Rahul Jandial: The Science Behind Bad Sleep & Dreaming (E271)

0:00Watch it early on the High Performance App. Available now, Roman Kemp, the broadcaster, opens up a powerful conversation on success and mental health. The brain wasn't still seen. It's covered in a sheath. And they picked up the sheath. It's like parachute material. And then I was looking at it. I said, man, this is impossible. It's beautiful. It's not gray matter. That's for cadavers, right? This is, it's like pearly white. The arteries, it's like a Jackson Pollock painting. I mean, it's stunning. Sleep is in order to dream, when I believe the dreaming brain is keeping those edges of your brain and mind fully engaged.

0:38I believe it's high-intensity training for thought and cognition and emotion. When you see cancer patients with the finish line in view, the great majority find strength that they never knew they had. that is neurosurgeon and neuroscientist rahul jandial an international best-selling author who's operated on thousands of brains and in this conversation he will empower you to unlock your mind and know what's really going on inside your skull this is high performance i'm jay comfrey and alongside our expert damian hughes we learn from the most fascinating people on the planet. Right, let's do it.

1:23And welcome to High Performance, Dr. Rahul Jandial. But first, let's quickly hear from our partners who allow us to offer you these episodes totally free.

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3:22Rahul, thank you very much for joining us on the show. Pleasure's mine. What do you believe high performance to be? There's performance in the racing industry. There's performance in the stock market. There's performing to get the kids off to school. I mean, I think everybody performs at a certain level. And for me, performance is in the operating room. But the lessons from the operating room, I think, can apply to somebody struggling to perform, getting the kids out of bed and getting them to school. What's happening at the brain level when somebody is at the edge of their ability is the same, whether the ability is racing F1 or doing a big brain surgery or, again, just doing the usual things at home, which can be a struggle increasingly so.

4:05So for me, performance is achieving your best under pressure. The key is under pressure. So can you explain then what is going on when we're looking for those 1%, when we're trying to perform highly in whatever our chosen aim is? Exactly. I think that's the context that's important. The individual performance is against your best self, your best performance. It's not against somebody else's. Because then it becomes, if you look at people who are superstars and high-level performers or athletes, or you look at elite surgeons, if you compare to them, I think it can become frustrating, but performances within your own context.

4:44What I do is I break it into what happens, an acute performance, meaning instantaneous. There's something you need to deliver, a thought or a physical action. And then there's performance over maybe a year. Like, how have you done this year in your career, in your writing? And they work a bit differently. The latter, the one year, it's a glacial process that I think draws on creativity. When you have time, when you're not under threat, when it's not time sensitive, you really are trying to extract the best ideas you can. So that's a whole different space in my mind about how do you perform through a year of a long form competition or demand.

5:26I think dreaming and creativity fit into that. But under pressure, there's something going on in the operating room. There's something going on in the neighborhood. Performing under threat or under pressure is quite a challenging task. Because if you have trained, you have created pathways and circuits in your brain. We're not hardwired. But if you train, the neurons you've activated to maybe make the shot or kick the ball or perform physically, they become habituated and what they do in my opinion and when i say my opinion it's out of respect because i'm trying to push concepts at the edge of what's known and beyond in my opinion what happens is that we we deposit myelin so the neurons which are like jellyfish and they have tentacles you know the axons when you do something more to be more efficient they'll they'll wrap the axon that the neuronal cells with something called myelin it's the good fat they talk about in salmon and the conduction is faster.

6:27The good fat provides the insulation for the neurons which are showering electricity at each other. So if you perform a behavior, a habit, it could be a bad habit or a good habit, your brain will want to make it more efficient. And so performance is practice. Performance is using the least amount of brain energy to achieve that performance, to achieve that physical feat. and then the pressure brings in the elusive part. So a lot of people can perform surgery when they're learning on a cadaver. So the pressure adds interference to those habits, those neurons where you've deposited that myelin. And that is something called emotional regulation.

7:14So performing under pressure is training, but also not letting the anxiety of the moment interfere with the training. And so for me, acute performance are those people who can actually be calm under pressure. And that's a skill that can be cultivated through something that's another big space called emotional regulation. That skill that the athletes cultivate under pressure to perform, those lessons apply to the mom or dad at home trying to deal with pressure at work or trying to get the kids off to school. So I try to bring in these big concepts, dreaming, long-form creativity, performance, under pressure, and then the lessons that can extend to everybody.

7:56Well, you used a phrase there, Rahul, about these can be cultivated. And that reminds me of a phrase that I've heard you use elsewhere about viewing your brain as a garden, seeing it as seasonal. So I'm wondering, have you got any tips for us on how we can cultivate our brain garden to be more effective? I worry that sometimes our language gets in the way of the complexity, but then complex language is not graspable. So how do you cultivate the garden in your mind? I think the first thing is we start to see it not as wires. I mean, I've opened skulls. I've got petri dishes with neurons in there.

