Live discussion with Dr Vicki Creanor - 7th January

Dr Creanor will be hosting a live online discussion here on Wednesday 7th January, 8.15pm-9.45pm GMT.

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Posted 5 Jan 2015 at 9:30 AM
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  • Sleepio Member

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    Expert

    Hi Kirke,
    From your post, it sounds as if you are experiencing a great deal of anxiety as well as sleep problems. I am wondering which came first – is the anxiety solely around poor sleep, or is poor sleep a symptom of anxiety? In either case, you will experience irrational fears. There is a whole section in Sleepio designed specifically to target the thinking around sleep, as our negative, irrational thinking styles significantly maintain most people's sleep problems. By unwrapping our thoughts and finding ways to reframe them in line with the full evidence in front of us, then we can retrain our mind to not worry so much about sleep. It sounds as if this section in Sleepio will tap into what you're talking about.

  • Sleepio Member

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    Graduate

    I have just done session 5 and am presently in the Sleep Restriction part of the program at 5 hrs/night.What is the process at this point and when is the restriction lessened? What are the parameters for decreasing the SR?

  • Sleepio Member

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    Expert

    Hi again Kirke – you talk about the same thing I mentioned in my previous post to you – sorry, should have read this one before I replied, but we're talking about the same thing so that's good! You can have primary or secondary insomnia, as you're aware – primary being insomnia that is not simply the symptom of another mental health problem, and secondary being the result of another MH problem.

    In practise, what we as psychologists are advised to do, is to treat the primary problem first, as often this will result in the secondary difficulty easing off naturally.

    Would you class your sleep problem as primary or secondary?

    The thing with CBT is that you can apply many of the techniques around behaviours and thoughts to other problems, so even if the secondary problem is the focus first of all, you could see benefit by applying the techniques to both primary and secondary problems at the same time.

    Hope that makes sense.

  • Sleepio Member

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    Expert

    Hi Lew,
    Thanks for your post and for joining us today. Sleep restriction is something that makes many people afraid – is seems crazy to lessen your sleep when it's all you crave and desire. It is, however, designed to create better sleep efficiency and has been shown to be very effective.

    In terms of when you can start increasing the time you are allowed to sleep, what you're aiming for is around 90% efficiency (being asleep for 90% of the time you are in bed). The Sleepio Sleep Diary will alert you to this when you complete it. At this point, we advise that you increase your time in bed by 15 minutes. Then you repeat the process – when you next achieve 90% efficiency, you can add another 15 mins to your sleep time.

    Does that make sense?

  • Sleepio Member

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    Expert

    Hi Pinky,
    Sorry to hear you're struggling. You mentioned a feeling that you have underlying, innate anxiety and I wonder if, in line with what I was speaking to Kirke about previously, the sleep problem is secondary to this? It may be that you require some support with the anxiety before the sleep improves? Again, with what I was saying earlier about the crossover of CBT techniques between the primary and secondary problems, you can use the thought challenging and the relaxation techniques for anxiety, too, but it is worth thinking about asking for an assessment and potentially intervention for anxiety if you feel it is an ongoing difficulty.

    As for coming off medication, I've worked with lots of people who take meds for a while to settle the system down, but then aim – and succeed – at coming off them and relying only on psychological techniques to manage their difficulties. Hope that reassures you a bit?

  • Sleepio Member

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    Expert

    Hi rachelb,
    Thanks for your post. Lots of discussion tonight about the primary and secondary nature of sleep problems. If the PTSD-related nightmares are what raise the anxiety before bed and affect sleep, then again I would suggest seeking treatment for PTSD to help ease the nightmares. It sounds as if the sleep problem is secondary to PTSD, which is very common.

    I'm glad to hear your efficiency is so good though – well done.

  • Sleepio Member

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    Graduate

    Thank you Dr Creanor;I just wanted to clarify, I assume that 90%sleep efficiency is required for several consecutive nights. I assume a solid week's worth. At this point I sometimes hit 90% and then 87% , but not ongoing at 90%. So it is then that a 7 day stretch is required? Thanks Lew

  • Sleepio Member

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    Hi Kirke,
    Just answering your questions in turn here. I would love to give you a list of tips to fall asleep quickly, however, unfortunately, it's not a quick-fix type of promlem. The techniques you have spoken about are great – keep doing them – relaxation is so important. All the other techniques and advice at the start of the Sleepio programme about winding down and watching what you eat/drink/do before bed are also important. You will soon come to the thought challenging section, too, where you will learn how to challenge any anxious or negative thoughts that enter your mind when you're trying to sleep. The quarter hour rule (QHR) is also important to put into practice to ensure that the bed-sleep connection is positive and solid…it sounds as if what happens to you is that the sight of your bed/being in bed alerts your body to become more alert, so the QHR is very important for you. Hope that helps, Kirke.

