Live Discussion with Dr Vicki Creanor - 17th February 2021

Dr Creanor will be hosting a live online discussion here on Wednesday 17th February, from 8.15pm to 9.45pm British Time or 3.15pm to 4.45pm 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 Creanor 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 12 Feb 2021 at 7:58 PM
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  • Sleepio Member

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    Graduate

    Hello Dr Creanor
    I wrote to you on 2 February about my waking up every two hours or so every night and you replied by saying that wakenings are ok if I go back to sleep again and that good sleepers will wake up fully at times but not see as it as problem.
    I would like to say 'Thank you' as it has reassured me that I don't have a great problem with insomnia after all these years of thinking that!!
    I still like to complete my sleep diary even after completing the course – out of interest!

  • Sleepio Member

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    Graduate

    Hello Doctor Creanor,

    I.ve had chronic insomnia for a couple of months now. It takes on average 3-4 hours to get to sleep, then I only sleep maybe for an hour or two. Some nights over the past month I've had 0 hours sleep and that can recur for 2 nights and more.

    I.ve been following sleep hygiene for years and live a healthy lifestyle drinking lots of water, healthy food and exercise 5 times a week step aerobics, cycling, walking, no caffeine etc etc.

    My SR is 12.00am – 5.00am

    No sooner am I in bed than I have to get up again because of QHR. Going to another room wakes me up further and I sit and crochet or read a book. By the time I possibly feel tired enough to go back to bed my sleep window has almost expired.

    I don't nap during the day (I can't) I am like a walking zombie and this has obviously started to impact my life. The SR is making me even more anxious even though I am following the wind down etc.

    My sleep issues started when I approached Menopause and after various herbs and potions that didn't work I resorted to the doctor. I was referred to a sleep clinic in Oxford (10 years ago) but the concluding answer was all they could offer was melatonin but this was further endorsed with “but I don't think that will work for you”!!!

    The doctor then prescribed10mg Amitryptiline – a miracle and it worked for 10 years.

    I've been withdrawing from this drug since beginning of December.

    Is it the withdrawal from this drug that is causing my chronic insomnia rather than my own behaviour towards sleep. Honestly, wished I never had took it.

    Thank you.

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  • Sleepio Member

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    Graduate

    I have a question about the QHR. I’m fine with it on the rare nights I can’t fall asleep, and also if I wake up in the middle of the night for too long. I think it might work against me if I try it for my frequent early morning wake-ups, which are by worst sleep problem. My wake up time is 7 AM, so I’m talking about anything from 5:30 on.

    When I got my SW from The Prof, I kept my established bedtime and moved my wake-up time earlier to 7 AM. My plan was to use future additional time from The Prof to go to bed earlier than my current 1 AM.

    Usually when I wake up early, before I have time to check my thoughts, I think “oh no, not again, I’ve woken up”, and experience anxiety and tension. But using meditation and relaxation techniques, I can dissipate this anxiety and get back to sleep. This is something I’ve only started doing since I joined Sleepio, as the course has made me aware of how much anxiety I have around my poor sleep. So I’m not lying in bed anxious for an hour and a half. Instead I think I’m working through my anxiety around sleep in a good way. I do thought-checking in my head in bed as needed as well. All this is really helping. Over time my anxiety and tension when I wake up too early are decreasing.

    By 5:30, my husband is awake, so our three cats also wake up, and it’s a small enough house that if I got up and out of the BR for QHR, it would be difficult to do anything but wake up with everyone else. (In the BR if necessary I can use my noise machine to drown out the sounds of any activity.)

    What worries me is that if I wake up at 5:30, and get up at 5:45 for QHR waking up at 5:30 will become a habit, my early wake ups will then happen at 4 AM, and where would all this end? Getting up at 7 AM quickly became a habit that I like, but sadly did not change my problem with waking up too soon, only changed the time that it happens.

    Or maybe getting up that early with everyone else would in the end work better for me and I would stop having the early wake-ups? As I age I think I’m becoming more of a lark. Maybe it’s more natural for me to get up when it starts to get light out? Currently that’s about 6 AM. When I started SR in January it was much darker. As sunrise gets earlier, it does seem that my morning wake-ups happen earlier. I know I have a lot more chance of falling back asleep easily if it’s still dark out.

    Just for context I started working my way out of delayed-phase sleep disorder before Sleepio. I used to go to bed at 3 AM or later. I worked my way back to 1 AM pretty easily on my own, but came to Sleepio because I couldn’t solve the early wake-ups on my own. I would be highly averse to going to bed later as that would seem to me like moving in the wrong direction. I have a flexible schedule so my ideal SW is whatever helps me sleep the longest.

