Moment 188: The Real Reason You're Always Tired: Professor Guy Leschziner

0:03Why 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 of 20 or 20 or two decades or something like that. Yeah. What why? Well, I think the first thing is is that 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, what it does to our biology. Obviously that's changing very, very quickly now. It has a great deal of overlap with the world of clinical neurology.

0:43So I also do, I do specialist clinics, specialist clinics in epilepsy and I do specialist clinics in general neurology. So 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 or understanding of it is exploding in ways that are not paralleled across other areas of clinical medicine. Is it important? Is it important? Yeah. I think it is of fundamental importance.

1:29You 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 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 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 and dolphins. That very much suggests, well, you know, that must be of great importance if sleep is a risk for our survival. Because if sleeping and you're unable to surface or unable to see what predators are around you, that the evolution has designed a system where it enables you to sleep with half of your brain at a time.

2:22So that in and of itself tells us it's important. 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 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 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 cardiovascular system or blood pressure risk of diabetes mental health, so depression and anxiety even how we perceive pain.

3:20So it really is fundamental to every system that we 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 whims 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 is and I've started prioritizing it a little bit.

4:06So you think, well, 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 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 think that there is a danger at the current time that we tend to obsessionalize about sleep and think that it is the the the be all and end all is of course part of normal life for our sleep to fluctuate depending on what's going on in our external and our internal lives.

4:46And I think the danger is that if you overemphasize the importance of getting eight or eight and a half hours sleep every night then you actually risk problems later down the line exacerbating things like insomnia. 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 pours 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 many of them have struggled with it for years and I doubt that there's some sort of genetic reason why this many people are struggling with sleep.

5:26So I imagine it's just some kind of behavioral reason. So I think that the genes that predispose 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 horrible term. I hate that term but it's the term that is most widely used and understood. Concertainly 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 is 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.

6:15And what is poor sleep hygiene? If I wanted to be the worst possible sleeper in the world what would I have to do? So I think you would probably have to set up your home office in your bedroom. Okay. You'd have to have your TV on in your bedroom all the time. Have be surrounded by electronic devices. Drink a lot of coffee late in the evening. Drinks a little bit of alcohol so alcohol in the short term of course is quite sedating. It's a central nervous system a depressant but it does dramatically worsen the quality of your sleep and for various reasons the direct chemical effect. In fact that you've got a full bladder fact that you're probably snoring a little bit more so alcohol is not a good thing.

7:02Not having a wind down period so gambling on the stock market until 1am switching your laptop and then trying to go to bed those kinds of things. So that's you know the quintessential very very bad sleep hygiene. What about when I eat? So you know eating is perhaps less important but avoiding a very large carbohydrate meal, carbohydrate rich meal before you go to bed for two reasons. One is that we know that it can cause some fluctuation 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've and again this goes back to no one rule for everybody.

7:46You know if you've got a sleep trait term sleep reactivity which is where your sleep is very liable to your environment 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 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 thinking the other day because it were of currently moved into there's no blinds or curtains in the 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.

8:31Yeah but the sun comes up at different times at on different days firstly. So if you were doing that routinely you might find yourself really rather sleep deprived in the summer months and also there is some emerging evidence that exposure to light 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 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 your wake up at an hour or so after it's got light during that hour or so it may have had a negative impact on the quality of your sleep.

9:16So having a dark bedroom is really part of good sleep hygiene as it's having a quiet bedroom that is not too hot or cold. What if you wear a sleep mask? 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 summer months is probably very helpful indeed. Does that mean that the only light receptors we have are behind our eyes? Well I think that there was a there were some rumors on the internet that there were light receptors elsewhere but certainly the only ones that we know to be of significance in terms of defining our circadian rhythm are the ones in our retinas.

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