  • Sleepio Member

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    Expert

    That's a good question, Lew. Off the top of my head I'm not sure what Sleepio requires but I imagine it is a weekly average of 90%. Have a wee look at the guidelines again in that section as the sleep diary is programmed in a certain way to fit in with calculating efficiency – want to make sure you are working to the correct figure! Come back to me or one of my colleagues if it's not clear and we'll clear that up for you.

  • Sleepio Member

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    Graduate

    It definitely helps, thank you so much.
    And answering to your question – my anxiety and panic came first and insomnia came as secondary. However, at the moment it is a bit vicious circle because I do not benefit fully from anti anxiety meds because my anxiety without sleep has become twice as high, and on the other hand, Zoloft even more disrupted my sleep.
    That is why I am coping with both problems simultaneously. My doc is trying to find for me the right meds for anxiety, and I also take part in Sleepio programme to get back my sleep patterns naturally. My doctor said that it was a good choice to join this programme and that I should go on with it.

  • Sleepio Member

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    Expert

    Hi Dartmouth,
    Thanks for your question. Exercise has often been regarded as a helpful way of tiring out the body to help it sleep for longer and to increase deeper sleep as well. In the library, there's a good article on this and I will copy part of it here which suggests that aerobic exercise was helpful in insomnia, but that there was little difference in the effects between this exercise being taken in the morning vs afternoon:

    “In a recent published study by Passos et al. (2011), adults with chronic insomnia were allocated to aerobic exercise (training on a treadmill) for six months, 3 times a week, either in the morning (about 10am) or late afternoon (about 6pm). Results showed that objective and subjective sleep improved over the 6 month period, with notable reductions in time taken to fall asleep, wakefulness during the night, and subjective ratings of sleep quality on awakening. In addition, improvements in sleep quality were also related to reductions in symptoms of depression and tension/anxiety, even though participants did not suffer from depressive or anxiety disorders prior to study initiation. Finally, there were no reported differences between morning or late-afternoon exercise, suggesting that both exercise times may be beneficial for sleep.”

    WHat I would say, though, Dartmouth, is that exercise is often a subjective activity – you may find that a few hours of golf, out in the open, helps you sleep better than an hour on the treadmill! It's a bit about trial and error in my opinion to see what works best for you as an individual.

    As for when is too close to bedtime, I'd leave approx 2 hours between strenuous exercise and bedtime, so you're not too stimulated for sleep.

  • Sleepio Member

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    Expert

    Hi Lew,
    You raise a very good question and the very name of the technique suggests it goes against intuition! The idea behind paradoxical intention (PI) is that, most people who struggle to sleep put so much effort into trying to sleep, that it activates an entire system dedicated to a huge amount of effort in achieving sleep. Actually, this is very unnatural, as good sleepers do not think about sleeping – they are passive to it – it happens TO them. Thus, by taking the pressure off putting effort into falling asleep by saying “don't fall asleep” over and over, the effort is no longer put into trying to fall asleep. The mind is also very good at neglecting the “don't” and so the brain is simply being told to fall asleep, while the impression on the sleeper is that the pressure is actually off to fall asleep. A clever wee trick! It can be very effective as a technique.

  • Sleepio Member

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    Expert

    Hi Kirke,
    That makes sense to tackle them at the same time, then. When you come to the thought challenging, try to apply the techniques to all of your negative thinking then, rather than just the sleep-related aspects, as CBT is very effective for anxiety, too.

  • Sleepio Member

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    Graduate

    Thanks Dr Vicki, I find that swimming late afternoon works very well for me. It also increases my appetite for supper, which I think may also be helping with my sleep. Will start session 4 tomorrow and am happy with where I am with Sleepio.

    John W (Dartmouth)

  • Sleepio Member

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    Expert

    Well that's great you've found something that works well for you. Glad to hear you're happy with your progress. Thanks for joining us tonight and for your questions.

  • Sleepio Member

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    Expert

    Thanks for your company everyone – some great questions tonight. Speak to you again soon.

  • Sleepio Member

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    Graduate

    Hi Dr Creanor; Thank you very much for clarifying this technique . lew

  • Sleepio Member

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    Graduate

    Hi Dr Creanor; That does make sense. Thanks lew

  • Sleepio Member

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    Graduate

    Thanks for your help.I'll check out the guidelines. lew

  • Sleepio Member

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    Graduate

    Hello zeebee,
    During the course of the sleepio programme you will come across other techniques as well to add to what you are already doing, that will help to control your thoughts and anxieties and stop them from controlling you! Just take it one day at a time, and I'm sure you will get through.

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