The Sleep Doctor: What Bad Sleep Is Doing To Your Health with Dr. Guy Leschziner

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1:06This is the Ed Myerich Show. Welcome back to the show, everybody. So today we're going to talk about sleep. And by the way, if you don't get great sleep, you're going to listen very closely. And if you do think you get great sleep, you may think otherwise after we talk to this man today. I think he's the foremost expert on the planet in sleep. He's sort of, I don't know, I'd say his work sort of is the convergence of like neuroscience and sleep where it sort of intersects. And I know I need this interview and this conversation and this information as much as anybody on the planet. So I'm going to put him to work today.

1:42And my guest today, by the way, great book. He's got a new book out that I should tell you about that we're going to talk about at the very end called The Seven Deadly Sins. But we're going to focus on a previous book of his called The Nocturnal Brain, Nightmares, Neuroscience, and the Secret World of Sleep, which I need to know a lot about. Dr. Guy Leshinner, welcome to the show. Thanks very much for having me, although I think you may have oversold me a little. Well, let's find out. Let's do this and see. I don't think that's the case. So let's start out fundamentally. I think everybody knows this, but health is such a huge topic online right now with everybody.

2:16you know anti-aging live longer live stronger and it's mainly focuses on nutrition diet exercise and sort of this other guy sitting over there almost nobody discusses or understands and thinks they have kind of wired is sleep i'm just one of the people i've been admit i don't so why does sleep matter so much from a neurological standpoint well i think the the obvious thing to say is that we spend hopefully about seven or eight hours a night doing it so it must have some importance and actually if you add up all the hours that you would be expected to sleep over an 85 year period it's probably about somewhere in the order of about 30 years so given that we spend so much of our lives doing it it really illustrates the fact that it is probably crucial to every aspect of our lives.

3:10And certainly, emerging evidence suggests that sleep is the, if not the cornerstone, then certainly a fundamental tenet of pretty much every aspect of our waking lives. So it's not just about sleep, it's about life itself. You said hopefully seven or eight hours. So is there a metric you used to indicate? I was just with somebody, I'll tell you who it was. There's an author named John Maxwell, one of the most prominent authors of all time, one of my dear friends, Johnson is late seventies. I was on a speaking tour with him. He sleeps four hours a night and he said, so does his father and his brother is what he was telling me.

3:47And I was with him. He's 78 years old. I'm going to tell you, he kicked my tail energetically on this tour. Is he sort of a freak? Is there a body type, a type of person who can get away with four or five hours? But yet that wouldn't be your advice to most people. I'd love to know about time of sleep since you said hopefully seven or eight hours. Yeah. So we kind of use the ballpark of seven or eight hours as the average sleep requirement for people. But of course, as with any aspect of humanity, there's a spectrum. And there are individuals who fall outside of that seven or eight hours and don't necessarily have any pathological consequences to that.

4:28I think what your friend is describing is we know that there are a few rare families who have extremely short sleep times, extremely short sleep requirements, and don't seem to have any negative consequences. But I think that is very, very rare. And for the majority of individuals, they probably sit somewhere between six and a half to eight and a half hours. So for the average individual, you are probably going to have some negative consequences, be that with regard to psychological health or cognition or performance or physical health, if you're sleeping much less than that. And if you're sleeping much more than that, then we know that there are issues.

5:16So for example, when we look at mortality, or cause mortality or things like cardiovascular disease rates, stroke rates, those increase when people are sleeping more than about nine hours. Now, that doesn't mean that sleep is toxic for you, but it certainly implies that there are reasons as to why people might sleep for excessive periods of time, be that through other diseases, be that through drugs that might make them particularly sleepy, or be that through some sleep pathology that seem to incur increased risk of death. So there is this sort of characteristic U-shaped curve when it comes to things like mortality and sleep duration.

6:01So sleep aids, I'll throw them out to you, and then I'll let you tell me what you think about them. So nighttime teas that people drink, melatonin, all the way to, you know, a lot of war fighters with PTSD, I know, or prescribed trezidone, which is what I've been told I should be very careful. I won't even say it. I was going to say it's non-addictive, but I don't know that that's actually accurate. All the way to something like Ambien, which I'm told can become addictive. And if I'm wrong about all of that, correct me. but how do you feel about those things and can you blow out a receptor like i'm if you if you take too much melatonin can you just blow out the receptor where it doesn't work on you anymore can you will you need more sleep aids if you take medication to sleep over time that you your your brain requires more of it to shut down how do you feel about all of those things well i think your question illustrates the significant difference in practice between the u.s and the uk um firstly here in the uk melatonin is by prescription only um and and the reason for that well first of all it illustrates that we do think it works because we wouldn't bother prescribing it um it works for a range of conditions and i use melatonin very frequently for people who've got issues with their circadian clock for people with um poor quality sleep for people who act out their dreams or for people who sleepwalk.

