Live discussion with Dr Vicki Creanor - 10th September

Dr Creanor will be hosting a live online discussion here on Wednesday 10th September, 8.15pm-9.45pm (BST).

She will discuss as many topics as possible in the hour and a half, starting with the most popular questions with answers being given in a way to give the most benefit to the general Community.

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Posted 4 Sep 2014 at 10:54 AM
  • 21 comments
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  • Sleepio Member

    • 20 comments
    • 14 helped
    Graduate

    Dear Dr Creanor,

    If I awaken after 4-5 hours and feel refreshed, should I technically treat that as my final awakening or a 'middle of the night awakening'. If the latter, my sleep efficiency goes down, if the former and I bounce out of bed, my sleep efficiency goes up (except that I would be ready to start the day at, say, 4am !)

    I'm not sure which is more appropriate since it feels like neither here nor there. If I relax then try to sleep again, its pretty disruptive in terms of timing. But if not, it sounds like a crazy hour to start the day as everyone else in the household is asleep.

    Wondering what you would advise. Apologies, I cannot join the live session due to time differences. Hope you can provide some pointers. Oh one point – even though I may feel refreshed initially after 4+ hours of sleep, that refreshing feeling doesn't last that long. Low energy sets in late morning and rest of the day.

  • Sleepio Member

    • 3 comments
    • 2 helped
    Session 3

    Dear Dr Creanor

    I am three days into week 3. Prior to this I was averaging 7.1 hours a night. (Starting the course had helped I think, in that I felt I was doing something positive). Anyway, I was enjoying better sleep.

    Since starting week 3 I've had a night of 3 hours and another of 2.5 hours. I'm so exhausted and am really struggling with the course – it feels like I am training my insomnia to be worse. (Although I think I understand the principles of what I'm supposed to be doing).

    Tonight I was literally weeping with frustration. And now when I get into bed, no matter how tired I am, I can't seem to not focus on falling asleep (ie. my mind doesn't just wander letting me drop off like it used to) which makes it virtually impossible to so so – this isn't an issue I had so much before. Also, I seem to be programming myself to sleep in tiny bursts and then wake up and have to get up. In short I don't understand what's happening to me and it's distressing and frightening. Any advice/thoughts appreciated. I really want this to work but I'm panicking because I think I'm making my problem worse.

  • Sleepio Member

    • 4 comments
    • 2 helped
    Graduate

    Dr Creanor,

    I can go through a few weeks and sleep around 3-5 hours most nights which is very good for me. But then I have one bad night (where I am awake all night) and I am back to square one. This signifies the start of a bad period which can then last up to 2 months. How can break this cycle?

  • Sleepio Member

    • 18 comments
    • 2 helped
    Graduate

    Dear Dr Creanor,
    I am on the sleep restriction stage week 2. It has been really hard to stick to the rules. Worse part is getting out of bed at 5.45am and stick to the QHR.
    I am so tired in the daytime having an average of 5.5 hours sleep. Last night I was so tired I slept from 11am to about 6.30 with 2 awakenings short time awake. It was such a good night sleep and I completed a day tired but functioning much better. I cannot function at work so tired all the time, I have also started having catch up naps from time to time when I am doing 2 shifts. However I am breaking the rules. My question is how much can I break the rules to get the results I want.

  • Sleepio Member

    • 37 comments
    • 3 helped
    Graduate

    Dear Dr Creanor. I am in week 3 and have just done one night of sleep restriction. I have suffered from insomnia for over 10 years and just wanted to know if it is normal to have muscle weakness after a bad nights sleep. I often hardly sleep at all and in the morning my legs feel weak and I feel shaky.

  • Sleepio Member

    • 22 comments
    • 3 helped
    Graduate

    Dear Dr Creanor:

    My physician has made a tentative diagnosis of “protracted post-withdrawal syndrome” from the z-drugs (zopiclone, eszopiclone, zolpidem).
    I was on nightly eszopiclone for over 2 years.
    I understand this to be a type of chronic withdrawal from these sleeping medications which can come and go, wax and wane in intensity, and last over one year. The many symptoms include anxiety, insomnia, restlessness, hypersensitivity to sound and light, depression, muscle weakness, and so on. All of which I experience daily/nightly.
    We have tried multiple different anti-depressants, which made the anxiety worse. Any z-drug or benzodiazepine eases the insomnia and anxiety, but profoundly worsens the depression to horrifying levels, and seems to worsen the subsequent withdrawal.

    I am having a very rough go of it.

    My only current treatment is the Sleepio programme.

    The sleep specialists that I have seen appear to have run out of suggestions, other than seeing a therapist to get into CBT (there is very limited service of this kind in my town) and continue with the sleep compression.

    Do you have any experience of this and/or comments?

