Ep 005 & Ep 006: The Nocturnal Brain: A Journey Through Sleep Disorders. Dr. Guy Leschziner (part 1 & part 2)

 
www.deepintosleep.co

Guest: Dr. Guy Leschziner

with Dr. Yishan Xu

 

TODAY’S GUEST

Dr. Guy Leschziner work as a consultant neurologist at London Bridge Hospital, the Cromwell Hospital and within the Department of Neurology and Sleep Disorders Centre at Guy's and St Thomas' Hospitals. He is the clinical lead for the Sleep Disorders Centre, Guy's Hospital, one of Europe's largest sleep units. He isalso Reader in Neurology at the Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London.

Dr. Yishan and Dr. Leschziner discussed sleep apnea, a condition where a person's airway partially or completely collapses during sleep, causing them to stop breathing or have difficulty breathing. Dr. Leschziner emphasizes the importance of self-awareness and seeking medical attention if experiencing symptoms. They also talked about the importance of recognizing sleep disorders and seeking treatment, as well as the impact of sleep disorders on various aspects of life. Dr. Leschziner recommends cognitive behavioral therapy for insomnia (CBTI) as a first-line treatment for insomnia, as it is as efficacious as medication in the medium to long term without the associated risks.

WHAT WILL WE LEARN

Different Sleep Disorders:

  • Obstructive Sleep Apnea

    • Even if you don’t snore, you may still have it.

    • If you fall asleep easily during day time, wake up with dry mouth, headache, etc., get up often at night to use the restroom, consider checking it out.

  • Insomnia

  • What a normal night of sleep looks like?

    • It is normal to have deep sleep, REM sleep, and wake up in the middle of the night.

    • It is normal if we dream and remember our dreams.

    • If we don’t remember our dreams, we still dream during the night.

  • Sleep trackers pros & cons?

    • If you want to use it to monitor and change your lifestyle, it is helpful.

    • For research purpose, it is helpful.

    • For ppl with insomnia, NOT helpful and could be harmful.

  • Sleep medication

    • Sleep medication doesn’t restore normal sleep.

    • Many sleep medication may be related to future cognitive dysfunctioning later in life.

    • The best method in literature right now for restoring normal sleep, is CBTi (Cognitive Behavioral Therapy for Insomnia).

    • Generally, nobody should be given any medication before trying non-medication based treatment, such as CBTi first.

  • Restless leg syndrome

    • NOT the same as REM sleep behavior disorder

  • Sleepwalking

    • Conflicts between various areas of the brain.

    • When we sleep, part of our brain is awake, when we are awake, part of our brain is asleep.

  • When to find help?

    • If we suspect some symptoms may be sleep-related, or not sure what happened”

      • We can go to our family doctor to find out whether it is something worth pursuing.

      • If yes, seek help from a sleep specialist.

RESOURCES

Dr. Leschziner’s website:

http://www.guyleschziner.com/

Sleep Disorders and "The Nocturnal Brain" [00:01:40] Dr. Leschziner's book, "The Nocturnal Brain," explores different sleep disorders through clinical cases.

Sleep Apnea [00:04:01] Dr. Leschziner explains what sleep apnea is, its symptoms, and risk factors, including its prevalence in the Asian population.

What is a Normal Sleep Pattern? [00:09:35] Dr. Leschziner discusses the importance of individual differences in sleep needs and the general recommendation of 7-8 hours of sleep for most people. He also explains the role of dreaming and the importance of regularity in sleep patterns.

Sleep Stages [00:11:43] Description of the different stages of sleep and their importance for cognitive and physical health.

Dreams and REM Sleep [00:13:06] Explanation of the relationship between dreams and REM sleep, and how waking up during REM sleep can lead to better dream recall.

Deep Sleep and Sleep Trackers [00:16:33] Discussion of the amount of deep sleep needed and the potential harm of relying too much on sleep trackers.

Subjective Experience of Sleep [00:19:13] Importance of the subjective experience of sleep and how it can differ from objective measurements.

Sleep Inertia [00:21:18] Definition of sleep inertia and its association with certain sleep disorders, such as idiopathic hypersomnia.

Disseminating knowledge of sleep disorders [00:22:56] Dr. Leschziner talks about the impact of sleep disorders on people's lives and the importance of recognizing and treating them.

