Live discussion with Dr Vicki Creanor - 4th October 2017

Dr Creanor will be filling in for Dr Sheaves' live online discussion here on Wednesday 4th 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 28 Sep 2017 at 12:56 PM
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  • Sleepio Member

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    Expert

    It is actually 'normal' to wake around twice a night briefly, usually at the end of sleep cycles (these occur every 90 mins). This is often what good sleepers experience. What is important is how quickly we get back to sleep and our view on these wakenings. If it takes longer than 15 mins, it's probably needing some intervention to help make the wakenings shorter…and if we dwell on these wakenings as problematic, it can make them longer! Good sleepers don't care about them as they are regarded as normal, hence they fall back to sleep quickly. So it may be helpful to know this is part of normal sleep to avoid seeing brief wakenings as a problem.

  • Sleepio Member

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    Expert

    OK – so this is a different problem. During the Sleepio course, you'll come across techniques called the quarter hour rule and sleep restriction. Both of these will be important to you to help deal with middle of the night wakenings – the aim of the quarter hour rule is to prevent people lying in bed for more than 15 mins if they are awake as this weakens the association between bed and sleep, while sleep restriction targets frequent wakenings as you mention. Look out for these in the next few weeks!

  • Sleepio Member

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    HI there,
    Good question – and it will affect many! So, I believe the key here is negative thoughts. When we have to get up early, often (even subconsciously) we are thinking “ I hope I don't miss the alarm”, “What if I sleep through??”, “what if I'm late??”. Anxiety is driven by these thoughts. It affects the body and essentially makes it more alert (and less likely to sleep!)

    Sometimes after just one sleepless night, the brain then gets hit with more negative thoughts…“what if I don't sleep tonight?”..“please don't tell me this will happen again”...“I think this may be a problem”...“I must get to sleep tonight otherwise…”

    So, the thoughts drive more anxiety and more thoughts and it becomes a vicious cycle. That's why part of the Sleepio programme is focused on targeting negative thoughts.

  • Sleepio Member

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    Expert

    Hi and thanks for your question. Waking up around twice a night is normal and usually occurs after a sleep cycle (they happen every 90 mins after falling asleep). If it is more than this every night and falling asleep again is difficult, then I would class that as problematic. Hope that clears things up?

  • Sleepio Member

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    Graduate

    It doesn't clear things up when falling asleep a few times per night is difficult. What is the answer to that?

  • Sleepio Member

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    Expert

    Hi – thanks for your post. If you are recording the data in the sleep diary and it is capturing the 5.5 hours' sleep per night, the reason you may be being asked to increase the window is because most of the time in bed (90%) is spent asleep. We would only look to cut back sleep windows if the efficiency drops (ie long periods of time being spent in bed awake). Hope that makes sense?

  • Sleepio Member

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    Expert

    This is where the quarter hour rule comes in again – it applies whether you struggle to fall asleep at the start of the night or after a wakening in the middle of the night and aims to break the negative association your brain holds about bed and sleep.

  • Sleepio Member

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    Expert

    Hi there,
    It can be harder to apply everything as normal when people work during nights, as it is by definition, disruptive to sleep. However, there is a good article written by Dr Kyle on this in the library which may be helpful…it is called “shift-work and sleep” and you can find it by searching for it in the search tab. There is some advice in there for what to do before and after night shifts to help the body prepare for wakfulness and sleep.

  • Sleepio Member

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    Expert

    Apologies if I wasn't clear – when I talk about falling asleep, this also applies to falling asleep after wakenings in the night. The quarter hour rule is a technique designed to break the negative cycle and when you come across it in the programme, it will be explained to you how to do this, but essentially you're getting out of bed after 15 mins of lying awake and moving to another room, so as to ensure that the brain doesn't further build an association between your bed/room and poor sleep/wakefulness.

  • Sleepio Member

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    Expert

    As I understand it from looking at them, it asks about using them to describe evening and night – so I would apply them if relevant from 5/6pm onwards.

  • Sleepio Member

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    Graduate

    I suppose I should try it? However how long does it take to feel sleepy enough to go back to bed after moving into another room?

  • Sleepio Member

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    Expert

    In my clinical experience, controlled crying for that age group is helpful and effective and recommended by many health professionals – clinical psychologists, health visitors etc. However it is a personal choice and some people will disagree with its use. It my be worth seeking local support with the health visitor to help discuss options?

  • Sleepio Member

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    Expert

    That varies greatly from person to person and often it takes a longer time at the start of the technique before shortening. I would wait until the programme directs you to use this though as the course will teach you techniques gradually so you can build them up. Good luck!

  • Sleepio Member

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    Expert

    Hi – thanks for you post. This is common in recovery – a few techniques that may help:
    – thought blocking
    – challenging the negative thoughts
    – paradoxical thinking
    – use of relaxation near and at bedtime
    Hopefully using some/all of these will help, but in long term, as sleep gets better and remains better, the issue often reduces naturally as the person builds evidence that they can, indeed, sleep well now.

  • Sleepio Member

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    Expert

    Hi – glad the SR has been effective – well done for sticking it out as it is tough, but effective!!

    So, a few tips for staying awake during the day can be found in Prof Espie's article “I feel sleepy during the day”...hope that helps!

  • Sleepio Member

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    Expert

    Hi – thanks for the post. What is important is that people stick to their set bed and rise times consistently every night. As for when these are, it's up to that person given their lifestyle and other commitments. If one can sleep mostly during the darker hours, this tends to help, but it has to fit with that person's life more than anything.

  • Sleepio Member

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    Expert

    Hello,
    So I'm wondering if you mean you're sleeping 11-6 (a window of 7 hours?)...if early wakenings are persistent, people can shift their sleep window earlier to mean that they wake at the time they usually do but for the day. It would then be important to have a plan for what to do once awake, so there's not an effect on the mood when awake so early. But often these early wakenings are squeezed out by use of techniques over time.

    As for what causes what, this can be confusing for many people, but is important as you would treat the initial problem first. People sometimes can't tell, but you might work it out by simply thinking about what symptoms appeared first and what they are more in line with. This is often easier with the support of a professional to talk things through completely. Hope that helps.

  • Sleepio Member

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    Expert

    Hi – to be honest I'm not an expert in neuropsychology so I'm unsure of the credibility of the theory – possibly worth asking a GP/family doctor their thoughts as they may see this in practise if it is a known theory?

  • Sleepio Member

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    Expert

    Hello – thanks for the question. The problem is that even if you went to bed earlier, you'd likely still wake up when you went to bed. The issue is often that people feel sleepy when outside their room, but as soon as the get into the bedroom or bed, their body knows this to be a place of anxiety, sleeplessness etc and the negative thoughts start popping into the head, wakening the body and mind up. It is often anxiety that pumps adrenaline through the body to make s feel suddenly unsleepy. The techniques within the programme are designed to combat this from various angles, though as it is so common for poor sleepers…

  • Sleepio Member

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    Expert

    That's all for tonight everyone – thanks for all the posts and I will speak to you again soon.

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