Podcast Summary: "What Your Sleep Is Trying To Tell You" with Professor Guy Leschziner #528
Introduction In this episode of Feel Better, Live More with Dr Rangan Chatterjee, host Dr. Rangan Chatterjee engages in an insightful conversation with Professor Guy Leschziner, a renowned neurologist specializing in sleep medicine at King's College London and Guy's and St. Thomas's Hospital. With over two decades of clinical expertise and author of several acclaimed books, including The Secret World of Sleep and Seven Deadly Sins: The Biology of Being Human, Professor Leschziner delves deep into the complexities of sleep, demystifying common misconceptions and offering practical solutions for improving sleep quality.
1. Understanding Sleep Disorders
Distinguishing Sleep Deprivation from Insomnia
Dr. Chatterjee opens the discussion by highlighting the modern epidemic of sleep problems, contrasting it with historical societies that seemingly lacked issues like insomnia. He poses a thought-provoking question about the difference between individuals who effortlessly transition from wakefulness to sleep and those who struggle despite their best efforts.
Quote:
Dr. Rangan Chatterjee [00:02]: "Modern world has created an epidemic of sleep problems which not only affect our creativity, empathy, appetite and moods, but countless other aspects of who we are as well."
2. The Spectrum of Wakefulness and Sleep
Professor Leschziner challenges the conventional binary view of wakefulness and sleep, explaining that the brain operates on a spectrum where different regions can exhibit varying states of activity simultaneously.
Quote:
Professor Guy Leschziner [02:56]: "We know that our brains are constantly sitting somewhere in the spectrum of wake and sleep and that different parts of our brain can exist in different stages at the same time."
3. Psychological Factors in Insomnia
Delving into insomnia, Prof. Leschziner elaborates on both conscious and unconscious psychological factors that hinder sleep. He emphasizes that approximately 50% of individuals with insomnia do not suffer from anxiety or depression, pointing to deeper, often unconscious associations with the sleep environment.
Quote:
Professor Guy Leschziner [02:56]: "We think that 50% of people who have insomnia don't have any issues with anxiety, don't have any issues with depression."
4. Evolutionary Perspectives on Sleep
The conversation shifts to an evolutionary lens, comparing pre-industrial societies with modern urbanized life. Prof. Leschziner notes that many tribes do not have a word for insomnia, suggesting that modern factors like artificial light and societal pressures have exacerbated sleep issues.
Quote:
Professor Guy Leschziner [07:16]: "There are some tribes that don't even have a word for insomnia. They don't have that difficulty in getting off to sleep."
5. Sleep Disorders in Clinical Practice
Discussing his work in sleep disorder clinics, Prof. Leschziner highlights how conditions like obstructive sleep apnea and neurological disorders impact sleep. He underscores that many sleep-related biological issues have existed throughout human history but were previously undiagnosed due to limited medical understanding.
Quote:
Professor Guy Leschziner [08:40]: "Conditions like obstructive sleep apnea... have probably existed throughout human history."
6. The Role and Purpose of Dreams
Exploring the enigmatic world of dreams, Prof. Leschziner outlines multiple functions of dreaming, including emotional processing, memory consolidation, and refining the brain's model of the world. He differentiates between REM (Rapid Eye Movement) and non-REM dreaming, noting the distinct characteristics and purposes of each.
Quote:
Professor Guy Leschziner [10:35]: "There are two major... potential functions for dreaming. One is to process the emotional content of certain memories... The other is tweaking the model of the world that we have within our minds."
7. REM Sleep Behavior Disorder as a Predictor for Parkinson’s Disease
A significant part of the discussion centers on REM Sleep Behavior Disorder (RBD), a condition where individuals act out their dreams. Prof. Leschziner reveals that RBD can serve as a prodrome for Parkinson’s disease, with studies showing a high correlation between the two over time.
Quote:
Professor Guy Leschziner [19:04]: "Many people... will develop a specific type of sleep disorder, which is called REM Sleep Behavior Disorder... the likelihood of developing Parkinson's disease or conditions like it is very high indeed."
