Who is Dr. Guy Leschziner?

Dr. Guy Leschziner is a neurologist specializing in sleep medicine at one of Europe's largest sleep clinics.

What happened to Kenneth Parks?

Kenneth Parks drove 23 kilometers, killed his mother-in-law, and attacked his father-in-law while sleepwalking. He was acquitted because of his sleepwalking defense.

How prevalent is sleep deprivation?

About 20% of the adult population is chronically sleep deprived.

Sleep apnea is a condition where a person's airway narrows during sleep, causing breathing difficulties and disturbances in sleep.

Can sleep disorders lead to criminal behavior?

Yes, there have been cases where individuals have committed crimes while sleepwalking.

How important is sleep?

Sleep is fundamental, affecting cognitive function, immune health, and even emotional well-being.

What is the link between sleep deprivation and weight gain?

Sleep deprivation can lead to increased calorie intake and altered processing of food due to hormonal changes.

What can help treat insomnia?

Cognitive Behavioral Therapy for Insomnia (CBTI) is considered the gold standard treatment.

The exact reason we dream is not fully understood, but it's suggested to help with memory and emotional processing.

What's the role of the glymphatic system in sleep?

The glymphatic system helps clear metabolites and toxins, like beta-amyloid, from the brain during sleep.

The Extreme Sleep Scientist: The Painful Trick To Fix Insomnia And Poor Sleep!

01:58:56

https://www.youtube.com/watch?v=Desm53JJVMA

Summary

TLDRThe discussion delves into the intricacies of sleep and its disorders, led by Dr. Guy Leschziner, a prominent neurologist and sleep expert. Highlighted is the perplexing case of Kenneth Parks, who committed murder and assault while allegedly sleepwalking and was later acquitted. The conversation touches on a wide array of sleep concerns such as insomnia, sleep apnea, and the neurological factors influencing sleep behavior. Dr. Leschziner emphasizes the prevalence of sleep disorders, noting that a significant portion of the population suffers from chronic sleep deprivation and conditions like sleep apnea, often underdiagnosed. He outlines the impact of sleep on various health aspects, from weight gain to cardiovascular and mental health issues, underscoring the critical necessity of sleep for overall well-being. The discussion also explores the cultural attitudes towards sleep, the role of sleep aids and methods like Cognitive Behavioral Therapy for Insomnia (CBTI), and the debate over the complexities of sleep tracking technology. Additionally, the conversation considers philosophical queries on free will and morality tied to neurological conditions and their effects on behavior. Dr. Leschziner’s insights provide a comprehensive view on understanding and improving sleep health.

Takeaways

🛌 Chronic sleep deprivation affects 20% of adults.
😴 Insomnia affects 30% of people annually, with effective treatment available.
🚗 Cases exist where crimes were committed while sleepwalking.
🔍 Sleep is crucial for cognitive and physical health.
🔗 Sleep deprivation is linked to weight gain and diet shifts.
🛠️ Non-medication treatments like CBTI can effectively treat insomnia.
💤 The glymphatic system in the brain clears toxins during sleep.
🧠 Local sleep deprivation can cause parts of the brain to 'sleep' during waking hours.
💡 Exposing yourself to too much blue light from screens affects sleep patterns.
👨‍⚕️ Sleep medicine is increasingly recognized for its importance in overall health.
📉 Sleep tracking can increase anxiety in those already worried about their sleep.
🎭 Our understanding of sleep and its disorders is still evolving.

Timeline

00:00:00 - 00:05:00
The video begins with a discussion on sleepwalking and its implications, highlighting the case of Kenneth Parks, who was acquitted after committing crimes in his sleep. The speaker introduces Dr. Guy Leschziner, a neurologist specializing in sleep medicine, and discusses widespread chronic sleep deprivation, insomnia, and sleep apnea in the UK.
00:05:00 - 00:10:00
Dr. Leschziner explains what constitutes healthy sleep and the mortality risks associated with too much sleep. He indicates that even a single night of sleep deprivation can lead to increased calorie intake, and mentions effective treatments for insomnia. He is generally not in favor of sleep tablets, preferring non-drug-based techniques for insomnia.
00:10:00 - 00:15:00
The channel announces a subscriber raffle giveaway to thank viewers for helping them reach 6 million subscribers. The speaker then transitions back to the interview with Dr. Leschziner, asking about his personal curiosity and career motivations related to understanding the brain and extreme human experiences.
00:15:00 - 00:20:00
Dr. Leschziner discusses his fascination with the brain and neurological extremes. He describes neurology as the study of brain diseases like epilepsy and Parkinson's and explains sleep medicine's emergence as a field. His work bridges sleep disorders with broader neurological conditions, which often significantly alter perception and behavior.
00:20:00 - 00:25:00
Dr. Leschziner describes his work at one of Europe's large sleep disorder centers, where extensive studies on sleep disorders like sleep apnea and narcolepsy are conducted. He emphasizes the large number of patients treated and discusses the overlap between sleep and neurological issues, underscoring sleep's fundamental biological role.
00:25:00 - 00:30:00
The discussion explores why humans require sleep and the evolutionary significance, noting how certain animals' sleep adaptations underscore its importance. Sleep's role extends across our immune, cardiovascular, and mental health systems. The conversation touches on societal changes in sleep perception and historical patterns of sleep.
00:30:00 - 00:35:00
Dr. Leschziner explains how societal factors, such as lifestyle and technology, contribute to widespread sleep issues, highlighting insomnia and sleep apnea. There's a deep dive into statistics showing the prevalence of these conditions and the underdiagnosis of sleep apnea, especially in the UK.
00:35:00 - 00:40:00
The speaker discusses the prevalence of various common and serious sleep disorders and asserts that most sleep issues can be improved significantly. Treatments like cognitive behavioral therapy for insomnia (CBTI) show high success rates, suggesting a large percentage of individuals can recover to healthy sleep patterns.
00:40:00 - 00:45:00
It's noted that some modern lifestyle factors exacerbate sleep disorders, with studies showing that traditional societies experience less insomnia. Researchers have studied these societies to understand natural sleep patterns, finding fewer instances of insomnia and some differences in sleep cycles compared to industrialized societies.
00:45:00 - 01:58:56
Dr. Leschziner discusses how normal wakefulness during sleep cycles is not pathological. He mentions a medieval hypothesis of segmented sleep and how modern sleeping patterns differ geographically, stressing the non-uniformity of human sleep needs,

Mind Map

Video Q&A

Who is Dr. Guy Leschziner?
Dr. Guy Leschziner is a neurologist specializing in sleep medicine at one of Europe's largest sleep clinics.
What happened to Kenneth Parks?
Kenneth Parks drove 23 kilometers, killed his mother-in-law, and attacked his father-in-law while sleepwalking. He was acquitted because of his sleepwalking defense.
How prevalent is sleep deprivation?
About 20% of the adult population is chronically sleep deprived.
What is sleep apnea?
Sleep apnea is a condition where a person's airway narrows during sleep, causing breathing difficulties and disturbances in sleep.
Can sleep disorders lead to criminal behavior?
Yes, there have been cases where individuals have committed crimes while sleepwalking.
How important is sleep?
Sleep is fundamental, affecting cognitive function, immune health, and even emotional well-being.
What is the link between sleep deprivation and weight gain?
Sleep deprivation can lead to increased calorie intake and altered processing of food due to hormonal changes.
What can help treat insomnia?
Cognitive Behavioral Therapy for Insomnia (CBTI) is considered the gold standard treatment.
Why do we dream?
The exact reason we dream is not fully understood, but it's suggested to help with memory and emotional processing.
What's the role of the glymphatic system in sleep?
The glymphatic system helps clear metabolites and toxins, like beta-amyloid, from the brain during sleep.

