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