7:33So melatonin does work. It doesn't work for everyone. Drugs like trazodone and other sedative drugs have their role for certain individuals. They should be used cautiously and they shouldn't be prescribed to everyone who has a sleep disorder. Most people who have insomnia should really undergo CBT for insomnia first before being prescribed medications. But, you know, it would be wrong of me to say that I don't use these drugs very widely. I just use them a bit more cautiously because they all have pros and cons. Drugs like Ambien, like Still Noct, yes, they are potentially addictive. They are potentially habit forming and really should not be used in a long term setting for the vast majority of individuals because they can create issues.

8:28And one of the things that you've alluded to, which is this sort of I think you used the term blowing out receptors, is we know that a lot of people habituate to these drugs. By habituate, I mean that they develop a tolerance for them. They require ever increasing doses in order to get the same effect. And that's essentially what you're doing. you are getting the system used to having these circulating drugs in it. And as a result, the receptors tend to be downgraded. They tend to be reduced. So you need never increasing dose in order to get the same effect. That's not the case for all of these drugs, but certainly for drugs like zopaclone and zolpidem, that can be a major issue.

9:09So, hey guys, I want to jump in here for a second and talk about change and growth. And you know, by the way, it's no secret how people get ahead in life or how they grow and also taking a look at the future. If you want to change your future, you got to change the things you're doing. If you continue to do the same things, you're probably going to produce the same results. But if you can get into a new environment where you're learning new things and you're around other people that are growth oriented, you're much more likely to do that yourself. And that's why I love Growth Day. Write this down for a second, growthday.com forward slash ed.

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10:04Go to growthday.com forward slash ed. That's growthday.com forward slash ed. and what I want to ask you about is I'm asking this a couple friends is there a difference between a nightmare and a dream number one and number two is there something to repetitive nightmares with somebody so I have friends who and I have had these two when I was younger where it's the same nightmare over and over again you know you almost realize you're in the nightmare again because you've had it so many times is there something happening in the brain is that trauma floating up now in our lives that makes a nightmare slightly different than a dream or a different type of dream?

10:44And what does a repetitive one potentially mean? So on a neurological basis, I think a dream is the same as a nightmare. The difference is really that a nightmare is a dream with negative emotional content. And undoubtedly, the emotional content of our dreams is affected by our psychological status. So, you know, people who are anxious will often have dreams that have negative emotional content. Anxiety is often a trigger for nightmares, for example. The second question which you asked is, is there anything to that recurring dream, that recurring nightmare? Well, this goes back to the answer that I gave with regard to post-traumatic stress disorder.

11:33So, you know, if you envisage that dreaming is some sort of emotional cleansing of certain memories or certain experiences, and that dream needs to be completed in order for that emotional cleansing to be properly worked through, then if you wake up from that dream or that nightmare on a regular basis, that process is never finished. And so it's much more likely for you to then have that dream again or that nightmare again because you're waking up because of that very strong emotional content of that memory, be that a real memory or be that a dream memory. You're never going to complete that process.

12:17There is one other aspect to nightmares, which is that people tend to think that all nightmares arise from REM sleep. But we know that a lot of people experience night terrors or other types of dreams because we've learned in recent years that dreaming doesn't only occur in REM sleep. It also occurs in non-REM sleep. So people who have their non-REM sleep disrupted will often have visions of spiders on the wall or rats on the bed or being crushed by the ceiling coming in. Those are rather characteristic of non-REM dreaming. So the difference is that in REM sleep, in what we usually term dreaming sleep, those dreams are typically of a narrative structure.

13:07They're like a plot evolving in our minds. Whereas in non-REM sleep, it's much more snippets, visual snippets. often associated with very strong emotions. And that's what causes sleep terrors or night terrors. It's not the same thing as nightmare disorder. Okay. By the way, everybody, we're going to get to dreams. So if sleep isn't part of your jam, we're about to talk about dreams in a minute, but I want to go to this. You're concerning me. I'll tell you why. I have some form of heart disease. I'm just curious. I want you to go a little deeper on this. I have struggled with sleep most of my life.