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Subtitles

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00:00:00
I've seen patients cooking a meal in
00:00:01
their sleep driven in their sleep
00:00:03
committed crimes in their sleep so what
00:00:06
is the story of Kenneth Parks he drove
00:00:09
several miles to his in-law's house
00:00:11
bludgeoned his mother-in-law to death
00:00:13
and then tried to kill his father-in-law
00:00:16
but it was deemed he was sleepwalking
00:00:18
and he was actually acquitted that's
00:00:21
crazy Dr guy leser is a leading
00:00:23
neurologist in sleep physician at one of
00:00:24
Europe's largest Leep clinics and with
00:00:26
over 25,000 studies of over 100,000
00:00:30
patients his pioneering research and
00:00:31
sleep medicine has provided the answers
00:00:33
we need to improve our sleep so many
00:00:36
people are chronically sleep deprived
00:00:38
30% will experience insomnia and 80% of
00:00:41
people in the UK don't know that they've
00:00:43
got sleep annea this is the problem but
00:00:45
the majority can be helped so let's get
00:00:47
into that is there such a thing as
00:00:50
healthy sleep somewhere between 7 and 8
00:00:52
and 1 half hours a night now what's
00:00:54
difficult to explain is why your Ora
00:00:56
mortality goes up if you're sleeping
00:00:58
more than 8 and 1 half hours is there a
00:01:00
link between sleep deprivation and
00:01:02
weight gain increases so even a single
00:01:04
night of sleep deprivation can result in
00:01:06
a dramatic increase in calorie intake
00:01:08
and that's because what hope would you
00:01:10
offer insomniacs there are very
00:01:12
effective treatments for insomnia for
00:01:14
example if you we know that helps about
00:01:17
80% of individuals are you a fan of
00:01:20
sleep tablets as a general r no because
00:01:22
there are many non-d drug-based
00:01:23
techniques what are these techniques to
00:01:25
improve our sleep the gold standard
00:01:27
treatment now is
00:01:30
guy why do we dream that's a really
00:01:33
important question the honest answer
00:01:36
is we've just hit 6 million subscribers
00:01:38
on the DI of a SE um so me and my team
00:01:41
would like to do something we've never
00:01:42
done before as little thank you and
00:01:43
we're calling it The dire of a SEO
00:01:45
subscriber raffle and here is how it
00:01:47
works every episode this month we're
00:01:49
going to pick three current subscribers
00:01:50
at random and we'll send one of you a
00:01:52
1,000 voucher one of you tickets to come
00:01:55
and watch the D SE behind the scenes
00:01:57
live with our team and one of you will
00:01:58
have a 10-minute phone call with me to
00:02:00
discuss whatever you want to talk about
00:02:02
if you're a subscriber you're in the
00:02:04
raffle thank you from the bottom of my
00:02:07
heart for allowing me to do something
00:02:08
that me and my team love doing so much
00:02:10
it is the greatest honor of my lifetime
00:02:12
and I hope it I hope it continues uh off
00:02:14
into the Future Let's get to the
00:02:16
[Music]
00:02:19
episode
00:02:21
guy should I say doct
00:02:23
guy what is it that is at the very sort
00:02:26
of heart of your personal curiosity
00:02:29
because as I look at your work and how
00:02:31
what you've committed your career to
00:02:32
there seems to be a bit of a through
00:02:34
line as to sort of the subject matters
00:02:36
that have captured
00:02:37
you so I've always been fascinated why
00:02:41
we are the way that we are and obviously
00:02:43
from a scientific perspective the core
00:02:46
of that is our brain and in the course
00:02:49
of my clinical practice I come across a
00:02:52
a whole host of individuals who really
00:02:54
sit at the extremes of The Human
00:02:57
Experience you know people who are
00:02:59
sometimes afflicted by very serious
00:03:02
neurological conditions who experience
00:03:04
the world in a very different way to how
00:03:06
we do so really the the at the core of
00:03:09
what I do particularly in the public
00:03:11
facing work that I do it's looking at
00:03:14
those people at the extremes of The
00:03:16
Human Experience and trying to work out
00:03:18
what it tells us about all of us about
00:03:20
how we all work when you say the
00:03:22
extremes of The Human Experience what
00:03:24
does what does that mean so individuals
00:03:26
who have who see the world in a very
00:03:29
different way experience the world in a
00:03:30
very different way understand the world
00:03:33
in a very different way so you know from
00:03:36
when it comes to individuals who have
00:03:38
very extreme Sleep Disorders to
00:03:40
individuals in whom their perception of
00:03:43
reality is very different from our own
00:03:45
or to people who behave in a very
00:03:47
different way so when it comes to things
00:03:50
like uh aggression or um the way their
00:03:55
relationship with food or um their
00:03:58
personality traits I think in in every
00:04:01
area of clinical neurology you see
00:04:04
individuals in whom something has
00:04:06
happened to their brain that
00:04:08
fundamentally changes the way they see
00:04:11
the world interpret the world or behave
00:04:13
within that world and what's your sort
00:04:16
of day-to-day and and if you if I was to
00:04:19
take a look at your CV what would I see
00:04:20
on your CV I uh studied medicine at
00:04:23
Oxford and then at Imperial uh and very
00:04:26
early on in my career started training
00:04:28
in the world of Neurology did a PhD at
00:04:31
Imperial in Cambridge what is neurology
00:04:34
neurology is the clinical study of the
00:04:37
brain so the brain in its disease state
00:04:41
so we see individuals with epilepsy with
00:04:44
Parkinson's disease with nerve problems
00:04:48
um with certain types of sleep disorders
00:04:51
basically any disease or disorder that
00:04:53
influences how the brain and the nervous
00:04:55
system works so I did a PhD at Imperial
00:05:00
and Cambridge looking at the genetics of
00:05:02
epilepsy and then started working uh as
00:05:05
an NHS consultant in
00:05:08
2010 and you're a consultant of neur um
00:05:12
neurology and sleep medicine that's
00:05:15
right yeah I've never heard the phrase
00:05:17
sleep medicine before well sleep
00:05:18
medicine has been around for a long time
00:05:21
um I was very lucky in the early on in
00:05:24
my training period I rotated through a
00:05:26
hospital where one of my now colleagues
00:05:29
had come from the United States he'd
00:05:32
been based in La where sleep medicine
00:05:34
was really starting out and he'd set up
00:05:37
a a sleep medicine unit and that was at
00:05:40
St Thomas's Hospital in London opposite
00:05:41
the house of parliament um and certainly
00:05:44
over the last 20 or 30 years this been a
00:05:47
really exploding area of uh of medicine
00:05:51
uh partly mirrored by the fact that we
00:05:54
are much more aware of the impact of
00:05:56
sleep on a range of biological and U
00:06:01
mental health issues um but actually in
00:06:05
the world of Neurology there are many
00:06:07
sleep disorders that have their basis in
00:06:09
the brain conditions like narpy like
00:06:12
people who Sleepwalk or act out their
00:06:14
dreams people who have uh episodes at
00:06:17
night that may or may not reflect
00:06:20
certain types of epilepsy so that's
00:06:22
really the primary focus of my work now
00:06:26
between 2013 and 2023 you ran gu St
00:06:29
Thomas's Hospital Sleep Disorder Center
00:06:31
that's right yeah what is that so the
00:06:34
the Sleep Disorder Center is probably
00:06:36
one of the largest sleep disorder
00:06:37
centers in Europe actually so we have 10
00:06:41
inpatient beds so every night 10 people
00:06:45
are brought into the Sleep laboratory
00:06:48
and we study their sleep it's got uh now
00:06:51
about 15 Consultants that's got a staff
00:06:54
of about 50 people and we see a range of
00:06:57
people with conditions like sleep apnea
00:07:01
which is where people stop breathing at
00:07:02
night and then some of the conditions
00:07:04
that I I've talked about conditions like
00:07:06
restless leg syndrome extreme
00:07:08
sleepwalking narcolepsy and other
00:07:10
related issues how many patients have
00:07:13
you had in your sleep disorder Center
00:07:16
that you've studied gosh uh an awful lot
00:07:18
so we do about
00:07:20
2,500 sleep studies a year and we've
00:07:24
been going for well a long time sort of
00:07:27
15 20 years so every year we see about
00:07:31
uh 10,000 patients in total so very very
00:07:34
large numbers if you had to estimate how
00:07:37
many you've seen I I I would imagine
00:07:40
somewhere in the region of upward of
00:07:42
100,000 if we're talking about 10,000
00:07:44
patients a year and and how many sleep
00:07:47
studies have you conducted in that
00:07:49
Center so we've been at the current site
00:07:52
with 10 beds for about 10 years mhm um
00:07:56
and so we're probably talking about 25
00:07:59
5,000 studies why sleep of all the
00:08:02
things that you could commit so much of
00:08:03
your time to because it appears you've
00:08:05
been really thinking and working on the
00:08:06
subject matter of sleep for about sort
00:08:08
20 OD years two decades roughly yeah
00:08:10
something like that yeah what why well I
00:08:13
think the first thing is is that um we
00:08:16
spend a third of Our Lives doing it and
00:08:19
yet we whatever people like me will tell
00:08:22
you we still understand relatively
00:08:25
little about it we understand relatively
00:08:27
little about you know what it's for
00:08:30
um what it does to our biology obviously
00:08:32
that's changing very very quickly now um
00:08:36
it's uh it has a great deal of overlap
00:08:39
with the world of clinical neurology so
00:08:41
I also do uh I do Specialist Clinic
00:08:44
specialist clinics in epilepsy and I do
00:08:46
specialist uh clinics in in general
00:08:49
neurology so and and sleep and the Brain
00:08:52
intersect every single level of course
00:08:55
you know it's not me saying this but a
00:08:56
famous statement is sleep is of the
00:08:59
brain by the brain and for the brain
00:09:01
it's in intimately linked to every
00:09:03
aspect of how our brain works so one of
00:09:06
the really exciting things is that
00:09:08
because it's a relatively new area our
00:09:10
understanding of it is exploding in ways
00:09:14
that are not paralleled across other
00:09:17
areas of clinical
00:09:19
medicine is it important is it important
00:09:22
yeah um I I think it is of fundamental
00:09:26
importance you know the fact is that if
00:09:28
sleep wasn't important it would be a
00:09:30
very stupid thing for evolution to
00:09:34
create in us the fact that we are
00:09:36
essentially SL Switched Off from our
00:09:38
external environment for a third of our
00:09:40
lives and actually there's a whole host
00:09:42
of evidence when you look at how um
00:09:45
certain animals have developed the
00:09:46
ability to be able to sleep with only
00:09:48
half their brain at a time you know
00:09:50
animals like aquatic mammals or certain
00:09:52
Birds dolphin and dolphins that very
00:09:55
much suggests well you know that must be
00:09:58
of great importance if it's if sleep is
00:10:02
um a risk for our survival because if
00:10:05
you're an aquatic mamal like a dolphin
00:10:07
and you're sleeping and you're unable to
00:10:09
surface or unable to see what predators
00:10:11
are around you that the that the the
00:10:14
evolution has designed a system whereby
00:10:17
it enables you to sleep with half of
00:10:18
your brain at a time so that in and of
00:10:21
itself tells us it's important the the
00:10:24
the the fact that the Circadian rhythm
00:10:26
so that 24-hour cycle that a whole host
00:10:29
of biological rhythms have is so
00:10:33
intrinsically linked to life itself that
00:10:36
actually every single um life form
00:10:40
exhibits features of this 24-hour
00:10:42
circadian rhythm tells us that this was
00:10:44
something that was prioritized at a very
00:10:47
very early stage in life's Evolution on
00:10:49
Earth so yes it's important and over the
00:10:53
last few years we've understand
00:10:55
understood precisely why it's important
00:10:57
I say precisely but we know that it's
00:11:00
important for pretty much every aspect
00:11:02
of our waking lives be it our immune
00:11:04
system be it our um cardiovascular
00:11:07
system or blood pressure risk of
00:11:10
diabetes um mental health so depression
00:11:14
and anxiety even how we perceive pain so
00:11:17
it really is fundamental to every system
00:11:20
that we uh rely on during our waking
00:11:23
Lives having seen you know thousands and
00:11:26
thousands and thousands of people that
00:11:27
struggle with sleep that have been sent
00:11:29
to your Center do you think the the
00:11:32
average person on the
00:11:33
street over or underestimates the
00:11:36
importance of sleep in their day-to-day
00:11:37
life well I think it's changing I think
00:11:39
it was not that long ago where you know
00:11:42
comments like sleep is for wimps uh Was
00:11:45
Heard fairly frequently and that there
00:11:47
were some bragging rights associated
00:11:49
with how little you sleep I think that
00:11:51
there has been a transformation over the
00:11:53
last sort of 15 or 20 years whereby
00:11:56
people have become much more aware of
00:11:59
how important sleep a sleep is and have
00:12:01
started prioritizing it a little bit so
00:12:04
you think where do you think we stand
00:12:06
then overestimate underestimate I think
00:12:08
that there is still in the general
00:12:09
population an underestimation of how
00:12:11
important sleep is but I think there are
00:12:13
certain uh segments of the population
00:12:16
that are much more aware of it and
00:12:19
perhaps even dare I say overestimate it
00:12:22
overestimate it yes I think so I I think
00:12:24
that there is a danger at the current
00:12:26
time that we tend to obsessional IE
00:12:30
about sleep and um and think that it is
00:12:33
the the the be all and end all it's of
00:12:35
course part of normal life for our sleep
00:12:38
to fluctuate depending on what's going
00:12:40
on in our external and our internal
00:12:43
lives and I think the danger is that if
00:12:45
you overemphasize the important of
00:12:48
importance of getting eight or eight and
00:12:49
a half hours sleep every night then you
00:12:53
actually uh risk problems later down the
00:12:56
line exacerbating things like insomnia
00:12:59
can you give me an overview of the
00:13:01
current state of sleep in terms of the
00:13:04
percentages stats of people that are
00:13:06
struggling with their sleep the variety
00:13:08
of ways that we struggle with our sleep
00:13:10
the different disorders associated with
00:13:11
with our sleep and just like a breakdown
00:13:13
of society at large is current sleep
00:13:16
health so we think that about 20% of the
00:13:20
adult population are chronically sleep
00:13:22
deprived so that they are not sleeping
00:13:24
enough and that's largely as a result of
00:13:27
Lifestyle factors and lack of
00:13:29
prioritization of sleep we think we know
00:13:32
that about 30% of the adult population
00:13:35
in any one year will experience a period
00:13:37
of insomnia so insomnia is different
00:13:39
from chronic sleep deprivation insomnia
00:13:41
is the the state whereby you want to
00:13:45
sleep where you're lying in bed and you
00:13:48
can't sleep which is very different from
00:13:50
you know burning the candle at both ends
00:13:52
and about 10% of the adult population
00:13:55
will have chronic insomnia so that's an
00:13:57
ongoing issue with
00:13:59
not being able to sleep for more than 3
00:14:02
months at a time so you know very very
00:14:05
high numbers there are some other sleep
00:14:07
disorders that are incredibly common so
00:14:09
a condition called obstructive sleep
00:14:12
apnea which is essentially a part of the
00:14:15
spectrum of of snoring but in
00:14:17
obstructive sleep apnea your Airway
00:14:19
Narrows uh you have difficulty breathing
00:14:22
it partially obstructs and you have
00:14:24
recurrent brief Awakenings sometimes
00:14:26
that you're not aware of that disrupt
00:14:28
your sleep
00:14:29
and estimates were vary wildly depending
00:14:32
on where in the world that they've been
00:14:33
done but I think you know our best guess
00:14:36
is something like 10 to 12% of adult
00:14:39
males experience sleep apnea clinically
00:14:42
significant sleep apnea and somewhere in
00:14:44
the region of about 6% of of women
00:14:47
experience clinically significant sleep
00:14:49
apnea so we're talking about very very
00:14:50
large numbers and the majority of
00:14:53
individuals with sleep apne are
00:14:54
undiagnosed so it's estimated that about
00:14:57
80% of people in the UK with with sleep
00:14:59
apnea don't know that they've got sleep
00:15:01
apnea and I've never seen anybody about
00:15:03
sleep apnea there are other conditions
00:15:05
like um restless leg syndrome which is a
00:15:08
neurological disorder whereby people
00:15:11
experience an urge to move a fidgetiness
00:15:15
in their usually their legs although it
00:15:17
can affect other body parts as well um
00:15:19
that can give rise to very huge
00:15:21
difficulties getting off to sleep and
00:15:23
actually staying asleep because a lot of
00:15:25
these individuals kick at night when
00:15:27
they are asleep and kick themselves
00:15:29
awake and that probably affects
00:15:31
somewhere in the region of about 5% of
00:15:33
the adult population even sleepwalking 1
00:15:36
to 2% of the population so lots and lots
00:15:39
of these conditions very very
00:15:41
common how many of the people that walk
00:15:44
in your sleep center do you think could
00:15:47
be helped and could you help well I
00:15:50
think the majority can be helped um a
00:15:53
cure is something different but the
00:15:55
majority can be helped in some shape or
00:15:57
form and if and if we talk about getting
00:16:00
someone that has walked in your clinic
00:16:02
with some kind of sleep disorder to a
00:16:03
state where they are a healthy sleeper
00:16:05
what kind of percentage do you think
00:16:08
well I think it's important to to
00:16:10
precede what I say by the fact that
00:16:11
actually we don't see many people with
00:16:14
insomnia we tend to divert people with
00:16:17
what we term primary insomnia or or or
00:16:19
insomnia without any underlying causes
00:16:21
to assist a service if you look at
00:16:24
insomnia chronic insomnia as a whole we
00:16:26
know that there are some very good
00:16:28
treatments for chronic insomnia and
00:16:30
actually most of those treatments are
00:16:33
focused on non-drug based treatments
00:16:35
psychological based treatments and we
00:16:37
know that those kind of treatments will
00:16:39
significantly improve sleep in up to
00:16:41
about 80% of individuals so that's a
00:16:43
very large number actually and there are
00:16:46
other treatments available it doesn't
00:16:48
just rely on these non-drug based
00:16:49
treatments there are some conditions
00:16:52
like for example
00:16:53
narcolepsy which is what's narpy so
00:16:55
narcolepsy is a a brain disorder that is
00:16:58
triggered by your immune system is that
00:17:00
where you fall asleep during the day
00:17:02