Sleep medication and cognitive behavioral therapy for insomnia [00:24:10] The discussion covers the risks associated with sleep medication, the benefits of cognitive behavioral therapy for insomnia, and the challenges of getting clinicians to use it as a first-line treatment.

Melatonin as a sleep-promoting agent [00:28:47] Dr. Leschziner explains the benefits and safety of melatonin as a sleep aid.

Thank You for Listening!

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Transcript

Episode 5:

-   0:02  

Welcome to deep into sleep with Dr. yishan xu. Let's improve sleep quality and live a healthy life together. Let's go deep into sleep. And now please welcome your host Yishan.

-   0:20  

Welcome everyone. It was a Chinese holiday recently, the Mid Autumn Festival. Hopefully some of you who celebrate that had some delicious mooncake with your family together. So today we have a special guest. Dr. Guy Leschziner from UK. Dr. Leschziner is a clinical lead for the sleep disorder center in guys hospital, which is one of Europe's largest sleep unit. In his new book, The nocturnal brain. There are many interesting clinical cases about this Sleep Disorders. He shared that book in MPR fresh air last month. I'm so excited to have him on our show today to share with us his expertise and knowledge about sleep. Dr. Leschziner. Welcome.

-   1:15  

Thank you very much for having me.

-   1:18  

Recently, I'm reading your new book, The nocturnal brain, which is a really great book. There are so many different sleep disorders you talked about in your book.

-   1:30  

Yeah, there are a range of some quite extreme conditions really illustrating the breadth of practice of sleep medicine.

-   1:42  

Mm hmm. Yes. So I'm wondering how what made you want to write a book about sleep disorders, a book like that the first place?

-   1:53  

Well, I was very much inspired in my medical career and in my neurological practice. Just by reading books like the man who mistook his wife for a hat by Oliver Sacks. So it was really the by reading the descriptions of people really at the extremes of the human experience, and trying to put the experiences of those individuals in your logical terms that really sparked my interest in neurology. But actually for sleep medicine, although there have been a number of books recently written about the importance of sleep and the functions of sleep, and I think that there is still a dearth of information out there about First of all, the range of sleep pathologies that exist within the human population. And, and also a dearth of understanding of what causes these conditions. Now, obviously, within the sleep community, we're very familiar with all these companies. But for the general population and, you know, who are suffering from these conditions, actually, you know, the very first step in terms of trying to get these patients diagnosed and, and treated is giving them an understanding that these conditions exist in the first place.

-   3:18  

Yes, I totally agree. I often hear people talk to me, even friends. They have no idea. There's such thing called sleep disorders. A lot of people are not aware, like, for example, sleep apnea, even though they snore so, so bad.

-   3:35  

Yes. And I think sleep apnea is a fantastic example of a condition that is incredibly common, you know, affecting depending on which population you study, but probably well over 10% of the adult male population. And yet people really don't even have any fundamental awareness that it exists, which is staggering, rarely, right?

-   4:00  

Yeah, since we are talking about sleep apnea, and I know some research talking about Asian population have a high high rate of having or being diagnosed of that. Yes. Right. So do you want to explain a little bit more? What is sleep apnea? What are some common symptoms of that?

-   4:21  

Sure, I have sleep apnea is a really a descriptive term for somebody stopping breathing or having a partial obstruction of the airway during sleep. So we know that the airway is a semi rigid tube, and some of the structural integrity of the airway is is as a result of small muscles that maintain some tension within them. Now, as we drift off to sleep, the tension in those muscles eases off and the airway becomes a little bit less rigid and frankly, floppy, and so is liable, particularly in individuals who are particularly prone to collapse down during sleep. Now, what this results in is that people are trying to breathe against a collapsed airway, which results in oxygen levels dropping, the heart rate increases, there is a surge of adrenaline, and there's a partial awakening. And so individuals who have this condition can really partially wake up from sleep several times an hour, sometimes as much as over 100 times an hour, which completely disrupts sleep. the sorts of things that cause this to be more common typically are individuals who are overweight. So having fat in the airway, having increased fat around the throat. Another risk factor is the anatomy of the airway. And this is of particular relevance to people of Southeast Asian ancestry is In whom there are some differences in in terms of the shape of the airway, or the shape of the bones of the face, that may increase the risk of obstructive sleep apnea. So, we we know that in these individuals who have their sleep disrupted many times now one of the principal ways in which they present to doctors is that they say that they feel very sleepy, their sleep is on refreshing. When they wake up, they feel like they've slept very poorly, and then we'll drop off to sleep relatively easily during the day. snoring is a very common feature of obstructive sleep apnea, although we often we do sometimes see people who have significant obstructive sleep apnea despite no awareness of snoring at all. And the other symptoms that people may complain of, are things like getting up at night frequently meeting your innate waking up with a dry mouth, a sore throat or a headache in the morning. So this is an incredibly common condition which has significant risks associated with it. It's not only the risks of falling asleep at the wheel of the car or falling asleep in situations where there might be some safety issues. But we think that there are also some long term implications in terms of risk of diabetes, risk of high blood pressure, risk of stroke and heart disease, and a range of other long term consequences to having obstructive sleep.

