Instant Genius - Dr Guy Leschziner: What is your brain doing while you sleep?

Episode Date: July 10, 2019

For most of us, switching off the light and curling up in a warm, cosy bed is the welcome reward for a good day done (or much-needed respite from a bad one). But not everybody can soak up their allotted hours in joyful slumber before the alarm goes off. In fact, according to the Mental Health Foundation, it is estimated that 20 per cent of adults suffer from some form of insomnia, while many more of us experience issues like sleep walking, sleep apnoea and night terrors. Dr Guy Leschziner is a world-renowned neurologist and sleep physician, whose new book The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep (£16.99, Simon & Schuster) attempts to unpick some of the mysteries around what is happening to your body whilst you doze off in the land of Nod. In this podcast, we find out what is happening in our brain while we dream, how to get a better night’s sleep, and whether sleep tech and apps are all they’re all cracked up to be. He speaks to BBC Science Focus Online Editor Alexander McNamara. Listen to more episodes of the Science Focus Podcast: How to get a good night's sleep – Alice Gregory Exploding Head Syndrome – Brian Sharpless The neuroscience of happiness – Dean Burnett Is religion compatible with science? – John Lennox What it’s really like to die – Dr Kathryn Mannix Follow Science Focus on Twitter, Facebook, Instagram and Flipboard Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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then that really does raise the possibility that you have an underlying sleep disorders. You're listening to the Science Focus podcast from the BBC Science Focus magazine team with the UK's best-selling science and technology monthly, available in print and in several digital formats throughout the world. Find out more at sciencefocus.com or look out for us in your app store.

Hello, I'm Alice Lipscomb Southwell, the production editor at BBC Science Focus magazine. For most of us, switching off the light and curling up in a warm, cosy bed is a welcome reward for a good day done, or a much-needed respite from a bad one. But not everybody can soak up their allotted hours in joyful slumber before the alarm goes off. In fact, according to the Mental Health Foundation, it is estimated that 20% of adults suffer from some form of insomnia. while many more of us experience issues like sleepwalking, sleep apnea and night terrors. Dr Guy Lesziner is a world-renowned neurologist and sleep physician, whose new book, The Nocturnal Brain, attempts to unpick some of the mysteries around what is happening to your body while you doze off in the land of nod.

In this podcast, we find out what is happening in our brain while we dream, how to get a better night's sleep, and where the sleep tech and apps are all there cracked up to be. He speaks to BBC Science Focus Online editor Alexander McNamara, who kicks things off by asking him what is actually happening in our brain while we sleep. We know that sleep is actually quite a complex series of states. So for the average adults, what tends to happen is we drift off into a stage of sleep called non-REM sleep. And during that stage of sleep, or stages of sleep, actually, the brain becomes much quieter. The electrical activity dies down.

look at the brain waves, the brain waves that are normally quite small and rapid actually slow down significantly and become of much greater amplitude. We think that during this stage of sleep, non-REM sleep, it has important functions predominantly for restoration, for rejuvenation, but also for maintenance functions. So we know that there are a series of channels within the brain called the glymphatic system. And these open up significantly in non-REM sleep, particularly in deep non-REM sleep. And when we measure the levels of certain chemicals,

certain compounds that are really a function of the fact that the brain has been very active, we see that that stage of sleep is involved in flushing out some of these toxins, some of these products out of the brain. But after a while of being in non-REM sleep, after about 60 to 90 minutes or so of sleep, we then go into our first stage of REM sleep, of rapid eye movement sleep. And this stage of sleep is very different from non-REM sleep. It's characterized by the brain waves becoming once again very active. The brain looks to be

in a state that is rather similar to wake. And this is the stage of sleep that we most strongly associate with dreaming or at least dreaming of dreams with a narrative structure, so stories that are evolving. And during this stage of sleep, we think it's probably quite important for maintenance of mood, for processing of emotions, and for learning as well. So there are some theories about REM sleep being involved in the pruning out of memories that have been acquired over the course of the day that perhaps serve no useful function. And then over the course of the night, we then go through usually four or five of these

