Live discussion with Dr Vicki Creanor - 11th October 2017

Dr Creanor will be filling in for Dr Sheaves' live online discussion here on Wednesday 11th October, 8.15 to 9.45pm British Standard Time or 3.15 to 4.45pm US Eastern Standard Time.

She 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.

Please do note that, as per our guidelines, Dr Creanor will not be able to give personal medical advice. Her replies to questions will be made in such a way as to help as many people as possible who might have similar issues. If there are a lot of questions, she may not be able to answer all in the time available, but will try to answer as many as she can.

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Posted 5 Oct 2017 at 2:52 PM
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  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks Dr Creanor, I see the suggested Sleep Window formula is Sleep Average plus 45 mins – thanks. Should I let the team know there may be a bug with the programme?

  • Sleepio Member

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    Expert

    Hi there – I agree that lighting is important. Blinds are a great idea to block summer morning light. However, I often think the reason the 15 min rule is harder as it gets closer to the rise time is because we get more anxious that we “only have an hour and a half before I have to get up!” which kick-starts the adrenaline and anxious thoughts, making sleep less likely. It is also a fair point about sleep pressure being lower then, too, but although it may be more difficult the later on it gets, the 15 min rule is important and lying in bed for any longer, at any time of the night, is detrimental to the bed-sleep association in the mind. Using relaxation/thought blocking in the 15 mins after waking (while still in bed) would be OK here.

  • Sleepio Member

    • 22 comments
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    in reply to Sleepio Member
    Graduate

    Thanks very much for your reply. I do have a slight problem with the blue light comments that have trickled through some commentaries. I have read the literature and the melanopsin intrinsically photosensitive ganglion cells fairly recently discovered certainly are more likely to absorb short wavelengths (bluish), which I think is what most people are referring to. However, the intensity needed to stimulate them are far more than what comes out of the normal screen, be it tablet, phone, TV, computer or laptop.

    If you do stimulate them you will also get discomfort, which most people don't get from screen use (I can add references). It's more likely your sleep is disturbed because you are up at 1am watching the tablet, phone, TV, computer or laptop and then thinking about the things that have come through on your laptop, phone, TV, etc that you are using. Some people rave about the night time settings you can get to reduce blue light, fine if it works for them, it's likely to be placebo. Same as for tinting the screen when reading. If it works for you: great. Not much science behind it though.

    Light, yes, will suppress melatonin and it peaks at 2-3am and if you put the lights on then, it can suppress it. Blue, nothing special there. So my question was on lights on or off. I'd say off at 2-4am, but I really don't know what to do then other than stick the radio on in the dark.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    I might raise this with the team as well just to ensure things are consistent – feel free to raise as well though. I'm unsure how things are calculated specifically via the sleep diaries – I will ask the technical team about this but it's a fair point…

  • Sleepio Member

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    Session 4

    Thanks. So I've done 17 days and noticed no difference, I get a shallow and broken 4 hours per night, and sometimes as little as 1 hour. I have very bad headaches throughout the day. Is it unusual for SRT to take so long to make an impact?

  • Sleepio Member

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    Expert

    I would stick with as dim a light as you can get away with as the point is juts to be away from the bedroom while awake and be as un-stimulated as possible so as to return as quickly as possible to bed. I agree that activity on computers is stimulating and have made a similar point before about the use of these devices during the evening/night time.

  • Sleepio Member

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    Expert

    Sleep restriction, like many other techniques, takes a variable length of time to be effective – it varies from person to person and can even vary within the same person at different times in their life. It is worth sticking with it, though, as it often takes longer than a couple of weeks to get used to a different pattern.

  • Sleepio Member

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    Expert

    It sounds very much like there is an underlying stress/anxiety here. When this is the case, I would recommend that support is also sought for this in itself, as if it goes untreated, it can serve to maintain the sleep problems and undermine any work you do on your sleep. Hope that helps.

  • Sleepio Member

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    Session 4

    I use blue light blocking glasses and when i first started using them i found the benefits extraordinary. There are studies on NCBI where they measure melatonin levels after blue light exposure – the levels are lower. Blue light is definitely much worse than longer wavelengths light.