-   7:29  

Wow. Yeah. So sounds like even if someone do not snore, but if they have they're experiencing some of the symptoms you're talking about, they may need to think about the possibility and check it out. Yes,

-   7:46  

I think that if you are falling asleep very easily during the day, despite the fact that you're sleeping a reasonable amount. Now reasonable amount can be defined in a number of different ways. But as a rule of thumb, I think The seven to eight hours. Rule is is pretty reasonable, then then it is worth considering whether or not you have a sleep disorder. And of course, obstructive sleep apnea is probably the communist sleep disorder that results in people falling asleep easily during the day. There is one communist sleep disorder and that's insomnia. But for the most part, people who have insomnia, no matter how little they sleep or feel that they sleep at night tend not to fall asleep during the day.

-   8:31  

Right, right. I definitely see that a lot. That's very great information. I hope a lot people hearing this description about sleep apnea and understand a little bit a little bit about insomnia, at least can improve their own self awareness. Be aware of the daytime symptoms since we talk about sleep. I'm so curious what a normal sleep supposed to look like, you know in China for itself. We have this belief, we should have a lot of lot deep sleep. If we dream too much, or remember our dream, it's not a good thing.

-   9:09  

Yeah, I think there are an awful lot of false beliefs or myths surrounding sleep, which, you know, I'm sure you see on a daily basis in your own practice. And I think it's, I think the first thing that it's important to stress is that a normal or a good night's sleep is a different thing for different people. You know, in clinical practice, we often see people in whom they require six hours of sleep or nine hours a night sleep in order to feel completely refreshed. So for each particular individual, the answer may be different as a general rule within the normal population, and we think that somewhere in the region of between seven and eight hours is an appropriate adequate amount of sleep in order to wake up feeling refreshed, to be able to function at maximal capacity during the day, and then to feel tired enough to, to fall asleep The following night, so that that pattern establishes some sort of regularity. It's normal to remember dreams. Remembering dreams often implies that you have woken or partially woken from rap what we term rapid eye movement sleep, which is a stage of sleep, which, for a typical individual, we pass through four or five times a night. And it's the stage of sleep that we most associated with dreaming. Although we now understand that actually dreaming occurs in different stages of sleep. So so the question that you have to ask yourself is when I go to sleep, am I roughly going to sleep at the same time and waking up at the same time? Am I waking up feeling refreshed? Or do I wake up feeling tired or fatigued and am I a To go to sleep at the same time every night, feeling ready for bed? And if the answer to all of those is yes, then you're probably getting a good night's sleep with a good duration of sleep.

-   11:15  

So how about deep sleep?

-   11:17  

so deep sleep has this or we term stage three sleep is the stage of sleep that we most associate with restoration, restoration of cognitive functions of brain health, or physical health as well. And for the average adult, that constitutes between some somewhere in the region of about 15 to 20% of the night. So we only get a minority of the night in very deep sleep. what one has to remember is that actually even if you're a bit sleep deprived, because deep sleep seems to have a more important function than perhaps other stages of sleep, the brain prioritizes this and when we are a little bit sleep deprived or we're catching up, the brain will often prioritize deep sleep. So give you more deep sleep The following night, rather than the other stages of sleep. So there is an adaptive process going on. I see.