13:40Recently, the last year, I've been many nights getting nine and 10 hours and still waking up tired. If there's someone like me listening to this, I just want to go back to what you just said. Could that be an indicator of something more serious? Well, I think there are really three determinants of how much sleep you need in order to wake up feeling refreshed. The first is genetics. And I think your friend illustrates the importance of genetics in defining your sleep duration your required sleep the the second is your age so we know that as we go through life our sleep requirements are a little bit different different so somebody who is in their 50s is going to have a different sleep requirement to when they were in their 20s and certainly a different sleep requirement to when they were an infant the third thing is whether or not you've got anything that's disrupting your sleep and one of the one One of the most common conditions that disrupt sleep is obstructive sleep apnea, which is when people snore and their airway collapses.

14:43And we know that conditions like sleep apnea, first of all, they make sleep less refreshing than it otherwise should be. It results in people feeling more sleepy than they should with the sleep that they're getting. But it also confers risk. and those risks include things like diabetes and more broadly metabolic syndrome so this is the association of diabetes with obesity and high blood pressure but it also seems to confer a risk of cardiovascular disease and stroke yeah so if you might i want to interject there sorry i did i didn't know you were on zoom everybody but i want everyone to know most people in my audience know I'm kind of on a break right now for my health.

15:26And the reason I wanted to have you on was both of my doctors are obsessed. I would say borderline obsession with a couple of different markers in my blood. But one of the things they're obsessed with is my sleep and sleep apnea and put me through a bunch of different sleep tests. Any of you that live with someone who snores or has any struggle with their breathing when they sleep, that's a very serious thing. And that you should do a sleep reading, in my opinion. I'm not a doctor. I'm just telling you, you know, every doctor I've had that's treated me recently is worried about that one thing.

16:01I'm going to ask you a controversial question. I don't know if you've ever been asked this before, but my friends that have passed away young and many of them have had cancer, and I know this is a reach, but I want to ask it anyway. One thing most of them had in common was a problem with deep sleep. And I'm wondering if you think or know, suspect, whatever, that potentially a lack of deep sleep could even, because you said neurology, could even affect gene expression of some type at all. Could the fact that a long-term challenge with sleep affect the way your genes turn on these different things we don't want, such as cancer, etc.

16:44Do you think there's a possibility of that? Is there any evidence of it? Or would you speculate that that's true? Yeah, I mean, I think that undoubtedly, what happens when we don't sleep enough is that there are hormonal changes within our bodies. So in particular, things like cortisol. So cortisol is often raised in response to sleep restriction or insufficient sleep. The other another thing that happens is that there is evidence of increased inflammation within the body. And obviously, increased inflammation is a risk factor for things like cardiovascular disease and potentially also cancer.

17:21What's interesting is that there is some evidence that circadian rhythm disruption, so people who are sleeping out of rhythm with their internal body clock, so shift workers for example is associated with an increased risk of certain cancers and and that evidence has resulted for example in certain countries in northern europe in scandinavia actually having compensation schemes for government shift workers who develop certain forms of cancer and the world health organization has added shift work onto its list of possible carcinogens. So certainly there is some evidence to support sleep as being, if not causative, potentially contributory to the development of certain cancers amongst a whole host of other conditions.

18:13Is that incredible, everybody? So it's not good to not have deep sleep. We've established that. So what should somebody do? What hacks or tips do you have that could help somebody who's struggling with sleep, sleep better? Are there routines, methods? You know, I hear often about cold in the room or a cold blanket or a cold pad, total darkness in a room, anything like that you believe in or you'd add to? Yeah, I mean, I think that what you're describing really is what we would broadly term sleep hygiene. So these are the behaviors surrounding sleep that are conducive to sleep. Certainly, a dark room is really quite important.

18:54In fact, there was a recent paper that came out of China that used a very big patient resource in the UK called the UK Biobank that looked at light exposure and risk of diabetes. And they found that actually light exposure in the bedroom at night was associated with an increased risk of diabetes. So, you know, light exposure is really important. I think it's very difficult to be didactic because, for example, different temperatures in the room very much depend on your own physiology and your own anatomy. And people prefer to sleep at different temperatures. Certainly, you know, cutting out caffeine at an appropriate time, it's important to understand that caffeine can hang around for a long time.