  • Sleepio Member

    • 6 comments
    • 2 helped
    Graduate

    Hi Dr Creanor, when I do a late shift finishing at 11pm. I miss the wind down routine. I usually don't have trouble going to sleep. However I wake 3-4 hours later and have a lot of trouble getting back to sleep. Then my sleep routine is out of sink. Do you have any recommendations?
    Regards Jas.

  • Sleepio Member

    • 1323 comments
    • 214 helped
    Expert

    Hi everyone sorry for the 5 min delay – technical problems tonight this end! I will stay on for an extra 5 mins at the end. Let's get started…

  • Sleepio Member

    • 1323 comments
    • 214 helped
    in reply to Sleepio Member
    Expert

    Hi Susanlawrie – thanks for your post. It's a really tricky thing to try and sort out your sleep when there are external factors that reliably keep you up, such as children. I suppose I would say a couple of things. It sounds as if you lie awake after they have woken you up due to anxiety. There will be a section in Sleepio (you may not have covered it yet) were anxiety is tackled in order to help you sort out any worries before bed. The other thing I would say is that, perhaps if you help your toddler sleep through (unless they are up for teething/pain-related problems, of course, which are unavoidable and important to attend to) this may avoid this problem. I am hoping that the techniques to combat anxiety will be very helpful for you, though, when you get to them. Hope this helps.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Lynn L thanks for that post – it's thought provoking! I suppose what matters is what was the norm for you before the sleep problems started. I'm guessing from what you have said that 4-5 hours' sleep wasn't what you were used to before. Also, if you do feel unrefreshed later on in the morning, it's a likely indication that you need more that this period of sleep. It also depends heavily on what you've had worked out as how ling you are supposed to sleep for when you started with sleepio. If your sleep time was compressed into 4-5 hours, then this is what you need to have until your efficiency increases, however I would shift the window so that this 4-5 hour period ends at a more reasonable wake time. I hope that makes sense? If, then, you wake before you are supposed to get up, treat any wakenings as middle of the night wakenings.

    Hope this helps and makes sense!

  • Sleepio Member

    • 1323 comments
    • 214 helped
    in reply to Sleepio Member
    Expert

    Hi Baldeagle – thank you so much for your post. I'm so sorry to hear how distressed you are. Lack of sleep and the start of any intervention are both difficult experiences. Sometimes it seems as though things get worse before they get better – and sometimes this is the case. It sounds as if you might be thinking about sleep more now that you are trying to help the problem. It's the same as when we are wanting to buy a new red car – we start to notice all the red cars on the road which were there before, but now it seems there are more of them. This is similar to when we start to tackle sleep problems – we sometimes will be more aware of how we are sleeping – or not sleeping.

    Be comfortable in the knowledge you are not alone on this one.

    What I would suggest is to practice the relaxation and distraction elements of the course daily (or more than daily) until they are automatic for you. Then you can use these at night time when you start to think about your sleep.

    I would also note that it is completely normal to have blips, even when things have been going well for a period. Please think of these as normal blips – we all have them – and not a complete relapse. If we think of these normal blips as full relapses, it can affect our sleep. Try to remember that you should expect some blips now and again and this should help reduce anxiety around them when they come up.

    I hope this helps?

  • Sleepio Member

    • 1323 comments
    • 214 helped
    in reply to Sleepio Member
    Expert

    Hi PH188 thanks for your post. When we look at any cycle, there is an assumption that it's a regular thing, a pattern. So what I reckon is important here is to start a daily diary and record what activities you are doing, what you are eating, whether there are any particularly stressful/difficult things going on. The fact it happens regularly and puts your sleep off track for so long indicates to me that there may be a trigger and once you have a diary where the poor night's sleep is recorded a couple of times, or perhaps more, then you may be able to see a pattern. It may be helpful to let someone else see this diary, if you feel comfortable doing so, as it's often easier for others to notice patterns rather than ourselves!

  • Sleepio Member

    • 1323 comments
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    in reply to Sleepio Member
    Expert

    Hi Pinky,

    I'm afraid you're going to hate me, but….if you really want the result of being a good sleeper, the rules must be followed strictly, as explained in the programme. I say this not to be annoying (!) but because techniques are firmly grounded in the very strong evidence base which shows that sleep problems can be treated using these techniques ONLY when they are followed as taught. Any rule changes – even if they are slight – alters the programme you are following and thus does not reflect the evidence base.

    Having said this, you must ensure that you are safe in your work and in other areas such as driving or looking after children. So, although we stick by the above argument about rules, if you are for any reason thinking that you will be unsafe to yourself or others by sleep restriction, take a nap when you need it to stay safe. It will not help your long term sleep, but it will keep you safe in the short term when needed.

  • Sleepio Member

    • 1323 comments
    • 214 helped
    in reply to Sleepio Member
    Expert

    Hi Dibby thanks for your post and all the best with this phase of your treatment. This is probably best answered by a medical doctor, however what I will say is that muscle weakness can be a form of anxiety, which is often a by-product of poor sleep. Our muscles often tighten when we are anxious and so if you are anxious during the night, you are likely tightening your muscles much of the night, so, upon wakening, it is possible that they feel weak having 'worked' overnight. This is one theory, based on anxiety, however it is always worth checking out medical concerns with your family doctor if you are worried about it.

