seeing a tremendous increase in both sleep problems and other mental health difficulties due to the pandemic. Even if you haven’t been directly impacted by COVID, the enormous amount of changes (including those to our daily routines and habits) can create a lot of psychological distress and unease. That said, I just want to point out that you’re not alone in struggling with sleep during this time. You might try searching the Sleepio community to connect with others who are struggling in similar ways. Sometimes just knowing you’re not alone (especially when it can feel so lonely in the wee hours of the night when you’re awake!) can bring some comfort.

    Second, there are things you can do that have been shown by research to help. Cognitive and behavioral techniques like those in Sleepio have been shown to help with all kinds of sleep problems. There are also cognitive and behavioral approaches for problems with mood, stress, and anxiety that are extremely effective, if you find yourself experiencing those. The fact that you are using Sleepio and seeking medication from a doctor are very good indicators that you’re on the right path toward finding some help and relief.

    For the difficult thoughts you’re describing, some of the cognitive techniques in sessions 4 and 5 may be useful. Below are some articles describing these techniques in depth:

    https://www.sleepio.com/library/article/cognitive-techniques-in-depth/

    https://www.sleepio.com/library/article/challenging-your-thoughts/

    I hope that you are able to find some relief soon. Please remember that if you are ever feeling hopeless or like self-help isn’t enough, it will be important to reach out to your doctor for more help (if you haven’t already).

  • Sleepio Member

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

    Also wanted to follow up to share this Sleepio community thread I found on quotes for those struggling with sleep problems:

    https://www.sleepio.com/community/discussion/best-quotes-for-overcoming-sleep-problems/

  • Sleepio Member

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

    Hi sleeplessinEDH,
    I remember your post from last week, and I’m glad to hear that you are sticking with the sleep restriction (even though it can be really difficult). I just want to reiterate that sleep restriction works differently for everyone, but it’s not uncommon for the first few weeks of sleep restriction to be the most difficult – it can often get a bit worse before it starts to get better. What you’re describing is not uncommon, and is not necessarily an indicator that this approach won’t work for you.

    My two general pieces of advice during this time are to continue practicing the QHR (i.e., getting out of bed any time you are awake for ~20 minutes and only getting back into bed when you are sleepy), and trying to help your body naturally regulate your circadian rhythms in a few different ways. First, getting some light exercise (not too close to bedtime) and paying close attention to light conditions (i.e., getting bright sunlight exposure first thing upon waking and keeping in dim lighting conditions in the hours before bedtime or when getting up for the QHR) can be helpful for helping sleep restriction do its job more efficiently.

    I’ve attached below an article describing how to manually shift your sleep window if you’d like to experiment to see if that might help:

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

    I hope this information is useful.

  • Sleepio Member

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

    Hi Kim22,

    What you’re describing is not uncommon and there are a few different things that can help. First, it’s important to know that worrying about the impact of your sleep on a bed partner can actually impact your sleep and make it worse (i.e., worrying about sleep problems tends to worsen them). It may be helpful to discuss your concerns with your husband, and see if he can try some solutions to troubleshoot (e.g., earplugs). Next, it may be important to see a doctor about your snoring, particularly if you find yourself waking up short of breath or gasping for air as this could be a sign of sleep apnea.

    I’ve linked below some discussions/articles on snoring and sharing a bed with a partner while having sleep trouble that may be of interest:

    https://www.sleepio.com/library/article/snoring/

    https://www.sleepio.com/community/discussion/snoring--sleep-/

    https://www.sleepio.com/library/article/poor-sleepers-impact-on-their-bed-partners/

    https://www.sleepio.com/community/discussion/how-can-you-minimise-the-effect-of-your-insomnia-o/

  • Sleepio Member

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

    Hi EmMore,

    I’m sorry to hear that you’re ill! It definitely is important to try to get as much sleep as you can while recovering from an illness, so postponing sleep restriction until you are feeling better is definitely an option, and one that we’ve seen many people have success with. Here’s an article describing how to put a “pause” on sleep restriction:

    https://www.sleepio.com/library/article/i-cant-put-sleep-restriction-into-action-right-now/

    Good luck and get well soon!

  • Sleepio Member

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

    Thank you very much for your answers. I really appreciate that you answered me direct.

    I felt so awful and ill the next day after sleep restriction, that I’m taking a longer window, even if it takes me longer to achieve my goal.

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