8. Prevalence of Sleep Deprivation and Insomnia
Prof. Leschziner provides alarming statistics, stating that 20-30% of adults in Western countries suffer from insufficient sleep, while about 10% grapple with chronic insomnia. Dr. Chatterjee extrapolates that up to 40% of the population may struggle with sleep-related issues, making it the most frequently reported complaint in GP consultations.
Quote:
Professor Guy Leschziner [25:27]: "About 20 to 30% of adults in Western countries are not getting enough sleep... about 10% of the adult population in Western countries have chronic insomnia."
9. Misconceptions About Sleep and Health Risks
Addressing common misconceptions, Prof. Leschziner clarifies that not all sleep issues are equal. He differentiates between sleep deprivation and insomnia, highlighting that the health risks associated with chronic sleep deprivation do not uniformly apply to all forms of insomnia.
Quote:
Professor Guy Leschziner [34:13]: "The fact is that we are not very good witnesses to our sleep... there is some evidence that... 'paradoxical insomnia'...some parts of the brain may not necessarily be achieving as deep sleep as you would like."
10. Cognitive Behavioral Therapy for Insomnia (CBTI)
One of the most enlightening segments discusses CBTI, a non-pharmacological treatment for insomnia with an impressive 80% success rate. Prof. Leschziner explains how CBTI retrains the brain to associate the bed solely with sleep, thereby improving both the quantity and quality of sleep without relying on sleeping pills.
Quote:
Professor Guy Leschziner [73:03]: "CBTI... aims to improve sleep quality and treat insomnia... about 80% of individuals get a significant improvement from this non-drug based treatment alone."
11. The Debate Over Sleep Trackers
The conversation also touches on the pros and cons of sleep trackers. While these devices can offer valuable longitudinal data by monitoring sleep patterns in a natural environment, Prof. Leschziner cautions against their use for individuals already anxious about their sleep, as the added data might exacerbate stress and worsen sleep quality.
Quote:
Professor Guy Leschziner [45:23]: "For those individuals who are already concerned about their sleep... wearing a sleep tracker is potentially very bad for your sleep rather than good for your sleep."
12. Practical Strategies for Shift Workers and Circadian Rhythm Adjustment
Towards the end, Dr. Chatterjee shares his personal experience of adjusting his circadian rhythm in preparation for a theater tour. Prof. Leschziner offers actionable advice on delaying sleep phases using bright light exposure in the evenings and adjusting other zeitgebers (time-givers) like meal and exercise times to align with new schedules.
Quote:
Professor Guy Leschziner [98:36]: "Using something like a sun lamp or glasses that generate really quite intense light in the evenings would probably be the single most useful thing you could do to delay your sleep phase."
13. The Broader Impact of Sleep on Society
Dr. Chatterjee emphasizes the profound implications of widespread sleep deprivation on societal well-being, suggesting that improving sleep quality could enhance social cohesion, reduce reactivity, and foster a happier, more harmonious society. Prof. Leschziner concurs, acknowledging that while sleep doctors alone won't change the world, optimizing sleep on a large scale could yield significant societal benefits.
Quote:
Dr. Rangan Chatterjee [90:13]: "If we could get everyone sleeping well in society... it's hard for me not to make that leap."
14. Final Thoughts and Recommendations
In closing, Prof. Leschziner urges listeners struggling with sleep issues to educate themselves and consult healthcare professionals. He reiterates the importance of personalized solutions, as sleep needs and challenges vary widely among individuals.
Quote:
Professor Guy Leschziner [104:44]: "The starting point should be educating yourself, but also going to speak to your GP."
Conclusion This episode offers a comprehensive exploration of sleep disorders, blending scientific insights with practical advice. Professor Guy Leschziner's expertise demystifies the intricate workings of sleep, distinguishing between different sleep issues, and presenting effective strategies like CBTI. The discussion underscores the critical role of sleep in individual health and societal well-being, making a compelling case for prioritizing better sleep practices in our daily lives.