  • Sleepio Member

    • 1323 comments
    • 214 helped
    in reply to Sleepio Member
    Expert

    Hi profomni I'm sorry to hear you're having such a tough time with all these drug trials. As much as I would love to be someone who could offer advice on this, I am not medically trained to know about drug withdrawal. What I do know, however, is that I have treated people in the past who have come off medication and have tried CBT instead (on which Sleepio is based) to find that CBT is effective by itself. I know this doesn't answer your question entirely but I hope it gives you some hope for your work with Sleepio.

  • Sleepio Member

    • 1323 comments
    • 214 helped
    in reply to Sleepio Member
    Expert

    Hi Jas44 thanks for this question. Shift work can have a real problematic effect on our sleep as it interferes with our internal body clocks which set the times at which it gets our bodies ready for sleep.

    A colleague of mine, Dr Simon Kyle, has written the following article on how to work around shifts, which can be found on the library page. I have copied it to this post for easiness, however:

    Shift-work can be defined as work that tends to occur outside the traditional working day, usually in the hours of 7pm to 6am. Shift-work schedules can take place exclusively in the usual sleep period, occur as early morning shifts (e.g. starting at say 4-6am), or be variable (rotating) on a day-to-day or weekly basis. All three patterns may lead to sleep disturbances and impaired daytime functioning due to:

    (1) Attempting to initiate sleep at a time that is inconsistent with our internal biological clock (e.g. during daylight hours)
    (2) Inconsistent bed and rise times due to changing, variable shifts, including weekday versus weekend patterns.

    Our biological clock has developed throughout evolution to accommodate sleep at night (when light levels are low) and maintain wakefulness and alertness during the main daylight period. Often those who work night-shifts will have difficulties sleeping during the day, after a shift, and will commonly have reduced total sleep time (sometimes by up to four hours!) and poorer sleep quality. Such workers may also feel intense sleepiness during night-shifts, due to our internal clock sending out a reduced alertness signal (after all, this is when most people are asleep). In extreme cases this excessive sleepiness may lead to occupational injury or accident.

    Whilst some workers adjust well to shift work, as a group those who work shifts tend to experience greater levels of sleep disturbance, fatigue, work-related accidents, cardiovascular, gastrointestinal problems and, in women, breast cancer. Disruption of the natural circadian rhythm due to light exposure at night, and resultant impairments to sleep, are thought to contribute to the higher prevalence of ill-health in shift-workers. Environmental factors like noise and social obligations may also make sleep during the daytime very difficult.

    Treatment of sleep disturbances due to shift-work focus on optimising the adaptation to the new shift pattern so that alertness is maintained during the scheduled shift and that sleep can take place during the day. For example, work has shown that exposure to bright light prior to or during the night-shift period can help one’s internal clock adapt and ‘re-set’, permitting sleep to happen in a block later in the day. Avoiding light during the early morning (e.g. on the way home from a night-shift) may also help with this. Other recommendations may be to schedule planned naps prior to starting a night-shift, to alleviate any sleep debt, as well as to use stimulants (such as caffeine) to help maintain alertness during the shift.

  • Sleepio Member

    • 1323 comments
    • 214 helped
    Expert

    I'm aware it's very quiet out there – anyone have any more burning questions?

  • Sleepio Member

    • 1323 comments
    • 214 helped
    Expert

    I will be on here for another 15mins – if anyone has a question about sleep/the programme/a particular difficulty, let me know…

  • Sleepio Member

    • 1323 comments
    • 214 helped
    Expert

    thanks for the posts everyone – sleep well and see you again soon.

  • Sleepio Member

    • 18 comments
    • 2 helped
    Graduate

    Thanks Dr
    Yes I know the drill I think I can handle it however I just need reassurance from time to time.The positives for me so far is the realisation that stressing about going to bed by 10.30pm is now diminished. I feel so much more relaxed about just winding down 1.5 hours before bed. Going to sleep and only having 5.5 hours sleep is restorative and I am getting to read so much more than I have for years. The days are up and down however I know this is the right path for me to take. It is addressing my underlying anxiety that has infiltrated my system for years. Not taking the mirtazapine is amazing and I can feel the difference in my system. I have not touched it for 3 weeks. I am extremely positive and I know that I can change my brain with the regulated schedule. The weather here in Sydney ( being spring now) is AMAZING the sun is up early and the weather is warmer so no excuses for getting out of bed early and enjoying the morning. I have led a crazy life that has all encompassed my work my business and racing from activity to activity. Time for some mindfulness and I do believe sleepio lets me practice that!! I will give you feedback to keep myself accountable.
    Thanks again and I do not hate you for your advice
    Pinky

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