when you fall asleep very very quickly
00:17:04
during the day you're excessively sleepy
00:17:06
you have very vivid dreams you will
00:17:08
often hallucinate as you drift off to
00:17:10
sleep or as you wake up you'll
00:17:12
experience something called sleep
00:17:13
paralysis where you wake up and you feel
00:17:15
that you are completely paralyzed you
00:17:17
cannot move and a lot of these
00:17:19
individuals also experience a condition
00:17:21
called cataplexy which is where usually
00:17:24
with strong emotion like laughter
00:17:26
sometimes it can be the telling of a
00:17:27
joke and they lose muscle strength and
00:17:30
will sometimes collapse to the ground so
00:17:32
it's a very pure neurological disorder
00:17:34
because we know precisely where that
00:17:36
area of immune attack occurs within the
00:17:39
brain and it knocks out a very small
00:17:41
number of brain cells to generate this
00:17:44
this is a you know once you have it at
00:17:46
the moment it's a lifelong condition but
00:17:48
actually it can be treated there are
00:17:49
many treatments available and even in
00:17:51
the Last 5 Years or there have been many
00:17:54
new treatments that have become
00:17:56
available so actually all of these
00:17:58
conditions are treatable they're
00:17:59
manageable um they're not necessarily
00:18:02
all curable is there something at the
00:18:04
heart of culture and how we're living
00:18:06
that's causing so many of us to struggle
00:18:08
with sleep the way that modern society
00:18:10
is at the moment certainly I think is
00:18:12
rather conducive to insomnia in fact you
00:18:15
know when uh researchers have looked at
00:18:19
um at pre-industrialized societies so
00:18:23
you know for example um tribes in um in
00:18:30
Eastern Africa or in South America
00:18:32
actually insomnia is relatively rare and
00:18:35
some of these tribes don't even have the
00:18:37
word for insomnia so I think that
00:18:39
certainly insomnia seems to be
00:18:41
correlated with the changes that have
00:18:43
occurred in our in our society sleep
00:18:46
apnea is often associated with weight
00:18:48
gain and obviously that is very much a
00:18:50
function of our modern societies so yes
00:18:54
undoubtedly some of these conditions can
00:18:56
be attributed to the way that we lead
00:18:59
Our Lives some has anybody ever put like
00:19:01
a sleep tracker on a tribe yes that has
00:19:03
been done there's a chap called Jerry
00:19:05
seagull who is based in the east coast
00:19:07
in one of the ivy league universities
00:19:09
who has spent his life doing that and
00:19:11
what did he find out so he found out
00:19:14
that actually sleep does vary a little
00:19:16
bit according to the seasons that uh
00:19:18
they don't necessarily sleep all the way
00:19:20
through the night but actually their
00:19:21
sleep is rather different to the sleep
00:19:23
of modern society in what way they will
00:19:27
not necessarily so this view that we
00:19:29
sleep when it gets dark and or used to
00:19:31
sleep when it gets dark and wake up at
00:19:33
dawn is incorrect um that they uh that
00:19:37
there is some fluctuation between the
00:19:39
seasons but not
00:19:40
necessarily um uh you know directly
00:19:44
related to the number of hours of
00:19:45
daylight and that insomnia is relatively
00:19:47
rare when so that are they waking up in
00:19:50
the middle of the night then uh I I
00:19:51
think it's normal to wake up in the
00:19:53
middle of the night that we all wake up
00:19:54
in the middle of the night it's very
00:19:55
rare that you uh for example do a sleep
00:19:58
study on somebody and you don't see
00:20:00
periods of awake in the middle of the
00:20:02
night it's normal to be awake for up to
00:20:04
about 30 minutes over the course of the
00:20:06
night that in itself is not a marker of
00:20:09
pathological
00:20:11
sleep when I say awake I mean I mean I
00:20:14
guess I mean getting up and walking
00:20:15
around and stuff but yeah I mean I think
00:20:17
that there are some individuals that do
00:20:18
that there's a there's a a chap called
00:20:20
Robert eirk who has spent a great deal
00:20:23
of time looking at Medieval texts and
00:20:25
seeing how they described sleep and he
00:20:28
has put forward a hypothesis that in
00:20:31
medieval times uh people would have a
00:20:33
first sleep and a second sleep now I
00:20:35
think that that theory is not
00:20:37
universally accepted but certainly for
00:20:39
some individuals getting up and walking
00:20:40
around is is you know certainly within
00:20:43
the Realms of normality I I think there
00:20:46
are different sleep hands if you look
00:20:47
for example at um Mediterranean Europe
00:20:50
the Siesta culture so people sleeping
00:20:52
for an hour or two at lunchtime but
00:20:55
sleeping slightly less at night so um
00:20:58
there are a range of sleep patterns that
00:21:01
sit within the spectrum of normality for
00:21:04
human beings is there such a thing as a
00:21:08
healthy sleep as in you know see these
00:21:12
sort of different sleep behaviors and
00:21:14
such but is there from a neurology
00:21:16
standpoint or clinical standpoint a
00:21:20
perfect sleep or a perfect sleeping
00:21:23
habit or you know right so I think the
00:21:26
first thing to say is that sleep is
00:21:27
different for everyone we know that
00:21:29
there are genetic factors uh that
00:21:31
influence for example your timing of
00:21:33
sleep your circadian rhythm whether or
00:21:35
not you're a uh a morning lck or an
00:21:38
evening hour there are also genetic U
00:21:41
influences over how much sleep we need
00:21:44
so for example there are one or two
00:21:47
families that I've seen in my clinical
00:21:49
career in whom every single member of
00:21:51
that family sleeps for 4 hours a night
00:21:53
and has no ill effects and does not seem
00:21:56
to have any long-term consequences from
00:21:59
that they don't feel tired they there's
00:22:01
no evidence that they're doing their
00:22:03
physical health any harm and there have
00:22:05
been some genes that have been
00:22:06
identified that Define that trait now
00:22:07
it's a rare trait and I wouldn't suggest
00:22:10
that most people who are sleeping 4
00:22:11
hours a night think oh I must be
00:22:13
genetically blessed because the reality
00:22:15
is probably somewhat different so I
00:22:18
think that in answer to your specific
00:22:20
question is there a perfect night's
00:22:21
sleep no there isn't because it depends
00:22:23
on the nature of who you are and what
00:22:26
your genetic inheritance is but but
00:22:28
certainly we can say on a population
00:22:30
basis well you know sleeping somewhere
00:22:32
between 7 and 8 and 1/ half hours a
00:22:34
night if you look and a stress on a
00:22:36
population basis we see ill effects in
00:22:40
terms of sleeping less than 7 hours or
00:22:43
sleeping more than 8 and a half hours if
00:22:45
you look at for example all cause
00:22:47
mortality or if you look at
00:22:49
cardiovascular disease now there are
00:22:52
various potential explanations for that
00:22:55
um certainly if you're sleeping
00:22:57
relatively little um you uh we can see
00:23:02
that there are changes in terms of how
00:23:04
your physiological system works that
00:23:07
might give rise to things like blood
00:23:09
pressure issues weight gain
00:23:11
cardiovascular disease stroke those
00:23:13
kinds of things what's a little bit more
00:23:16
difficult to explain is why your
00:23:17
mortality and other uh ill health goes
00:23:20
up if you're sleeping more than about 8
00:23:22
and 1 half hours and I think that that
00:23:24
is probably a much more complicated
00:23:27
picture in that we know that there are
00:23:30
certain drugs that people will be on and
00:23:32
when you're on drugs that's a marker
00:23:34
that your health is not necessarily 100%
00:23:37
already that will make you a bit more
00:23:39
drowsy than you normally are and will
00:23:42
extend your sleep time it may be that
00:23:43
you have a sleep disorder which is
00:23:45
causing you to sleep more but there's an
00:23:47
another interesting potential
00:23:49
explanation in that we know that for
00:23:51
example in certain diseases of the brain
00:23:54
there are changes to your sleep many
00:23:56
years before sometimes even decades
00:23:58
before for a really good example of that
00:24:00
is Parkinson's disease so we know that
00:24:02
in people with Parkinson's disease many
00:24:05
individuals will start acting out their
00:24:07
dreams at night sometimes even three
00:24:09
decades before they then go on to
00:24:11
develop Parkinson's disease so is it
00:24:14
that our sleep intrinsically changes in
00:24:17
as a precursor to certain conditions
00:24:19
like Alzheimer's disease and there is
00:24:22
some emerging evidence now that actually
00:24:24
a change in your sleeping patterns
00:24:26
either in terms of How Deeply you sleep
00:24:28
how long you sleep whether or not you
00:24:30
nap during the day that may be a what we
00:24:33
term a prodromal feature of Alzheimer's
00:24:35
disease do you see anything interesting
00:24:37
happen when someone has a baby in terms
00:24:39
of their I was wondering this the other
00:24:41
day cuz I have a friend who's had um a
00:24:43
couple of kids and I was looking at
00:24:45
their sleep tracker and it seems like
00:24:47
they have this inherent ability to
00:24:50
survive now that they've had kids on
00:24:51
like no sleep I was wondering if there's
00:24:53
some sort of evolutionary mechanism that
00:24:55
makes parents I don't know require less
00:24:59
sleep yeah I'm not sure I can
00:25:01
specifically answer that I've certainly
00:25:02
seen a lot of people whose sleep has
00:25:04
gone to pots after they've had kids and
00:25:06
you know a lot of people say that their
00:25:08
sleep has never returned to normal after
00:25:10
they've survived having a couple of kids
00:25:13
um but you know what you have to
00:25:15
remember is that the brain is a
00:25:17
remarkable organ in that it has all of
00:25:19
these adaptive mechanisms that enable us
00:25:23
to cope with changes in our
00:25:25
circumstances changes in our environment
00:25:27
so if you put put somebody in a sleep
00:25:29
deprived State sleep also changes so
00:25:33
what what the brain does is it
00:25:34
prioritizes the very deepest stages of
00:25:37
sleep stage three slow wave sleep over
00:25:40
other stages of sleep and you know what
00:25:43
we can see that in the sleep lab so if
00:25:45
somebody's very sleep deprived before
00:25:46
they come in and we put them in the
00:25:49
sleep lab we see a sort of huge increase
00:25:52
in their slow wave sleep which is the
00:25:54
stage of sleep that's most associated
00:25:56
with restoration with healing with
00:25:58
feeling uh feeling more refreshed than
00:26:02
other stages of sleep like for example
00:26:03
REM sleep or dreaming sleep so the brain
00:26:06
is prioritizing restoration faster than
00:26:09
it would because the person sleep
00:26:11
deprived absolutely yeah
00:26:14
H so what is the you as you were saying
00:26:18
there you've seen families that just
00:26:20
require 4 hours sleep and they're
00:26:21
apparently great is that is that a lot
00:26:24
of people no it's as I said it's very
00:26:27
very rare very rare cuz I've looked at
00:26:29
people sleep trackers before and I've
00:26:30
been astonished by how little sleep they
00:26:33
seem to require but how active and great
00:26:36
they seem to feel and I've and I I had
00:26:38
this the other day cuz one of my fellow
00:26:40
dragons I said this to her she requires
00:26:42
very little sleep but then she gets up
00:26:43
at 5 a.m. and goes for like a 10m run
00:26:46
and I was like I was looking at her
00:26:47
sleep tracker thinking you've been in
00:26:48
bed for like 5 hours and you are
00:26:51
extremely more awake and energetic than
00:26:54
I am and you just did a 10mile run and
00:26:56
I'll go in bed for seven hours
00:26:58
and my it says that my you know stage
00:27:00
three stage four sleep is higher than
00:27:02
hers but for some reason she's like you
00:27:05
know bouncing into the room well I I
00:27:07
think there's two explanations for that
00:27:08
the first is um maybe she is one of
00:27:11
these genetically short sleepers
00:27:13
although as I said that seems rather
00:27:15
unlikely I think the other explanation
00:27:18
is we we know that that you know I
00:27:20
talked a little bit about how genes
00:27:22
influence our sleep we know that there
00:27:23
are genes that influence how resistant
00:27:26
you are to the effects of sleep
00:27:29
deprivation uh and what I mean by that
00:27:31
is that there are there seem to be some
00:27:33
individuals who don't feel or or who
00:27:36
feel less sleepy than other people when
00:27:38
they are sleep deprived but that may be
00:27:41
separate from the cognitive effects of
00:27:44
sleep deprivation so she might just not
00:27:47
feel it she might not just feel it but
00:27:48
she may exhibit those cognitive effects
00:27:51
of sleep deprivation in the same way as
00:27:53
you or or I for example she's 10 years
00:27:56
older than me as well does that have
00:27:58
well I think that certainly we do see
00:28:00
some reduction in sleep requirement as
00:28:04
we get older um we're also a little bit
00:28:06
less about less good about maintaining
00:28:09
sleep as we get older and that's because
00:28:10
the brain mechanisms that stabilize
00:28:13
sleep are becoming a little bit weaker
00:28:16
so so this view that we need much less
00:28:19
sleep as we get older is probably
00:28:22
incorrect although there is a a slight
00:28:24
reduction in sleep requirement you
00:28:26
mentioned earlier that when people don't
00:28:28
get enough sleep the chance of obesity
00:28:31
and weight gain increases how how does
00:28:33
that happen what's the mechanism so what
00:28:36
there are probably many mechanisms but
00:28:37
one of the the ones that is best
00:28:39
understood is that we know that when
00:28:41
you're sleep deprived or indeed when
00:28:43
your sleep is disrupted by anything else
00:28:45
like for example sleep apnea there are
00:28:49
changes that occur in terms of hormone
00:28:51
levels of of uh hormones that regulate
00:28:54
our appetite and our satiety and so even
00:28:57
as single night of sleep deprivation can
00:29:00
result in a dramatic increase in your
00:29:02
calorie intake uh overnight there have
00:29:05
been some studies done for example in um
00:29:07
nurses so uh there was a study done that
00:29:10
followed up nurses for 18 years and they
00:29:13
looked at their weight and how much they
00:29:15
slept on a regular basis and what they
00:29:17
found is that those nurses that were
00:29:20
sleeping less than about 6 hours a night
00:29:24
on a regular basis first of all started
00:29:26
off at the beginning of that 18year
00:29:28
period uh at a slightly higher weight
00:29:31
but over the course of those 16 years uh
00:29:34
18 years they put on much more weight
00:29:36
than other groups so there is a very
00:29:38
clear correlation between sleep duration
00:29:42
Sleep Quality and weight gain we see
00:29:45
that for example in individuals who we
00:29:47
treat with sleep apnea so one of the
00:29:50
treatments for sleep apnea is a mask
00:29:52
like device that you wear that stops
00:29:54
your Airway from closing down at night
00:29:57
and and for some very overweight
00:30:00
individuals actually when you treat
00:30:01
their sleep apnea they do manage to
00:30:04
successfully lose weight where in the
00:30:06
past they found it absolutely impossible
00:30:09
to do
00:30:10
so okay so if I'm underslept I'm more
00:30:13
likely to eat more calories the next day
00:30:17
yes am I also more likely to to reach
00:30:19
for foods that are like high in sugar
00:30:22
and bad for me certainly some studies do
00:30:24
suggest that I think it's also important
00:30:27
to say that sleep disruption or sleep
00:30:29
deprivation has some fundamental effects
00:30:32
for example on um uh your glucose
00:30:35
tolerance so your insulin resistance um
00:30:38
which of course is a particular issue
00:30:39
for people with diabetes but it affects
00:30:42
us all so if you're very sleep deprived
00:30:44
there are changes to the way that not
00:30:46
only your appetite or what you're
00:30:49
reaching for but also how your body
00:30:51
processes the breakdown of those food
00:30:53
stuffs interesting CU I anecdotally I
00:30:57
think I can I can clearly say that if
00:31:01
I'm if I'm underslept I'm much more
00:31:03
likely to eat something that is high in
00:31:05
sugar or well I think we can we can all
00:31:08
testify to that can't we you know I
00:31:09
think everybody has known that situation
00:31:12
where they're very sleep deprived and
00:31:13
they think oh well I just need a bit of
00:31:15
chocolate or um you know what what
00:31:17
what's going on in the brain though why
00:31:19
is that is it is it something to do with
00:31:20
the amigdala the prefrontal cortex the
00:31:22
like the emotional center of our brain
00:31:23
and the yeah I I don't I don't think we
00:31:26
know I think it's probably to do with
00:31:29
the reward mechanisms that underly our
00:31:33
our behaviors that uh there is something
00:31:36
about sleep deprivation that alters the
00:31:40
rewards that we're seeking but I don't
00:31:42
think I can give you a clear answer on
00:31:43
that you you also talked about circadian
00:31:46
rhythms if I if I was a 10-year-old what
00:31:49
do I need to understand about the
00:31:50
Circadian rhythm what it is what it does
00:31:53
and why it's important so within pretty
00:31:55
much every cell of our bodies there is
00:31:58
this 24-hour clock and in fact if you
00:32:01
take a single cell and stick it in a
00:32:03
Petri dish about 40% of the genes within
00:32:07
that cell will exhibit this sort of
00:32:09
24-hour cycle and that 24-hour cycle
00:32:13
really controls pretty much every
00:32:15
biological system within our bodies be
00:32:17
it how our liver Works how our heart
00:32:19
Works how our lungs work there is one
00:32:22
particular area of the brain called the
00:32:24
supermatic nucleus that is viewed as the
00:32:26
Master Clock it's the clock that
00:32:29
coordinates all the other clocks within
00:32:31
our within our bodies and that
00:32:34
influences uh not only all of these
00:32:36
other clocks that are occurring within
00:32:38
the cells throughout our bodies but
00:32:40
influences our Behavior as well so
00:32:42
influences generally speaking when we
00:32:45
feel tired and when we want to go to bed
00:32:48
and when we wake up um and also
00:32:51
influences things like you know when we
00:32:52
feel most mentally alert when we want to
00:32:55
eat when we want to drink when we feel
00:32:57
most a able to cope with work for
00:33:00
example um now that circadian rhythm
00:33:03
that circadian clock for most people uh
00:33:06
confers the Sleep onset of somewhere
00:33:10
between 10: p.m. and midnight if you're
00:33:12
an adult and waking up somewhere between
00:33:15
6:00 and 8:00 a.m. now the timing of
00:33:18
that body clock is governed by two
00:33:21
things it's governed by our genetics so
00:33:23
whether or not we are um genetically
00:33:26
predetermined to be slightly later in
00:33:28
terms of our body clock or slightly