19:39And if you drink enough of it, it can hang around for an awfully long time. So making sure that your caffeine intake is relatively moderate, making sure that you're not doing lots of stimulating activities like scrolling on the internet or watching these kinds of interviews late at night in bed, it is all very conducive to good night's sleep. It's important to stress that sleep hygiene, which is a horrible term, but it's something that a lot of people recognise, is not going to suddenly transform you from being a chronic insomniac into sleeping like a baby. And there are other techniques or other treatments that are perhaps more appropriate if you've tried making these changes to your behavior surrounding sleep and you're still sleeping very badly.

20:28A lot of people tell me, everyone, that alcohol contributes to their lack of being able to sleep, which is ironic to me because it's a depressant. I would have thought that, you know, it'd help people sleep. But so many of my friends say, boy, if I drink alcohol, especially as they get older, they have a hard time with deep sleep. By the way, I appreciate you saying they shouldn't be watching the show late at night, but I have been accused of putting people to sleep. So maybe they should listen to me. I want to ask you this question. So this is from my producer. I've never done this before on the show, ever had my producers ask a question, but this is such a topic and we're going to talk about dreams in a minute, everybody, but here's what Steven's asking.

21:05He says, I go to bed around 10 30 or 11 but i don't fall asleep until about 12 or 1 a.m and when i do fall asleep i'm waking up around 3 or 4 a.m i'm struggling to get good sleep constantly thinking in bed but not stressed why would that be or what would your recommendation be why would that be if he's not stressed he's just he can't stop thinking yeah so so um one of the key aspects of people who develop insomnia is that they develop on a, sometimes on a conscious level, but sometimes on an unconscious level, altered associations between bed and sleep. So what I mean by that is that for most of us, the bed is an environment that is associated with a diminishment of brain activity, a relaxation.

21:57But in individuals who have spent an awful lot of time in bed awake, that association is broken. and instead they begin to associate either on a conscious or on an unconscious basis an association between bed and wake and so what a lot of people experience is a term that we use quite frequently which is hyper arousal so this is where your brain is activated the hormonal systems within your body are activated all of which precipitates an awakening an elevation of wakefulness in bed And that is crucial to the development and the persistence of chronic insomnia, because we need to try and break that association between bed and wake and rebuild the association between bed and sleep.

22:44So what Stephen is describing is a really characteristic feature, which is termed hyperarousal, associated with the sleeping environment. Should he, I mean, this is extreme. Should he switch rooms? Should he go to sleep in a different room to change the association short term and then come back when the association has been broken? Yeah. So one of the ways in which we try and treat this is through a technique which is termed cognitive behavioral therapy for insomnia. And this has really become the gold standard treatment for people with insomnia. It's a structured program during which we try and break that negative association and rebuild it.

23:25And there are some tenets to it that I think very much are in keeping with what you're saying. So we tend to suggest that if people are awake in bed for more than about 20 minutes, they actually remove themselves entirely from the sleeping environment. Go and do something relaxing, like listening to music or reading a book, not exposing yourself to bright light, not consuming caffeine. and then when they start feeling sleepy again to go back into the bedroom environment and and try and go to sleep again one of the other tenants of that is really to try and limit the amount of time that you are spending in bed awake and the way that that is done within the umbrella of cognitive behavioral therapy for insomnia is a a protocol which is called sleep compression or sleep restriction so say for example Stephen is only spending six hours a night in total in bed asleep yet he's spending nine or ten hours in bed then what we would say within that context is okay for a period of time we want you just to stay in bed for six hours whether you sleep or not and in the first few days he will still have that insomnia he'll still have that difficulty getting off to sleep but as time goes on he'll become more and more sleep deprived and the sleep deprived brain when it's really sleep deprived will go to bed and eventually what will happen is when he gets into bed at say midnight because he's very sleep deprived he'll fall asleep very quickly and the the brain is an adaptive creature if you're very sleep deprived it will try and compensate for that gradually what that does is it reduces the amount of time you're in bed awake and is the first step in the process of breaking that association between bed and wake and rebuilding the association between bed and sleep that is so good i have to anecdotally tell you that because i have struggled with this i have decided that that is the place i sleep and that's it and so that means guys like you shouldn't be watching tv before you go to sleep at night but if you do i don't watch it in bed because it's trained me that i'm awake in that bed for two or three hours I don't get up in the morning and scroll my phone while I'm still sitting in bed because it's training me to be awake in that bed.

