The Sleep Scientist: Sleeping Patterns Can Predict Future Diseases! THIS Fixes Poor Sleep!
01 Jul 2024 (3 months ago)
Intro
- Kenneth Parks drove to his in-law's house, killed his mother-in-law, and tried to kill his father-in-law while sleepwalking.
- Dr. Guy Lesch is a leading neurologist and sleep physician with over 25,000 studies of over 100,000 patients.
- 30% of people will experience insomnia and 80% of people in the UK don't know they have sleep apnea.
- The gold standard treatment for insomnia is cognitive behavioral therapy (CBT).
Dr. Guy's Fascination With Neurological Conditions
- Dr. Guy is fascinated by why people are the way they are, particularly those with extreme neurological conditions.
- He studies individuals who experience the world differently, such as those with severe sleep disorders, altered perceptions of reality, or unusual behaviors related to aggression, food, or personality traits.
- Dr. Guy believes that studying these individuals can provide insights into how all humans function.
What Is Dr. Guy's Background
- Studied medicine at Oxford and Imperial.
- Trained in neurology.
- Completed a PhD at Imperial and Cambridge on the genetics of epilepsy.
- Became an NHS consultant in neurology and sleep medicine in 2010.
- Sleep medicine focuses on the impact of sleep on biological and mental health issues, as well as sleep disorders related to brain conditions.
What Is A Sleep Disorder Centre?
- Guy ran the Sleep Disorder Centre at St Thomas's Hospital from 2013 to 2023.
- The center is one of the largest in Europe, with 10 inpatient beds, 15 consultants, and a staff of 50.
- The center sees a range of patients with sleep disorders such as sleep apnea, restless leg syndrome, extreme sleepwalking, and narcolepsy.
- The center conducts approximately 2,500 sleep studies per year and has seen over 100,000 patients in total.
Why Dr. Guy Chose To Study Sleep
- We spend a third of our lives sleeping, yet we still understand relatively little about it.
- Sleep has a great deal of overlap with clinical neurology, as it is intimately linked to every aspect of how our brain works.
- The field of sleep medicine is relatively new and our understanding of it is rapidly expanding.
Is Sleep Important?
- Sleep is fundamentally important for life.
- Evolution has prioritized sleep as a vital process.
- Sleep is linked to various biological rhythms and life forms.
- Sleep affects the immune system, cardiovascular system, blood pressure, diabetes risk, mental health, and pain perception.
Why We Need Sleep For Good Health
- Public perception of sleep's importance has shifted positively in recent years.
- There is still an underestimation of sleep's importance among the general population.
- Certain segments of the population may overestimate the importance of sleep.
- Obsessively focusing on achieving a specific amount of sleep every night can lead to problems like insomnia.
A Large Percent Of The Population Has Insomnia
- About 20% of adults experience chronic sleep deprivation due to lifestyle factors and lack of sleep prioritization.
- Approximately 30% of adults experience insomnia in a given year, which is the inability to sleep despite wanting to.
- Chronic insomnia, defined as ongoing sleep difficulties for over 3 months, affects about 10% of adults.
- Obstructive sleep apnea, a condition involving recurrent brief awakenings due to airway narrowing, affects 10-12% of adult males and 6% of adult females, with a majority remaining undiagnosed.
- Restless leg syndrome, a neurological disorder causing an urge to move or fidget, particularly in the legs, affects around 5% of adults and can disrupt sleep.
- Sleepwalking affects 1-2% of the population.
- The majority of individuals with sleep disorders can be helped in some way.
- For chronic insomnia, non-drug-based psychological treatments can significantly improve sleep in up to 80% of cases.
- Other treatments are available for conditions like narcolepsy, a brain disorder that causes excessive daytime sleepiness.
What Is Narcolepsy
- Narcolepsy is a neurological disorder where the immune system attacks a small area of the brain, causing vivid dreams, hallucinations, sleep paralysis, and cataplexy (loss of muscle strength triggered by strong emotions).
- Narcolepsy is a lifelong condition but can be treated and managed.
What's Causing So Many Sleep Problems?
- Modern society, with its emphasis on artificial lighting and disrupted sleep schedules, contributes to insomnia.
- Sleep apnea is often associated with weight gain, which is prevalent in modern societies.
- Pre-industrialized societies have lower rates of insomnia and different sleep patterns compared to modern society.