00:33:30
earlier and we see that in families
00:33:32
where lots of people with for example
00:33:34
will say well you know I've always gone
00:33:36
to bed late and woken up late but so is
00:33:38
my father so is my grandfather etc etc
00:33:42
um but it's also influenced by what's
00:33:44
happening in our environment about 50%
00:33:47
of the uh definers of our circadian
00:33:50
clock are governed by what's going on
00:33:52
around us be that in terms of when we're
00:33:55
exposed to light so we know that light
00:33:57
is a very
00:33:58
important driver of our circadian rhythm
00:34:01
when we're eating when we're exercising
00:34:04
when we're doing a whole range of other
00:34:06
activities and also one of the markers
00:34:08
of our Cadian rhythm is the secretion of
00:34:11
melatonin so there's a very small gland
00:34:13
in the center of our brain called the
00:34:15
pineal gland which secretes a a hormone
00:34:18
called melatonin that hormone tends to
00:34:21
start being secreted in most people at
00:34:23
around 6:00 in the evening it Peaks at
00:34:25
the time that we want to go go to sleep
00:34:28
and then it starts dropping down a few
00:34:30
hours before we wake up it's almost a a
00:34:33
chemical marker of our Cadian Rhythm but
00:34:35
we also know that giving people
00:34:37
melatonin in tablet form for example can
00:34:40
influence our Cadian Rhythm so there's
00:34:42
this sort of feedback loop between our
00:34:44
own body's secretion of melatonin and
00:34:47
what our supermatic nucleus our
00:34:49
masterclock is doing so by giving people
00:34:52
melatonin at particular times of the day
00:34:54
we can shift your cadan Rhythm forward
00:34:57
or or back so that Master Clock in the
00:34:59
brain where is it positioned the
00:35:02
supermatic nucleus is in a small area of
00:35:05
the brain called the the hypothalamus
00:35:07
and is that linked to the eye there are
00:35:10
links from the back of the eye to the
00:35:13
hypothalamus so there are some cells in
00:35:15
the back of the eye in the retina that
00:35:17
are not involved in Vision not involved
00:35:19
in conscious Vision but what they are
00:35:21
involved with is detecting blue light in
00:35:24
particular which is the part of the
00:35:26
spectrum of light that is most important
00:35:28
in terms of regulating our Cadian clock
00:35:31
and there are direct links between these
00:35:32
cells that are called retinal gangan
00:35:34
cells and the supermatic nucleus so
00:35:38
exposure to light to Blue Light in
00:35:41
particular is really very important in
00:35:44
reinforcing or adjusting arcaden Rhythm
00:35:46
now of course we live in a in a world
00:35:48
whereby the seasons change and the
00:35:50
amounts of light that we're exposed to
00:35:52
changes so if we were on a set Rhythm
00:35:55
all the time that was immovable and un
00:36:00
unadjustable then there would be times
00:36:03
where our Cadian Rhythm might not be uh
00:36:07
might might be at odds with our
00:36:08
environment so there does need to be
00:36:10
some slight adjustment of that Cadian
00:36:12
Rhythm and light is probably the most
00:36:15
important adjuster blue light is that
00:36:17
the light that comes from my smartphone
00:36:20
uh so it's so blue light obviously the
00:36:22
the strongest source of blue light is
00:36:24
Sun yeah um but yes these kinds of
00:36:27
devices your smartphone your iPad in
00:36:30
front of you a range of electronic
00:36:32
devices also have Blue Light Within them
00:36:35
so so that's why if I'm if I'm up on my
00:36:37
phone till 1: a.m. in the morning
00:36:39
staring into the screen I'm kind of
00:36:41
tricking that sort of optic nerve which
00:36:43
is then impacting my master clock and
00:36:46
I'm I'm telling it that it's a different
00:36:48
time yeah so so the thinking on that has
00:36:50
changed a little bit over over the last
00:36:52
few years so it you know it was said
00:36:55
that using these devices will trigger
00:36:58
insomnia as of as a result of blue light
00:37:01
actually it's likely that the amount of
00:37:03
blue light that these devices put out is
00:37:06
probably insufficient to do that
00:37:08
directly but there are two effects of
00:37:10
using your Gadget until 1:00 a.m. the
00:37:13
first is on a on a long-term basis if
00:37:15
you're doing that regularly it will
00:37:17
result in an adjustment of your
00:37:19
circadian clock and push it back so you
00:37:22
will want to go to bed a little bit
00:37:23
later and wake up a little bit later
00:37:25
which is fine if you're self employed or
00:37:28
you don't have any restrictions on your
00:37:29
time but most of us need to be up at a
00:37:31
certain time in the morning and if your
00:37:33
circadian rhythm is delayed
00:37:35
significantly the net effect of that is
00:37:38
that you're going to end up sleep
00:37:39
deprived I mean there's also the issue
00:37:41
of being you know on Twitter or being
00:37:43
engrossed in a in a movie on Netflix at
00:37:46
1:00 a.m. that is going to make you
00:37:48
delay sleep anyway so there are those
00:37:51
two it's arousing it's arousing and it
00:37:54
grips your
00:37:55
attention well what do you make of these
00:37:57
people me being one of them that watch
00:37:59
you know serial killer movies when we
00:38:01
fall asleep well I think that that's
00:38:03
only an issue if it's stopping you from
00:38:04
falling asleep do you see because I have
00:38:06
this argument a lot with my partner she
00:38:08
she can't understand why I I need to
00:38:10
watch this like really stimulating stuff
00:38:12
when I fall asleep she likes quiet and I
00:38:15
need to I I tell myself I need to like
00:38:17
listen to something do do you see like
00:38:21
variance in in this kind of thing and is
00:38:23
there a better approach or this comes
00:38:25
down to
00:38:27
individualized approach to sleep and
00:38:29
that's why I'm always very reluctant to
00:38:31
say this is the perfect night sleep
00:38:32
these are the rules for sleep you know
00:38:35
for example there are some people who uh
00:38:37
for whom caffeine doesn't really
00:38:39
influence their sleep and can have a
00:38:41
double espresso an hour before bed and
00:38:43
still have no problems getting off to
00:38:44
sleep for most of us that's not the case
00:38:47
um if you are somebody who can watch
00:38:50
something very stimulating very scary
00:38:53
and then switch it off and roll over and
00:38:55
go off to sleep then I I guess that's
00:38:57
not a problem for you for most people
00:39:00
that's probably not the best thing to be
00:39:01
doing at night I think that longterm one
00:39:04
of the issues is with all of these kinds
00:39:07
of activities in bed at night before you
00:39:10
go off to sleep is that they weaken the
00:39:14
psychological associations between bed
00:39:16
and sleep and so if you start
00:39:19
associating bed being a place where
00:39:21
you're mentally active where you're
00:39:23
engaged then if you have an underlying
00:39:26
predisposition to insomnia for example
00:39:29
then that can sometimes set the stage
00:39:32
for developing insomnia later on the
00:39:34
average person that you've treated
00:39:37
worked with in your clinical practice
00:39:39
that's struggling with sleep is at the
00:39:42
heart of the issue just poor sort of
00:39:44
sleep hygiene like you've said there
00:39:46
yeah because I've got so many friends
00:39:47
that say to me that they struggle with
00:39:49
their sleep um many of them have
00:39:51
struggled with it for years and I I
00:39:54
doubt that there's some sort of genetic
00:39:56
reason why this many people are
00:39:58
struggling with sleep so I imagine it's
00:39:59
just some kind of Behavioral reason so I
00:40:02
think that the genes that predisposed to
00:40:05
insomnia are pretty widespread but
00:40:07
obviously you know in pretty much all
00:40:09
areas of medicine there is an
00:40:10
interaction between genetics and
00:40:12
environment and certainly poor sleep
00:40:15
hygiene and that's a it's a horrible
00:40:17
term I hate that term but it's the term
00:40:19
that is most widely used and understood
00:40:22
can certainly put in place certain
00:40:25
aspects of behavior that then can give
00:40:29
rise to Chronic insomnia in the long
00:40:31
term so if you've got very bad chronic
00:40:34
insomnia then suddenly putting good
00:40:37
sleep hygiene in place it's unlikely to
00:40:39
fix it but it may be that that poor
00:40:41
sleep hygiene in the first
00:40:43
instance gave rise or at least
00:40:46
predisposed you to developing insomnia
00:40:48
and what is um poor sleep hygiene if I
00:40:51
wanted to be the worst possible
00:40:53
sleeper okay in the world what would I
00:40:56
have to do so I think you would probably
00:40:59
have to uh um set up your home office in
00:41:02
your bedroom okay you'd have to have um
00:41:05
you know your TV on in your bedroom all
00:41:07
the time okay uh have be surrounded by
00:41:10
electronic devices drink a lot of coffee
00:41:12
late in the evening alcohol uh drinks a
00:41:15
little bit of alcohol so alcohol in the
00:41:16
short term of course is is quite
00:41:18
sedating it's a central nervous system
00:41:20
dep uh depressant but it does
00:41:23
dramatically um worsen the quality of
00:41:26
your sleep and for various reasons the
00:41:28
direct chemical effect fact that you've
00:41:30
got a full bladder um the fact that
00:41:31
you're probably snoring a little bit
00:41:33
more so alcohol's not a good thing um
00:41:35
you know not having a wind down period
00:41:38
so you
00:41:39
know gambling on the stock market until
00:41:42
1:00 a.m. switching your laptop and then
00:41:44
trying to go to bed uh those kinds of
00:41:46
things so that's you know the
00:41:48
quintessential very very bad sleep
00:41:50
hygiene what about when I eat so uh you
00:41:54
know eating is perhaps less important
00:41:55
but avoiding a very large large
00:41:57
carbohydrate meal carbohydrate Rich meal
00:42:00
before you go to bed for two reasons one
00:42:03
is that we know that it can cause some
00:42:04
fluctuations in terms of your blood
00:42:06
sugar and also if you've got a bit of
00:42:08
reflux it can make that much worse okay
00:42:11
what about sleeping in bed with somebody
00:42:13
else well I think that for some people
00:42:16
they and again this goes back to no one
00:42:18
rule for everybody you know if you've
00:42:20
got a a a sleep trait termed sleep
00:42:22
reactivity which is where your sleep is
00:42:24
very liable to your environment and then
00:42:27
obviously sleeping next to somebody
00:42:29
who's snoring loudly or who gets up in
00:42:31
the middle of the night two or three
00:42:32
times to to to urinate can be can be
00:42:36
very disruptive to your sleep if you've
00:42:38
got very little sleep reactivity you may
00:42:40
actually find it comfortable more
00:42:42
comfortable to sleep with somebody in
00:42:43
the same bed as you I was um I was
00:42:45
thinking the other day because where
00:42:47
I've currently moved into there's no
00:42:50
blinds or curtains in my bedroom and I
00:42:52
was wondering if that might be a good
00:42:55
thing because it at least means that in
00:42:58
terms of my circadian rhythm I'm waking
00:43:01
up at the same time every day because
00:43:03
I'm waking up when the sun comes up yeah
00:43:04
but the sun comes up at different times
00:43:06
uh at on different days firstly um so if
00:43:10
you were doing that routinely um you
00:43:13
might find yourself really rather sleep
00:43:15
deprived um in the summer months um and
00:43:19
also there is some emerging evidence
00:43:21
that exposure to light at um at night in
00:43:24
your sleep is not very good for you so
00:43:27
there was a very recent study that
00:43:29
implied that light exposure at night
00:43:31
increases your risk of diabetes so um it
00:43:36
certainly is not good for the quality of
00:43:37
your sleep and the likelihood is that
00:43:39
you won't wake up as soon as it's light
00:43:41
you'll wake up uh an hour or so after
00:43:43
it's got light but during that hour or
00:43:46
so it may have had a negative impact on
00:43:48
the quality of your sleep so having a
00:43:50
dark bedroom is really part of good
00:43:53
sleep hygiene as is having a quiet
00:43:56
bedroom that is not too hot or too cold
00:43:59
what if you wear a sleep mask does that
00:44:02
solve it yes it does I mean I wear a
00:44:04
sleep mask I think it's you know
00:44:05
particularly if you don't have good
00:44:07
blackout curtains or blinds in your
00:44:10
bedroom using a sleep mask particularly
00:44:12
in the in the summer months is probably
00:44:14
very helpful indeed does that mean that
00:44:16
the only light receptors we have are
00:44:18
behind her eyes well I think that there
00:44:20
was a the there were some rumors uh on
00:44:23
the internet that there were um light
00:44:25
receptors elsewhere but certainly the
00:44:27
the only ones that we um know to be of
00:44:30
significance in terms of defining our
00:44:32
Cadian Rhythm are the ones in our
00:44:34
retinas because I I did psychology when
00:44:37
I was in uh secondary school and I
00:44:39
remember reading one of the psychology
00:44:40
books maybe my psychology teacher told
00:44:42
me this I think it was Mrs ly that there
00:44:44
was some studies where they shined a
00:44:45
light like underneath someone's knees
00:44:48
yes and people would like wake up when
00:44:50
they Shine the lights there I I think
00:44:52
that that's been that's been very much
00:44:53
discounted now it it's a bit strange
00:44:55
though that the only light receptor
00:44:56
would be behind the eyes it just feels
00:44:58
like I don't know feels like poor design
00:45:02
that there's only one place where we
00:45:04
figure out if it's night or day so so
00:45:06
you know you see that for example in
00:45:08
people who've lost their sight right so
00:45:10
so uh in uh some individuals who have
00:45:13
lost their sight completely then they
00:45:16
lose the regulation of their circadian
00:45:19
rhythm and they develop circadian rhythm
00:45:21
disorders something called a non 24-hour
00:45:24
rhythm disorder whereby um their
00:45:26
circadian rhythm is on a for example a
00:45:29
25-hour cycle and so every night they
00:45:32
will go to bed 1 hour later uh than they
00:45:35
did the previous night and will go right
00:45:37
the way around the clock you know every
00:45:40
month or so um so you know that's a very
00:45:43
good piece of evidence that actually
00:45:45
it's those cells in the in the retina
00:45:48
that are of crucial importance for
00:45:49
maintaining the stability of Arcadian
00:45:52
Rhythm I I've wrote that down it I wrote
00:45:54
down in one recent study 40% of totally
00:45:56
blind indiv ual had a non 24-hour
00:45:58
circadian rhythm which really kind of
00:46:01
for me also highlights just how
00:46:02
important it is
00:46:03
to um think about my circadian rhythm
00:46:06
and how much impact it's having on my
00:46:08
whole body the the other part you
00:46:09
mentioned was the biological element to
00:46:12
our Cadian rhythms which which people
00:46:14
refer to as chronotypes yes and I this
00:46:17
idea of chronotypes which is essentially
00:46:18
from my understanding that genetically
00:46:21
we all have a slight sort of disposition
00:46:23
to sleep in at certain times yes and to
00:46:26
wake up at certain times yeah so there's
00:46:28
these names right there's like the
00:46:30
owl the L or whatever else I think I'm
00:46:33
an owl but that also could just be bad
00:46:35
habits yeah so so the you know certainly
00:46:37
there's that sort of genetic
00:46:39
predisposition there's also these
00:46:41
environmental factors but there's also
00:46:43
age in that our circadian rhythm changes
00:46:45
a little bit as we go through different
00:46:47
stages of life so you know it's not at
00:46:49
all uncommon for teenagers to become
00:46:52
more evening chronotypes and then as we
00:46:56
get older we tend to shift back to the
00:46:58
morning so that's part and parcel of our
00:47:01
aging biology as well so so I think that
00:47:05
you know genetics is really important
00:47:07
but so but so are other factors as well
00:47:09
studies in twins um suggest that up to
00:47:12
50% of our chronotype is under genetic
00:47:15
control so does that suggest that we are
00:47:17
likely to have a similar chronotype to
00:47:21
our
00:47:22
family we are likely to but obviously
00:47:25
our environment is not going to be
00:47:27
exactly the same as our parents or you
00:47:29
know what we do our behaviors are not
00:47:30
going to be uh um identical to our
00:47:33
parents or our siblings so yes we more
00:47:36
frequently see that for example people
00:47:39
have a evening chronotype that runs in
00:47:42
families um but that doesn't mean that
00:47:45
you know look we we we're more than just
00:47:47
the destiny of the genes that we hold um
00:47:50
obviously our genes are really important
00:47:52
um but so are other factors as well if
00:47:55
someone came to and they said I'm
00:47:57
struggling with my sleep you know
00:48:00
multiple nights in a row I haven't been
00:48:01
able to sleep I'm getting in bed and
00:48:03
nothing's happening and then I'm waking
00:48:04
up and I'm just sat there thinking about
00:48:07
you know sleeping and um I feel horrific
00:48:10
where would you start so I would start I
00:48:13
think by trying to understand what it is
00:48:16
that is causing their sleep issues
00:48:18
because a lot of the individuals that I
00:48:21
see who have been referred in with that
00:48:23
sort of picture assume that they've got
00:48:25
insomnia and they may not always have
00:48:27
insomnia so I I think a key issue is
00:48:31
that we are really really poor witnesses
00:48:35
to our own sleep and what I mean by that
00:48:38
is that we
00:48:40
often our experience of sleep is very
00:48:43
different to the reality of sleep when
00:48:45
we bring in people into the Sleep
00:48:47
laboratory it's not at all unusual and I
00:48:50
will almost always ask this question
00:48:52
when I'm going through a sleep study
00:48:53
with one of my patients is how much
00:48:56
sleep do you s you got over the course
00:48:58
of that night and it's not at all
00:49:00
unusual for people to say to me well I
00:49:01
think I got two or 3 hours sleep
00:49:03
occasionally even they say well I didn't
00:49:05
sleep at all and then you look at their
00:49:07
brain waves you look at the best
00:49:09
objective marker that you've got of
00:49:12
their sleep and you see that they've
00:49:14
slept s and a half eight hours so
00:49:17
obviously what people are experiencing
00:49:19
is really important because ultimately
00:49:20
from my perspective I want to improve
00:49:23
people's experience of their sleep and
00:49:25
what it is that they're they're they're
00:49:27
complaining of but it's important
00:49:30
to understand that what they're telling
00:49:32
you may not necessarily be the objective
00:49:35
truth now that's really important when
00:49:37
it comes to insomnia because it's not
00:49:39
unusual for me to see individuals who
00:49:43
you know they give you a story of very
00:49:44
clear insomnia but actually when you
00:49:46
look at their sleep objectively you find
00:49:48
that although they say they haven't
00:49:51