8:36They're not wires. I like to think of it as microscopic jellyfish and they're floating in a liquid bath inside our skull. The brain doesn't sit on the bottom of the skull. It's buoyant. It's literally floating in cerebral spinal fluid. And when you think of those jellyfish, they're not directed towards any direction. They're throbbing. And what happens is when you have a behavior or you have an emotion, a little electrical storm, much like Aurora Borealis or like a murmuration of birds, it's not directed. It's not this way, that way. It's not turn this brain on and I have more emotional regulation.

9:17It's sort of an electric flow that happens. And if people think of it that way, I think there's an impermanence to it, meaning just because you felt something yesterday and just because you have a behavior habit you had yesterday doesn't mean you have to have it today. At the same time, if you've had a good day, you still need to cultivate having a good day tomorrow. If you look at the brain, the limbic system, the emotional brain, this is a well-established thing, is sort of at the center. It's the instinct. It's what my puppy has. It's emotion. It's the places we put the catheters into and tick electricity to address tremors, to address obesity.

9:59Primal drives are sort of in the core. And then what happens if you look at our foreheads is the part of the brain that pushed our foreheads forward, the frontal lobes, the prefrontal cortex in front of the frontal lobes, that's the region right behind your forehead. There are neuronal branches that go from our frontal lobes to our emotional limbic system. And those physical microscopic neuronal extensions can be cultivated through deep breathing to train yourself to be less anxious. They can be cultivated with thought that does this emotion have a right to be in my body, in my mind? like the fact that your frontal lobes the most advanced evolutionary advanced the the newest part can reason down emotion that's the superpower and people say well give me a you know that that's that's really out there when if i put a fake snake on the ground we'll jump that's the limbic system there's no time to think that out yeah and that's an advantage but the second time i put it down your prefrontal cortex, tamps down your instinct.

11:16Tamps down, almost tamps down a reflex. That is possible. You can break your habits. You can break your instincts. And that's the cultivation that I want people to have is how do I dial what I'm experiencing now? Let emotion flourish. I'm falling in love. I'm having a great time. We don't want to be too tight. I mean, the emotion has tremendous value. Decision-making requires emotion. or, you know, this, I'm walking in to see my boss right now, or I'm going into a big game time performance. I need to tamp down this emotion and stay in a rhythm. So that, uh, that dial, not on off, emotion is never off and reason is never a hundred percent.

11:56It's never a hundred zero. The brain will toggle between emotion and reason, you know, 40, 48, 52. You're trying to always control that thermostat. And that control of the thermostat is a lifelong responsibility. It's not just an adolescent where we know we go through a lot of changes, but that's something you're working on. And if you work on that, you cultivate that. The next storm that comes your way, you're a little bit better positioned for it. If the storm is intense, maybe you have a child who gets diagnosed. I do pediatric neurosurgery. Then nobody's ready for that. Nobody has built in resilience for that.

12:34But you've cultivated that capacity. and if you're working on that continually through your life I think you can navigate the challenges of life better as well as you know enjoy and cherish the joys. So what are the things that we should all be doing to train our brain to be able to deal with not the huge things you've just spoken about because you know have you seen Hamilton the musical? You know when they sing about Alexander Hamilton losing his child like you know Massive. We don't want to even consider those things right? The unimaginable they call it don't they in Hamilton? But what can we be doing so that the daily things that derail us, the stubbing our toe, the losing our wallet, the row with a partner, the aggressive driver on the road, what can we be doing to deal with those things?

13:17So I'll give you a specific example for that. And the big idea here in my mind is that the same concepts apply for that massive unspeakable tragedy all the way down to the daily struggles. Is that right? Yeah. There's a separate thing that happens. And the thrill of somebody at a university level winning the championship, the brain chemistry, the brain electricity is no different than at the World Cup. So we're all equipped with the same pathways, if you will. So not thinking on and off, we have a reward pathway. We have an emotional brain system, various structures that come alive. We have an important anxiety pathway.

14:04You should get anxious under certain situations. But let's focus on that anxiety pathway that tends to get in the way of people enjoying their lives, doing well in life. These different pathways, so reward would drive you towards getting up and going to work, but too much of it also make you an addict. Again, it's a continuum of that reward pathway. Similarly, for anxiety, what is the way we can navigate anxiety in our life? That's a massive question again, right? First, recognize that anxiety is important. Stress is important. Those people who go to space and they come back down, they have to carry them out of the module.