-   12:19  

Yeah. So sounds like we all have a certain amount of deep sleep a certain amount of a dream sleep, and many other stage of sleep every night. And that's normal. We have dream we remember dreams and we have some kind of deep sleep, that's fine.

-   12:41  

Yes, the normal the normal pattern of sleep. The average pattern of sleep for an adult is that we tend to start off in light sleep and then over about 30 minutes or so we descend into deep sleep or stage three sleep. And then after about an hour to an hour and a half of sleep. That's when We enter into our first cycle of REM sleep. And over the course of the night, we tend to go through these cycles of all the stages of sleep about four or five times with the majority of deep sleep occurring in the first half of the night. And the majority of rapid eye movement sleep in the in the last half the night. But for all of us, almost all of us we cycle through all of these stages of sleep overnight.

-   13:28  

Mm hmm. Yes. So, you mentioned if we remember our dreams, very likely we actually woke up during the ram dream period, is that a common phenomenon?

-   13:42  

Yes. So so if we know that if you wake people up in REM sleep that is typically when they will have the most recall, of a dream of a narrative structure and what I mean by that is that is the dream that you are experiencing. is one of a story evolving where there are consequences we were various things are happening. And actually, if you wake people up in non REM sleep in non rapid eye movement sleep, people will often also have some dream recall. But these are typically little visual snippets. And and that sense of a story unraveling during these dreaming periods is in non REM sleep. But actually, when we record individuals in the sleep laboratory, when we bring people into hospital and we attach electrodes to their scalps, and we monitor their brainwaves, we see that actually, brief awakenings from all stages of sleep are very, very common. And the brief awakenings from REM sleep are also very common, which is why perhaps people remember their dreams. It's also important to to know that actually because we do the majority of our REM sleep in the latter half of the night It's very common for people to be in REM sleep when their alarm goes off in in the morning. And so you're much more likely then to remember your dreams.

-   15:12  

Ah, I see. Okay. So also, if we don't remember any dreams does not means we do not dream. Precisely.

-   15:23  

So we often see people who say, Oh, I can't remember the last time I had a dream. But when we bring them into the sleep laboratory, they have usually as much REM sleep as anybody else. So just because you can't remember your dreams does not mean that you're not dreaming.

-   15:41  

Right. Good to know. Good to know. Regarding the deep sleep, you mentioned deep sleep actually we spend about 15 to 20% per night in deep sleep. Yeah, I often hear people complain that if you know use some kind of device tracking their sleep, they gets really anxious. The opt in group plans Oh, I only had one half hour of deep sleep last night and slept poorly.

-   16:07  

Yep. So so so I think the first thing to say about these watches is one and a half hours of deep sleep may actually be enough. But this is the single most important thing that these watches is that and in fact, most sleep trackers almost all sleep trackers, some are better than others in actually measuring the time you spent asleep. What by and large they're very poor at doing is discriminating deep sleep light sleep and rapid eye movement sleep. They are not particularly accurate when it comes to when it comes to differentiating the different sleep stages. And that anxiety that you describe is is really very illustrative of this condition that has recently been given a name which is author Sanja, where people are They're essentially causing sleep disorders as a result of the use of these devices. It's when people become convinced that they have an issue with their sleep as a result of, of these devices that essentially, the sleep trackers create problems rather than solve them.

-   17:20  

Wow, sounds like the high technology the oldest, highly developed newly developed a technology it helped us in a way but also brings more problems for us.

-   17:31  

Yes, I think I think that they are that there are two sides to the use of sleep tracker technology. If you are tracking your sleep, because you know that you're not getting enough sleep because you are perhaps, you know waking up early to go to work or staying out late and you want to try and change your lifestyle. then being able to demonstrate that you're spending more time in bed or that changing certain behaviors or As the duration of the time that you spend in bed, then that may have a useful aspect to it. I think that these sleep trackers may have a very useful role in terms of research, for example, but I think that where they are not useful, in fact, they are potentially harmful is when they are used by individuals who are anxious about the quality of sleep have, or may have a degree of insomnia because by tracking their the severity of their insomnia, be that accurate or inaccurate, that can sometimes create more anxiety with regard to their sleep and actually make the insomnia much worse. I'm not sure if that's something that you're familiar with in your own practice, but certainly, it's something that I've seen quite a lot.