- Humans naturally wake up during the night for short periods, and this is not a sign of pathological sleep.
- Some individuals may have a first sleep and a second sleep, as suggested by medieval texts.
- Different sleep patterns, such as the Siesta culture in Mediterranean Europe, fall within the spectrum of normal human sleep.
What's The Perfect Sleeping Habit?
- Sleep is different for everyone due to genetic factors.
- Some people can naturally sleep for 4 hours a night without any negative effects.
- On a population basis, sleeping between 7 and 8 and a half hours a night is optimal.
- Sleeping less than 7 hours or more than 8 and a half hours can lead to health problems such as blood pressure issues, weight gain, cardiovascular disease, and stroke.
- The reasons why sleeping more than 8 and a half hours can be detrimental to health are not fully understood.
- Certain drugs and sleep disorders can cause excessive sleepiness.
- Changes in sleep patterns, such as acting out dreams at night, can be an early sign of brain diseases like Parkinson's disease.
- Emerging evidence suggests that changes in sleeping patterns may be a prodromal feature of Alzheimer's disease.
Sleep Quantity Variance Per Person
- The brain prioritizes the deepest stages of sleep (stage three slow wave sleep) over other stages during sleep deprivation.
- Some individuals require very little sleep (4 hours) and still feel active and great.
- Two possible explanations:
- Genetically short sleepers (rare).
- Resistant to the effects of sleep deprivation (may not feel sleepy but still exhibit cognitive effects).
- Sleep requirement slightly reduces as we age.
- Brain mechanisms that stabilize sleep weaken with age, making it harder to maintain sleep.
The Link Between Sleep And Weight Gain
- Sleep deprivation or disruption can lead to changes in hormone levels that regulate appetite and satiety.
- A single night of sleep deprivation can result in a significant increase in calorie intake.
- Nurses who slept less than 6 hours a night on a regular basis gained more weight over 18 years compared to those who slept more.
- Treating sleep apnea, which improves sleep quality, can lead to successful weight loss in some overweight individuals.
- Sleep deprivation affects glucose tolerance and insulin resistance, which is particularly relevant for people with diabetes.
- Sleep-deprived individuals are more likely to crave high-sugar foods.
- The exact reason for this is not fully understood but it may be related to changes in reward mechanisms in the brain.
- Our circadian rhythm, or body clock, is influenced by light and darkness.
- When our circadian rhythm is disrupted, it can affect our sleep-wake cycle and overall health.
- Shift workers, for example, who have irregular sleep schedules, are more likely to experience obesity, diabetes, and cardiovascular disease.
- Jet lag is another example of circadian rhythm disruption that can cause sleep problems and other health issues.
- Maintaining a regular sleep-wake schedule and getting enough sunlight during the day can help keep our circadian rhythm in sync and promote good health.
Circadian Rhythms Explained
- The circadian rhythm is a 24-hour cycle that controls various biological systems in the body, including the liver, heart, and lungs.
- The suprachiasmatic nucleus (SCN) in the brain acts as the master clock, coordinating all other clocks in the body and influencing behavior, sleep-wake cycles, and alertness.
- The circadian rhythm typically leads to sleep onset between 10 p.m. and midnight and waking up between 6:00 and 8:00 a.m. for adults.
- Genetic factors and environmental cues, such as light exposure, meal times, and exercise, influence the timing of the body clock.
- Melatonin, a hormone secreted by the pineal gland, serves as a chemical marker of the circadian rhythm, with secretion starting around 6:00 p.m., peaking at bedtime, and decreasing before waking up.
- Melatonin administration can influence the circadian rhythm, allowing for adjustment of the sleep-wake cycle.
- The SCN is located in the hypothalamus and receives input from retinal ganglion cells in the eye, which detect blue light and play a crucial role in regulating the circadian clock.
- Light exposure, particularly blue light, reinforces and adjusts the circadian rhythm.
- Seasonal changes in light exposure necessitate slight adjustments to the circadian rhythm, with blue light serving as the primary adjuster.
Blue Lights
- Blue light from electronic devices can impact the master clock and disrupt circadian rhythm.
- Using gadgets until late at night can delay the circadian clock, leading to sleep deprivation.
- Engaging in stimulating activities like watching movies or using social media before bed can make it harder to fall asleep.
- Individual responses to sleep triggers like caffeine and stimulating activities may vary.