  • Sleepio Member

    • 22 comments
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    in reply to Sleepio Member
    Graduate

    Ok thanks, you didn't take on the blue light topic though.

    As I live in a studio my choice is sofa or bed, both in the same room. If I want to go to another room I will be standing in the kitchenette or sitting on the loo or bathtub.

  • Sleepio Member

    • 35 comments
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    Graduate

    I seem to be having just as much trouble getting to sleep at midnight on the Sleep Restriction prog as I normally do, with the addition that I'm so tired from staying up later than normal that my body's pain is worse – e.g. back and shoulder. My back has been really bad the last couple of days, I think that's because although I wasn't asleep, my back did at least get more rest than it is now. I try not to sit still in one position for too long as I know this is bad for it, and I'm avoiding yoga in the evenings, that I used to do, as this is counted as exercise. Should I stay optimistic that things will improve, or give up because then at least my back and shoulder won't be so painful? I wonder how many weeks generally it takes for people to see a difference – or is it different for everyone? thanks!

  • Sleepio Member

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    Expert

    Hi and thanks for your post.

    It can be a long process, so please know it will take time and you're not alone in this.

    We know that sleep cycles tend to last roughly about 90 mins, so it may be that the wakenings are happening at the end of these, when sleep gets a bit lighter again. It is common to wake once or twice a night (good sleepers do this) but getting out of bed after 15 mins is a good strategy. We would recommend, though, that people only go back to bed once sleepy again. Sometimes it takes a while to get back to sleep and that's why the activities we do during this time are important. Don't do things that keep you stimulated/too interested – do things that relax you and make you feel more sleepy.

    Also, it may sound very simple, but making sure fluids aren't taken approx an hour before bed is helpful to eliminate the need to get up to go to the loo.

  • Sleepio Member

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    Expert

    I don't feel it's an appropriate platform to get into a debate about blue light as the main thing is to promote sleep as much as we can, through physical, behavioural, cognitive and environmental aspects. As for the other rooms, it has been advised previously to others in similar studio accommodation that the bathroom/hall/kitchen can be used for these purposes during the quarter hour rule to get away from the bedroom. This is OK if it works for you.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi there – it is always tricky to say how long it takes for these techniques to be effective because of the widespread differences among people – their health, lifestyles, daily patterns are all so different, with many varied elements affecting their sleep. If there is pain, we would always recommend getting this checked out. Often neck/back/shoulder pain can come from stress/anxiety so it may be worth considering help in this area, too, as this can also affect sleep significantly. If I can reassure you here, though, often it gets tricky before things start to improve, as the body is getting used to new patterns and routines.

  • Sleepio Member

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    in reply to Sleepio Member
    Session 4

    thanks

  • Sleepio Member

    • 22 comments
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    in reply to Sleepio Member
    Graduate

    Well I am very pleased for you, keep going. If it works, that's fab! I have loads of students who use tints when reading (various colours). It works for them to reduce contrast, so that's great as well.

    I maintain the science is missing. Doesn't mean placebo isn't there, or that more science is needed.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hello – sleep restriction tends to be the treatment for those who cannot sleep through the night and have fragmented sleep. Non-restorative sleep is an issue with sleep quality, which CBT has been shown in clinical trials to help too. Although it is less clear with this type of sleep problem exactly which elements are important, I would work on the bedtime routine being consistent, the use of relaxation before bed, consistent bed and rise times and also making sure things such as caffeine are eliminated. Any underlying mental health problems should also be considered (anxiety/low mood) as these can also affect sleep quality. Hope that helps.

  • Sleepio Member

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    Expert

    That's all for this session – thanks for all the questions and I will speak to you all soon…

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks Dr Creanor :)

  • Sleepio Member

    • 22 comments
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    in reply to Sleepio Member
    Graduate

    ok thanks, that's me told. To engage in this system I need to be confident in it, and I have had some uncertainties about the science behind it, as it is something I do know about. I know that these questions would be on my mind attempting stage three, when I am not convinced. But, I'll give it a go a shut up for a while.

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