cycles of dipping in and out of dreaming and in and out of non-REM sleep until we finally wake up in the morning. So is it better to have like one REM sleep longer or non-REM sleep longer than the other one? So the brain seems to prioritise non-REM sleep. If we're sleep deprived, then often REM sleep is sacrificed. And although we think the REM sleep has some very important functions, particularly in later life, we can't really see any very clear long-term repercussions on losing REM sleep. In fact, in the olden days,

some of the drugs that we use to treat psychiatric disorders completely abolish REM sleep. And there remains a little bit of a mystery about the precise, function of REM sleep. In reality, actually, REM sleep probably serves different purposes at different stages of life because we know that, for example, children that are or babies that are still inside the womb, will spend about a third of every 24-hour period in REM sleep. And that drops off very quickly once they're born. So we think it may have a very important function in terms of the development of the nervous system and the development of consciousness. Whereas,

in adulthood, the functions of REM sleep are much less clear. So these have already sort of been developed throughout childhood and adolescence to the point that when you're older, you need less of it? Precisely. Well, that's at least what we think. Now, there are some features surrounding REM sleep that suggest in later life it may well help certain things like, for example, reinforcing memories, but trying to cleanse emotional context from those memories. So, for example, who have post-traumatic stress disorder, they will typically have recurring dreams or nightmares that in some way relate to their original psychological trauma. The reason why we think that that may be

occurring is because in REM sleep, whilst many chemicals in the brain are at very high levels, actually the chemical transmitters that are involved in the emotional flight, fright or fight response are actually significantly suppressed. But if you're having a strong nightmare again and again and again that really continues to cause these hormones or these neurotransmitters to be secreted, then that may make it difficult to stay asleep during this nightmare. And that's why the nightmare plays again and again. So out of this phenomenon, there has come the theory that actually REM sleep has a function

in terms of dissipating very strong emotions from memories. It allows us to remember those events, but perhaps removes the emotional context from them. And is it the REM sleep, so forgive me if I get this confused, but is it the REM sleep that we're having like the dreams that we remember more? Or is that the non-REM sleep? That's typically REM sleep. So when we wake from REM sleep,

we often have some dream recall. We used to call non-REM sleep, non-dreaming sleep, but actually that's incorrect we now know. And in fact, when people have conditions like sleepwalking or night terrors, people do sometimes recall little snippets of dreams. It's often little vignettes of scary visions, but they do dream of sorts in non-REM sleep. So what happens if we?

don't sleep at all or we just don't get enough of these periods of sleep that are really sort of, you know, helping our brains develop? Well, we now are beginning to understand the repercussions of sleep deprivation. We know that very limited sleep increases your risk of certain conditions like diabetes, high blood pressure, increases your risk of cardiovascular disease, can have a significant impact on your mood. And long-term disruption of sleep, and this may be to do with a disruption of our circadian rhythm, of our internal body clock,

seems to increase our risk of even conditions like cancer. But it's really important to stress that, and one of the things that I often see in my clinic, is that people come in with insomnia and say, I've read that this is going to cause me an early death. it's going to cause me to get demented, it's going to cause me to get cancer. But one of the fundamental issues that I think has been communicated very poorly is the fact that insomnia does not necessarily equate to sleep deprivation.

Insomnia can sometimes be as a result of a perception that you're not sleeping particularly well. If you have some slight insomnia, then actually, to some extent, your brain compensates by that. As I've already said, it promotes non-REM sleep, which seems to have a greater importance to our general health. And in fact, the other thing that I often see is people say, I slept very little last night, for example, when they've come in for a sleep study and we've stuck electrodes all over their scalp. And when you actually look at their sleep, they're actually sleeping periods of time that are not dissimilar to somebody without insomnia. So it's a much more complex area than just saying, well, look, if I'm not sleeping particularly well, or I've got a bit of insomnia, then that's going to put me at risk of all these conditions.

