Live Discussion with Dr Michelle Davis -25th September 2019

Dr Davis will be hosting a live online discussion here on Wednesday 25 September, 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 20 Sep 2019 at 8:32 AM
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  • Sleepio Member

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    Graduate

    Early waking seems to be a common theme in this week’s discussion and something I am troubled by too. I generally fall asleep easily but then wake 3-4 hours later and cannot get back to sleep. Applying the QHR I get out of bed and do something not too stimulating. I don’t however feel sleepy again- presumably because the sleep pressure has been removed by the 3-4 hours I have got. Come 6 am I am exhausted and then really struggle to stay awake the following evening. My sleep efficiency is great if I don’t go back to bed so I can extend my sleep window, but this doesn’t help as I am never in bed at the end point unless I break the QHR. If I wake after 2-3 hours I sometimes take a sleeping pill which can give me another 2-3 hours but has knock on effects on following nights. Any suggestions on how to extend initial sleep duration would be most welcome! Thank you.

  • Sleepio Member

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    Graduate

    I have chronic upper back pain from an accident. I have had deep brain surgery and am off meds but need to lie on stomach often as a pain management program. During the day should I do this not in my bedroom, and then is it ok if I sometimes nap as pain is exhausting. Is Sleepio relevant for someone with pain?

  • Sleepio Member

    • 10 comments
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    Graduate

    Hi Dr Davis

    I fall asleep after 5 minutes having got into bed at 10.15
    However i wake up almost every day between 2.15am and 2.30am
    Some nights i fall asleep again (meditate)) and others i got to get out of bed .ps started sleepio 2 months ago and went and stopped drinking coffee +refined sugar 2 weeks ago (4cups a day)Im a fit 62 yr old .Any chance you can get short term insomnia from dropping coffee +refined sugar from the diet at the same time ?

    Thank you

  • Sleepio Member

    • 8 comments
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    Graduate

    P.s. my sleep diary tells me I am averaging 5 hours a night I’d that helps you come up with a sleep restriction regime? Thanks in advance

  • Sleepio Member

    • 11 comments
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    Graduate

    I have only had one increase to my sleep window and seem to have plateaued and am now waking before the end of the sleep window. If i were to get up then my sleep efficiency would go up and i might get to the 90% average and get the window increased, but because it is half an hour before when I would get up I have hoped I might drop off again. If i did get up would it increase the sleep drive?

  • Sleepio Member

    • 9 comments
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    Graduate

    Hi Dr Davis.
    My question is about anxiety. It is my long term anxiety that has caused my insomnia to start since May this year. I have the same battle that I'm sure everyone here does. It's the what if i can't sleep tonight worry. When it is bad it has the effect of stopping me sleeping that night. And no matter what I try I don't have a tool to deal with that thought. Do you have any ideas? Because without that worry I don't think i would have any sleep issues.

    All that happens when I can't sleep is the next night I'm normally so tired I get a few hours sleep but the effects of that waking night lasts for days.

    Wishful thinking but hope is you have just the right solutions for me.

    Thank you.

  • Sleepio Member

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    Expert

    Hi agrael482,

    Thanks for your question. You’re absolutely correct that stress and anxiety can have a huge impact on sleep, particularly if you begin to have anxiety around whether or not you will be able to sleep (or in your case, whether you will have early morning awakenings)!

    Sleep and anxiety have a bidirectional relationship – anxiety can negatively impact sleep and sleep can contribute to and worsen anxiety. The good news is that it also works the other way around – improving your anxiety can improve your sleep, and vice versa.

    By using techniques to manage your stress and anxiety (like pre-bed relaxation, cognitive strategies for coping with stressful thoughts, and physical exercise), you will likely also improve your sleep (as you noticed this week).

    The Sleepio program takes you through some of these anxiety-busting strategies. Here’s some more information from the Sleepio library:

    https://www.sleepio.com/library/article/anxiety-introduction/

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

    https://www.sleepio.com/library/article/how-does-relaxation-work-to-help-poor-sleep/

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

    If you notice that your anxiety continues to cause you significant distress, you may want to discuss this with your doctor or a medical provider.

    I also want to quickly highlight that early morning awakenings can have a biological component (our circadian rhythms advance with age), and as we age, they can become more common. If you find that this problem persists, the recommended advice is to 1) try sleep restriction, 2) keep consistent sleep and wake times, and 3) pay attention to your light exposure (low light in the evenings, bright light upon waking) to regulate your circadian rhythms.

    Hope this is helpful!

  • Sleepio Member

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    Expert

    Hi Peter99,

    I know that this can be a difficult period, but I’d like to reiterate what Dr. Kanady said, in that if you’re fighting to stay awake until your scheduled bedtime, that means your sleep drive is high, which is a good thing. The first few weeks of sleep restriction are the most difficult. You may feel similar to (or initially, worse than) how you felt before you started Sleepio – this is to be expected.