slept at all they've slept 7 hours but
00:49:53
that 7 hours has been completely
00:49:55
disrupted by conditions like periodic
00:49:58
limb movement disorder which is this
00:50:00
these leg kicks associated with restless
00:50:02
leg syndrome or sleep apnea for example
00:50:05
now sometimes it's very evident from
00:50:06
what people tell you that actually
00:50:08
that's not the case that they've just
00:50:10
got very clear insomnia so so that's
00:50:14
really the starting point to try and
00:50:16
decide whether or not you feel confident
00:50:19
enough in your clinical evaluation of
00:50:21
them that that you know what the issue
00:50:24
is without doing a sleep study and if
00:50:25
you think that they do need a sleep
00:50:27
study then that's the point at which we
00:50:29
we we arrange for that it's also trying
00:50:31
to understand some of the factors that
00:50:33
might be driving their sleep
00:50:34
difficulties so for example was their
00:50:37
sleep were their sleep difficulties
00:50:39
triggered by a life event did they have
00:50:42
sleep reactivity before this insomnia
00:50:44
started so were they one of those
00:50:46
individuals who could sleep anywhere at
00:50:47
any time whatever they wanted uh
00:50:50
whenever they wanted to put their head
00:50:51
down or were they kind of an individual
00:50:53
who the night before an exam before a
00:50:55
job interview before a
00:50:57
a presentation would lose sleep because
00:51:00
that often is a very strong marker for
00:51:02
developing insomnia uh later on in life
00:51:05
uh and then it's also about trying to
00:51:09
understand how the rest of their health
00:51:10
is impacted by their sleep but also how
00:51:14
the rest of their health impacts on
00:51:16
sleep so it's not at all unusual for me
00:51:18
to see individuals who have been started
00:51:20
on medications for other reasons that
00:51:21
have generated sleep issues for
00:51:24
example you talked about this sort of
00:51:26
obsession with sleep and I was wondering
00:51:28
in the case of the patient you've just
00:51:30
described would you encourage them to
00:51:32
wear a sleep tracker so first of all I
00:51:35
have to say that I'm not ideologically
00:51:37
opposed to sleep trackers in general I
00:51:39
think that they are really really good
00:51:42
for example in research um you know
00:51:44
fantastic for research it allows us to
00:51:46
track sleep in very very large numbers
00:51:49
of individuals and try and work out how
00:51:51
that correlates with whatever we're
00:51:53
interested in one of the major issues
00:51:56
with sleep trackers is that the people
00:51:58
who often use sleep trackers are
00:52:00
individuals who already are concerned
00:52:03
about their sleep so if you know that
00:52:06
you're sleeping relatively little and
00:52:08
you wake up feeling tired then you
00:52:10
probably know you're not sleeping enough
00:52:12
you don't necessarily need a sleep
00:52:13
tracker to tell you that if you're one
00:52:15
of these individuals who has insomnia
00:52:17
who is spending plenty of time in bed
00:52:19
but simply cannot get the amount of
00:52:21
sleep that they need um then what a
00:52:23
sleep tracker will do is it'll increase
00:52:26
your
00:52:27
concern your anxiety around your sleep
00:52:30
it's a very different picture from for
00:52:32
example using a a step tracker if you're
00:52:35
sitting on the sofa and you look at your
00:52:37
step tracker and you realize you've only
00:52:38
done whatever it is 5,000 steps it's
00:52:41
very easy to get up and go for a walk
00:52:43
and do another 5,000 steps if your sleep
00:52:46
tracker is telling you you slept really
00:52:47
badly and you know you slept really
00:52:49
badly and you're already worried about
00:52:50
how badly you sleep there's nothing that
00:52:52
you can do on the basis of the
00:52:55
information that your sleep tracker is
00:52:56
giving you to suddenly go and get a
00:52:59
little bit more sleep and It's
00:53:01
Complicated by the fact that you know
00:53:03
sleep trackers are pretty good at
00:53:05
telling you how much time you spent in
00:53:06
bed they're reasonably good at telling
00:53:09
you how quickly you dropped off to sleep
00:53:12
the reliability the accuracy of these
00:53:14
devices most of these devices drops off
00:53:17
significantly when it comes to for
00:53:19
example defining nighttime Awakenings
00:53:21
defining stages of sleep those kinds of
00:53:24
things so then you have that additional
00:53:26
is in the mix which is that sometimes
00:53:28
your sleep tracker may be giving you
00:53:30
information that is not factually
00:53:31
correct and that may increase your
00:53:33
anxiety further so I'm really very very
00:53:37
keen for people who have issues with
00:53:41
their sleep rather than just burning the
00:53:43
candle at both ends to put away their
00:53:45
sleep tracker and actually go and have a
00:53:47
chat with their GP or somebody who knows
00:53:49
a little bit about sleep rather than
00:53:51
relying on this sleep tracking
00:53:53
technology do you think sleep trackers
00:53:55
have had a net negative NE ative or
00:53:56
positive impact on sleep
00:53:58
culture I think that for those
00:54:01
individuals who can fix their sleep in a
00:54:05
very straightforward Way by spending
00:54:07
more time in bed so the kind of people
00:54:10
that I talked about that 20 years ago
00:54:12
would be saying well you know I only
00:54:14
sleep 5 hours and you know because I'm
00:54:16
busy doing x y and Zed and I can get
00:54:18
away with it I think it's probably
00:54:19
encouraged them to spend a bit more time
00:54:21
in bed because they know they have a a
00:54:23
very clear um very clear bit of
00:54:27
information that's telling them that
00:54:28
they're not sleeping enough but for the
00:54:31
people that I see the people who are
00:54:33
already concerned about their sleep uh
00:54:36
and who have difficulties with their
00:54:37
sleep I think it's been a very negative
00:54:41
impact um and I have some reservations
00:54:45
about well people like myself um sitting
00:54:49
on these kinds of podcasts or writing in
00:54:52
newspapers telling you well you know if
00:54:54
you don't get enough sleep you're going
00:54:55
to die early you're going to have all
00:54:56
these negative Health consequences
00:54:59
because for a subgroup of individuals
00:55:01
who are already very concerned about
00:55:02
their sleep that actually can cause
00:55:06
problems and I have seen individuals who
00:55:09
for example have read books on sleep and
00:55:11
how important it is on sleep who have
00:55:13
ended up going into a spiral of insomnia
00:55:15
and very catastrophic depression and
00:55:17
anxiety as a result so so it's very you
00:55:20
know it's very important to be clear
00:55:21
that the all of this is a double-edged
00:55:23
sword it's interesting with with sleep
00:55:25
trackers um um I can see I think it's
00:55:29
worth me saying that I am both an
00:55:32
investor in whoop and I'm also sponsored
00:55:35
by whoop okay but I also agree with the
00:55:37
things you've said so I've seen this
00:55:40
this sort of variance in how a sleep
00:55:43
tracker can improve some people's lives
00:55:47
and it can make other people more
00:55:48
anxious in a way that's not helpful so
00:55:51
for me my sort of testimony on it is um
00:55:55
I was one of those people described
00:55:56
earlier that thought sleep was take it
00:55:58
or leave it and when I started seeing a
00:56:02
sleep track it's kind of like that when
00:56:03
I saw my brain for the first time I did
00:56:05
a brain scan and I didn't even kind of
00:56:06
like realize it was there and that I
00:56:08
could influence it and that things I was
00:56:10
doing um without really thinking much
00:56:12
were having this big impact and for me
00:56:15
what it did is it allowed me to finally
00:56:17
make this link between how much sleep
00:56:19
I've had and then how I behave now I
00:56:22
thought my behavior was random before
00:56:24
but seeing that when when my sleep um
00:56:26
scores were down I was way more
00:56:28
emotional I was way more likely to eat
00:56:31
crap uh and the other thing that I saw
00:56:32
which was really interesting was that
00:56:34
when I had a glass of wine or two
00:56:36
glasses of wi three glasses of wine that
00:56:37
it just like destroyed my sleep and I
00:56:40
never knew that before and I was in
00:56:41
search of reasons to quit alcohol anyway
00:56:43
and when I saw that I quit alcohol
00:56:44
forever so I've not drunk since so and
00:56:47
then for me I have to also say there are
00:56:49
moments in my life where life happens
00:56:51
and I know I'm not going to sleep and I
00:56:53
don't pay attention to my sleep tracker
00:56:54
but there are other moments where um I
00:56:57
have a bit more control and that's when
00:56:59
I kind of tune into my sleep tracker
00:57:00
I've also had Parents message me a lot
00:57:02
and say listen I've got a one-year-old a
00:57:04
2-year-old a three-year-old whatever
00:57:06
there's no point me wearing a sleep
00:57:07
tracker because listen I'm not going to
00:57:08
get any sleep and I also completely
00:57:10
agree with them that there's really no
00:57:11
point in that situation I think there's
00:57:13
a point when there's something you can
00:57:15
do about it and that's kind say that's
00:57:17
absolutely key yeah so so the the the
00:57:20
the point of doing anything like that is
00:57:23
if there are very clear things that you
00:57:25
can do on your own to close that Loop
00:57:28
there's no point having information
00:57:30
without being able to act upon it and I
00:57:32
guess if you are one of those
00:57:33
individuals like yourself who very
00:57:36
clearly can correlate certain things
00:57:37
that they're doing in their daytime
00:57:39
lives with their sleep and and and how
00:57:41
they feel subsequently then then great
00:57:44
you know I guess I have a little bit of
00:57:45
bias in that the people that I see are
00:57:47
already struggling with their sleep
00:57:49
already and so it goes back I guess
00:57:51
we're completely in agreement yeah yeah
00:57:53
we are yeah and it's so interesting cuz
00:57:55
I that's been a developing idea cuz
00:57:56
obviously my bias is always like
00:57:58
wouldn't you rather know cuz that's you
00:58:00
know but then from doing this podcast
00:58:03
I've I've seen the comments and I've
00:58:04
seen the struggle in from speaking to
00:58:06
parents that struggling with their sleep
00:58:08
and it's kind of sometimes just makes
00:58:10
them feel worse about it um I think
00:58:12
Nuance is necessary on this issue um and
00:58:16
I'm sure there's a lot of a lot of
00:58:17
things in my life that I wouldn't like
00:58:19
to be able to track because either I I
00:58:21
don't have control of them right now or
00:58:23
you know um maybe they'd make me feel
00:58:26
more anxious there's this thing called
00:58:28
the glymphatic system which I find
00:58:30
really which when I discovered this I I
00:58:32
it really helped me to understand the
00:58:34
importance of sleep can you explain what
00:58:36
the glymphatic system is as if I was a
00:58:38
10-year-old yeah so um within our bodies
00:58:43
there is a a system a very similar
00:58:45
system called the lymphatic system so
00:58:47
people will have heard of lymph nodes
00:58:48
for example and this is a system whereby
00:58:51
fluid that comes out of the blood
00:58:53
vessels and into the tissues is then
00:58:56
collected and transported back into the
00:58:59
the cardiovascular system and we used to
00:59:01
think that there was no equ equivalent
00:59:05
system in the brain but actually you
00:59:07
know over the last 20 years we've
00:59:09
understood that whilst there are no sort
00:59:11
of lymph nodes or things like that there
00:59:13
are these very small channels between
00:59:15
the cells that are responsible for
00:59:18
draining fluid from the brain and um
00:59:23
those um systems are responsible for
00:59:27
removing certain toxins or metabolites
00:59:30
chemicals that have built up as a result
00:59:32
of metabolic activity within the brain
00:59:34
and removing them from the brain
00:59:36
substance
00:59:37
itself now it's like a car wash um like
00:59:41
like a drainage system you know like
00:59:43
like like a gutter for example um you
00:59:46
know that takes the suds from the car
00:59:48
wash away and puts them into the drain
00:59:51
um in about 2011 if my memory serves me
00:59:56
correct there were some studies done
00:59:58
that looked at that lymphatic system in
01:00:00
different stages of sleep and what they
01:00:03
described was that that lymphatic system
01:00:06
opens up significantly by about
01:00:09
60% in very deep sleep in the deepest
01:00:13
stages of sleep and so and so subsequent
01:00:16
research showed that for example one of
01:00:18
the proteins that was being removed was
01:00:21
a protein called betoid that is that is
01:00:24
intimately tied to Alzheimer's disease
01:00:27
and so the view that deep sleep was
01:00:32
particularly resp responsible for
01:00:34
housekeeping of the brain for chemical
01:00:36
housekeeping of the brain came about it
01:00:38
gets a bit more complicated because
01:00:40
actually only two or three weeks ago
01:00:42
another study suggested that that 60%
01:00:44
increase in the lymphatic system was not
01:00:47
the case and so I think that this
01:00:50
remains an area that there is some
01:00:53
uncertainty about but actually there are
01:00:56
many reasons to tie in sleep in general
01:01:00
separate from the lymphatic system into
01:01:02
a general housekeeping role of the brain
01:01:05
and I think that um certainly this is an
01:01:09
area that is going to keep researchers
01:01:11
very very busy over the next 10 or 20
01:01:14
years this uh association between sleep
01:01:18
cognition and cognitive decline in later
01:01:21
life that that protein that seems
01:01:24
to Spike if we are sleep deprived beta
01:01:28
ameloid beta amid yeah and that's linked
01:01:31
to alzheimer's it is yeah so in
01:01:33
Alzheimer's disease we see beta ameloid
01:01:35
deposition within the brain substance
01:01:37
itself what does deposition mean so uh
01:01:39
it's deposited within the brain if
01:01:42
someone has Alzheimer's they have a sort
01:01:44
of the build a buildup of buildup of
01:01:46
beta ameloid in the the brain substance
01:01:50
is there a link between sleep
01:01:51
deprivation and Alzheimer's do we see
01:01:53
high numbers so there is some evidence
01:01:56
to suggest that uh both chronic sleep
01:02:00
deprivation and insomnia are associated
01:02:03
with cognitive decline and conditions
01:02:07
like dementia it goes back to what I was
01:02:09
saying earlier which is but by the way
01:02:12
there's also some studies that have
01:02:13
suggested links between sleeping tablets
01:02:15
and conditions like Alzheimer's so it
01:02:18
goes back to this issue of whether or
01:02:21
not it's the insomnia or the sleep
01:02:24
deprivation that causes Alzheimer's is
01:02:27
it sleeping tablets that causes
01:02:30
Alzheimer's or is it the fact that
01:02:32
Alzheimer's many many years before
01:02:35
causes changes to our sleep and and so I
01:02:39
think that that story is not yet been um
01:02:43
has not yet come to fruition in terms of
01:02:46
our fundamental understanding of the
01:02:47
links between sleep and Alzheimer's
01:02:51
disease and whether or not it's directly
01:02:53
causative do you
01:02:57
recommend slash are you a fan of you
01:03:00
reference sleep tablets there sleep
01:03:02
medicine medication yeah so as a general
01:03:05
we know because I think that there are
01:03:07
um good now non-drug based techniques
01:03:12
for trying to improve sleep in the
01:03:15
majority of people with
01:03:17
insomnia um there is some evidence that
01:03:21
for example if people don't respond to
01:03:24
these non-drug based methods giving them
01:03:25
sleeping tablets alongside these
01:03:27
non-drug based methods makes it more
01:03:29
likely for the psychological route to
01:03:34
help but you know unfortunately as part
01:03:36
of my clinical practice I see lots of
01:03:38
people who've been struggling with their
01:03:39
sleep for many many years and they've
01:03:41
tried all non-drug based
01:03:44
treatment and the risks of them sleeping
01:03:48
so little in terms of their mood their
01:03:51
anxiety their ability to function are so
01:03:55
great that actually you have on a caseby
01:03:57
casee basis to make a judgment call as
01:04:00
to whether or not to say well I give up
01:04:01
on your sleep or actually you say well
01:04:03
look there are a number of drugs that we
01:04:05
can try to try and improve your sleep
01:04:08
and it's not going to get you back to
01:04:10
normal but it's going to potentially
01:04:12
make the difference between you you know
01:04:14
end up very depressed or or or or highly
01:04:16
anxious and unable to cope in your life
01:04:18
or actually get some decent sleep um and
01:04:22
the risks of those drugs and that needs
01:04:25
to be judged on a case-by casee basis
01:04:27
and is part of clinical medicine
01:04:29
whenever we prescribe any medication for
01:04:31
anybody for any condition we have to
01:04:34
evaluate what the potential benefits are
01:04:36
versus the potential risks a lot of
01:04:38
people seem to be taking melatonin yeah
01:04:40
tablets is is that healthy is that free
01:04:43
from side effects so it's not entirely
01:04:45
free of side effects um but it's
01:04:48
generally a pretty well tolerated safe
01:04:51
drug as far as we know there are some
01:04:54
specific issues surrounding melatonin um
01:04:58
but a question really would have to be
01:05:01
well why are you taking that melatonin
01:05:02
is there something that you can do to
01:05:05
fix your sleep without relying relying
01:05:08
on an exogenous substance something that
01:05:10
you've bought off the shelf or being
01:05:12
prescribed is is the my hesitation and
01:05:16
reservation with taking things like
01:05:17
melatonin is always that I just assume
01:05:19
that my body will become a little bit
01:05:20
reliant on it yeah well fair I I think
01:05:24
whether it become whether you become
01:05:25
come physiologically biologically
01:05:27
Reliant upon it or psychologically
01:05:30
Reliant upon it it it it remains
01:05:33
unanswered but certainly that you know
01:05:35
there are individuals who for example
01:05:37
will say well as long as I know that
01:05:38
I've got a bottle of melatonin or you
01:05:40
know the sleeping tablets in my bedside
01:05:42
cabinet I sleep fine as soon as I know
01:05:45
that I haven't got access to them I
01:05:46
don't sleep very well at all and so that
01:05:49
I think exhibits that this is almost
01:05:50
like a psychological crutch knowing
01:05:52
something that they've got uh next to
01:05:55
their bed that they can reach for in
01:05:57
order to achieve a good night's sleep is
01:05:59
sometimes as important is as important
01:06:01
as the biological effects of taking that
01:06:04
tablet I mean that kind of leads to the
01:06:07
non-medical techniques to improve our
01:06:09
sleep so you said typically with with
01:06:12
someone that comes to your sort of sleep
01:06:13
center instead of going straight to
01:06:15