It sounds like there are, with sleep in general, there are a lot of different disorders and things that go on that have, you know, completely different symptoms and effects, but ultimately they're all centered around the same thing. And obviously in your book, there's a lot of case studies about these sort of issues and that sort of thing. What are the sort of things that you see commonly as someone who studies people with disorders of sleep? Well, I think the commonest disorder in the population is insomnia, which affects about one in 10 people on a chronic long-term basis. But actually, in terms of the things that we see in our NHS unit, it's primarily conditions like sleep apnea, like narcolepsy, which is a neurological disorder that really. results in a complete lack of regulation of sleep, but also other conditions like very prominent sleepwalking or people who act out their dreams.

So that's the thing. I was thinking these are the things that you hear about, but obviously you, unless you're experiencing or something, it's very hard to sort of get an idea of what's happening. And I know something like sleepwalking is you get these fanciful images of just people wandering around and opening the fridge or whatever. going downstairs. But what is happening? Why do people sleepwalk and how serious a problem can it be? Well, a lot of these conditions really have the same underlying origin. We used to think that the brain is either awake or asleep, and when it's asleep, the whole of the brain is in one particular stage

of sleep. And what we're now beginning to understand is actually that the brain, the sleeping brain, does not act as one unit. And it's quite possible for certain parts of your brain to be in very deep sleep while other parts of the brain are awake. For thinking, for planning, for consciousness, and for memory remain in very deep sleep. But other parts of the brain involved in movement and also an area of the brain called the limbic system, which is involved in emotion, actually exhibit wakefulness. So in a way, your two parts of the brain are detached from each other and allow these behaviors to arise in the middle of the night without any conscious control or any rational thinking.

Many of the other conditions that we see that are not sleepwalking are also examples of crossovers of overlaps between the different stages of wake and non-REM sleep or wake. and REM sleep. So things like sleep paralysis, for example, which is when people wake up but feel completely paralyzed for a few seconds or a few minutes. We know that in REM sleep, in rapid eye movement sleep, the body is completely paralyzed. The only muscles that continue to work are the muscles that control our eyes and the muscles that allow us to breathe. But when REM sleep is overlapping with wakefulness, then sometimes that paralysis that is a feature of REM sleep continues. That crossover that you say, is that similar to how, you know, we're in one place or another? Is that where we're remembering our dreams or is that where something that's happening?

Like obviously a lot of these things, it seems to be that there's a problem between the two sides, not marrying up, efficiently crossing over from one side to the other. The best metaphor for this is that we think that, we think that. we are very, very slick at changing the gears of our brain. We're a bit like a formula, one car, where you can go between the different gears very, very quickly. But actually, the reality is that we're probably like an old banger and that occasionally the gears grind and the switch between non-REM sleep and REM sleep or the switch between REM sleep and wakefulness or non-REM sleep and wakefulness actually is not quite so smooth. And it's when you get these two

states at the same time that it often results in these kinds of conditions. Is that why, is there anything that we can do to sort of, you know, grease the wheels as if to help us? To pour oil into the gearbox. Yeah, exactly. So I think it is about making sure that your sleep is as regular as possible, that there are as few extrinsic factors in your environment, or from a psychological perspective or from the behavior that you're undertaking surrounding sleep to prevent you, for example, waking up in a stage of sleep that you shouldn't do and to make your sleep as stable as possible. And a really good example of that is that we often see people who experience something called hypnagogic

or hypnopic hallucination. So these are people in whom they wake up from dreaming sleep. but their REM sleep continues into wakefulness. Now, sometimes that can manifest as sleep paralysis, but at other times it can manifest as hallucination, so often people in the room or out-of-body experiences, these kinds of things. And we think that these represent a continuation

of the processes of dreaming into wakefulness. We often see these conditions in people who have disrupted sleep patterns, who have a degree of insomnia or sleep restriction, and sometimes simply trying to regulate sleep and try and get a better night's sleep results in a resolution of these phenomena. It sounds eerily familiar to some of the things that I've had before, which I guess it's one thing.