-   18:48  

Yes, definitely. Same here. I see a lot in my own practice and see a lot in Stanford sleep Center also. So when I run my Mandarin insomnia group with people China during the period of the treatment, I would encourage people not wearing those device just really frocks on their body understand their body. Sounds like yeah, you're seeing something. Similarly, you mentioned when people wake up in the morning, how they feel, whether they feel refreshed, like whether they feel quite well rested. It's kind of like a standard or a cue to tell how the sleep was the night before. Uh huh. Yeah.

-   19:31  

And the thing and the thing that I always say is that, although sleep is not objective state is not objective physiological states. It's also a subjective experience. And we know that the subjective experience and the objective sleep states often don't correlate well and that to people may have exactly the same night's sleep according to a sleep study, but their experience of that night might be completely Different. And it may well be modulated by your expectation be that a priori. So at the beginning of the night, but also, as you say, when you wake up in the morning and you have your sleep tracker telling you that you had a very poor night's sleep, then that actually may influence or feed into your own perception of your night's sleep that you've just heard. I think that's what you're saying, isn't it?

-   20:24  

I really like what you said sounds like when we have perception, how we slept the night before, sometimes it may not be 100% accurate. And how we feel in the morning kind of we use that as evidence.

-   20:41  

Well, sounds like sleep in the US is same as sleep in London.

-   20:46  

Yes. And this reminds me of this phenomenon called sleep inertia.

-   20:52  

So it says sleep inertia really describes that feeling that we will all will have to some degree on some occasions whereby we Wake up and find ourselves incredibly sluggish finding it very difficult to get out of bed in the morning. Now, to some extent, this is something that people who are sleep deprived commonly commonly experience. But there are some conditions in which sleeping nurseries is a very prominent. The the absolute classic condition is a condition called idiopathic hypersomnia, which is a neurological disorder that is, seems to be related to another neurological disorder called narcolepsy, whereby people find that it can sometimes take them several hours to get out of bed, feeling very sluggish, groggy, sometimes with a headache, occasionally, even to the extent that they would describe themselves as feeling drunk. Oh, wow. You know, so this can be really quite problematic for people who suffer from these sorts of things. In the actually getting to school, getting to college, getting to a job on time can be really challenging.

-   22:10  

Yes, I'm actually not aware how see where this phenomenon going to be among people with different type of sleep disorder. So if if people experience very severe sleep inertia due to other type of sleep disorders, is there a way to help them? Do you have a way to treat them?

-   22:30  

Yes, I I think that one of the other reasons why I was very keen to disseminate knowledge of sleep disorders through this book and through a radio series that I did before the book was really to demonstrate to people that whilst you know for some of these conditions, there is no cure. But for the majority of the conditions, there is either a cure or treatment. You know, people often suffer from these kinds of symptoms for many Many years without seeking medical attention to consider sleep disorders as being a bit of a joke, you know, these people are perhaps, you know, snoring very loudly or are a bit sleepy and other person in their meeting at work that will always drop off to sleep. But actually, the reality of the impact of these disorders on people's lives is hugely influences their working life, their social life, their family life, and really every aspect of what we without significant sleep disorders take for granted. And so recognizing the fact that these conditions exist and recognizing the fact that there are treatments available, can transform people's lives.

-   23:45  

That's great to know that I think that can bring hope to allow people to get diagnosed to understand what's going on. Exactly. And receive the treatment. Yeah, yeah. So When we talk about this, this sleep inertia or this phenomenon, I also remind me when we treat insomnia hearing us, we see, it's very common for people to take sleep medication, like Ambien. And even in China. Similarly, a lot of Chinese patients really difficult to help them get out of medication. What are your thoughts about sleep medication, such as MDM or some other common ones?