- Creating strong psychological associations between bed and sleep is important for good sleep hygiene.
The Main Reasons People Are Struggling With Their Sleep
- Poor sleep hygiene, such as setting up a home office or keeping the TV on in the bedroom, can disrupt sleep quality.
- Consuming caffeine and alcohol late in the evening, not having a wind-down period before bed, or eating a large carbohydrate-rich meal before bed can also contribute to poor sleep hygiene.
- Sharing a bed with someone who snores or gets up frequently during the night, or not having a dark, quiet, and temperature-controlled bedroom can further disrupt sleep.
- Light exposure at night, particularly from electronic devices, can disrupt sleep quality and increase the risk of diabetes.
- Wearing a sleep mask can help block out light and improve sleep quality.
- The circadian rhythm is primarily regulated by light exposure through the retinas.
Sleep Myths
- Shining a light under someone's knees does not affect sleep.
- The only light receptor is behind the eyes, which seems like a poor design.
- People who have lost their sight completely lose the regulation of their circadian rhythm and develop circadian rhythm disorders.
- A study showed that 40% of totally blind individuals had a non-24-hour circadian rhythm.
Chronotypes
- Chronotypes are genetic dispositions to sleep and wake at certain times.
- There are different chronotypes, such as "owls" and "larks".
- Chronotypes are influenced by genetics, environmental factors, and age.
- Studies in twins suggest that up to 50% of our chronotype is under genetic control.
- People with similar chronotypes tend to run in families.
- Genes are important, but other factors also influence our chronotype.
Where To Start Fixing Sleep Problems
- Understand the cause of sleep issues.
- People are often poor witnesses to their own sleep.
- Objective markers of sleep may differ from subjective experiences.
- Insomnia may not always be the cause of sleep problems.
- Conditions like periodic limb movement disorder or sleep apnea can disrupt sleep.
- Some individuals may have clear insomnia without other underlying conditions.
- A sleep study may be necessary to determine the root cause of sleep problems.
- Consider factors that might be driving sleep difficulties, such as life events or sleep reactivity.
- Assess how sleep impacts overall health and how health impacts sleep.
- Medications for other conditions may generate sleep issues.
- Sleep patterns can predict future diseases.
- Poor sleep is linked to an increased risk of cardiovascular disease, obesity, diabetes, and depression.
- Sleep duration and quality are important factors in predicting health outcomes.
- Consistent sleep patterns are associated with better health outcomes.
- Irregular sleep patterns can disrupt the body's natural rhythms and lead to health problems.
- Establishing a regular sleep schedule and maintaining good sleep hygiene can improve overall health and well-being.
The Rise Of Sleep Trackers
- Sleep trackers can be beneficial for research purposes but may increase anxiety and provide inaccurate information, especially for individuals with insomnia.
- Sleep trackers can be helpful for individuals who can easily fix their sleep by spending more time in bed but may have a negative impact on those already concerned about their sleep, leading to a spiral of insomnia and depression.
- Sleep patterns can predict future diseases, and poor sleep can cause emotional instability and unhealthy eating habits.
- Sleep tracking can be beneficial for individuals who have control over their sleep habits and can take action to improve them, but it may not be as useful for those with limited control over their sleep due to factors like young children.
- The use of sleep trackers requires nuance, as some individuals may find them anxiety-provoking or overwhelming.
- The glymphatic system is a drainage system in the brain that removes toxins and metabolites.
- It opens up significantly during deep sleep, allowing for efficient removal of waste products.
- One of the proteins removed by the glymphatic system is beta-amyloid, which is linked to Alzheimer's disease.
The Link Between Sleep Deprivation And Alzheimer's
- Chronic sleep deprivation and insomnia are associated with cognitive decline and conditions like dementia.
- There is evidence suggesting a link between sleeping tablets and conditions like Alzheimer's.
- The exact relationship between sleep deprivation, insomnia, sleeping tablets, and Alzheimer's is still not fully understood.
Medicating To Help Sleep
- Non-drug based techniques are generally recommended for improving sleep.
- For individuals who do not respond to non-drug methods, sleeping tablets may be prescribed alongside non-drug methods to increase the effectiveness of the psychological route.
- The risks of poor sleep, such as depression, anxiety, and impaired functioning, must be weighed against the potential benefits and risks of sleep medication.