    Ultimately, you’ll be the best judge of whether you’re able to stick to the recommended schedule or need to modify it. If you find that you’re still waking up too early, it would make sense to push your bedtime later – it is generally recommended that you stick to the same window (or length) of sleep, but shift your bedtime or wake time. Here is a link to more detailed information on how to shift your sleep window from the Sleepio library:

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

    You might also try limiting your light exposure in the evenings, and making sure you are getting bright light exposure upon waking to help naturally regulate your circadian rhythms.

    Best of luck!

  • Sleepio Member

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    Expert

    Hi ZCat,

    Great question! You’re correct that sleep efficiency scores can be misleading, due to the problems you outlined. Instead, it is recommended that you focus mostly on how you feel during the day as an indicator for how things are going, rather than just your sleep efficiency.

    I want to reiterate that the first few weeks of sleep restriction are difficult, and feelings of sleepiness means that it is working (your sleep drive is high!). When your sleep drive is high, you’ll be more likely to fall asleep and sleep through the night. The daytime fatigue should continue to improve as you stick with it.

    While it is recommended that you do your best to stick to the sleep schedule, if you are unable to function during the day it will be important to either take a nap, or change your sleep schedule – you will be the best judge of how to apply sleep restriction in a way that works with your schedule. If you’re feeling sleepy during a situation that could be dangerous (for example, while driving), you will absolutely want to pull over and take a nap.

    One more thing – it is not recommended that you shift sleep times significantly from day to day. This is similar to jet lag – consistency is key!

    Hope this helps and best of luck!

  • Sleepio Member

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    Expert

    Hi Lucie28,

    Thanks for the question and great job on completing Sleepio!

    Daytime functioning should improve over time and with continued work to stick to the program.

    If you’re unable to function during the day (e.g., not able to drive), it will be important to either take a longer nap, or change your sleep schedule. You’ll be the best judge of whether you need to do this, but if you find that you’re sleepy while driving, it is recommended that you pull over and take a safety nap. If this continues, you may want to speak to a doctor.

    As for how to stay awake – beyond caffeine (which can be helpful), research studies indicate that 1) making sure you’re getting enough bright light at the right times (sunlight in the mornings and dim light at night), 2) doing some light exercise (e.g., a brisk walk), and 3) socializing (e.g., having a conversation with a friend or family member) are the best ways to fight daytime sleepiness.

    Here is a link to a community discussion for additional support and information: https://www.sleepio.com/community/discussion/dealing-with-the-new-sleep-regime/

    Best of luck and great job sticking with it!

  • Sleepio Member

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    Expert

    Hi Montycat5,

    Thanks for the question.

    As I mentioned in a previous response to another member’s question, early morning awakenings can have a biological component. Our circadian rhythms advance with age and we can be more likely to wake up earlier as we age. Early morning awakening is a very common issue!

    However, we can help combat this with sleep restriction (as you mentioned). You might consider reducing your time in bed from 12 to 6 to start – or, if you’re already waking up early, leaning into that early morning awakening and shifting your rise time to be an hour earlier (11 to 5). The most important advice is to keep a consistent schedule, even on weekends/non-work days.

    One more tip – for circadian issues, it can be helpful to monitor your light exposure. Only exposing yourself to dim light before bed and getting some bright sunlight first thing in the morning can help regulate your circadian rhythms.

    Best of luck with the sleep restriction!

  • Sleepio Member

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    Expert

    Hi Senora,

    Early morning awakening is extremely common, and even more common as we age. This can be biological – as we age, we wake up earlier. It’s important to remember that this happens to everyone, even “good” sleepers!

    My advice is similar to Montycat5’s above – the most effective ways to combat early morning awakening is through sleep restriction (i.e., reducing your sleep window) and keeping a consistent schedule each day, and to make sure you are monitoring your light exposure (so that you are exposed to dim lights at night and bright light first thing in the morning).

    Here’s a link to an article on early awakenings that you may find helpful:

    https://www.sleepio.com/library/article/frequent-awakenings-when-will-they-go-away--/

    Best of luck!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Ann D!

    You’re right, lots of early waking questions today!

    Great job sticking with the QHR during those times – I know it's difficult, but it's the best thing you can do to keep working toward more consistent, consolidated sleep.

    My feedback is similar to the above – 1) early waking is common, and happens to everyone (even good sleepers). It tends to increase as we age. 2) The best way to combat early waking is through sleep restriction, which should get better/easier as you continue. 3) Paying attention to your light exposure can help with circadian rhythms – make sure you are in dim light exposure before bedtime and get bright light exposure first thing in the morning.

    A note on the sleeping pills – you’re absolutely right in noticing that they can seem to help in the moment, but can cause a “hangover”-like effect the next day.