-   24:31  

Well, I think that the the general view of physicians involved in sleep medicine has changed dramatically over the last 10 or 20 years. We know that many of the drugs that historically have been used very widely for insomnia have a range of problems associated with them. So in the short term, they make people feel groggy in the morning and increased risks of things like falls and road traffic accidents. They don't mimic. They don't cause normal sleep. They primarily act as sedative drugs so they don't restore normal sleep. We're aware that they are addictive for many people and people require an ever increasing dose in order to get the same effect. But perhaps most concerning is some emerging evidence to suggest these drugs that are very widely used, may actually increase the risk of cognitive dysfunction and may actually be risk factors for the development of cognitive problems later on in life. Now, this this area of the medical literature is not fully elucidated, but certainly it raises some very worrying prospects about these drugs and how widely they are used. That we have increasing evidence actually that one of the best training for insomnia, it's the use of a technique called cognitive behavioral therapy for insomnia, which is a behavioral technique in order to try and restore normal associations between bed and sleep, rather than the association that many people with insomnia have, which is that when they get into bed, the bed is an instrument of torture, it's where they lie awake at night, desperately seeking sleep, becoming increasingly frustrated at the prospect of being unable to sleep. And that we know that this treatment cognitive behavioral therapy for insomnia actually is probably as efficacious, at least in the medium to long term as these drugs without some of the risks associated with them. So my own view and in fact, my own practice is that really, nobody should be given drugs like Ambien unless they have at least tried Cognitive behavioral therapy for insomnia. Now, of course, there are some exceptions to this. But by and large, I think that people should really go for non drug based treatments in the first instance before any prescribed medications. Were it good to know?

-   27:17  

Yeah, I know in America CBT I, which is a method you talk about CBT is the first line treatment for insomnia.

-   27:28  

Yeah, but the difficulty is that still many clinicians are not aware of CBT or either that or there are issues with access. Or sometimes it comes down to a failing of us as physicians in that we don't explain fully the risks associated with these products and actually giving somebody a drug that they can take straight away and get what they perceive to be a good night's sleep. On the night that they come away from your your clinic room. is sometimes very tempting and it's it's difficult to resist the prescribing pad sometimes.

-   28:08  

Yes. Sounds like quite a challenge for sure. So, when we talk about sleep medication, how about melatonin? I know it's slightly different than other type of sleeping pills. Yeah, so

-   28:22  

Melatonin

-   28:26  

is a sleep promoting agent It really is. It's an analogue of, of naturally produced melatonin which is a hormone that an area of the brain called the pineal gland pushes out, which really promotes sleep it sends a signal out to the brain and to to the body that it is time to go to sleep. meditating does have some beneficial effects on sleep for many individuals and certainly in the UK is now licensed as a treatment for insomnia in some age groups for a limited period of time. We don't have good evidence of long term issues, but we think that it is pretty safe. I think one of the issues in the states is that, of course, is that Melatonin is available from any Walmart or Walgreens, any health food supplement store. And because it's not a pharmaceutical grade, the dosage that is on the bottle is not necessarily the dosage that you're taking. So so there is that problem in in the US, but certainly melatonin seems to be significantly safer than any of the standard medications that we would prescribe.

-   29:40  

I see. And also I just want to add, like, actually listening from physician talking about CBT for insomnia is a is a good way of treating insomnia. It's very validating, I think, for a lot of providers, when we when we

-   29:59  

Yes, we would definitely

-   30:03  

use CBT AI as a first line treatment. And I think that it certainly I would feel somewhat irresponsible prescribing medication first off for the majority of my patients who have significant insomnia without at least

-   30:20  

trying CBT. So this is the first part of my conversation with Dr. Leschziner. I learned a lot myself. I hope you too. If you want to learn more about CBT for insomnia treatment he mentioned you can go to my website deep into sleep.co. I have a resource page to help you find CBT I providers with formal credentials in my own clinical practice. I also provide CBT eye treatment for both individuals and groups in both Mandarin and English. If you want to find more about my service You can go to my clinical practice website, mind body garden.com slash insomnia. To read more about that. Please leave comments feedback. I would love to hear from you. By the way, I'm heading to Vancouver for the world asleep conference for the rest of this week and early next week. Maybe I will see some of you there. Starting next week. I will turn this podcast into a weekly updated show. That way, I will get a lot of great conversations I already had out to you quickly. Again, I would love to hear from you to know what you want to hear what you think about the show, so I can make it better for you. Please feel free to leave comment on the website deepintosleep.co, or email me directly. Look forward to it. See you next time.

Episode 6:

-   0:02  

Welcome to deep into sleep with Dr. yishan xu. Let's improve sleep quality and live a healthy life together. Let's go deep into sleep. And now please welcome your host Yishan.