14:47Lack of gravity leads to withering of bone, right? So just like that, lack of emotional intensity, lack of vibrant dreaming, lack of anxiety will actually dull your mind and the neurons in your brain. So you need appropriate anxiety. So I don't think it's got to be, inflammation's bad. No, it's not. You need some inflammation. Again, it's setting the dial. Anxiety's bad. No, actually, in this situation, anxiety might be an ally, but it's bad when there isn't an external situation that warrants it. so anxiety on overdrive anxiety on autopilot anxiety that has no role and then you say well well that you know that rahul he came by and said there's an interaction between our logical prefrontal cortex and our emotional brain why can't i think down my anxiety well anxiety is very powerful and reason cannot for for many people be enough to say hey i shouldn't feel worry during this time.

15:47So then what are the built-in mechanisms? What are the things, specific things that we can do? You got to stay with me for this a little bit. We have a built-in path, an anxiolytic. So that word means, how do you break anxiety? There's a chemical pathway for it. So in the hospital, benzodiazepines, Xanax, Valium, they're anxiolytics. But that's not our approach we want to have in life. So what happens is just like we can think down our heart rate, so let's say deep divers, they can actually think down something that's automatic that should not be in their control. How does that happen? So this brain-body connection actually has to do with two nerves that come down the groove of your neck.

16:39And so the vagus nerve, there's 12 pairs that come out. It's the way you would control when you feel butterflies in your stomach when you're nervous. It's that sending a shiver up to your brain. When you think down your heart rate and they've got it, you know, a Buddhist monk or somebody who's a deep diver, you say, how does that control happen? So there's definitely a downward brain-body connection, right? And here's what's powerful. There's also an upward connection from how we breathe up to our brains. So I'm just going to give you a little side here. It doesn't matter if it's in one nostril or mouth or not.

17:18I know there's a huge field about it, but the nose and the mouth connect right in the throat. They come down a main tube right here. They break into this. It doesn't matter how you get to the trachea, in my opinion but what we found was when children have epilepsy so erratic brain electricity right we talked about the electric jellyfish and we can't break it with a pill the anxiolytic is also an anti-seizure pill it calms electricity we we do a little we put a little nick here we find the vagus nerve we put a little coil of metal on it we put a little pacemaker there just like a pacemaker for the heart we put a pacemaker for the vagus nerve you can look it up it's called vagus nerve stimulation so i'm pulling from lots of different examples to come up with a big concept for people how can breathing change our brain electricity well when we tickle that not only did it break the brain electricity causing the seizure the the children reported feeling more calm so that is proof that the brain body connection going down as with all nerves is reciprocal.

18:28So the mechanism by which a stressed out parent or LeBron James, you know, going for his game winning shot is the same. It's to pace your breathing. It's not, I can't control what you're thinking. I can't know what you're thinking. But pacing your breathing, just five slow breaths I've done in the operating room will send calming signals up the vagus nerve to your brain. And that's accessible to everybody. And the key there is not to practice paced breathing in the moment of crisis, but to practice it on smaller elements. So again, it's in your toolkit for coping. You practice it. You're going to go see your boss.

19:13Things aren't going well. You think there may be an issue here. You take that moment a few minutes before. You just have that time to just pace your breathing. When something goes wrong, I've got somebody's skull open and there's something going on in there. The room doesn't even know.

19:32I'll just fight the panic. You know you're doing something important. If you don't feel panic, if you don't feel fear, so I'll fight the panic and I'll fight the fear by just pacing my breathing. That is my ally by sending calming signals to my emotional brain, as well as, I'm 51 now, I think I have more control of my prefrontal cortex, but also saying, you've done this before. You've been in this bad situation before. Pace your breathing. So there's a dual approach to calming down that emotional limbic instinctive part of my brain. That's a take-home approach based on big, big science. And the reason I approach it like that is, because I don't like being told what to do.

20:18Do this, don't do this, hold this, stand on one leg, eat one blueberry. I just, but how? But why? If you know the one step past it, that breathing can send calming shivers up a nerve into your brain, I think people are more likely to do it. So what about people that say, oh, I'm just a naturally anxious person, so that wouldn't work for me? Right. Well, the, very good. The thermostat is set differently for all of us. Yeah. and the thermostat gets thrown off course as life hits us with different things but that same approach wherever your level of anxiety is that's your built-in to the coping kit now does it work for you whether it works for you i can't give everybody those answers because i don't know what life is bringing for you i don't know what i don't know nobody knows what happened last night we might have endured terrifying trauma we might have won the lottery so i never assume i know what in your brain what you're going through just based on your outside and i think for people that's your that's your built-in anxiolytic and to take it a little deeper the pace breathing not only does it send signals up see neurons they don't they don't touch each other they shower neurotransmitters out of each other right like prozac is a selective serotonin reuptake you don't they don't send the electricity to each other they release neurotransmitters and they fly around this little cleft and they pick up on the other side.