    Sorry this is one of the longer questions, and I’m happy for any insights.

  • Sleepio Member

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    Expert

    Hi and welcome to the live Sleepio session today with myself, Dr Vicki Creanor. For those who haven't 'met' me before, I'm a clinical psychologist with a special interest in sleep and I work clinically with those with mental health problems – which often include sleep problems. I see there are a few Qs waiting today so I'll start answering these but if anyone is on live, please feel free to get in touch if you have any questions :)

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi Suzie,
    Thank you for getting in touch. This sounds very frustrating and you're right to raise the risk element that your job requires you to be awake and alert. The Sleepio techniques are designed to help people achieve the best possible night time sleep, however some of them (such as sleep restriction and avoidance of naps) should be looked at carefully if you feel they increase risk in the short term. I would advise anyone in a job such as yours (or for those needing to drive) that puts you and others at potential risk without sleep to put safety first. If this means having a nap during the day if you're exhausted, take a nap. If sleep restriction is also risky just now, perhaps wait until you have a holiday from work and try it then. The safety of you and others must always come first.

  • Sleepio Member

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    Expert

    Hi and thanks for getting in touch.

    First of all – meditation. Scheduling in meditation – or other forms of relaxation/mindfulness – can help us sleep better at night. This is because it helps with any stresses that may be building throughout the day. In terms of how long, though, that will vary from person to person (and likely from day to day depending on what's going on in their life). Meditation alone might not help one sleep through the night, though (although reduction of stress is very important) – things such as getting exercise throughout the day and avoiding caffeine will also be important factors.

    Weighted blankets – anecdotally they have been shown to be helpful for some people who move around a lot in sleep or for those who feel comforted by pressure around their bodies (often some people with Autism or sensory needs can find them comforting).

    Lastly – with many of us now working from home, you raise an important talking point. Desks in bedrooms…If possible, I would set it up elsewhere. The reason being that you want to keep your bedroom simply for sleep (and sex). Anything else will confuse the brain and we want to make it is obvious as possible that when we get into our bedroom, we're wanting to sleep. It can also be subconsciously stressful when we see our unfinished work sitting on a desk as we're trying to relax into sleep.

    Hope this helps!

  • Sleepio Member

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    Expert

    Hi and thank you for raising such a relevant question in these times. As we learn more about this disease, including 'long Covid', the answer to this question may become more clear/different. At the moment, though, I would follow the same advice as per the programme states. What I would say, however, is that it is always important to pay attention to – and if need be discuss with your medical doctor – any changes in physical health. I'm aware that fatigue is a huge factor in post-Covid health and so there may be times where you need to pay attention to this and sleep to help the body heal even when the Sleepio programme may say you shouldn't. This is such a new disease that we're all still learning about it, but we always say to pay attention to ill physical health and take sleep when needed.

  • Sleepio Member

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    Expert

    HI – thanks for getting in touch. First of all, it is really hard to get up with an alarm if we're sleep deprived, but we do recommend getting up at the time set. This helps the bed-sleep connection become stronger so you associate bed with sleep, not wakefulness. When you wake an hour before the alarm, I'm curious – do you feel as if going to the loo has become habit? If so, try and juts roll over and go back to sleep rather than go to the loo and see if this helps you get more sleep up to the alarm. As for whether you count that last hour as awake or asleep, this is not so clear-cut. Think in % terms – were you more awake than asleep? This may help you decide. If you're awake enough to be wondering about it, you were probably awake…

  • Sleepio Member

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    Expert

    Hi Fiery,
    I'm sorry you've had such a hard time lately. Sleep restriction can be very challenging. Effective, but challenging.
    Something that might help for those who find SR too difficult/stressful, is sleep compression. This is when you gradually reduce the amount of time you're in bed by 15-30 mins a week until the time in bed matches the average time you're asleep. It's a gentler form of SR – it has the same goal (matching the time in bed with time asleep to increase sleep efficiency), although improvements will often take longer to happen with this approach.
    In terms of herbal remedies, this is not my area of expertise so I'm afraid I can't comment on this.
    I hope the sleep compression idea makes sense and is perhaps more appealing to try.

  • Sleepio Member

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    Expert

    Hi there, thanks for your questions. As a clinical psychologist, I can't comment on herbs, but I can offer some advice re exercise and tiredness.