You're probably not sleeping well enough, I think we need to work on your sleep. Yeah. That's actually one thing, like reading the book, there are a lot of things that, you know, on a person of life, I've had pretty bad sleep all my life, but like recognizing things here and there. Is that sort of something that you want to get when, you know, you publish the book to make people aware of things that actually

these things exist? Because obviously when you're asleep, it's a very sort of personal and private thing going on, so you don't really know what's normal and what's not. Yeah. So, so many, many of the patients that I see have gone for many, many years, either having difficulty getting a diagnosis or actually realizing that what they have, is a real phenomenon for which we can do something about. And so the power of these stories, and in many ways, it's what drove a lot of the people who were involved in the book, because everybody that I describe in the book

was actually involved in the writing of the book and actively participated in the telling of their story. And what drove them was really to try and communicate to other people who might be experiencing similar things out there, to know that they can ask for help. The people that you had that are in the book, they talk, you know, as you say, they want to get their stories out. Are there sort of certain things, are these like the most extreme cases of these that

you've seen, or are these just generally things that do exist that people just aren't aware of? I think some of the cases are very extreme. So if you consider the patient I describe who, you know, I describe, who, you consider the patient that I describe who was riding her motorbike in her sleep or the patient who was convicted of rape as a result of his sexomnia, those are obviously very extreme cases. But some of the other cases are fairly standard cases. So, for example, the people that I describe with narcolepsy or sleep apnea or insomnia, they're rather typical. And then there's something we can do about that.

Yes, most of these conditions, if they are not curable, they are treatable. Absolutely. Otherwise, there would be no point in simply giving people diagnoses. And I think I would feel very depressed in my clinic on an ongoing basis. So on that note, there's obviously a lot of things. There's obviously a few questions that probably come up quite a lot in your field of work. There must be things like, for instance, What are they and why do we get them?

I'm not sure that I can answer that in an hour podcast, never mind a couple of sentences. I think the short answer is we don't fully know what dreams are. There are lots of theories about why we dream, but none of those have been definitively proven. In the past, it was even postulated that dreams were simply, the byproduct, the garbage of various parts of the brain being activated. I think that that view is no longer very strongly held. And we think that probably dreams are a function of these various parts of the brain that are firing off at the same time, creating different connections between the various parts of the brain that is part of the underlying process, the underlying

function of REM sleep, be that the development of consciousness, modeling our world around us to a sort of virtual reality in which we practice to simply a function of learning or creativity. Does that mean that things like recurring dreams, they're the same parts that are firing over and over again working to improve them? Presumably, yes. I mean, you know, we talked earlier about the dreams of or the nightmares of post-traumatic stress disorder. And we, you know, we think that that is a function of essentially psychological healing in a way. So the removal of a very strong traumatic emotion from an experience that we've had. So, and this might come from a personal as opposed to a bigger thing.

But like, for instance, like some nightmares that I tend to find that, even though it's a fairly mundane thing happening in the dream, the nightmare is far more terrifying than it is in reality. Now, obviously, something that's happening in post-traumatic stress, that is a bad thing that's happening in reality. But is there any reason why our brains would be amplifying the sort of, the menace that's going on there in some way? Well, I don't know how to answer that.

That's a difficult question to answer. I think the short answer is we just don't know. So those big compendium books that we've had in the past saying this is what your dreams mean, they're nonsense really? Well, I think they're unprovable. And if you are, for example, a believer of Freudian theory, he would argue that dreams are a nightmare, are a censored form of your inner thoughts and that you require a psychotherapist in order to

interpret your dreams. I think that most of these views have been strongly discounted in recent years. And then, so also, how does your brain sort of responds to other factors that you might be doing to sort of help with sleeping? So, for instance, taking sleeping pills. Like, how does your brain respond to that and does that have like an effect that's that's long term in a way? Well, sleeping pills are essentially sedatives. So they don't, they don't mimic natural sleep. What they do is they lower the, sorry, what they do is they raise the threshold at which you would wake. And actually most sleeping tablets increase the amount of light non-REM sleep, but not the really deep sleep that your brain craves.