medication as the answer to their sleep
01:06:16
issues you would suggest and or try
01:06:20
non-medical interventions yes and you
01:06:23
said that these work well yes what are
01:06:25
these non-medical intervention so the
01:06:27
gold standard treatment now for insomnia
01:06:30
is a treatment called cognitive
01:06:31
behavioral therapy for insomnia okay so
01:06:34
a lot of people have heard of CBT
01:06:36
because they will have heard of it in
01:06:37
the context of depression and treatment
01:06:39
of depression or anxiety now CBT for
01:06:42
insomnia is not actually directly
01:06:44
related to the CBT that's used for
01:06:46
depression and anxiety it borrows from
01:06:48
the principles of CBT and applies them
01:06:51
to sleep and it serves two purposes the
01:06:55
first is to try and address some of
01:06:58
those conscious psychological factors
01:07:00
that are driving insomnia and when I
01:07:02
talk about conscious factors I'm talking
01:07:04
about things like the frustration or
01:07:06
anxiety of the night ahead of lying in
01:07:09
bed at night feeling that you can't get
01:07:12
off to sleep and the frustration and
01:07:14
anxiety that that engenders of having
01:07:16
your partner snoring away in bed next to
01:07:19
you whilst you're struggling to go off
01:07:20
to sleep of worrying about how you're
01:07:23
going to be able to function the
01:07:24
following day or potentially even the
01:07:26
long-term effects of your insomnia so
01:07:29
those are the conscious psychologic
01:07:31
factors and cbti aims to address those
01:07:34
but it also aims to restore
01:07:37
normal um
01:07:39
unconscious factors that give rise to
01:07:41
good sleep so if you've spent a great
01:07:43
deal of time in bed at night awake then
01:07:48
those normal associations that good
01:07:50
sleepers have between bed and sleep so
01:07:52
for a good sleeper they will associate
01:07:55
bed with being a place of comfort with
01:07:57
being a calming relaxing place a place
01:07:59
that they associate with a good night's
01:08:01
sleep if your sleep has been disrupted
01:08:03
for a period of time and you've spent
01:08:05
long periods of time in bed awake then
01:08:08
that positive association between bed
01:08:10
and sleep is replaced by negative
01:08:12
association so you you begin on a
01:08:14
unconscious basis
01:08:16
pavlovian conditioning it's called um
01:08:20
you associate that bed environment with
01:08:22
being awake with being wired and that's
01:08:25
often what gives rise to this sensation
01:08:27
of having lost the switch to be able to
01:08:30
get off to sleep in fact some people
01:08:32
with insomnia will say well look you
01:08:33
know if I'm sitting in front of the
01:08:35
television and I'm sitting on the sofa
01:08:37
and I'm not thinking about sleep at all
01:08:39
I'm not thinking about bed I will often
01:08:40
find that I've dozed off and then I'll
01:08:43
go upstairs get into bed and as soon as
01:08:45
my head hits the pillow ping I'm wide
01:08:47
awake and I suddenly feel wired so
01:08:49
that's very illustrative of that sort of
01:08:52
unconscious association between bed and
01:08:56
being awake rather than being asleep and
01:08:57
so cbtr aims to address that as well how
01:09:00
does it how does it do that so it uses a
01:09:02
variety of different techniques so uses
01:09:04
some standard sort of relaxation
01:09:06
techniques to try and reduce the level
01:09:09
of vigilance of physiological of mental
01:09:13
arousal that you have when you get off
01:09:14
to bed but also it aims to utilize a a
01:09:18
variety of techniques to reprogram your
01:09:21
brain to associate bed with sleep so one
01:09:24
of the ways in which you can do that is
01:09:26
you can actually utilize your brain's
01:09:28
own
01:09:30
mechanisms um that drive you to go off
01:09:33
to sleep so that's something called the
01:09:35
homeostatic mechanism which we'll all be
01:09:37
very familiar with but not in those
01:09:39
terms so the more you've been awake the
01:09:42
stronger the chemical drive for your
01:09:44
brain to go off to sleep so one of the
01:09:49
features of cbti is to compress your
01:09:52
sleep or to restrict your sleep for a
01:09:54
period of time essentially what that
01:09:57
means is well if you are an in somebody
01:09:59
with insomnia and you estimate for
01:10:02
example that you're only sleeping a
01:10:03
total of 6 hours a night in bed um but
01:10:07
you're spending 8 hours a night in bed
01:10:11
then you for a period of time you say
01:10:13
well look I want you to get into bed at
01:10:15
midnight and whatever happens I want you
01:10:18
to get out of bed at 6:00 a.m. so to
01:10:20
restrict the time in bed to 6 hours so
01:10:24
the first few nights
01:10:26
most people with insomnia will sleep
01:10:27
really badly because they know that
01:10:28
their alarm is going off at 6:00 and
01:10:30
they know they have to get off get out
01:10:31
of bed at 600 but after a little while
01:10:35
they become so sleep deprived that the
01:10:37
brain starts forcing you to go off to
01:10:41
sleep much more quickly and over time
01:10:44
more and more of that 6 hours a night
01:10:46
will be spent asleep in bed and that's
01:10:48
the first step in Breaking that negative
01:10:51
association between bed and wake and
01:10:54
rebuilding a positive of association
01:10:56
between bed and sleep I mean at its
01:11:00
extreme there is a technique that was
01:11:02
developed in Australia which is called
01:11:04
intensive sleep retraining and in that
01:11:07
technique people who've got very bad
01:11:09
insomnia are brought into a sleep
01:11:12
laboratory having been awake for the
01:11:15
night before they come in so they come
01:11:17
in in the evening having been awake for
01:11:20
now probably 36
01:11:22
hours every half an hour they're given
01:11:25
the opportunity to drop off to sleep
01:11:28
they have some wires on their heads
01:11:30
their brain waves are being tracked um
01:11:32
but as soon as they've been asleep for 3
01:11:34
minutes based on their brain waves
01:11:36
they're woken up again and that happens
01:11:38
every half hour for 25 hours so over the
01:11:41
course of that 25-hour period they have
01:11:43
50 opportunities to nap now for most
01:11:46
people with insomnia having been awake
01:11:47
even having been awake the previous TW
01:11:50
uh 36 hours they will still not be able
01:11:53
to get off to sleep for the first few
01:11:54
naps but as they get more and more sleep
01:11:56
deprived every time they're given the
01:11:59
opportunity to drop off to sleep they
01:12:01
will start falling asleep more quickly
01:12:03
and at the end of that 50 naps they will
01:12:06
be dropping off to sleep very quickly as
01:12:08
soon as the lights go off um and
01:12:11
actually the evidence suggests that
01:12:12
that's a very good um short-term
01:12:15
treatment for chronic insomnia and in
01:12:18
some individuals it works extremely well
01:12:21
in reassociating your head hitting the
01:12:24
pillow with drifting off to sleep I
01:12:26
wouldn't suggest it for most people cuz
01:12:28
it's basically a form of torture but I
01:12:30
think it illustrates the power of trying
01:12:33
to get people into a more sleep deprived
01:12:36
state if they've got insomnia it's
01:12:38
interesting because much of what you
01:12:39
said makes me think that we we all have
01:12:42
our own sleep identity and when I say
01:12:45
sleep identity I mean a story We Tell
01:12:48
ourselves about our relationship with
01:12:49
sleep and it makes me think that our
01:12:51
sleep identity is much more powerful
01:12:53
than I think we think cuz if you speak
01:12:54
to anybody anybody in this room upstairs
01:12:57
wherever and you say what do you like at
01:12:59
sleeping they will deliver their sleep
01:13:00
identity they'll say I'm a bad sleeper
01:13:03
and I wonder how much of that is
01:13:04
self-fulfilling because I I think I've
01:13:06
always told myself that I'm a good
01:13:07
sleeper and therefore I find sleep easy
01:13:10
um and I've got friends who will say oh
01:13:12
I'm a really bad sleeper and I'm
01:13:13
wondering how much that's impacting
01:13:15
their ability to sleep and or if they
01:13:17
they even know objectively if they are
01:13:19
actually a good or bad sleeper it's just
01:13:20
this identity we've embodied do you do
01:13:23
you see that a lot do you see that how
01:13:24
someone sleep by density kind of
01:13:25
determines how they actually sleep I
01:13:27
think all of that is true undoubtedly uh
01:13:30
and I think this comes back to the
01:13:31
earlier bit of our conversation about
01:13:33
sleep trackers because obviously sleep
01:13:35
trackers reinforce that sleep identity
01:13:39
whether whether they are 100% accurate
01:13:42
or not um and so yes that would that
01:13:45
sort of sleep identity would undoubtedly
01:13:47
influence both those conscious and
01:13:49
unconscious factors that give rise to
01:13:51
sleep you know if you're a good sleeper
01:13:53
and you've always been a good sleeper
01:13:54
you don't worry about any of these
01:13:55
things you probably don't even worry
01:13:57
about any aspects of sleep hygiene you
01:13:58
quite happily you know like you watch a
01:14:02
horror movie in in in in bed before you
01:14:04
drift off to sleep but for those
01:14:06
individuals who are who are not um yes
01:14:10
absolutely that that the way that you
01:14:11
view sleep and your relationship with
01:14:13
sleep is of fundamental importance it is
01:14:17
again coming back to genes we know that
01:14:19
there are undoubtedly genetic factors
01:14:22
that influence whether or not you're
01:14:24
likely to develop insomnia so again as
01:14:27
with all aspects of sleep it's that
01:14:29
combination of genetics environment and
01:14:32
when I talk about environment I'm also
01:14:33
talking about your own psychological
01:14:35
internal environment I am the other
01:14:37
thing I was think we talked about sleep
01:14:39
happen here earlier on but it seems that
01:14:41
a lot of people believe they have a
01:14:43
deviated septum is it called deviated
01:14:44
septum uh septum yeah septum yeah septum
01:14:47
I've heard some people say that that's
01:14:49
the reason that they can't sleep and
01:14:51
they've gone off to get surgery to kind
01:14:52
of correct the deviated septum
01:14:55
MH what's your thoughts on that is that
01:14:58
is that true because I wonder I'm like
01:15:00
we can't all be being born broken with
01:15:02
these deviated septums or whatever I
01:15:04
think it's normal for us to have some
01:15:06
asymmetry in our noses and a lot of
01:15:08
people have a deviated septum septum as
01:15:10
a result of having broken their nose for
01:15:12
example um you know I'm a little bit
01:15:16
suspicious about you know operations for
01:15:20
that kind of thing unless there are very
01:15:22
clear abnormalities that might be
01:15:25
responsible for sleeping poorly so one
01:15:28
of the major issues for example in sleep
01:15:31
apnea is sleep apnea the obstruction is
01:15:34
in the throat it's not in the nose and
01:15:36
so uh issues with nasal congestion or
01:15:40
difficulty breathing through the nose do
01:15:41
not directly cause obstructive sleep
01:15:43
apnea what they can do in some
01:15:45
individuals is they can encourage them
01:15:47
to people to breathe through their mouth
01:15:50
and breathe with their mouths open which
01:15:53
Alters the position of the jaw and
01:15:55
create a bit more narrowing in the back
01:15:56
of the throat so for some individuals
01:15:58
who have very prominent nasal congestion
01:16:01
at night and who have evidence of sleep
01:16:04
apnea sorting out their nasal congestion
01:16:06
and correcting a deviated septum may be
01:16:09
one way of doing that there is
01:16:11
undoubtedly a rational for sorting that
01:16:14
out I think that there are probably
01:16:16
quite a few individuals who are having
01:16:18
unnecessary operations makes sense I um
01:16:22
so we've got the cognitive behavioral
01:16:25
therapy for insomnia as one cure we've
01:16:27
got that extreme torch therapy that they
01:16:28
did in Australia yeah we've got
01:16:32
melatonin
01:16:33
um magnesium people have mentioned
01:16:37
magnesium so so anecdotally magnesium
01:16:40
can help some individuals um and you
01:16:42
know anecdotally also magnesium is a
01:16:44
very good treatment as testified to by
01:16:47
some of my patients for conditions like
01:16:50
restus leg syndrome so restus leg
01:16:52
syndrome is this sort of neurological
01:16:54
disorder whereby people um and it's
01:16:58
often associated with things like
01:16:59
pregnancy or low iron levels but it's
01:17:02
under genetic control as well people ex
01:17:05
uh experience a number of different
01:17:07
things so the first thing is that they
01:17:08
get an urged to move at night um and
01:17:11
it's typically at night rather than
01:17:13
during the day often associated with
01:17:15
unpleasant Sensations that if they try
01:17:17
and keep still that sensation builds and
01:17:20
builds and builds until they have to
01:17:21
move that if they do move they get some
01:17:24
transient relief and it's often
01:17:26
associated with kicking at night in your
01:17:29
sleep um it's very common very common in
01:17:32
pregnancy um very common in people who
01:17:35
are anemic and in people who've got
01:17:38
problems with their kidneys but it's
01:17:40
common in the general population as well
01:17:42
and so uh for people with restus leg
01:17:45
syndrome magnesium does sometimes help
01:17:47
significantly and it what's it doing is
01:17:49
relaxing us I don't think we actually
01:17:51
know precisely what it's doing okay um
01:17:54
when you look at an underslept brain so
01:17:56
if I was sleep deprived what what would
01:17:59
the difference in my regular sleep
01:18:01
activity be what would you see would you
01:18:03
see my brain is like not active would
01:18:06
you see part of it not not active so we
01:18:09
would see on a gross level on a sort of
01:18:11
macro level we would see that your brain
01:18:14
is prioritizing very deep sleep over um
01:18:18
other stages of sleep at night on during
01:18:22
the day if you're chronically sleep
01:18:23
deprived using the techniques that we
01:18:26
use in clinical practice you would see
01:18:28
very little there is some increasing
01:18:32
evidence that actually what is happening
01:18:34
within our brains is that we are
01:18:38
constantly showing little areas of our
01:18:40
cerebral cortex the outer lining of our
01:18:42
brain the bit of the brain that's
01:18:43
responsible for our cognitive abilities
01:18:45
for example that dip in and out of
01:18:48
electrical silence what has been termed
01:18:50
local sleep so that there are little
01:18:52
islands of local sleep that are
01:18:54
constantly occurring over our cerebral
01:18:56
cortex whilst we're awake and as we get
01:18:59
more and more sleep deprived and you
01:19:01
know depending on how much we've used
01:19:03
that particular bit of our brain those
01:19:05
islands tend to get slightly um longer
01:19:09
that the periods of Silence get longer
01:19:12
and those islands become more widespread
01:19:15
so we're constantly even if you and I
01:19:17
are talking there are little areas that
01:19:18
are brain that are constantly dipping in
01:19:20
and out of sleep but if we're very sleep
01:19:22
deprived actually that uh electrical
01:19:25
Silence of our cerebral cortex gets more
01:19:28
extensive and more widespread which is
01:19:31
probably why or at least one of the
01:19:33
reasons why we decline from a cognitive
01:19:37
perspective when we are very sleep
01:19:39
deprived okay so my okay interesting
01:19:42
because okay so different little parts
01:19:44
of my brain are doing little micro
01:19:46
sleeps if I'm sleep deprived yes and
01:19:48
that from a behavioral standpoint will
01:19:51
show up in my day-to-day life as worse
01:19:54
cognitive performance maybe less
01:19:56
Focus um are there because I've always
01:20:00
I've always wondered why on an unslept
01:20:02
day I feel like I'm more emotional you
01:20:04
know people say they attest to the fact
01:20:06
that if someone's a little bit cranky
01:20:08
they think oh they probably not slept
01:20:10
last night there's that phrase isn't
01:20:11
there like who woke up on the wrong side
01:20:13
of the bed etc is is there a scientific
01:20:15
basis for that so I don't think we can
01:20:17
fully explain it I think that there are
01:20:20
certainly the areas of the brain that
01:20:22
are responsible for for for emotion and
01:20:24
emotional cognition are more
01:20:26
metabolically active and so may be more
01:20:28
vulnerable to the effects of sleep
01:20:30
deprivation I think um uh we it is
01:20:33
likely that when you're sleep deprived
01:20:35
there are some changes in terms of
01:20:37
certain neurotransmitters within the
01:20:38
brain that may exacerbate that um but
01:20:42
what is very very clear is that that
01:20:44
association between
01:20:46
sleep mood anxiety levels is very very
01:20:50
clear and in fact we see that for
01:20:51
example in people with clinically
01:20:53
significant anxiety or clinically
01:20:55
significant depression that actually
01:20:57
treating anxiety or depression in
01:20:59
somebody who is sleep deprived or has
01:21:02
insomnia is much more difficult that
01:21:05
treating the insomnia in somebody who is
01:21:07
anxious or depressed is much more
01:21:09
difficult without addressing the anxiety
01:21:10
and depression and so this is you know
01:21:12
this is really significant not just on a
01:21:14
day-to-day basis for all of us but also
01:21:16
in in clinical medicine and clinical
01:21:19
Psychiatry so jumping back to the point
01:21:21
about when we're under slept certain
01:21:24
parts of our brain are doing little
01:21:25
micro sleeps it is fair to say that the
01:21:28
phrase that you know we're half
01:21:31
asleep there's some Merit to that yeah
01:21:34
we may not be half asleep but we could
01:21:35
be a thousandth asleep or a h hundredth
01:21:38
asleep and you know this this idea that
01:21:41
the brain can exist in different stages
01:21:44
of sleep or wake at the same time by the
01:21:47
way also extends to to the nighttime so
01:21:50
for example in people who Sleepwalk who
01:21:52
do really rather dramatic things and you
01:21:54
know I've had I've seen patients for
01:21:56
example who've driven in their sleep one
01:21:58
patient who rode a motorbike in her
01:21:59
sleep I've seen uh people do some
01:22:02
incredibly complicated things like
01:22:04
cooking a meal in their sleep all of
01:22:06
these sleepwalking type events relate to
01:22:09
the fact that certain parts of the brain
01:22:11
are in very deep sleep whereas other
01:22:14
parts of the brain actually demonstrate
01:22:15
waking activity so the bits of the brain
01:22:19
that are remain asleep are the frontal
01:22:21
loes which are you know basically where
01:22:23
our rational thinking where our decision
01:22:25
making occurs and the parts of the brain
01:22:27
that are responsible for memory uh part
01:22:29
of the brain called the hippocampus
01:22:31
whereas actually in these events there
01:22:34
are other areas of the brain like the
01:22:35
areas responsible for movement or Vision
01:22:38
