Live Discussion with Dr Michelle Davis - 8th July 2020

Dr Davis will be hosting a live online discussion here on Wednesday 8th 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 2 Jul 2020 at 5:20 AM
  • 15 comments
  • 2 helped

Comments

  • Sleepio Member

    • 4 comments
    • 0 helped
    Graduate

    Hi,

    I graduated 4 weeks ago and in most respects Sleepio's been a complete success (restored bed-sleep connection, so going to sleep easily; good energy, mood and concentration during the day; as a self-employed person, my work capability has hugely improved, which makes me very happy and has improved my quality of life!). Thank you, Sleepio!

    But there is one remaining problem: after the initial 4-5 hours of deep sleep, I usually wake up and feel too alert to go back to sleep. I do QHR and go to the relaxation area, where I always stay for about 1.5-2 hours. If I feel a bit sleepy, I go back to bed (which ruins my SE), and sometimes I don't go back to bed but start the day early. Emotionally I would really prefer to have a longer rest. My SE is still in the 80s, and I have not been given any extension yet. My sleep window is 6 hrs 15 mins, but I have only filled that time with sleep once or twice.

    Should I shorten the SW?

    Are there any techniques I could use to fix this, i.e. to achieve a longer sleep. In the wind-down period I feel less exhausted than at the beginning of the SR, but I still feel seriously tired, so I believe I need a longer sleep than I'm getting right now.

    Thank you very much!
    Barbarah11

  • Sleepio Member

    • 2 comments
    • 0 helped
    Session 4

    Hi,

    I'm guessing I already know the answer. But would like to ask the professionals their opinion. Using Sleepio with two young children, youngest being 1. Obviously broken sleep etc. What would your advice be on using the program and improving sleep whilst also having a young child and all the broken sleep that comes with this age.
    Thanks.

  • Sleepio Member

    • 2 comments
    • 0 helped
    Graduate

    Using SR I am falling asleep very quickly which is a great positive as it used to take quite a few hours. But I also experience regular wakefulness around 4am anything from 3-5am as a window and am pretty restless after that. Is this a hormonal thing ?didnt have this when I was a normal sleeper. Not using the QHR very well as I keep hoping I will nod off. My window is 0200-0600 so not much time to re-sleep after 5am.

  • Sleepio Member

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

    Sorry I made a typo – should have been 0100-0600… also re menopause – how much of this wakefulness pattern is to do with hereditary issues? My mum has hardly slept since she was 55 and is now 89! And my sister also has sleep problems since during and after menopause and that’s ongoing for nearly 15 years … I hope by doing the SR that I can break the cycle BUT is there research around whether CBT can overcome the sort of disruption you get after menopause/ major hormone changes? I feel there isn’t enough specific material on Sleepio about this and what there is is rather generalised.. would appreciate some insight into an area that affects 50% of the population. Many thanks

  • Sleepio Member

    • 13 comments
    • 0 helped
    Graduate

    Hi, I’ve had insomnia for a few months now and am week 4 into sleepio, but am not seeing any improvements. I’m starting to lose hope and am very frustrated.

    I can fall asleep easily but I wake up around 2-3am every morning. My SW is 9pm to 5am. I wake up around 2-3am and I have a hard time falling back into deep sleep. I don’t get out of bed because I am drifting in and out of sleep, but it is not restful sleep like I used to have.

    During the day, I am extremely tired, sleepy, headaches chest tightness and heart palpitations. I cannot focus on work or do anything productive.

    Do you have any advice? I’m starting to lose hope..

  • Sleepio Member

    • 29 comments
    • 4 helped
    Graduate

    I think I'm coming to the end of my time with Sleepio which has been helpful. I now worry less about waking up at 3/4/5 am. Like Jogger2020 I'm not good at the QHR. If I get up and put my glasses on my brain tells me it's time to get up. So I hope I will drift off again. I find if my mind is racing, which it usually is when I wake in the night, if I put my ipod on and listen to a podcast I will drop off again. Music doesn't work for me. I will also be interested in the reply about menopause. Should i continue filling in my times etc after I have finished Sleepio, eg in a book/paper?

  • Sleepio Member

    • 453 comments
    • 182 helped
    in reply to Sleepio Member
    Graduate

    I have left you a detailed message jocetmo, on the
    Ask the Grads page, hope this helps.
    Kurly :)

  • Sleepio Member

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

    Hi Barbarah11,

    Thanks for the question and glad to hear you’ve been able to make some great improvements. You should give yourself a pat on the back for sticking with it!

    First off, it’s great that you’re practicing the QHR – it can be really hard to stick with, but will pay off.

    I have a few different general suggestions for people who experience early awakening and/or aren’t getting consistent sleep throughout the sleep window.

    The first is (as you suggested) to try shortening the sleep window. Because I don’t know your medical information/history, I wouldn’t recommend a window shorter than 6 hours (though you can speak to a medical provider about whether this would be a good option for you), but you could reduce your current window down by 15 minutes (to 6 hours).

