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