-   0:20  

Hi, everyone, welcome back to deep into sleep. So if you listen to my last episode you possibly know I just travel to Vancouver, Canada for the word sleep conference. And I got to interview some really awesome speakers there. And I cannot wait to publish those episodes to you in the future shows. So last week, we had a really nice conversation with Dr. Guy Leschziner from UK who is an expert in the sleep science field. And today we're going to continue the conversation with him to discover more about the Different sleep disorders. Dr. Leschziner. I read your book The nocturnal brain. And you have covered so many interesting clinical cases about different sleep disorders, such as insomnia, narcolepsy, sleep, walk, sleep eating sexsomnia. So I'm wondering, is there any of the cases really stand out to you that you want to share here with our audience?

-   1:31  

Well, I think I think they all the cases, in my mind stand out to me, which is why that I included in the book, I think that you know, a lot of the cases that I described are really quite extreme, you know, individuals who have written their motorbike in their sleep individuals who have been convicted of crimes as a result of acts undertaken in their sleep. One one particular chapter describes the story Psychology of sleep disorders and how indeed sometimes people can experience a sleep disorder as a result of what their partner is telling them about their own sleep. So what I've tried to do is really explore the the the vast range of sleep disorders that we see in our sleep clinics day in day out from narcolepsy, for example, people falling down to the ground when they experience positive emotions to people acting out their dreams, for example. Hmm,

-   2:35  

yes, yes. I really enjoyed reading the book, to learn all this different type of disorder and ways real examples. And also knowing that you actually are treating them, you you clarify the diagnosis and offer some treatment. So I think that brings a lot of hope to those who are struggling. You also mentioned People act out in their dream. So I do want to ask that a little bit. I often, I often hear people asking me, when I went back to China, for example, a lot patients asked me, well, if I move around in my, in my dream or in my sleep, do I have restless leg syndrome? How can I treat that? But are they the same thing?

-   3:26  

Well, I think that there are lots of lots of different types of movements in sleep, there are individuals who will move their legs or kick repeatedly in different stages of sleep, not necessarily in dreaming, sleeping, that may be a manifestation of restless leg syndrome. But there are people for example, a condition called REM sleep behavior disorder, where they will physically act out the actions that they are dreaming of very typical pictures of somebody imagining that they're having an argument or a fight. their dream, and then they will actually physically lash out or punch in their sleep, often hurting themselves or their bed partner. That's something slightly different that is that is when the normal neurological mechanisms, the normal brain pathways that are switched on in REM sleep, which caused us to be paralyzed to prevent us from acting out our dreams actually don't work properly, resulting in these movements. We used to think that this was of no relevance to any other sphere of life. But we now understand that this condition REM sleep behavior disorder is often associated with other neurological disorders. And so it's important both in terms of establishing a diagnosis for treatment of that condition to prevent people injuring themselves or their bad partners, but it also may have some long term implications on brain health.

-   4:56  

I see. Yes, I definitely. I saw some videos about About the symptom when people act out in their dream or their sleep, they can be quite violent sometime they can kick their partners or they can hurt themselves really bad. I heard the safety is quite important strategy

-   5:18  

is and there are other conditions that can also look rather similar for example, people having seizures at night or sometimes people who have variants of sleepwalking that involve a lot of agitation or fear. So just because you move in your sleep does not necessarily mean that you have restless leg syndrome.

-   5:41  

Right Ray when people should know whether they should see a sleep specialist for for that, how do they know that sleep related?

-   5:51  

Well, I think if if the if the owner is telling them that they are doing odd things in the night, things that are Unusual, then I think they're very in the very first instance having a discussion with your family doctor to see whether or not this is worth. If you are having these sorts of problems and you're injuring yourself, you're injuring your bed partner, it's waking you up at night is waking your bed partner up at night, or you're waking up feeling unrefreshed or sleepy during the day, then I think that these are all indications that you may have an underlying sleep disorder and you should be having a chat with somebody who's medically qualified. They may be able to reassure you very quickly and very easily, but they may say actually, now is a good time to go and send you to somebody to look into this a little further.

-   6:46  

I see Yeah, that's that's good to know. If people suspicious or their partner reports them thing, they should check out with their doctors and figure out whether they need to go to a specialist.

-   7:00  

Exactly.