- The decision to prescribe sleep medication is made on a case-by-case basis, considering the individual's specific situation and needs.
Side Effects Of Melatonin
- Melatonin is generally well-tolerated and safe, but it is not entirely free of side effects.
- The use of melatonin should be questioned to determine if there are underlying issues that can be addressed without relying on an external substance.
- Some individuals may develop a psychological reliance on melatonin, feeling that they cannot sleep without it.
- The psychological aspect of having melatonin available can sometimes be as important as the biological effects in achieving a good night's sleep.
Non-Medical Alternatives To Help Sleep
- Cognitive Behavioral Therapy (CBT) for insomnia is an effective non-medical treatment that aims to address psychological factors and restore normal unconscious factors contributing to insomnia.
- Techniques used in CBT for insomnia include relaxation techniques, sleep restriction, and intensive sleep retraining.
- Sleep restriction involves compressing time in bed to increase sleep drive and break negative associations between bed and wakefulness.
- Our sleep identity, or the story we tell ourselves about our relationship with sleep, can significantly impact our ability to sleep.
- Sleep trackers can reinforce our sleep identity, regardless of their accuracy.
- For individuals with insomnia, their view of sleep and their relationship with it are of utmost importance.
- Both genetics and our psychological internal environment play a role in our sleep patterns and insomnia development.
Surgery To Fix Sleeping Issues
- Deviated septum is a common belief as a cause of poor sleep, but it's not always the case.
- Most people have some asymmetry in their noses, and a deviated septum is often a result of a broken nose.
- Surgery for a deviated septum may be necessary if there are clear abnormalities causing sleep apnea, but it's not always necessary.
- Nasal congestion can encourage mouth breathing, which can worsen sleep apnea.
What Would Brain Scans Reveal About Sleep Deprivation
- Sleep-deprived brains prioritize deep sleep over other sleep stages.
- There is evidence of "local sleep," where small areas of the cerebral cortex dip in and out of electrical silence while we're awake.
- Sleep deprivation causes these periods of electrical silence to become longer and more widespread, which may contribute to cognitive decline.
Sleep Deprivation Affects Your Mood
- Sleep deprivation leads to worse cognitive performance and reduced focus.
- Sleep deprivation may cause emotional dysregulation and irritability.
- The association between sleep, mood, and anxiety levels is well-established.
- Treating anxiety or depression in individuals with sleep deprivation or insomnia is more challenging.
Can Parts Of Our Brain Be Asleep?
- The phrase "half asleep" has some merit, as parts of the brain can experience micro sleeps during sleep deprivation.
- The brain can exist in different stages of sleep or wakefulness simultaneously, even during nighttime sleep.
- Sleepwalking involves deep sleep in certain brain regions while other parts exhibit waking activity.
- During sleepwalking, the frontal lobes (responsible for rational thinking and decision-making) and the hippocampus (involved in memory) are asleep.
- Brain areas controlling movement, vision, and emotion show waking activity during sleepwalking, both electrically and metabolically.
Dreaming
- The reason why we dream is still unknown.
- There are many theories about why we dream, including:
- Memory reinforcement.
- Emotional regulation.
- Emotional therapy.
- REM sleep is the stage of sleep associated with dreaming.
- REM sleep declines significantly as we age.
- The decline in REM sleep may be related to the development of consciousness and learning new things.
- REM sleep is not the only stage of sleep in which we dream.
Nightmares Explained
- Nightmares do not seem to have an evolutionary advantage.
- Nightmares represent mental experiences that are interrupted by waking up.
- We forget most of our dreams, but we remember the ones we wake up from directly.
Why Do We Remember Some Dreams And Not Others?
- The transition between REM sleep and wakefulness affects memory consolidation.
- REM sleep may act as emotional therapy, processing emotional experiences.
- Recurrent nightmares are common in post-traumatic stress disorder due to high emotional content.
- Dreams may help us understand, process, and learn from traumatic events.
- From an evolutionary perspective, strong emotional associations with traumatic events are important for survival.
- However, excessive emotional responses can be detrimental, so dreams help moderate these emotions.
Most Upsetting Sleep Disorder Dr. Guy Has Seen
- Dr. Guy has seen various upsetting cases related to sleep disorders, including individuals committing crimes during their sleep, such as murder and sexual assault.
- He also treats patients with Klein Levin syndrome, a rare condition that causes excessive sleepiness and abnormal behavior during episodes.