or emotion uh demonstrate waking
01:22:41
activity both on an electrical basis but
01:22:44
also on a metabolic basis as well why do
01:22:47
we dream it's a big question isn't it
01:22:50
it's such a big question the the short
01:22:51
answer is I think we still don't know I
01:22:53
think there are lots and lots of
01:22:55
theories about why we dream that the um
01:22:59
those range from uh dreaming sleep being
01:23:02
fundamental for memory uh for
01:23:06
reinforcing memories for regulation of
01:23:09
our emotional memories and I think
01:23:11
you've had Matthew Walker on previously
01:23:13
you probably talked about this view that
01:23:17
uh dreaming sleep is a sort of emotional
01:23:20
Rehabilitation therapy yeah a form of
01:23:22
emotional therapy there are you know one
01:23:25
of the unanswered questions is for
01:23:27
example why when we are born or when
01:23:29
we're in our mother's womb we spend a
01:23:31
third of our lives in REM sleep and yet
01:23:34
and that drops off significantly as we
01:23:37
get older uh to the point where by the
01:23:39
time you know we are elderly we're doing
01:23:43
very little REM sleep at all o o
01:23:46
overnight so this kind of Rapid decline
01:23:49
in the proportion and the amount of REM
01:23:51
sleep that we are exhibiting um has been
01:23:55
explained by some individuals as it
01:23:56
being fundamental to the development of
01:23:59
Consciousness for example so there's a
01:24:01
chap called Hobson and who is uh based
01:24:04
in one of the Ivy League colleges in the
01:24:06
in the states who was um very keen on
01:24:09
this idea that REM sleep is part of the
01:24:12
de early development of Consciousness as
01:24:14
we are as as as we are inside our
01:24:16
mother's womb and may be fundamental
01:24:19
subsequently to learning new things to
01:24:22
learning new motor tasks the honest
01:24:24
answer is I think that there's probably
01:24:26
more than one function in fact many
01:24:28
functions of REM sleep so REM sleep is
01:24:31
the stage of sleep where we where we
01:24:32
start to dream right so so REM sleep is
01:24:35
the stage of sleep that we most
01:24:37
associate with dreaming and it's the
01:24:39
stage of sleep that is most associated
01:24:41
with dreams of a narrative structure so
01:24:43
these kinds of stories that evolve that
01:24:45
have a plot but actually we know that
01:24:46
lots of people dream in nonrem sleep as
01:24:49
well and you can see that in for example
01:24:51
people who Sleepwalk or have night
01:24:53
terrors they will often very clearly be
01:24:56
able to remember dreams um but those
01:25:00
events will have Arisen from very deep
01:25:03
non-re sleep so we do dream in other
01:25:06
stages as well it feel it feels like
01:25:09
it's not a great evolutionary trait to
01:25:11
have nightmares like I can't understand
01:25:14
the basis of having a nightmare and why
01:25:15
that's a good thing you know I'm not
01:25:18
sure that that we're evolutionally
01:25:20
driven to have nightmares I think that
01:25:22
what nightmares represent is the fact
01:25:25
that we've had these kind of mental
01:25:28
experiences but we've woken up to the
01:25:30
extent that that nightmare has never
01:25:32
been completed because usually we forget
01:25:36
our dreams you know we all almost all of
01:25:38
us go through four or five cycles of REM
01:25:42
sleep a night and so we're probably
01:25:43
having dreams throughout the night but
01:25:46
you know most of us don't remember the
01:25:48
vast majority of our dreams we remember
01:25:50
the dreams whereby we've woken directly
01:25:52
out of rem's sleep why is that why do we
01:25:55
remember the Drey when we wake up um I
01:25:57
think that's another unanswered question
01:25:59
but it's quite clear that that rapid
01:26:01
transition between REM sleep and wake
01:26:04
means that the memory of whatever it is
01:26:06
that we've been experiencing has not
01:26:07
been fully cleansed has not been removed
01:26:11
now that goes back to to Matthew
01:26:13
Walker's theory of of of uh of REM of
01:26:17
dreaming as a as an emotional therapy
01:26:20
because you know the the argument is
01:26:22
that if you've experienced something
01:26:23
that is
01:26:24
so strongly um driven by emotion you
01:26:29
know you've had a very traumatic
01:26:31
experience the one of the thing one of
01:26:33
the reasons why you don't recover from
01:26:34
that is because you are when you're
01:26:36
dreaming about that event you will
01:26:39
invariably wake up because the emotional
01:26:41
content of that dream is so high which
01:26:43
is why these kind of recurrent
01:26:45
nightmares are part and parcel of
01:26:47
post-traumatic stress disorder you're
01:26:48
never completing that process and you're
01:26:51
never allowing uh yourself to achieve
01:26:53
emotional recovery from that original
01:26:57
trauma so so one could argue under the
01:27:00
theory that our dreams are therapy that
01:27:05
it's our like subconscious mind playing
01:27:07
through the scenario in order to maybe
01:27:09
better understand it and process it and
01:27:10
to come to peace with what happened
01:27:12
maybe learn from it you know from an
01:27:13
evolutionary perspective okay so if
01:27:16
you've had a traumatic event say you
01:27:18
were attacked by a lion you know out in
01:27:22
out in the Wilds then obviously having a
01:27:25
very very strong
01:27:27
emotional association with the terror of
01:27:30
being attacked by a lion is very
01:27:32
important for you to avoid that again
01:27:34
and to learn from that event yeah but
01:27:38
what you don't want is you don't want
01:27:39
the next time you see that lion to have
01:27:42
such an strong emotional response to it
01:27:45
that you can't do anything about it that
01:27:47
you that you freeze because that's not
01:27:50
very good for your survival so you want
01:27:52
to learn from these very strong
01:27:54
emotional events but you don't want that
01:27:56
emotion to be heightened to the same
01:27:59
extent that it was during that original
01:28:01
experience so from an evolutionary
01:28:04
perspective there is some rationale to
01:28:05
that what's the um the most upsetting
01:28:10
case of a sleep disorder that you've
01:28:12
ever seen I mean I've seen a lot of very
01:28:14
upsetting cases you know I've seen um
01:28:18
individuals who have committed crimes in
01:28:22
their sleep really um yeah um what kind
01:28:24
of crimes so uh was involved with
01:28:27
somebody who not in the UK I would
01:28:30
stress who uh shot uh a family member in
01:28:34
their sleep um I've uh seen individuals
01:28:38
who have um um committed sexual assault
01:28:43
in their sleep um but also rape uh yes I
01:28:48
somebody who was convicted for rape in
01:28:51
uh as a result of a sleep disorder now
01:28:53
obviously you know one of the great
01:28:54
difficulties is is that you can never be
01:28:58
absolutely sure whether during that
01:28:59
particular episode they were in their
01:29:04
that that occurred during their sleep
01:29:06
disorder but what you can certainly say
01:29:07
with a degree of certainty is that there
01:29:09
is clear evidence that they have
01:29:11
exhibited similar things that have
01:29:13
definitively occurred out of their sleep
01:29:16
but but also some of the effects of
01:29:18
these Sleep Disorders on people's lives
01:29:20
is really dramatic so um I look after a
01:29:25
large number of individuals with a
01:29:26
condition called Klein Levin syndrome
01:29:28
which is a very poorly understood
01:29:30
condition that often affects young kids
01:29:32
and teenagers and they will go through
01:29:36
they'll be fairly normal between
01:29:38
episodes and then during episodes they
01:29:41
will be profoundly sleepy sometimes
01:29:43
sleeping 23 24 hours a day when they're
01:29:46
awake they're very confused they exhibit
01:29:49
very abnormal behavior eating Behavior
01:29:51
sexual behavior and that can last for
01:29:54
days or weeks out of the blue which can
01:29:56
have a massive impact on um people's
01:30:00
education people's social lives you know
01:30:02
how they're uh managing in the workplace
01:30:05
so the these sorts of conditions can
01:30:07
devastate people's
01:30:09
lives in in the case of the person that
01:30:11
killed somebody while they were
01:30:14
asleep did they get convicted of that
01:30:18
crime that is still in process U as I
01:30:21
said it's not in the UK which is why I'm
01:30:22
mentioning it um but you know there have
01:30:25
been many examples of individuals who
01:30:28
have um who have been found not guilty
01:30:32
as a result of a crime including murder
01:30:36
um having occurred in their sleep now as
01:30:39
I said there is always a degree of
01:30:41
uncertainty as to whether or not a
01:30:43
particular event happened in sleep but
01:30:45
what in those individuals we can say is
01:30:48
that there are many individuals who
01:30:50
exhibit similar sorts of patterns of
01:30:52
behavior that have been clear
01:30:54
uh demonstrated to arise from sleep what
01:30:58
do you have to demonstrate in order to
01:31:00
when that goes to court what are they
01:31:02
looking at are they looking at your past
01:31:03
sleep Behavior do they put you in a
01:31:05
sleep laboratory and check I think I
01:31:07
think both both of those things so you
01:31:09
know first of all is past Behavior
01:31:12
consistent with what has happened on
01:31:15
that night in question um secondly are
01:31:18
there any features about the event
01:31:19
itself that suggest that there was an
01:31:22
attempt to for example cover it up up or
01:31:25
a degree of uh pre-planning in order to
01:31:28
commit that particular act and also
01:31:31
whether or not there can be uh evidence
01:31:35
found by studying that individual's
01:31:38
sleep that they suffer from these kinds
01:31:40
of sleep
01:31:41
disorders I am I read about the famous
01:31:43
example of Kenneth Parks yes which is
01:31:46
pretty unimaginable yes what is the
01:31:48
story of Kenneth Parks so so Kenneth
01:31:50
Parks uh was a uh chap who uh was based
01:31:54
in Ontario um who um apparently uh in
01:31:59
his sleep uh drove several miles to his
01:32:03
parents in-law's house 23 km yeah uh
01:32:08
long long way and apparently um got a um
01:32:13
tire iron out of the boot of his car uh
01:32:15
bludgeoned his mother-in-law to death
01:32:18
and then tried to um kill his
01:32:20
father-in-law and and and ended up
01:32:22
throwing him into a swim sing pool um
01:32:25
now it was this was made even more
01:32:29
Curious by the fact that there had been
01:32:31
some um evidence that he'd been having
01:32:34
some financial difficulties and had had
01:32:37
some discussions with his parents-in-law
01:32:38
about um about financial issues but it
01:32:43
was deemed by a court of law that this
01:32:46
happened whilst he was sleepwalking and
01:32:49
he was actually acquitted so this is a
01:32:51
remarkable story um now is it impossible
01:32:56
for somebody to drive in their sleep no
01:32:58
I've seen it myself um uh it
01:33:01
seems stretching credibility that
01:33:05
somebody could have undertaken all of
01:33:07
that whilst sleeping but you know in the
01:33:10
courts of law he was found not guilty
01:33:12
that's
01:33:14
crazy have you ever seen someone Drive
01:33:16
miles in their sleep yes yeah you know
01:33:18
I've got I've got a a patient who I
01:33:20
don't see anymore who I mentioned in my
01:33:22
book who um has driven several miles in
01:33:26
her sleep and in fact has driven a
01:33:27
motorbike in her youth in her sleep and
01:33:30
the only knowledge that she had was her
01:33:32
land lady at the time said where were
01:33:34
you going at 1:00 in the morning
01:33:35
clutching your motorcycle helmet and
01:33:38
she'd obviously been for a ride in the
01:33:39
middle of the night without any
01:33:40
recollection I think this goes back to
01:33:42
what we were talking about which is you
01:33:44
know are we half asleep are we a
01:33:46
hundredth asleep are we a thousand
01:33:48
asleep so in those kinds of situations
01:33:51
it's likely that actually the majority
01:33:53
of the brain is probably awake because
01:33:54
it's very hard to envisage how somebody
01:33:56
may be able to do something quite so
01:33:59
complicated when the majority of their
01:34:01
brain is asleep but crucially the parts
01:34:03
of the brain that remain asleep are the
01:34:06
bits that are responsible for rational
01:34:08
thinking I mean why would she have gone
01:34:09
for a motorcycle ride in the middle of
01:34:11
the night uh if she was thinking
01:34:13
rationally and also the bits of the
01:34:15
brain that are responsible for memory I
01:34:18
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description link below What proportion
01:35:18
of people that are because there's
01:35:20
various types of insomnia isn't there
01:35:22
there's not just one type of inia
01:35:24
um I read about this sort of short sleep
01:35:26
duration insomnia and then in other
01:35:29
insomniacs where they might be in bed
01:35:32
for 8 hours and sleep for eight hours
01:35:33
but they're not getting sufficient
01:35:35
restorative sleep is that it so we we
01:35:40
know that you know and going back to
01:35:42
what I was saying about us being poor
01:35:44
witnesses to our sleep the majority of
01:35:46
individuals who have insomnia subjective
01:35:50
insomnia when you bring them into a
01:35:51
sleep lab they may be sleeping slight ly
01:35:54
shorter than normal based upon tracking
01:35:57
of their brain waves but probably don't
01:35:59
sleep a huge amount less than normal
01:36:01
individuals it's their subjective
01:36:03
experience of sleep that is um impacted
01:36:07
rather than the true duration of their
01:36:10
sleep um those make up the majority of
01:36:13
individuals with insomnia but there is a
01:36:15
subgroup of individuals who say well you
01:36:17
know I sleep 4 hours a night or 3 hours
01:36:20
a night and they really do only sleep 2
01:36:22
or 3 hours night now in those
01:36:25
individuals who kind of have the feeling
01:36:27
that they are sleeping very little what
01:36:30
we are actually beginning to understand
01:36:32
is that there are some again some local
01:36:35
changes in the way that the brain acts
01:36:39
so that there are areas of the brain for
01:36:41
example that might be responsible for
01:36:43
awareness that don't switch off to the
01:36:45
same extent at the rest of the brain so
01:36:47
whilst the majority of the brain may be
01:36:48
sleeping those little areas of the brain
01:36:51
that are responsible for our awareness
01:36:52
at night what's going on in our
01:36:54
environment may not be switching off to
01:36:56
quite the same extent and so there's a
01:36:59
sort of huge spectrum of what insomnia
01:37:02
actually
01:37:03
is what hope would you offer insomnia
01:37:05
insomniacs because you know this video
01:37:08
is going to draw in a lot of insomniacs
01:37:10
it always does whenever we talk about
01:37:11
sleeps when I look at the the comments
01:37:13
and the feedback and the reviews Etc and
01:37:15
it seems that insomniacs converge here
01:37:18
looking for answers
01:37:20
yeah so I would say that um the odds are
01:37:25
in your favor that there are some very
01:37:27
effective treatments for insomnia um
01:37:31
that it's not always straightforward
01:37:34
because insomnia interacts with a whole
01:37:36
range of other conditions that may be
01:37:39
affecting you like your mood like your
01:37:42
anxiety levels like what's happened in
01:37:44
in your past and sometimes it requires a
01:37:47
multipronged approach but for the
01:37:50
majority of individuals we can make
01:37:52
sleep better you know one of the real
01:37:55
big issues that a lot of people are
01:37:57
seeking for Rapid or instant answers to
01:38:01
their insomnia which is why a lot of
01:38:03
people end up on drugs and that that may
01:38:06
not necessarily be the right approach
01:38:08
for you and I would really countenance
01:38:10
that you know the treatment of an
01:38:12
insomnia can in some individuals take
01:38:15
some time um and it's important to have
01:38:17
a degree of patience to try and fix this
01:38:19
in the long term rather than to provide
01:38:21
a short-term
01:38:22
solution what sort of percentage of
01:38:24
insomniax do you think recover well I
01:38:27
think that if you extrapolate on the
01:38:29
basis of CBT yeah CBT based approaches
01:38:32
we know that helps about 80% of
01:38:34
individuals really 80% yeah up to um and
01:38:38
you know that that these drugs do help
01:38:42
some individuals as I you know I would
01:38:44
uh stipulate again I would stress that
01:38:47
you know drugs are need to be used
01:38:49
cautiously in the right individuals so
01:38:52
you know as I said the odds are in your
01:38:53
favor you wrote this book called um you
01:38:56
know the secret world of sleep which is
01:38:59
a real pioneering book on the subject of
01:39:01
sleep but I also have this other book in
01:39:04
front of me called The Man Who tasted
01:39:06
words yeah and at the bottom of this
01:39:08
book it says it's a fascinating
01:39:09
important and disturbing
01:39:12
book all of your work seems to Center on
01:39:15
the weird way that the brain operates
01:39:17
and its patterns and how that impacts
01:39:19
our everyday lives but the man who
01:39:21
tasted words why did you call the book
01:39:24
The Man Who tasted words so one of the
01:39:28
individuals in that book is a is an
01:39:30
individual who is not a patient who
01:39:32
doesn't have anything wrong with him
01:39:34
he's got a condition called synesthesia
01:39:36
which is the melding the the the
01:39:39
combining of certain senses so when he
01:39:44
sees objects or hears objects he gets a
01:39:49
taste associated with them so he gives a
01:39:51
really good example of his um
01:39:54
you know in childhood his um friend had
01:39:57
a girlfriend whose particular name in
01:39:59
him gave him a awful taste and he every
01:40:02
time he his friend mentioned this girl's
01:40:05
name his mouth was filled with a a
01:40:08
terrible taste so he will read words he
01:40:12
will hear words and all of those words
01:40:14
will be associated with a particular
01:40:15
taste that has lasted his entire life
01:40:18
and it's been very fixed so as a as a
01:40:21
kid when he started reading he learned
01:40:23
how to to read by looking at the tube
01:40:24
map on the way to school and each of
01:40:27
those tube stations has got a particular
01:40:29
taste associated with it and that taste
01:40:32
has remained fixed throughout his life
01:40:34
now this sounds really very strange but
01:40:36
actually we know that some degree of
01:40:38
synesthesia some degree of melding of
01:40:40
our uh of our uh senses is actually
01:40:44
quite common that up to about 4% of
01:40:46
individuals exhibit some form of
01:40:49
synesthesia and it really I think
01:40:51
illustrates how in all of us our minds
01:40:54
and our brains and our nervous systems
01:40:57
work in slightly different ways to
01:40:59
Define our reality and it's an
01:41:03
exploration of how our nervous system
01:41:06
can influence how we perceive reality to
01:41:09
be and that truth may not always be what
01:41:12
we perceive there's another um patient
01:41:15