So they're not a mimic for natural sleep. And in fact, in recent years, we've become increasingly concerned about the long-term, the long-term and the short-term consequences of these tablets. So in the short term, we know that these tablets can often result in morning confusion or sedentation. They're associated with an increased risk of road traffic accidents, And in the elderly, they often cause people to have falls.

In the long term, there are some concerns that they may actually have a very deleterious consequence on the brain and may put you at risk of conditions like dementia. Although I think it's important to stress that it may be that there is an alternative explanation, that people who are in the very, very early stages of dementia may have an insomnia as part of the, that. And at the moment, that story has not been fully unravelled. Does that mean sleep disorders in some way can actually suggest that there are other problems happening or things that are happening in that, you know, you're more susceptible to something else? Absolutely. We now, for example, recognize that in some people who act out

their dreams, so in people in whom the normal paralysis that we get in REM sleep doesn't kick in properly, actually are at much higher risk of developing conditions like Parkinson's disease. And the reason for that, we think, is because the areas of the brain that are involved in generating the paralysis of REM sleep are often affected by the underlying neurological disorder that will in later life go on to develop more overt features of neurological dysfunction. And so we're now looking at patients with this condition called REM sleep. behavior disorder where people act out their REM dreams to see whether or not those people might be candidates for drugs that might modify the risk of Parkinson's disease. And in the world of

neurology, we're very aware now that many neurological disorders have subtle manifestations maybe years or even decades before they become more overt that are really important clues as to some sort of progressive neurological dysfunction. And sleep is one of those manifestations. So it's quite interesting to think that something that we think of so removed from one thing and another can actually have quite a good indicator of what's happening in your body and your brain in general. Yes. And I think that in a way, that is the case across the board in the world of neurology. So we know that how well you sleep or whether or not you've got a sleep disorder affects a really wide array of neurological conditions, some of which are extremely common, like, for example, a headache or epilepsy.

So we know that sleep disruption or sleep disturbance increases your likelihood of having seizures and is also a very potent trigger for conditions like migraine. What about things? So obviously there's been a lot of technology now that's come about. that's supposed to help you aid sleep or to track your sleep? Can sleep tech and apps and that sort of thing, can I actually help you get a better night's sleep or at least understand your sleep better? Well, I think that this is a very controversial area. We know that if you sleep normally, then actually these sleep trackers that are commercially available are becoming increasingly reliable in terms of measuring how much sleep we have. But if you're a normal,

sleeper, then you probably don't need those sleep tracking devices. And if you're a light sleeper or you have a sleep disorder, then these sleep trackers become increasingly unreliable. And in particular, their lack of reliability is the case when it comes to sleep stages. So a lot of these trackers will claim to say, well, they can tell the difference between deep sleep and light sleep and REM sleep and non-REM sleep. But if you have something going on with your sleep, that reliability drops off even further. And so the people who are using these sleep trackers are typically people who have sleep issues already. And sometimes seeing that in black and white, you know, that is presented as an accurate representation of your night's sleep,

can sometimes simply increase your anxiety about sleep and make your sleep even poorer. So I'm a very strong proponent of using these devices very cautiously. So, and then sort of that would be a good reason to say if you feel you need to use a device or an app or something to actually say maybe I need to speak to someone about it. Precisely. Are there any things that can have like a really positive effect on the quality of your sleep, whether you have a sleep disorder or not? We refer to behaviour surrounding sleep as sleep hygiene. And we know that sleep hygiene can make a huge difference to the. quality of sleep. And when we talk about sleep hygiene, we talk about things like the effects of