-   7:01  

So where we were talking about the moment during sleep time that I know somebody is sleepwalking. And in your book, you talk about a lot of interesting cases about sleepwalking, sleep, driving, sleep eating. Can you tell me more about those kind of behaviors?

-   7:17  

Yeah, so so we used to think that that sleep was an on or off state. So either we were asleep or awake. And there was nothing in between. But actually, what we're what we're now beginning to understand is that not only is this view of sleep incorrect, but but actually one can be asleep in one part of the brain and awaken another part of the brain. And in fact, this is what is happening during these episodes where people sleep, walk or sleep, eat or have night terrors or, or even drive in their sleep. And we see that in these individuals. While certain parts of the brain remain in very deep sleep, so the top the areas of the brain The particularly prone to stay in very deep sleeper the frontal lobes, which is really the seat of our rational thinking or decision making are the inhibition of certain actions. And other parts of the brain can be wide awake. So the the areas of the brain that responsible for physical physical movement, and in particular parts of the brain that are involved in strong emotion, we really now understand that these sorts of behaviors that we describe as sleepwalking are as a result of sitting somewhere in the spectrum between waking sleep where where there is a conflict between the various parts of the brain and the states that they're in. So it could be actually that for some individuals who are performing particularly complex tasks, then actually rather than them being described as sleepwalking, they may be largely awake and only a very small part of their Remaining sleep.

-   9:01  

Oh, I see. So sounds like sleep actually is a mixed state. It's not like when you fall asleep, you're totally in the sleep state when you wake up in your in the wake state.

-   9:13  

Yeah, so So in addition to us passing through the various stages of sleep, we also know that actually different parts of the brain may different may be at different stages of sleep at the same time. That's a concept that we're very familiar with in the animal world. So for example, animals like dolphins or seals, or certain birds, we've known that they can sleep with one half of their brain at the top at a time. So one half will be awake and one half will be asleep. This allows them to, for example, get some sleep while they're flying or once they're swimming. But that's not a concept that we've been particularly familiar with in humans, but I think the fact that humans can exist in these states where different parts of the brain are in different stages of sleep or related to this phenomenon of what we termed local sleep where sleep does not affect the brain globally, but can affect the brain in its parts. Paul's.

-   10:20  

Oh, I see. So when we sleep, actually, maybe only parts of a brain can be impacted by sleep, not always a whole global brain activity.

-   10:33  

Exactly. And it may actually be that occurs in wakefulness as well. So when we appear to be fully awake, there is increasing evidence that actually, we may be experiencing what we termed local sleep. So little areas of the cerebral cortex, the outer lining of the brain may actually be demonstrating some sleeping activity constantly. And it may be that actually that's why we've been Perform less well when we are sleep deprived, because actually the extent to which our cerebral cortex is exhibiting local sleep increases with sleep deprivation.

-   11:11  

Interesting, very interesting. Well, thank you so much Dr. Leschziner for sharing all this wonderful information and knowledge about sleep with us all.

-   11:23  

My pleasure. Thank you very much.

-   11:25  

Yeah, yes. Thank you. So how people gonna find your new book, The nocturnal brain? Where do they buy it? I bought it on Amazon.

-   11:34  

Yeah, so any of the any of your online stores or any good bookshop?

-   11:42  

Do you have a blog? Do you have your own website?

-   11:45  

I have my own website, www.guyleschziner.com.

-   11:50  

Great. I will put it on my website on the show notes so people will find you. Thank you again.

-   11:56  

Yeah. Okay. YISHAN, thank you very much for chatting.

-   11:58  

So, Inspiring conversations with Dr. Leschziner. Hopefully you learned as much as I did. As he mentioned, if you are experiencing some kind of symptoms, but you are not sure, go to seek professional advice. You can go to your family doctor to find out whether it's worth pursuing, or see asleep specialist to double check. More information about this interview with Dr. Leschziner and his books, and he and his website can be found on our website deep into deepintosleep.co/episode/005. Starting this week, our show will be published on a weekly basis. If you like our show, please feel free to leave comments to read us in Apple store or leave comments on our website. I look forward to hearing from you. Thank you see you next time.

Dr. Yishan Xuinsomnia, sleep medication, sleep apnea, sleep trackers2 Comments