Live Discussion with Dr Vicki Creanor - 4th Sept 2019

Dr Creanor will be hosting a live online discussion here on Wednesday 4th Sept, from 8.15pm to 9.45pm British Time or 3.15pm to 4.45pm US Eastern 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. 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.

Please do note that, as per our guidelines, Dr Creanor will not be able to give personal medical advice including those about medication. Her 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 29 Aug 2019 at 12:26 PM
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  • Sleepio Member

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    Expert

    Good evening and welcome to the live discussion session. If anyone has any sleep or sleepio related questions over the next 90 mins, please get in touch! I see there are a few questions waiting so let’s get started…

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi there and thanks for getting in touch. You are right, we do have sleep cycles that last 90 mins and go from light sleep through to deep sleep and back to light again. Good sleepers can find that they toss and turn a little as the cycle ends and the new one begins again, as their brain moves into lighter sleep and we tend to be more easily wakened at these points. However, try not to worry too much about adjusting the sleep window to fit in with sleep cycles – at this point, we are juts trying to get more of a solid block of sleep and go to bed and wake up at a regular time to help the body learn to sleep through the night again. Eventually, once sleep has learned a new pattern, the cycles will work themselves out. Sleep is homeostatic and so it finds a way to naturally even out the phases of sleep once sleep becomes more regular. Hope that helps?

  • Sleepio Member

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    Session 2

    Dear Dr Creanor,
    I fluctuate between nights whereby I feel like I hardly sleep at all and others where I fall asleep quickly and sleep deeply until morning. It feels like I have a narrow window to fall asleep within half an hour or so of getting into bed and that if this doesn't happen I am then resigned to a night of restlessness. Sometimes I notice that I seem to fall asleep and then seem to get a surge of adrenaline equivalent to when someone makes you jump or you react to a hazard when driving. This jolts me back awake. My excitement at potentially falling asleep causes me to awaken! Two questions – If I miss my perceived 'sleep window' would you advocate getting out of bed for prolonged period out of bed or staying in bed. Secondly, can you recommend any techniques that might help me to avoid jolting myself out of falling asleep.
    Appreciate your advice!

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi – hopefully the reply above helped somewhat. Again, with sleep being homeostatic and finding a way to take what type of sleep it is needing, we do sometimes go straight into deeper sleep if we have missed out on it on previous nights. If we wake quickly out of deep sleep, there may be an internal difficulty causing this, such as a mood/anxiety disorder/stress/medication side effects/alcohol intake, but it also may be that our sleep has not yet found its pattern and is not maintaining deep sleep for as long as it should under normal circumstances.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    I have been trying sleep restriction, but am finding it hard to get out of bed. I keep thinking I am going to fall asleep if I stay in bed a little longer. How do I change my thinking around getting out of bed?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hello and welcome to the live discussion session tonight. Thanks for your questions.

    So first of all, what you describe in terms of fluctuating between good sleep and poor every other night is quite common. One thing that can be at play is that, after a poor night's sleep, the sleep pressure that has built up is high, and there is a large sleep debt, so sleep is easier the following night. When sleep pressure isn't so high, however, anxiety about sleep prevents a good sleep the next night, and the cycle continues.

    The jolt you mention is also a common feature in people who have built up anxiety about sleep and can be caused by increased stress/anxiety – whether this is about sleep or other life factors. With regards to helping with this, I would recommend building in a good amount of relaxation into a very consistent wind down routine every night. Some relaxation throughout the day may also help. Cutting down on caffeine and alcohol would also be important and making sure there is no full-on exercise in the hours before bed, so that the body is not stimulated too much.

    With regards to your other question, you will learn about something called the quarter hour rule soon in the programme, which teaches us that, when we struggle to fall asleep for more than 15 mins at the start of the night, it's better to get out of bed than to stay in bed and struggle. Staying in bed only serves to strengthen the association in our minds between our beds and NOT sleeping. An association we want to avoid! But once the sleep window is worked out (the programme will also help you with this) then it's good to find a time that suits you best to go to bed – this is up to you, so you can time it to within the best window that you feel most sleepy. Hope that helps answer your questions.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi there – thanks for your question, Just checking, is this the quarter hour rule you are referring to?

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hello and thanks for getting in touch. Yes – this is OK to lie on your side to do the exercise, whatever is most comfortable. In terms of breathing, this is simply how we tend to teach people to breathe when anxiety is at play – only breathing through the nose is less effective as sometimes the breath flows back through the nose to the lungs again. Keeping to this 'in through the nose and out through the mouth' creates a deeper, slower and more relaxing breathing style.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi there – yes you have the right idea. It can be frustrating looking at the data and seeing the efficiency so high when you don't feel sleep is as good in real life, however it's high because you're either getting out of bed for the quarter hour rule each time, or you fall asleep fairly quickly again. It is helpful to capture this subjective data in the diary in this way, though.