    I guess for me, this comes down to personal resources. If you feel you can manage a gentle walk for example that would allow fresh air and exercise, this may be beneficial for deeper sleep that night. However, any vigorous exercise when tired can be unsafe as the body doesn't have enough energy. Listen to your body and if it feels too exhausting to exercise that day, perhaps wait until you feel more able. We are often pretty good at knowing what our bodies can cope with/what they can't.

  • Sleepio Member

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    Expert

    Hi Robert,
    I have many clients who find this helpful when they wake and can't get back to sleep straight away. I wouldn't go straight into it when you wake – see if you fall asleep naturally first, but if not, you could use this during the quarter hour rule time (or if you're on the verge of sleep, it may help to get you over). Breathing exercises are a form of relaxation but they also give you something else to focus on rather than lying awake 'trying' to fall asleep. It can help sleep happen while you put efforts into something else.

  • Sleepio Member

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    Expert

    Hi – thanks for your post Anna.

    I'm curious about a few things here. Do you get up straight away when you wake at 4am or do you employ the quarter hour rule and wait til it's been 15 mins? I'd always try and wait to see if you can fall asleep again rather than getting up straight away. I'm also curious about the activities that happen when you're up at 4am. Make sure they are not stimulating at all as this may be maintaining/lengthening the time you're awake. Try simply sitting in a dark room away from the bedroom to see when sleep comes. Lastly, if this pattern keeps happening, and you're getting anxious about the 4am wakenings, I'd suggest pushing back bedtime to an hour later (and also pushing back wake time to an hour later) to see if this knocks out the wakening and allows you to sleep through a bit better.

  • Sleepio Member

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    Expert

    Hi Ruth,
    It's such a valid point. You cannot ignore your kids' cries throughout the night and yet it is so disruptive to our sleep as parents. I wonder if you saw my earlier post about sleep compression? This may be a more manageable alternative to sleep restriction?

  • Sleepio Member

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    Expert

    Hi Rebecca,
    Thanks for getting in touch and welcome to the programme. I see you're in session 1, so you're just at the start of your Sleepio journey. It can be so overwhelming sometimes if we can't sleep and are constantly exhausted. Most people feel this way when they start Sleepio. What I would say, though, is that, over the next few weeks, many of the problems you have mentioned will be addressed by specific techniques so you will have the tools to start turning the sleep problems around. It's not a quick fix, but I hope that you will start to see improvements over the next number of weeks.

  • Sleepio Member

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    Expert

    Thank you so much for getting in touch again and letting me know :) sometimes it's good to normalise some things about sleep – we're often prone to see things as a problem when they may be perfectly normal…

  • Sleepio Member

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    Expert

    I'm so sorry to hear you're having such a hard time just now. It sounds really tricky.

    The first thing I'd say is that, because I'm not a medical doctor, I can't comment on medication – please consult your GP/family doctor for more info on the withdrawal side effects to see if this is something at play.

    What I can suggest is the following:
    – it may be that there is a level of stress/anxiety at play that is keeping you awake, so having a good relaxation routine during the day and during wind down may be helpful
    – it might be worth trying something other than crochet/reading during the QHR in case this is keeping you too stimulated – making sure you get good exercise and fresh air during the day may help you feel more tired and ready for sleep at night time
    – trying sleep compression (as mentioned a couple of times in this thread today) might be a helpful alternative for you if SR is making you anxious (the results will be slower but it may be something you find less stressful)

  • Sleepio Member

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    Expert

    Hi and thanks for your questions. I have a few suggestions…

    First of all, it sounds as if you're very sensitive to the light outside, so an eye mask can be super helpful for this to avoid earlier wakenings in the summer.

    I wonder if there is something wakening you at this particular time? Do the cats make noises early in the morning that you could alter by the noise machine being closer to you? This is just an idea if there is noise that may wake you. Sometimes even the heating coming on can wake people out of sleep at certain times in the early hours.

    The other thing I wondered about is actually moving your bedtime earlier. If you're against moving it later, sometimes just shifting the window can knock out early wakenings. Worth a shot?

  • Sleepio Member

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    Graduate

    I forgot to mention that I do wear an eye mask.

    Earplugs might help but I’ve heard they can be bad for your ears if used each night, due to causing wax problems. I am seeing an ear doctor in March and will ask him.

    Moving my bed time earlier historically just pushes the morning wake-ups to be earlier. But I think it is worth a try because if it’s still dark when I wake up earlier I might do better. Thanks.

  • Sleepio Member

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    Expert

    Worth a try and let us know how you get on – if it doesn't help, we can look at something else to try…

  • Sleepio Member

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    Expert

    That's all for tonight – thanks to everyone for these great and varied questions. Speak to you again soon.

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