25:39So little things like that are significant, and they can impact your health, your performance. Of course, we already talked about this, but weight gain, obviously, with cortisol levels, there's all kinds of impacts on not getting the sleep that you need.

25:57what happens when we dream and why do some people recall dreams more vividly than others what why do we dream well that's a very uh important question that i'm afraid i'm not going to be able to fully answer i think we have some indications as to why we dream we think that it is important for memory consolidation um there are there is some evidence that dreaming is also about emotional processing so for example cleansing our experiences our daytime experiences of their emotional content there's quite a lot of um evidence for example when you look at people who've got post-traumatic stress disorder one of the reasons why they repeatedly dream the event that they experienced that was traumatic is because the dream when they have it is so rich in emotional content that they fully wake up and that dream is never played through fully and uh this has led some people like for example matthew walker who who wrote the book why we sleep to describe dreaming as overnight therapy now what why some people will recall their dreams and others won't for the most part people who recall their dreams are people who have had awakenings during the stage of sleep that we most associate with dreaming which is called REM sleep and so anything that destabilizes your sleep particularly your REM sleep is more likely to give you very vivid dream recall the kinds of conditions that cause that are things like obstructive sleep apnea because that is often worse in REM sleep and causes people to wake up.

27:41Anxiety and other psychological conditions can destabilize sleep. And then the other thing that I often see is individuals with narcolepsy, which is a brain disorder during which REM sleep is unstable as a result of the loss of a particular chemical in the brain. And people with narcolepsy can have absolutely amazing dreams with lots of lucid dreaming so that they're aware of the fact that they're dreaming or can sometimes even control their dreams. And they can even dream before they're fully asleep. So they can have dream experiences whilst they're awake as well. Do you, have you done much work on, you talk about REM sleep, of the different brainwave states, the alpha, beta, theta brainwave states, and what each of them do for us?

28:26Maybe you could share a little bit of that. so so i think there are a couple of things to say about the brainwaves and sleep so we use the brainwaves actually to define the stages of sleep and you know during wakefulness particularly with our eyes closed we see a very rapid rhythm which is called alpha rhythm which is very very small in amplitude and then as we become more drowsy the brainwaves slow down and as we go into the deeper stages of sleep, they slow down even more and you start getting something called delta waves, which are really a hallmark of very deep sleep. Those are very slow, very big waves.

29:07When we go into REM sleep, actually, the brain waves look rather similar to wakefulness, which is perhaps not that surprising because our brains are very active, but we're attending to our internal environment rather than our external environment. So there are some similarities in terms of brain activity between wakefulness and REM sleep. There is something crucial to add here though, which is that actually different parts of the brain can exist in different stages of sleep or wake at the same time. So in conditions like, for example, sleepwalking, we know that there are certain areas of the brain that exhibit electrical activity that's in keeping with very deep sleep, But then there are other parts of the brain that actually look to be at least electrically awake.

29:55And there's a whole host of different experiences of different sleep conditions that really represent the brain's ability to exist in more than one stage of sleep or wake at the same time.

30:10Someone says right now, this is a lot of info, info overload. I need to sleep better. I got the world's expert on the show right now. And he says, all right, I'm going to cast a wand. This is a general statement, but do this and you're going to sleep better. Yeah, if only life was so easy. I think the key thing is to try and recognize what is going on with your sleep. So if you are spending a lot of time in bed and you're tired and you want to sleep but can't sleep, then that suggests you've got insomnia if you are if you are sleeping as much as you want and you still wake up feeling unrefreshed and and and sleepy then it suggests that you may have a sleep disorder and that's the time to go and see your physician because it's important to distinguish insomnia from a sleep disorder because the treatments are sometimes very different indeed if you are sleeping whenever you can when you're in bed but you're getting less than about seven or eight hours sleep a night then consider whether or not you are sleep deprived for you and therefore try and give yourself a sleep an increased sleep opportunity and see if you feel better so i think those are the three major pictures once you've recognized that you've got a sleep disorder, a biological sleep disorder, or insomnia, or whether you're just chronically sleep deprived, that is the key to really making progress in terms of improving your sleep.