  • Sleepio Member

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    Expert

    HI there – I wonder if you logged on early and so the discussion hadn't started yet? Hopefully you can see this now if you're logged on…

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hello – thank you for your post today.

    It sounds as if you have tried many things for this anxiety re sleep itself. It's so common. I would recommend paradoxical thinking – just remember to say over to yourself, “don't fall asleep, don't fall asleep”. It sounds silly, but I have had it work for many of my clients! It takes the pressure off you to fall asleep and this in turn relaxes the brain and lets sleep simply happen naturally, without your involvement.

    Something else that those in a similar situation might try is taking a note of all the good sleep you've had – tracking your progress – so you have evidence of how far you've come and how well you're doing. This implicitly tells the brain, “I can do this, I'm able to sleep” and can help reduce worries about not sleeping.

    In terms of not feeling sleepy at bedtime, make sure naps are always avoided (unless they are essential to safety/health reasons) and try shifting the sleep window a little later to a time you may feel more sleepy.

    Hope this helps.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Hi Dr Creanor-yes I am talking out the quarter hour rule. I have not being following it because I keep thinking that if I stay in bed I will eventually fall asleep. Its not working and I end up staying in bed 2-3 hours before finally getting up. Secondly, I fall asleep sometimes but wake up after an hour. After getting out of bed I stay up until sleepy. After returning to bed I find I am waking up after about an hour. I am waking up too early. Is this chronic insomnia. Additionally, I have being told I stop breathing 8 times an hour. Is this sleep apnea. I don't know if I have insomnia or apnea. My doctor can't figure it out. I am confused by the situation. Thanks.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hi there – I'm sorry to hear this is an ongoing difficulty. It's so hard to be awake for so long during the night. Often it's good to go back to basics that we learned during the Sleepio programme and take it step by step again.

    When I hear similar posts from graduates, I tend to suggest they have a think about all the steps they did when they started the programme. Recalculate the average sleep across the week and make sure sleep restriction is in place, as is the quarter hour rule. Make sure good sleep hygiene is in place and that any thoughts are challenged. Have a think about any other factors that are causing these wakenings – health factors, medication, diet (including alcohol/caffeine/drugs), anxiety, mood problems, stress. If there are external problems at play, it can help to get support for these in order to then ease the sleep problems.

    Sometimes taking it one step at at time again can be helpful, rather than trying to do all the techniques at once.

  • Sleepio Member

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    Expert

    Hmm it does sound as if this may be apnoea. If your doctor is unsure, it may be a good idea to find another local doctor or sleep specialist who can properly diagnose (or rule out) apnoea, because it's important you get the right treatment.

    In terms of the quarter hour rule, we would recommend getting out of bed after approx 15 mins, especially if you are lying awake in bed for so long. But in the first instance, I think it would be wise to have the potential apnoea explored further in order to get the correct support.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Hello and thank you for getting in touch with us. I'm so sorry to hear this is such a difficult situation for you just now. It sounds very tough indeed. As I'm sure you will understand, Sleepio is a self-help programme and although we can speak to people weekly via these live discussion sessions, it's not an appropriate vehicle to support people who are needing more urgent support – especially as all communication is conducted remotely.

    It sounds as if you need urgent medical or psychological care just now – with such a lack of sleep added to the underlying condition you mention. As you know we cannot provide this via Sleepio, however I would advise you to get back in touch with doctors – perhaps a different doctor? – or a mental health service to request that they provide you with support. I am not familiar with the Russian mental health care system as I am based in the UK, however your doctor may be able to point you in their direction if you are not aware of them.

    I'm glad that you are keen to get support and to get through this very difficult period. I really hope you find the right person to help you as soon as possible.

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thanks-this could be why the medication (4 kinds) are not helping. I will find local help to get a proper diagnoses.
    regarding the quarter of an hour rule-on the nights when I do get out of bed early, I am able to fall asleep for 3 hours before waking up again.

  • Sleepio Member

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    in reply to Sleepio Member
    Expert

    Yes – good idea to seek a thorough assessment. That's good you are managing a three hour block after a wakening. It may all be related to the potential apnoea, which is why it's important to understand what's at play.

  • Sleepio Member

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    Expert

    Thank you for all the posts this evening. That's our session over for this week – speak to you all again soon.

  • Sleepio Member

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    Graduate

    My question was not answered. What is the point of organizing the live discussions if you do not answer questions?!

  • Sleepio Member

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    in reply to Sleepio Member
    Graduate

    Thank you for your response.

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