    Here’s a link to an article on early awakenings that you may find helpful:

    https://www.sleepio.com/library/article/frequent-awakenings-when-will-they-go-away--/

    Best of luck!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Christine,

    Great question. Pain can be really challenging when you are trying to implement stimulus control! It may take some creativity to figure out how to modify the advice to suit your needs, but many people with chronic pain have successfully completed Sleepio, and research indicates that cognitive behavioral therapy for insomnia can help individuals with chronic pain.

    I would tend to agree with your thought that you should try not to lay down in your bedroom during the day if possible – keep the bed for nighttime sleep only. Sometimes people find it helpful to lie down in another location or room (e.g., on the couch). Ultimately, you’ll be the best judge of whether you need to take a nap or not.

    Here’s a link to a Sleepio community discussion that may be helpful:

    https://www.sleepio.com/community/discussion/back-problems-and-insomnia/

    Best of luck with the program!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Also – regarding your comments about the results you are awaiting – it definitely makes sense that you would experience increased sleep problems during a time of stress. Stress and sleep have a bidirectional relationship – with more stress, your sleep can worsen, and poor sleep can make it more difficult to manage stress. Using the cognitive and relaxation techniques in Sleepio to manage your stress during this time may be helpful.

    Best of luck during this difficult time.

  • Sleepio Member

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    Expert

    Hi Livingbeyond135,

    Thanks for the question! Waking up too early is extremely common, especially as we age. The circadian rhythms are biological and as we age, we tend to wake up earlier. I note this because it’s important to remember that early wakings happen to everyone sometimes, even “good” sleepers!

    My advice is similar to the advice I’ve given above – the most effective ways to combat early morning awakening is through sleep restriction (i.e., reducing your sleep window) and keeping a consistent schedule each day, and to make sure you are monitoring your light exposure (so that you are exposed to dim lights at night and bright light first thing in the morning).

    Here’s a link to an article on early awakenings that you may find helpful:

    https://www.sleepio.com/library/article/frequent-awakenings-when-will-they-go-away--/

    Regarding the coffee, it is definitely possible for increasing/decreasing your caffeine intake to impact your sleep. I am unaware of any research on the role of sugar and sleep, but it would also make sense that changing your diet could impact your sleep. However, the advice I’ve given above (and the Sleepio program) would not change based on these factors.

    Best of luck with the program!

  • Sleepio Member

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    Expert

    Hi Glisglis,

    Thanks for the question. If I’m understanding your question correctly, I think you’re asking whether getting out of bed would increase your sleep drive for the next night, in which case you’re correct. Getting out of bed won’t help you fall back asleep in the moment, but it should increase your sleep drive so that you should be able to fall asleep more easily the next night.

    Hope that helps!

  • Sleepio Member

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    Expert

    Hi Eddie06,

    There is research evidence to suggest that trying NOT to have worrisome thoughts (like the ones you’re having about sleep) can actually make the thoughts worse and more frequent.

    For example, if I tell you, “whatever you do, try NOT to think about a pink elephant for five minutes” – likely a pink elephant will be the first thing to pop into your mind!

    It sounds like you are very distressed by these thoughts and worries and may be trying to avoid them, or not to have them, which can make it even harder.

    Have you reached the “paradoxical intention” described in Sleepio (where you learn that trying too hard to go to sleep is not helpful, and instead it can be helpful to “trick your brain” by reducing your effort to fall asleep and instead trying to stay awake)? Similarly, trying not to think about your sleep will likely not be effective. Instead, try letting yourself worry about it, and even trying to stay awake for a night, to combat the anxiety that is causing you problems.

    Research shows that cognitive techniques, like the ones described in the Sleepio program, are helpful for managing these thoughts. It may be helpful to review those techniques, as well as the relaxation techniques, and practice these daily.

    Here is a link to some articles from the Sleepio on these techniques:

    https://www.sleepio.com/library/article/anxiety-introduction/

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

    https://www.sleepio.com/library/article/how-does-relaxation-work-to-help-poor-sleep/

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

    Another tool (which is not covered in Sleepio) that research has indicated may be helpful for managing worrisome thoughts is the practice of mindfulness. Practicing mindfulness (or meditating) involves being aware of the thoughts that are running through your mind, but trying not to react or respond to them – they are just thoughts, after all. A quick internet search should provide you with lots of information on how to practice mindfulness or meditation.

    If you find that your anxiety doesn’t improve or continues to worsen, you may want to consult a doctor.

    I hope this is helpful!

  • Sleepio Member

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    Expert

    Hi ZCat – that sounds really difficult! I'm sure you are trying your best.

    Again, I would absolutely recommend taking a nap in situations where it may be unsafe. You might also consider speaking with your doctor again, or seeking a second opinion.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Many thanks Dr Davis

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