alcohol, the effects of nicotine, and the effects of other drugs that may influence our sleep. But we also are talking about things like avoidance of bright light in the evenings. We know that light, particularly light in the blue spectrum, which unfortunately a lot of electronic devices put out at very high levels, can have a really quite significant consequence. on your sleep. And the way that it does that is because there are direct connections between the back of your eye and your retina and the part of the brain that's responsible for your master clock, your circadian rhythm. And so bright light suppresses a hormone called melatonin, which is the brain signal to the rest of the brain and also the body that it's time to go to

sleep. We know that if you expose yourself to a burst of bright light in the evenings, it's very effective at suppressing your natural melatonin levels. And so it can have really quite significant consequences both on the quality of your sleep, but also on your internal body clock. It can push your internal body clock back and make it more difficult to get off to sleep at an appropriate time. So all of these things can have really quite significant impact on sleep quality and your ability to go to sleep at an appropriate time. So how long should it be really before, in the evening before I go to bed, when should I put my phone down, switch the tele off and just go screenless?

Well, if you are one of those fortunate individuals in whom sleep is a very easy occupation, then I don't think you need to worry about it. And I think that's the key thing, that you only need to worry about these things if you are a poor sleeper, if you're not, then don't worry about it. It's the same as caffeine. You know, there are some people who can drink an espresso before bed. and it actually has no impact whatsoever on their sleep. I wouldn't necessarily say stop drinking coffee.

It's only if you are having significant problems with sleep like insomnia that you need to worry about it. If you are a poor sleeper, then generally speaking, avoidance of bright light for at least a couple of hours or so before bed is the general recommendation. And then so what about if, what about something like exercise? Does that have a positive benefit? Well, we think that exercise certainly can in some individuals

improve the quality of sleep and increase the proportion of deep slow wave sleep. So exercise is generally recommended for people who are having sleep issues. Okay. And then so just a few, a couple more general questions. why is it that some people they can sleep for hours, like get to sleep very easily, sleep for a long time, and then wake up and still feel groggy, whereas there are some people who can just go for a relatively short amount of time

and feel, you know, sickeningly, sprightly in the morning? So we know that our sleep requirement is to a large extent genetically predetermined. and those genetic factors influence whether or not we're likely to have insomnia. They influence our own internal body clock. So there are genes that influence whether or not we're morning larks or evening owls. But it also to some extent defines our sleep requirement. So for example, I look after some families in whom everybody in the family only needs five. hours to feel refreshed, whereas other people, for example, need nine or even ten hours to feel refreshed.

But if you are having a very long sleep requirement and you're waking up unrefreshed, then that really does raise the possibility that you have an underlying sleep disorders. It suggests that there is something that might be disrupting the quality of your sleep or lessening the depth of your sleep and therefore those individuals should probably at least speak to their doctor to see if there's an obvious explanation. Is it something that can't be fixed with a good nap? Well, if you have a very long sleep opportunity and it is purely a function of the fact that you have a genetically long sleep requirement, then that may be fixable by sleeping a little bit more. Actually, it's much more likely that you may have a condition like, for example, sleep apnea,

where your breathing, your snoring disrupts the quality of your sleep, or that you have neurological disorders like a condition called periodic live movement disorder, which results in recurrent kicking at night that is disrupting the quality of your sleep. That was Dr. Guy Leshziner explaining what happens in our brain while we sleep. His book, The Nocturnal Brain, is out now. If you're looking for a little bedtime reading, the latest dish is, of BBC Science Focus is packed full of features, news and interviews to help you make sense of the world around you. In the July 2019 issue, we explore the lives of the Technicolored dinosaurs, meet the

scientist who wants to redefine masculinity, and find out the truth about CBD oil. And don't forget to go back and listen to one of our previous podcasts. We have more than 75 episodes of the Science Focus podcast, each of which is still well worth a listen. We think you'll really enjoy them, so be sure to let us know what you think in the comments and reviews. Thank you for listening to the Science Focus podcast from the BBC Science Focus magazine team. With the UK's best-selling sites and technology monthly, available in print and in several digital formats throughout the world. Find out more at sciencefocus.com or look out for us in your app store. This podcast is sponsored by name, audio and focal. The texture and emotional

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