in that not a patient another woman in
01:41:18
that book who has synesthesia she's a
01:41:21
musician and when she plays music
01:41:23
she will see uh colors washing in and
01:41:27
out of her vision um and so for her
01:41:30
every time she hears a piece of music
01:41:33
that will be accompanied by a a visual
01:41:35
phenomenon sometimes even a sensory
01:41:37
phenomenon so certain pieces of music or
01:41:40
certain sounds will precipitate certain
01:41:42
sensory
01:41:44
experiences I've often heard you know
01:41:45
you hear about Rainman and um various
01:41:48
types of autism where these sort of
01:41:51
apparent geniuses say that they
01:41:54
see what do they say they say they do
01:41:57
maths with like shapes in their brain MH
01:42:00
I if you ask them what four plus4 is
01:42:02
they describe that it kind of appears in
01:42:04
front of them as a shape yes so so that
01:42:07
is a form of synesthesia and we know
01:42:09
that cesia is much more common in people
01:42:11
with autistic Spectrum Disorder than it
01:42:12
is in individuals without
01:42:15
neurodevelopmental uh disorders what
01:42:18
does this tell us about the nature of
01:42:20
our experience you know on a for someone
01:42:22
that's not you know um living with
01:42:26
synesthesia does it does it mean that
01:42:30
there is no such thing as truth I think
01:42:33
what it tells us is that
01:42:36
our our reality what we perceive truth
01:42:40
to be is intimately linked with the
01:42:43
structure and the function of our brains
01:42:46
and whilst we all assume that people's
01:42:50
experiences of the world and by the way
01:42:53
the way that we interpret those
01:42:55
experiences of the world are all
01:42:57
identical that is very far from the
01:42:59
truth and I think it gives us some
01:43:01
insight given the fact that how we
01:43:05
perceive reality even in the context of
01:43:08
an entirely normal and entirely
01:43:11
functioning nervous system is so
01:43:13
predicated upon our experiences is so
01:43:17
predicated on our model of the world
01:43:19
that you know the brain works as a
01:43:21
prediction system so it works by um
01:43:26
assessing whether or not what our senses
01:43:28
are telling us are in keeping with what
01:43:30
our expectation of the world is so we
01:43:31
need a model of the world as we
01:43:33
understand it and that model of the
01:43:35
world is influenced by our experiences
01:43:37
by our genes by the structure and
01:43:38
function of our brain so it's not
01:43:41
necessarily surprising given that we all
01:43:43
have very different experiences in life
01:43:45
that we have different genes that we
01:43:46
will have gone through different things
01:43:49
that our truth may be very different
01:43:52
from the truths of others and our
01:43:56
experiences our perceptions of the
01:43:58
reality of the world may be very
01:44:01
different kind of explains why you know
01:44:04
there's a lot of polarization and a lot
01:44:05
of conflict to some degree I think it
01:44:08
does I think you only need to have a
01:44:09
look on Twitter to see how differently
01:44:12
different people perceive exactly the
01:44:15
same
01:44:19
situation but also one might argue that
01:44:23
you know if there's people who have
01:44:24
entirely different perceptions of the
01:44:26
world because of their brain and their
01:44:28
nervous system
01:44:29
that maybe they're not guilty of crimes
01:44:32
that they've committed well I think
01:44:34
that's the subject of the third book
01:44:36
yeah seven deadly sins the biology of
01:44:38
Being Human I had this debate with my
01:44:41
friend the other day because I was
01:44:42
reading about some studies I think it
01:44:44
was um it was a study that showed a guy
01:44:47
with a brain tumor had gone out and
01:44:50
suddenly he was like a normal teacher
01:44:51
and he' gone out and committed some
01:44:53
horrific horrific crimes and when they
01:44:55
remov the brain tumor from his head he
01:44:57
stopped committing all these crimes and
01:45:00
so the question becomes like is this
01:45:02
person to blame for these crimes because
01:45:05
but then you could obviously stretch
01:45:06
that out further and just go when people
01:45:08
are serial killers often times we find
01:45:10
that there's something in their brain or
01:45:11
there's some early trauma or there's you
01:45:13
know there's some kind of neurological
01:45:15
issue that they've had so are they are
01:45:16
they guilty well indeed and you know and
01:45:19
that's a really important question which
01:45:22
is you know how much free will do all of
01:45:25
us have if we are all um essentially
01:45:29
machines that are doing the bidding of
01:45:30
our brains than anything that affects
01:45:33
our brain function defines our behavior
01:45:36
and you know the the the book that is
01:45:38
out in November very much discusses um
01:45:42
the neurological and psychological
01:45:44
conditions that can influence our
01:45:46
behavior in really rather dramatic ways
01:45:49
you know be that you know from the
01:45:51
perspective of gluttony or wroth or
01:45:53
Pride or any of the other uh seven
01:45:56
deadly sins why why did you write this
01:45:58
book this book Seven Deadly Sins because
01:46:01
it again reflects some of my clinical
01:46:03
practice that I see individuals who have
01:46:06
brain conditions that dramatically
01:46:09
influence their behavior now the
01:46:11
question in always in my mind is well um
01:46:15
firstly does this
01:46:17
reflect their own morality and it's
01:46:19
quite clear that in those individuals it
01:46:21
doesn't but what are the implications
01:46:25
for all of us and as you already said
01:46:27
you know if that is the case for if a
01:46:29
brain tumor can suddenly cause a
01:46:32
dramatic change in Behavior if a stroke
01:46:34
can if Parkinson's disease can if a
01:46:38
chemical change and some of the people
01:46:39
that I detail in the book are
01:46:41
individuals who are very similar to
01:46:43
patients of mine in whom I've started an
01:46:45
anti-epileptic drug for example exhibit
01:46:47
a dramatic change in their behavior and
01:46:51
so a simple chemical Tak in tablet form
01:46:54
can result in those changes of behavior
01:46:56
what about all of us are there things in
01:46:58
our environment are there things that we
01:46:59
are doing that influence the
01:47:01
machinations of our brains so do do
01:47:04
these kinds of behaviors then take a a
01:47:06
moral Viewpoint or should we be looking
01:47:10
at them from a biological perspective
01:47:12
rather than a moral one give me one such
01:47:14
extreme Behavior where you've seen um
01:47:17
some kind of chemical intervention or
01:47:18
other intervention completely eradicate
01:47:20
that behavior so I I've certain he seen
01:47:23
a lot of individuals so you know I said
01:47:25
at the start that one of the um
01:47:27
specialist clinics I do is an epilepsy
01:47:29
clinic and there are anti-epileptic
01:47:32
drugs that are well known in a very
01:47:33
small proportion of individuals to cause
01:47:37
a dramatic increase in irritability
01:47:40
anger and aggression and you know I
01:47:43
remember one of the earliest patients
01:47:45
that I saw started on this drug was a uh
01:47:48
very frail little old lady who must have
01:47:51
been in her 70s
01:47:53
and who um was arrested by six police
01:47:56
officers in her front garden um being
01:47:59
pinned down because she was so so
01:48:01
violent and aggressive so that's one
01:48:04
example lots of patients who for example
01:48:07
exhibit behavioral change after a
01:48:09
seizure uh I've seen individuals who
01:48:12
have had autoimmune conditions of their
01:48:14
brain who have become frankly psychotic
01:48:17
you know ripping um sinks off the wall
01:48:21
in their hospital room trashing um the
01:48:24
their hospital room attacking um their
01:48:28
their nurses who actually when that
01:48:30
condition is treated they've reverted to
01:48:32
normality and in the case of the very
01:48:35
angry grandmother who was uh kicking off
01:48:38
at the police was she cured of thator
01:48:40
the the drug was stopped and and she
01:48:42
returned to normal the drug was stopped
01:48:45
yes so it was took her off the took took
01:48:48
her off the anti-epileptic drug and
01:48:49
replaced it with another and and she
01:48:51
normalized of all the um of all the
01:48:54
extreme cases you've seen throughout
01:48:55
your work and through these these books
01:48:57
you've written about sleep and the seven
01:48:59
deadly sins and the man who tasted
01:49:01
words what is the
01:49:03
um what is the most surprising crazy
01:49:08
story that you've encountered that that
01:49:10
show just how extreme and bizarre the
01:49:13
human brain can be so I think probably
01:49:16
um the one
01:49:19
that sits with me in a mo in the most
01:49:22
emotional way is probably a young man
01:49:25
that I met who has never been able to
01:49:27
feel pain um throughout his entire life
01:49:31
from the moment that he was born and in
01:49:32
fact he has a genetic disorder that was
01:49:35
also inherited by two of his siblings
01:49:38
and none of the three children have ever
01:49:41
been able to experience pain now at
01:49:43
first clance you kind of think oh that
01:49:44
might be quite nice never to experience
01:49:46
pain but meeting somebody like that and
01:49:48
you realize quite how important pain is
01:49:52
for our normal development for our
01:49:54
normal lives you know he tells stories
01:49:57
of him and his sisters essentially
01:50:00
holding their hands up to the fire to
01:50:01
hear the sizzling of their hands because
01:50:03
they thought it was funny they didn't
01:50:05
feel any pain they he would regularly
01:50:07
jump off the roof of his garage in order
01:50:10
to get attention because he knew that if
01:50:11
he broke a limb he would end up in
01:50:13
hospital being looked after by these
01:50:14
nice nurses and there was no downside to
01:50:17
it yet he is now you know terribly
01:50:21
physically scarred doesn't really you
01:50:23
know he has no comprehension of what
01:50:25
pain is so there is that disconnect
01:50:28
between The Human Experience of pain
01:50:30
which is common to all of us and what he
01:50:33
experiences and I think that he feels
01:50:35
that that is very much a a barrier
01:50:37
between him and understanding all the
01:50:39
people around him but it's also resulted
01:50:41
in him uh being terribly damaged by the
01:50:46
inability to feel
01:50:48
pain gosh it really does um perfectly
01:50:51
highlight the role of of pain very much
01:50:54
something all of us think we'd rather
01:50:56
live without yes and then you see
01:50:58
somebody who has never experienced pain
01:51:00
and see the impact it has on them um I
01:51:03
think it makes you appreciate it in a
01:51:05
slightly different way is there anything
01:51:07
else pain oh load I mean so much you
01:51:10
know um there are you know one one woman
01:51:13
who lost her vision as a result of
01:51:16
multiple operations to her eye who sees
01:51:18
visual hallucinations everywhere she
01:51:20
goes um you know I think that very much
01:51:23
illustrates uh the fact that our brain
01:51:26
even when it's starved of inputs creates
01:51:29
its own inputs because it's so eager to
01:51:31
experience the world um you know
01:51:34
individuals in whom is she okay she
01:51:37
what's her experience so so she has um
01:51:41
lost her vision entirely and sees
01:51:45
sometimes rather scary hallucinations as
01:51:48
a result of that loss of vision um you
01:51:51
know what's really fascinating about her
01:51:54
is that when she was asked by a a doctor
01:51:57
whether or not she wouldd want those
01:51:59
treated because there are some things
01:52:00
that we can do to try and improve those
01:52:03
she had to think very long and hard
01:52:05
about it because she said look you know
01:52:07
at least I'm seeing something now
01:52:08
whether that is real or not there is a
01:52:11
comfort to seeing something and in the
01:52:14
end decided that she didn't want it
01:52:16
treated she'd rather live with the
01:52:19
hallucinations what else sorry I
01:52:21
interrupted so
01:52:23
um individuals who have lost their sense
01:52:26
of smell or lost their sense of taste
01:52:28
now you know you kind of think well I
01:52:31
could live without my sense of smell
01:52:34
probably it wouldn't be as quite a rich
01:52:36
a world as I would as I would like but
01:52:39
actually the implications of losing your
01:52:41
sense of smell both in terms of um
01:52:45
memory you know you think how important
01:52:46
smell is for memory for those sort of
01:52:48
emotional memories that we have you know
01:52:51
smelling your your your mother's perfume
01:52:54
or a particular meal and taking you back
01:52:57
directly to Childhood and the impact of
01:52:59
smell on emotion on your mood on uh you
01:53:03
know depression is really
01:53:05
underappreciated until you look at
01:53:08
individuals who have lost their sense of
01:53:09
smell and that was particularly
01:53:11
important over covid because a lot of
01:53:12
people were um losing their sense of
01:53:14
smell as parts of covid and didn't know
01:53:17
whether or not they would ever get their
01:53:18
sense of smell back so all of our senses
01:53:21
and they were depressed
01:53:23
and they were depressed and you know it
01:53:24
is very clearly associated with with um
01:53:28
changes in mood uh smell and mood are
01:53:31
very closely linked um you know if you
01:53:34
think about some of the other um sensors
01:53:38
so hearing so people who experience
01:53:40
auditory hallucinations or you know in
01:53:43
in in in the man who tasted words
01:53:44
actually I was very kindly uh Bill Odie
01:53:47
agreed to talk to me and bill has been
01:53:49
experiencing musical hallucinations for
01:53:52
many many many years so everywhere he
01:53:54
goes in his house he will hear a
01:53:56
soundtrack of of music and you know what
01:53:58
the implications of of that are um what
01:54:02
what's the implication so so initially
01:54:04
he thought he was going slightly mad he
01:54:06
thought that actually well first of all
01:54:08
he thought that his neighbors were
01:54:10
playing radio very very loudly and then
01:54:11
he thought he was going slightly crazy
01:54:13
but actually it turned out that one of
01:54:15
the reasons why he was experiencing
01:54:17
musical hallucinations was because he
01:54:19
was losing his hearing anyway and so you
01:54:22
know it goes back to the fact that when
01:54:23
the brain is starved of inputs it
01:54:25
creates its own experiences because it's
01:54:27
eager to experience life um but also the
01:54:31
the the the counter side to that is that
01:54:34
this association between hearing loss
01:54:36
and cognitive decline that actually you
01:54:40
know it's important to look after your
01:54:41
hearing because it provides important
01:54:45
inputs that maintain the health and the
01:54:47
Integrity of our brains so there are
01:54:50
lots of these aspects of that you can
01:54:52
take from Clinical medicine and apply
01:54:55
them to what it tells us about ourselves
01:54:57
and how our own brains work how has it
01:54:59
changed you meeting all these people and
01:55:01
doing all this work because it it can't
01:55:04
be easy at times it must have had left
01:55:08
sort of fingerprints on you in some sort
01:55:09
of way look I think the problem is that
01:55:12
particularly when you're sitting in a
01:55:14
busy NHS Clinic where you've got a very
01:55:17
limited amount of time to see people is
01:55:19
you're often very much focused on the
01:55:22
the problem that is sitting in front of
01:55:24
you and by problem I mean the issue the
01:55:26
medical issue that is affecting that
01:55:29
individual uh whereas writing these
01:55:32
books and talking to these patients I
01:55:34
think has given me much broader
01:55:37
appreciation of you know what it is that
01:55:40
we are actually doing so in you know in
01:55:42
the NHS you kind of yes you see well
01:55:45
look I'm treating that I'm diagnosing
01:55:47
that I'm maybe curing that but actually
01:55:50
you see the much wider implic ations on
01:55:53
those individuals when you are
01:55:55
addressing their stories their
01:55:58
experiences in a much broader way you
01:56:00
see the impacts on their families and
01:56:02
the the people around them yeah and that
01:56:05
stuff stays with you
01:56:07
undoubtedly how do you take care of
01:56:09
yourself to make sure that that stuff
01:56:10
doesn't um the honest answer is not very
01:56:13
well really no I mean you know look I I
01:56:16
try and uh have downtime and I try and
01:56:19
get away and get out of London um but I
01:56:22
think you know this is something that
01:56:23
everybody in the NHS is currently facing
01:56:25
everybody is feeling very very burnt out
01:56:28
do you sleep well
01:56:32
sometimes we have a closing tradition
01:56:34
where the last guest leaves a question
01:56:35
for the next guest not knowing who
01:56:37
they're leaving it for okay and the
01:56:38
question left for you is what is the
01:56:41
most difficult decision you ever had to
01:56:43
make and how did
01:56:45
it benefit you oh
01:56:49
God I think there's lots of ways to
01:56:51
answer that question isn't it
01:56:52
what came to mind well I think the uh
01:56:55
the
01:56:57
um I can think of you know clinical
01:57:00
situations where I've had to make very
01:57:02
difficult decisions about whether or not
01:57:04
to treat somebody or not to treat
01:57:06
somebody to whether or not to
01:57:09
um whether or not to give up on somebody
01:57:12
or whether or not to to continue working
01:57:15
you know the sorts of situations like
01:57:17
cardiac arrests which all doctors have
01:57:19
to face um personal decisions
01:57:22
um you know I think certainly making the
01:57:25
decision to study medicine um was a an
01:57:29
important fork in the road for me
01:57:32
because you know medicine brings with it
01:57:35
lots of amazing things and amazing
01:57:38
experiences and we see through windows
01:57:41
on life that very few other people get
01:57:44
to see but it comes with it with it
01:57:47
quite a lot of responsibilities and
01:57:50
implications in terms of the future
01:57:52
direction of your life so I think there
01:57:54
are different ways to answer that thank
01:57:57
you guy you write such interesting books
01:57:59
in such interesting ways and they're all
01:58:00
absolutely fascinating so usually I'd
01:58:02
recommend one of them but I have to
01:58:03
highly recommend all of them I'm going
01:58:04
to link all of them Below in the
01:58:05
description um seven deadly sins the
01:58:08
biology of Being Human I've got the man
01:58:10
who tasted words inside the strange and
01:58:12
startling world of our senses and The
01:58:14
Secret World of sleep all of them will
01:58:16
be linked below um the seven deadly sins
01:58:18
book is not out until November 21st I
01:58:21
believe so um you can probably pre-order
01:58:23
that now can interested in getting that
01:58:25
so check out the the description below
01:58:26
all of the books are linked there and
01:58:28
thank you so much such a fascin pleasure
01:58:30
talking to you
01:58:34
[Music]
01:58:52
ah