    Since you report feeling tired during the wind-down routine and waking up too early, another option is to try shifting the schedule to be gradually earlier (e.g., shift the window up by 15 minutes every week). For example, for a sleep window of 12:00AM to 6:15AM, first shifting the sleep window from 11:45pm to 6:00AM (or 5:45AM if also decreasing the sleep window), and experimenting to find the optimal window by slowly shifting it back in 15 minute increments.

    My final thought is to be sure that when you’re leaving the bed for the QHR, you are doing the relaxation techniques in a dark or dimly lit room, as too much light can be stimulating.

    Hope this information is helpful!

  • Sleepio Member

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

    Hi Steve,

    Thanks for the question.

    We have a guide specifically for new parents (or parents of young children), which I think you might find helpful.

    https://www.sleepio.com/articles/parent-sleep/

    The guide is primarily around helping children to sleep consistently and with a routine, but I think it’s important to remember that 1) many new parents and people with young children have still been able to successfully use and make great improvements using Sleepio, and 2) even if parents are unable to stick to the specific recommendations in Sleepio exactly, they can still make great improvements by doing what they can to tailor the program recommendations to be suitable for their lifestyle.

    Trying (as much as you can!) to stick to a schedule (which may need to be modified based on your child’s sleep needs/habits), preserving the bed as a place for sleep and sex only (to maintain the bed-sleep connection), and paying attention to factors that can affect your sleep (such as sunlight exposure, getting light physical activity not too close to bedtime, and caffeine intake) can go a very long way in improving the quality of sleep you are able to get.

    I hope this information and resource is helpful to you!

  • Sleepio Member

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

    Hi Jogger2020,

    Thanks for the info and great questions.

    Glad to hear you are falling asleep more quickly! Many people experience waking up too early, and while I can’t be sure of the cause in your case, the same general advice would still be applicable.

    One option is to try shifting the schedule to be gradually earlier (e.g., shift the window up by 15 minutes every week) to find a sleep window that is optimal for you. For example, for your sleep window of 1:00AM to 6:00AM, first shifting the sleep window from 12:45am to 5:45AM, and experimenting to find the optimal window by slowly shifting it back in 15 minute increments. You can also experiment with shifting in the other direction (i.e., going to bed 15 minutes later) if you find you are not feeling tired by bedtime.

    It’s also important to (as difficult as it can be!) try your best to stick to the QHR. When you stay in bed while awake, your brain forms an association between your bed and wakefulness – you want to strengthen the bed-sleep connection as much as possible! When you do leave bed, try to do a relaxing activity in dim light, and only return to bed if/when you are sleepy.

    Finally, regarding menopause/hormones, you’re definitely right that individuals going through menopause (or perimenopause, or some other reason for hormonal changes) can experience worsened sleep problems (or sleep problems for the first time), and both sleep-related problems and difficulties related to menopause can be influenced by genetics. If you are concerned about your hormones, I would recommend speaking to your doctor about this.

    However, genetics are only one piece of the puzzle and luckily, regarding your question – research has demonstrated that CBT can be effective at reducing sleep problems in perimenopausal and menopausal individuals.

    For additional reading on sleep and menopause, see this Sleepio article:

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

    Hope this information is helpful!

  • Sleepio Member

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

    Hi Jocetmo,

    Sorry to hear you are feeling frustrated. It can feel really difficult to not make the progress you are hoping to achieve as quickly as you’d like.

    A few thoughts –

    If you find you are waking up too early, there are a few pieces of general guidance.

    First, it sounds like your sleep window (time you are in bed) is approximately 8 hours now. If you find you are not sleeping during that time (and waking up too early), the general suggestion is to restrict (or reduce) your sleep window to only the amount of time you are spending in bed currently (which sounds like it is from 9pm to 3am, or 6 hours). This (sleep restriction) is the most effective tool for reducing early awakenings. As you sleep more solidly throughout your sleep window, you can gradually build out the window to increase the amount of time you are in bed. Since you are easily able to fall asleep, you may want to shift your sleep time a bit later (rather than waking up earlier), but you can experiment with this.

    Below are instructions for how to manually shift your sleep window (should you decide to do so):
    https://www.sleepio.com/library/article/how-to-shift-your-sleep-window/

    I generally advise trying to be patient (though I know it is hard!) and giving yourself the opportunity to experiment with different sleep windows to find one that has you sleeping efficiently throughout the window.

    Last, it’s very important to observe the QHR, even though it can be really difficult. Continuing to lay in bed when you are not sleeping (while tempting!) trains the brain to associate your bed with being awake. By getting out of bed and moving to a dimly lit location and engaging in a relaxing activity, you can maintain the bed-sleep connection.

    I hope this information is helpful, and I hope you start noticing some improvements soon. If you find that you are doing all you can and still not seeing the improvements you’d like, talking to your doctor will be the best option. Best of luck!

  • Sleepio Member

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

    Hi Senora,

    Thanks for the question. I’m glad you’ve found Sleepio to be helpful!