21:44The same neurotransmitter that this modulates called GABA is the same one that the medicine is also modulating. So there's a consistency in what we're finding with breathing, showering the brain with calming electricity and a chemical. That same chemical here in the pharmaceutical world, there's a match. So all the pieces are consistent that that kind of stuff really really i find compelling interesting we were lucky enough to interview the astronaut tim peak who spoke to us around a psychological effect that he brought back to earth with him called the overview effect where he said seeing the world from outside our atmosphere gives you a sense of perspective and i was interested when we were preparing to interview you rahul about you've almost had the opposite the interview effect The first time I saw the professors remove the, you know, the incision was made behind the hairline.

22:41So when the patient woke up and the nurses shampooed the hair, the patient was like, where's the incision? I was like, whoa. The incision was behind the hairline. The scalp was dropped down. You know, like holes were made. The forehead was lifted off. The brain wasn't still seen. It's covered in a sheath. And they picked up the sheath. It's like parachute material. And incised it in the clear fluid that I told you about. and then I was looking at it and I was like, is this even possible? Like, you know, and I think it likely was, it's the same feeling of when you're, when you're way out there and you're like, that's finite.

23:14That, this is a, this is a globe. It's not, it's not flat indefinitely. There's a sense of awe that comes across in your writing and the research on awe from like Keltner and John Haidt suggests that that has two effects. One, it gives you a sense of the perceived vastness of the world that we're in, but it also then forces you to change your view of the world and shift beliefs. And I'm interested as somebody that's seen inside our heads, what are the beliefs that you have shifted? The first thing was, it's beautiful. I mean, it's opalescent. Under the operating lights, it's not gray matter. That's for cadavers, right?

23:56It's like pearly white. The arteries, it's like a Jackson Pollock painting. I mean, it's stunning. And it's just weird because you go through flesh and bone. It looks like in the movies, you know, they show flesh and bone. So is there a lot of blood? No, actually, that's a very interesting question. It gets 20 % of the blood flow from the heart. You know, the heart, when it sends out material, 20 % goes to just a 5-kilogram organ. And you think it's going to just, you're getting all of this blood coming in there. It should be red. It's white. It has to do with some of the myelin that wraps it.

24:32So when you look at it, it doesn't make sense. It's immediately something sacred. And I don't think that's completely ever gone away from, I still have that moment. It's always about the person, the family waiting outside, the pitfalls. I'm running through my drill scenarios. But that first time you see the surface, that's something different. And so that feeling, I think it was something I realized that this is a craft that I will always take seriously. I'm never going to be good enough at this. I'm always going to bring my next level for this. And that was something I had in my mind. So now another big concept you've raised, wonder, awe, these themes that are being thrown around now, flow, I mean, what does that mean, right?

25:18Reason and emotion is the modular interplay of brain that is expanding and developing over, you know, not 30 ,000 years, but 30 ,000 generations. It's outward and inward. So outward is executive network and inward is something called default mode network, but it's more, I like to call it imagination network. So now you've got all these structures and all these connections and I have a job to do and it's intense. Certain structures and connections pop up. So what happens in wonder, I think, or if you're operating, you're like, I'm not even thinking about it and the tissue's falling apart or somebody's racing a car and there's like there's this this where you're in this liminal space right and I think what's happening is you've got you're as close as possible to a 50 50 where it's not mostly executive network I gotta get this done I gotta get this done excel word sheet looking at my calendar that's 40 that's 52 executive mind wandering drifting off that's 52 percent imagination but when you're doing a i think a physical task or when you see something and you're looking out at the world or you're looking out at the frontal lobes exposed and you're and you're still contemplative and you're reflecting i think that experience comes from those rare times when when both networks are in a true balance that's my best explanation of wonder awe flow childbirth seeing the planet seeing the human front lobes and what is it that you do to get yourself into the that perfect flow state and this can apply to athletes looking to deliver on a on a field it can apply to parents looking to get the best out of their kids what what do you do so that in that operation which means an awful lot to the patient and their family you're on your way again to me yeah so i think the answers that have been given before are like with music you train train train train but at some point you have to let it go dancers right you train train train train train but if you're out there running through your maneuvers i don't know it just shows the other like the audience the The uninformed audience can, they can almost smell it, sense it, that this is something rigid.

27:48Athletes, you know, when they ask, how did you make that throw? And I said, I don't know. It's just for a moment I wasn't thinking about it. And I think, again, what's happening is, whereas training is 52 % executive network, and all the different structures, old and new, prefrontal and emotional and reptile, all of it. The executive network pulls from all of those. It's not some corner sitting here that goes, I'm the executive network. We have to get away from that thinking. That what happens when people let go is the executive network is dialed down. It's brought down from 52, maybe brought down to 51, maybe brought down to 50.