- The impact of these disorders on individuals' lives can be devastating, affecting their education, social life, and ability to manage in the workplace.
The Sleepwalking Murderer
- Dr. Guy discusses the case of Kenneth Parks, a man who allegedly drove several miles to his in-laws' house, killed his mother-in-law, and attempted to kill his father-in-law while sleepwalking.
- Parks was acquitted in court due to his sleepwalking condition.
- Dr. Guy confirms that it is possible for individuals to drive in their sleep, citing a patient who drove several miles and even rode a motorbike while asleep.
There Is Help For Insomnia
- Insomnia is a common problem, but there is help available.
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The Different Types Of Insomnia
- There are different types of insomnia, including short sleep duration insomnia and insufficient restorative sleep.
- Most individuals with insomnia have subjective insomnia, meaning they feel like they are not getting enough sleep, but their actual sleep duration may be close to normal.
- A subgroup of individuals with insomnia have short sleep duration insomnia, meaning they actually sleep for only a few hours each night.
- Recent research suggests that individuals with short sleep duration insomnia have local changes in the way their brains act.
The Man Who Tasted Words
- The brain's awareness doesn't switch off completely during sleep.
- Insomnia is a spectrum disorder with varying causes.
- Effective treatments for insomnia exist, but it may require a multi-pronged approach.
- Rapid or instant solutions, such as drugs, may not be the best approach.
- Patience is important for long-term solutions rather than short-term fixes.
- CBT-based approaches have been shown to help about 80% of individuals with insomnia.
- Drugs should be used cautiously and only for the right individuals.
Autism And Synesthesia
- Synesthesia is a condition where certain senses are combined, leading to associations between objects and tastes, colors, or shapes.
- Synesthesia is relatively common, with about 4% of individuals exhibiting some form of it.
- Synesthesia illustrates how our brains and nervous systems work differently to define our reality.
- People with synesthesia may perceive the world differently from those without the condition.
Are We Guilty Of Crimes If We Are Mentally Ill?
- Our perception of reality is closely linked to the structure and function of our brains.
- People's experiences and interpretations of the world vary greatly, leading to different truths and perceptions.
- This variation in perception can explain polarization and conflict in society.
- It raises the question of whether individuals with significantly different perceptions due to brain conditions should be held responsible for crimes they commit.
Interventions To Help The Criminally Mentally Ill
- The author discusses the complexity of determining guilt in individuals with brain conditions that significantly influence their behavior.
- The book "Seven Deadly Sins" explores neurological and psychological conditions that can dramatically impact behavior.
- The author's clinical practice involves encountering individuals whose brain conditions drastically affect their actions.
- The author questions whether these individuals' behavior reflects their morality and considers the implications for society.
- Brain tumors, strokes, Parkinson's disease, and chemical changes can all cause sudden and significant behavioral changes.
Crazy Stories Resulting From A Brain Disorder
- Anti-epileptic drugs can cause significant behavioral changes, including increased irritability, anger, and aggression.
- Certain brain conditions, such as autoimmune conditions, can lead to psychotic behavior that can be resolved with appropriate treatment.
- A rare genetic disorder can cause individuals to be unable to feel pain, resulting in self-harm and physical damage.
- The brain can create its own inputs when deprived of sensory information, as exemplified by a woman experiencing visual hallucinations after losing her vision.
- Losing the senses of smell or taste can diminish quality of life and impact memory, as smell plays a crucial role in memory recall.
How Meeting People With Brain Disorders Has Changed Dr. Guy
- Emotional memories linked to smells can have a significant impact on mood and depression.
- Loss of sense of smell, as experienced by many during COVID-19, can lead to depression.
- Smell and mood are closely connected.
- Auditory hallucinations, such as musical hallucinations, can be a symptom of hearing loss.
Guest's Last Question
- Hearing loss is linked to cognitive decline because it deprives the brain of important inputs needed to maintain its health and integrity.
- Writing books and talking to patients has given the guest a broader appreciation of the wider implications of their work on individuals and their families.
- The guest admits to not taking very good care of themselves due to the demanding nature of their work in the NHS.
- The guest mentions clinical situations where they had to make difficult decisions about whether or not to treat someone or give up on them.
- Personally, deciding to study medicine was a significant decision that brought both amazing experiences and responsibilities.