    The QHR can be very difficult to observe, so kudos to you if you keep at it! I would try experimenting with different activities/locations during this time to see what helps. For example, if you get up and put on your glasses and find that this act in itself makes you feel awake, what if you don’t put on your glasses, move to another (dimly lit) location and try listening to a podcast there? It’s important to get out of bed during the QHR to make sure you are not allowing your brain to form an association between being awake and being in your bed.

    For your last question – yes – you can continue tracking your Sleep using sleepio, or write it down on paper, until you find that you’re happy with your sleep. It will always be important to pay attention to your sleep schedule and factors that can influence your sleep, even after finishing the program. I often recommend people to google sleep tracking worksheets and forms if they'd like to do something on paper – there are many out there – or create your own!

    Finally, you mentioned you were interested in the response to a previous question about menopause, so I’ve pasted this information below. Hope this is helpful!

    -----

    Finally, regarding menopause/hormones, you’re definitely right that individuals going through menopause (or perimenopause, or another reason for hormonal changes) can experience worsened sleep problems (or sleep problems for the first time). And both sleep-related problems and difficulties related to menopause can be influenced by genetics.

    Luckily, regarding your question – research has demonstrated that CBT is effective at reducing sleep problems in perimenopausal and menopausal individuals.

    For additional reading on sleep and menopause, see this Sleepio article:

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

  • Sleepio Member

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

    Hi Dr. Davis,

    If I change my SW to 9pm-3am, does it retrain my brain and body to not wake up in the early mornings? I'm curious about the science behind it and how it works.

    How long does it take for Sleep Restriction to work?

    It's hard for me to do QHR because it feels like I am drifting back to sleep, but it isn't deep sleep. Should I still be getting out of bed? I'm more like half awake instead of fully awake so sometimes I don't even notice what is happening until my wake up time.

    What are your tips for helping with the tiredness, nausea, fatigue, chest tightness, heart palpitations that I feel during the day due to lack of sleep? I really can't function on anything less than 7 hours of sleep and it's so miserable for me. I can't work well or even drive without it being dangerous… What are your thoughts?

    Also I read this book Why We Sleep by Matthew Walker and he talks about how being sleep deprived is extremely detrimental for our health. It gives me some anxiety that every night that I sleep less than 7-8 hours is destroying my health and I will get sick. What are your thoughts on this?

    Best,
    Jocelyn

  • Sleepio Member

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

    Hi Jocelyn,

    Here are some articles that I think might be helpful reads – the first describes the science behind how sleep restriction works:

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

    And the second describes how to put sleep restriction into action:

    https://www.sleepio.com/library/article/sleep-restriction-putting-it-into-practice/

    The 3am wake time may be a bit too early – this was meant as an example for the length of window to choose (i.e., 6 hours). Again, I would emphasize trying out different schedules and seeing what works for you – picking a consistent rise time that makes most sense.

    In terms of the sleep window question, yes, you can train your circadian rhythms to adapt to a new schedule. You can do this by waking up at the same time every day and exposing yourself to bright light (preferably sunlight) upon awakening and in the early morning hours and dim light at night. Also, establishing regular meal times and exercise times (regularity in general) can be helpful for further stabilizing rhythms.

    The length of time it takes sleep restriction to work varies by individual … some need a couple weeks, some need significantly more. It is not at all uncommon for many people report feeling worse before feeling better (e.g., more sleepiness/fatigue in the first couple of weeks is to be expected).

    In terms of the QHR, if you feel like you are half asleep, you may not need to get out of bed. Light sleep is still sleep and is also important! We tend to get most of our deep sleep in the first half of the night. But if you estimate that you’re mostly awake for 15 minutes or more, this is when we advise people to get out of bed.

    Regarding the concerns you have during the daytime, it may be helpful to use the cognitive techniques in Sleepio to address the negative thoughts that arise as a consequence of those symptoms (i.e., to address the anxiety experienced about feeling tired). If you experience excessive daytime sleepiness, please be sure not to drive – pull over and take a nap, or use carpooling, Lyft, etc.

    As far as the research you mentioned, yes – sleep deprivation is detrimental to health; however, everybody’s need for sleep is different (some people need more or less than the typically described 7-8 hours), and peoples’ resiliency to sleep deprivation varies across individuals.

    While it is good to focus on good sleep and feel motivated to improve, overfocusing or worrying about sleep can have the opposite effect and make achieving sleep harder. If you find yourself having anxious thoughts about sleep, the cognitive techniques I mentioned before (taught in session 4 and 5) can help to mitigate/manage some of this anxiety.

    Hope this is helpful!

  • Sleepio Member

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

    Hi Dr. Davis,

    Thank you so much.

    I also read some articles about light therapy for middle insomnia. (exposing to bright light at night to delay melatonin to be released later at night, and shifting the circadian rhythm to later so that I won't wake up in the early mornings)

    Do you have any thoughts about that?

    Best,
    Jocelyn

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