28:31and the imagination network, the creative network, the I'm not sure how, I didn't think I need to throw this ball at this trajectory. Something is released from you, something instinctive, something built on training. So I think what's happening when people get into their peak performance is learning that they have mastered as much as training can do and now they have to leave room for something bigger to be released from them. It can only happen if you let go a little bit. In the operating room, if you're thinking about the steps too much, it shows. You can tell when people are learning or people have never mastered their craft.

29:17When you use a blade, some people, the blade is like this. Always left to right, left to right. But then you see some people and they use it like a paintbrush. And this is all happening inside you. You see the same maneuver is done with a few less steps. The tissue is tugged less. It's balletic. I mean, it is sport. And that takes a little bit of, there isn't a thought in my mind like, oh, don't hold the tissue so strong. You're actually, the executive network is dialed down. You're exquisitely trained. This isn't for somebody like your first shot at it. Like, yeah, I dialed down the executive network and I didn't do well.

29:55You're a master of the craft. you've learned all the dots, then you're letting creativity, you're letting flow, you're letting performance somehow release from you. And then when you see the greats, you know, you see that. So you use an example in your book, On Dreaming, about Salvador E. Dalle and how he sits on the backseat or how he sat on the backseat in the legs of a chair so his imagination network could go to work. And then when it fell forward, the executive network can kick in and gather it. Yeah. So when you hear that, without the when i'll explain it to you like wait a second that sounded way out there yes but he's explaining in a way that you could look up and he's pulling in different scientific techniques so um so we we hit on big things we hit on the architecture of our brains is interconnected like you turn the microscope on we're going to see that we've hit on other big things executive network and imagination network that pulling from all corners with a different set of structures and connections take turns.

30:58Now let's explore a thought from the electrical patterns it generates, right? 20 % of the blood flow goes up here because it's energetically demanding. It's burning hot. What is that energy being used for creating electricity? You put an electrode on somebody, you can measure electricity. You can also send in electricity, shock therapy and other things. That's more conventional. But you put a sticker on somebody's forehead or 96, the right way to do it, you can detect electricity enough to actually amp up a light bulb. So the glucose goes into your blood. Your heart pumps it up. It's used by those 100 million jellyfish, little factories to spark electricity.

31:46but when 100 billion spark in waves called brain waves that's what an EEG measures you know when somebody has epilepsy those brain waves are thrown off but what happens if you don't have epilepsy and you put the three of us uh and you put 96 electrodes on there'll be a pattern you know and some people say I can't wrap my head around that okay let's back up a bit if I put a few stickers on your heart on your chest and I showed you an EKG you'd say like yeah that's an EKG that's electrical pattern from my heart you know it you know it's like on the ambulances or it's on shows yeah you know that little that's from two electrodes from three nerves on the surface of your heart what if we took the whole brain 96 electrodes and they show different types of brain waves so what happens is when you put those electrodes on if you fell asleep i can tell we can tell the field can tell when you're asleep and when you're awake and now when you're awake there's a lot of different brainwaves that will happen.

32:45And when you're asleep, we know two very well-established ones that are trippy. REM sleep, but it's rigid at night. When you sleep, it's vroom, vroom, 90 minutes, vroom, vroom, 90 minutes, vroom, vroom. And you look at that, and you're like, that's design. That there's a purpose that's being served there. So sleep brainwaves and waking brainwaves are different. and then you say well when you fall asleep is it a rigid transition like you know you're awake and you're asleep no like all things in nature I was diving like in the Yucatan it was like a river turning into ocean and there's like a four foot period where it was like blurry the transition from salt water or fresh water to salt water it wasn't like a little vertical line there's a liminal space almost well what Dolly is talking about and what in that movie Inception they're talking about is that when we fall asleep there's a period about 10 15 20 minutes called sleep entry and at that time it's your awake brain waves and your sleep brain waves but at that time there's a slight overlap and that's called sleep entry so the creative more imaginative more uh imagination network thoughts ideas are starting to happen yet their recollection of your waking brain can still pluck a few out so they're devising uh you know new technologies that like you sit there and when you're falling asleep it wakes you up and you write down what you're thinking well that's what dolly was doing he was rocking on a chair and i uh edison also and when when he would fall asleep something like a coin in his hand would hit the floor and he'd wake up and he was trying to extract the thoughts happening at sleep entry where you're waking brain waves and you're sleeping brain waves that where they're sort of both present and that's the science behind how you might be able to get better ideas from that moment going back to the original question we had that's how you perform over a year you build that into your habits i do that not not that way specifically but more in the morning I wake up real slow and sometimes, and then I just, and I pick up my phone and I write a few things down.

35:02Then I start the day. So that's the performance over a year, how to extract the most creative potential out of yourself. That's a different approach than hitting the game-winning shot.

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37:20This is really interesting for me, right? Because I'm a very quick waker-upper. I'm awake. But when I fall asleep and my wife likes to stay awake a bit later than me, I have these mad trippies. And I actually wake up, and you know what I think? I think I can't believe, I can't quite remember what they are after about 20, 30 seconds. But straight away, I think, I can't believe my brain is that incredible to think of that story. I sort of think if I wrote that down, that would be the greatest novel ever. Because it feels so creative and so deep and so vivid and so far out. And you think, what is going on?

37:56And this makes perfect sense that my sleep brain is starting to come into my weight brain. And in your sleep brain, it's more of the imagination network. Yeah, but then it makes you think there's so much in there. That's exactly right. So you may not have that experience. I may not. It's not your dream. It's not my dream, but it's sleep and dreaming when you look at 10 ,000 dreams, when you look at 3 ,000 years of people writing about it from Aristotle to Freud, you see that pattern. And that's called sleep entry. They call it hypnagogic. It's got a fancy word for it, but I'm trying to bring those down to sleep entry for centuries and in the past.

38:38and now understood with the science of brain waves, recording the sizes, make patterns, there are a lot of people that report that. So our brains are operating totally differently when we're asleep. They're doing something fundamental. That pattern, that much energy that they're using, that much blood flow that they're using, and they're putting you at risk of injury and predation, that's not happening on accident. So I believe that sleep is in order to dream when I believe the dreaming brain is keeping those edges of your brain and mind fully engaged. I believe it's high-intensity training for thought and cognition and emotion that without it, if it were just the day, we would become so narrow.

39:21If we were just based on lived experience, how inflexible. It's not just pretty little thoughts. It's meant to be wild. So that if you need the wildness of emotion and thought to deal with adaptation, it's still available to you. It hasn't become derelict. Because, you know, if you don't move your arm, it'll ossify. You'll get a contracture. You'll become inflexible. I think I have an issue with the sleep exit. Oh, yeah, that's a big one. Because I wear a whoop, right? I wear a whoop band. And it, you know, whether you agree or disagree with that kind of technology, it measures your stress throughout the day.

39:58Every single day, the minute I wake up, it shows high stress. And I think I feel the pressure of a couple of kids, a few businesses lots going on it's almost like the minute I wake up the executive network is back in action straight away straight away that's the executive network coming back in action right get back get back to the daily the thoughts of the day the acts of the day and I think the stress is there because I'm lying in bed so I'm not I'm not doing the things I feel I need to do so is that an issue for me I don't know what you mean by is that an issue for you I think that's the usual thing that busy people people who have many demands yeah when they come out of sleep, there's a mountain of things to be done.

40:40And so the executive network takes the reins. It's 51, 52. I got to do this. Oh, shit, I got to wait. And I've been there. When I'd wake up in between operations or thinking, sometimes I'd have 15 patients in the ICU. You think about your kids and all these. I just, patient number one has got their band image. I mean, I'm running through a list of people on the brink. And that's normal. You've asked to have these adventures. You've signed up for it, right? I mean, for me, it might be a burden to have nothing to think about when I got up. But I don't think there's anything wrong with that. But to do those things better, what if you gave yourself an indulgent 10 minutes, if you have that luxury, to say, all those 10 things that I've signed up to do, I want to do a few things better.

41:28But I just haven't been able to crack that code. I haven't been able to break through it How am I going to be better at that podcast? How am I going to be better at that surgery That continues to be challenging That 10 minutes of sleep exit And that 10 minutes of sleep entry May be your portal To some fresh ideas That are particular for you in your life Going back to the book you wrote before The current book about dreams Which was about the brain What is the one thing you would love to leave our audience With a better understanding of When it comes to finding their own version of hyperspace and the role of the brain in that?

42:06That if you see your brain and the mind that it sprouts as constantly evolving, shifting, electrical flows, chemicals, neurotransmitters as this ecosystem, then whatever tragedy you have today, it doesn't have to be there tomorrow. And at the same time, whatever triumph you're feeling today, it's your responsibility to continue to cultivate that. That every day, if you looked at the brain at a microscopic level, we are brand new every day. And our dreams keep us fresh every night. Last year, Jake and I were lucky enough to meet a para-Olympian athlete that had been diagnosed with six months left to live, a terminal illness.

42:55And it had quite a profound impact on us. in terms of perspective and the finality of life. As somebody that is charged with that honor and responsibility of delivering those kind of messages to thousands of other patients, I'm interested in what lessons have you learned about delivering bad news and equally how people receive it? Yeah, it's heavy. so I think this is where you know it's what you wanted other people to walk away with an understanding of their brain and mind maybe they didn't have but also maybe an understanding of where I'm coming from I'm not tackling these topics without some real psychological mileage I have shaken 10 ,000 hands I have opened several thousand skulls I'm a I have three sons I've had my own difficulties.

43:53But out of those several thousand patients that I've cared for, most of them cancer from the breast or the body that spreads to the brain, they're not around anymore. In the beginning, the invitations to their funerals and stuff, my drawers are packed with hundreds of invitations. And then some people say, man, this sounds like it's depressing. I said, no, man, it's triumphant. When you see cancer patients with the finish line in view, if I hadn't witnessed, I would say 95 % are going to fall apart. What I'm seeing is the opposite. A great majority find strength that they never knew they had. It's the fight that's bringing it out in them.

44:42They're not coming with coping mechanisms because there's no way to cope for that word when it hits. And so it's inspiring for me to see how they navigate. They show up to clinic. They get dressed up every three months. They're like, what is this scan going to show? What is Rahul going to say? I mean, that's a lot of uncertainty and stress. And they cope and they manage and they're triumphant and their dreams are positive. Not all. Some suffer. Some have miserable endings, no doubt. but a surprisingly large amount fare well, do well, when that finish line comes into view. So when I speak to them, what I realized is I've implemented pauses because it's too easy to just roll it out off for them.

45:39And so when you do talk to them about what has been found, I'll put in a deliberate one to two minutes just let them run through all of the things they're thinking about what does this mean with my kids it's going to be painful let them have some space to think about cancer and then when I then I try to read their energy I try to understand their story and as they're as I feel like they've caught the breath there's a free fall and as I feel like once they've caught their breath then I get into if it's appropriate the hope and the positive options in front of them if it's appropriate it's not to be their cheerleader in fact the opposite I am their partner through what's going on in their body so I always show their scan this is your name this is your brain this big white thing is a cancer why do we tackle that?

46:40and I think they understand things like you have months and likely years, but not decades. So I've learned to pull back my language rather than saying studies for this cancer show that there's in that moment they need a framework. Time to run their thoughts, brace them with some general concepts, and I give them holidays. So the next few months will be tough, but when we get to Christmas, you will have a wonderful Christmas. And so they have a pace, they have a finish line, they have these things. So that's after 10 ,000 patients, you know. So it's a very personal question. But that's where a lot of these lessons are coming from.

47:25They tell me about their dreams. I see their injury from their disease and then I get it to the Petri dishes, to these conversations, to the little stickers on the electrode. I'm trying to pull from everything to come up with what's the unified theory of what's really going on in our heads. Amazing answer. Thanks, man. And I think you're right when you, you know, it's a privilege to have those conversations as much as it's a challenge. The ultimate classroom. Yeah, I bet. Right, quick fire questions. All right. What are the three non-negotiable behaviors that you, and ideally the people around you as well, would buy into?

47:58One is that no matter who the person is, before I open them up, it's 100 % dialed, 100 % respect. that what I feel about the patient, because sometimes we had to take care of patients who were in jail, you know, the complex, the interactions when you see 10 ,000. But once that drape is on, I'm 100%. And so it's a sacred space for me, not just the operating theater, but inside your body, it's sacred. Every time, every patient. That you can count on. um the second thing is is limitations knowing my limitations um if there are a hundred neurosurgical operations there's a there's a there's a handful i'm i feel like at the other centers of throughout the world my performance measures um but there are things that i know other people are better than me at maybe they've trained more in it or they have an aptitude at it, you know, I got to pass the ball if somebody else can take a better shot.

49:04And I do that in my practice to know my limitations that you may be served best going to my partner for this type of operation. I've learned to say that too. One example would be going through the nose and tinker with a pituitary gland. I can do that, but somebody does that better. I'd rather have you go to them. That's also respect. And, you know, the other thing I think is um is attitude in that operating room once I mean there's like eight seven or eight people the anesthetists technicians are going to hand me stuff there's people on the back wall there's a lot it's a physical place machines cables you know that in the past I used to come in and say you look I would I would tell people about the importance of the stage and now I think it's the subtleties, it's the attitude.

49:58When I'm there first, and the counter's all clean, and the trash can's where I want them, they're like, oh, he's dialed today. Then that attitude is infectious. Rather than saying, I need your best today, and all those rotten, no, no, no. It's just the look in the eye, then I walk back to the person opening all the tools up and say, I need this one, I need this one, this one. Yeah, you're good today. They see, if my attitude, he's super focused, he's super calm, that's the best way to get the most out of those eight people. Rather than a checklist on the wall and a song or a speech, it's to set the attitude of the room.

50:35So if I run into trouble, if we run into rough weather, I've already got them on board. So when I dial it up, they knew that this was a possibility because he came in early that day. He was setting it up like this today. Great. Thank you. If you could go back to one moment in your life, where would you go and why?

50:55the uh it's the moment i live all the time is the first time i showed up at lax and it was like wow there's this blue ramp coming out of tom bradley international terminal at the apex of the horseshoe people always say where were you born i said lax because that's really when my memory started i was age eight um and now when i fly home tomorrow when i came out here last night when I go to LAX, it's like this recurrent dream, if you will, of where anything is possible in Los Angeles at LAX. When you come out of that ramp, you know, it's infinite. Nice. What's your greatest strength and your biggest weakness?

51:33I think my strength is realizing that

51:39I've come to a real acceptance that this isn't forever through my cash patients. So I'm trying to leave my mark on the world that will last. But it comes from this recognition of our impermanence. That the meaning of life, I've come to accept, I think it was somebody else who wrote this, but the meaning of life is that it ends. It's a short run and I'm going for it. So I think that attitude is my strength.

52:09And my weakness is that I can perseverate on my failures. you would think, you know, like, look at all the good stuff you've done. No, man, there's like four or five mistakes and things and regrets that I just, I can't shake, you know. It's a personal answer. You've played a game of high stakes, though, with your life, haven't you? Yeah, actually, I like that. High stakes, and I hope high performance. And the final question, with all you've seen, learned, done, experienced the good and the bad, the positive and the negative what would you like to leave ringing in the ears of the people that have watched this conversation for them to find their own version of high performance the biggest thing about performance is to be dedicated in learning and training and then be open to something transcendent happening unexpectedly Well, I can't thank you enough for coming on the show and sharing so much of your lived experience with us.

53:19And I think it's a great reminder that the power of the brain, the complexity of the brain, it so often derails us. But actually, I think it's a reminder of just how incredible it is and just the amazing things it does for us. So thank you so much. Pleasure.

53:39Damien. Jay. It's a complex topic, and I think that people might have to listen to that episode maybe two or three times to really understand the power of what Rahul is sharing with us, because there is a lot of power in that conversation. Yeah, you know, he gave us that stat, I'd not heard it before, that 20 % of our blood supply goes up to feed something that accounts for about 5 % of our body weight. So to treat something so significant, with such significance, felt like a real privilege to be in the company of a man that's spent so long studying it. And this idea that dreaming is more than just a dream, a nightmare is more than just a nightmare, a thought is more than just a thought.

54:24There's a reason that all of these things are happening and I love that idea that when we're asleep we're dreaming so our brain is almost like in the gym working on the very margins of the brain that maybe in the day we don't use. and that is an eye-opening thought for me. Yeah, I mean we didn't talk about it so much in the conversation with Rahul here but in his book he talks about how sometimes the dreams that we do are alerting us to get our executive function to pay attention. So there's examples of people imagining like a rat gnawing at their stomach and that can be a sign of an ulcer for example or another health condition.

55:02You know nightmares are sometimes just giving us up for something that we might have anxiety for and just allowing us to practice. So I think when we start to be open and explore the possibilities of all the amazing things our brains can do, some of Rahul's advice is essential. And he also kind of offers the idea of freedom, really, doesn't he? It's about doing the work, doing the prep, having the knowledge, but then also trusting yourself. Yeah, I love that. I love the idea of do the work and then just let go. Just be prepared to let it go. I think I've heard some coaches talk about, they talk about the game itself as literally the very origins of play.

55:41Just go and play now. You've done all the work, just trust in the preparation and just go and enjoy the moment of play. And I think that's certainly something that we can all take away from Rahul's experience of, as he said, opening up thousands of brains where you've got the lives of an individual and their families in your hands. and yet he's learned to trust himself to just go out there and do the best he can. And whether it is cycling without a helmet on, eating junk food, smoking, drinking too much alcohol, like he said, don't be reckless with your body, take care of this. It's a reminder that it is miraculous what is going on inside our brains, those neurons, the electricity, the power surges.

56:24We all have a responsibility to take care of that part of our body. And I think if people leave with even just a slightly bigger understanding of the fact that we are all a miracle, I think it's not a bad thing. Thanks a lot, mate. Thanks, mate. Loved it.

56:43And that's it. I can't thank Rahul enough for coming on the show, flying over to the UK from the US to share so much fascinating advice and information about a part of the body that I think we know so little about, but obviously rely on so much. I thought it was a really cool conversation. I would love you to just do one thing for us. If you can, please hit follow. It makes such a difference to the show. It means we can continue to grow and attract more incredible people to high performance. Remain humble, curious and empathetic and we'll see you next time.

57:27Thank you.

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