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Dr Guy Leschziner

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  1. Well, I think I can think of clinical situations where I've had to make very difficult decisions about whether or not to treat somebody or not to treat somebody, whether or not to Whether or not to give up on somebody or whether or not to continue working, you know, the sorts of situations like cardiac arrests, which all doctors have to face, personal decisions. You know, I think certainly making the decision to study medicine was an important fork in the road for me because medicine brings with it lots of amazing things and amazing experiences and we see through windows on life that very few other people get to see but it comes with it quite a lot of responsibilities and implications in terms of the future direction of your life. So I think there are different ways to answer that.

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  2. The honest answer is not very well No, I mean, you know, look, I try and have downtime and I try and get away and get out of London. But I think, you know, this was something that everybody in the NHS is currently facing. Everybody is feeling very, very burnt out.

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  3. Look, I think the problem is that particularly when you're sitting in a busy NHS clinic where you've got a very limited amount of time to see people is you're often very much focused on the problem that it's sitting in front of you. And by problem I mean the issue, the medical issue that is affecting that individual. Whereas writing these books and talking to these patients I think has given me much broader appreciation of what it is that we are actually doing. So in the NHS you kind of yes you see well look I'm treating that I'm diagnosing that I may be curing that but actually you see the much wider implications on those individuals when you are addressing their stories, their experiences in a much broader way.

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  4. So initially, he thought he was going slightly mad. He thought that actually, well, first of all, he thought that his You know, it's important to look after your hearing because it provides important inputs that maintain the health and the integrity of our brains. So there are lots of these aspects that you can take from clinical medicine and apply them to what it tells us about ourselves and how our own brains work.

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  5. They were depressed. And, you know, it is very clearly associated with changes in mood, smell and mood are very closely linked. You know, if you think about some of the other senses, so hearing, so people who experience auditory hallucinations or in the man who tastes words, actually I was very kindly bill Oddy agreed to talk to me and Bill has been experiencing musical hallucinations for many, many years. So everywhere he goes in his house, he will hear a soundtrack of music. And, you know, what the implications of that are.

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  6. So individuals who have lost their sense of smell or lost their sense of taste. Now, you know, you kind of think, well, I could live without my sense of smell, probably. It wouldn't be as quite a rich a world as I would like, but actually the implications of losing your sense of smell both in terms of memory. You know, you think how important smell is for memory for those sort of emotional memories that we have, you know, smelling your mother's perfume or a particular meal and taking you back directly to childhood and the impact of smell on emotion, on your mood, on depression is really underappreciated until you look at individuals who have lost their sense of smell. And that was particularly important over COVID because a lot of people were losing their sense of smell as part of COVID and didn't.

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  7. So she has lost her vision entirely and sees sometimes rather scary hallucinations as a result of that loss of vision. You know, what's really fascinating about her is that when she was asked by a doctor whether or not she'd want those treated because there are some things that we can do to try and improve those, she had to think very long and hard about it because she said, look, you know, at least I'm seeing something now, whether that is real or not. There is a comfort to seeing something and in the end decided that she didn't want it treated.

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  8. Oh, load. I mean, so much, you know, there are, you know, one woman who lost her vision as a result of multiple operations to her eye who sees visual hallucinations everywhere as she goes. You know, I think that very much illustrates the fact that our brain, even when it's starved of inputs, creates its own inputs because it's so eager to experience the world. You know, individuals in whom

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  9. Yes, and then you see somebody who has never experienced pain and see the impact it has on them. I think it makes you appreciate it in a slightly different way.

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  10. and there was no downside to it, yet he is now terribly physically scarred, doesn't really, you know, he have no comprehension of what pain is, so there is that disconnect between the human experience of pain, which is common to all of us and what he experiences, and I think that he feels that that is very much a barrier between him and understanding all the people around him, but it's also resulted in him being terribly damaged by the inability to feel pain.

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  11. So I think probably the one that Sits with me in the most emotional way. It's probably a young man that I met who has never been able to feel pain throughout his entire life from the moment that he was born and in fact he has a genetic disorder that was also inherited by two of his siblings and none of the three children have ever been able to experience pain. Now at first glance you kind of think oh that might be quite nice never to experience pain but meeting somebody like that and you realize quite how important pain is for our normal development for our normal lives. You know he tells stories of him and his sisters essentially holding their hands up to the fire to hear the sizzling of their hands because they thought it was funny. They didn't feel any pain. He would regularly jump off the roof of his garage in order to get attention because he knew that if he broke a limb he would end up in hospital being looked after by these nice nurses.

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  12. Psychotic, you know, ripping sinks off the wall in their hospital room, trashing their hospital room, attacking their nurses who actually, when that condition is treated, they've reverted to normality.

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  13. So I've certainly seen a lot of individuals. So I said at the start that one of the specialist clinics that I do is an epilepsy clinic. And there are anti-epileptic drugs that are well known in a very small proportion of individuals to cause a dramatic increase in irritability, anger and aggression. And, you know, I remember one of the earliest patients that I saw started on this drug was a very frail little old lady who must have been in her 70s and who was arrested by six police officers in her front garden being pinned down because she was so violent and aggressive. That's one example. For example, exhibit behavioral change after a seizure. I've seen individuals who have had autoimmune conditions at their brain who have become frankly

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  14. exhibit a dramatic change in their behaviour, and so a simple chemical taken tablet form can result in those changes of behavior. What about all of us? Are there things in our environment? Are there things that we are doing that influence the machinations of our brains? So do these kinds of behaviors then take a moral viewpoint or should we be looking at them from a biological perspective rather than a moral one?

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  15. Because it again reflects some of my clinical practice that I see individuals who have brain conditions that dramatically influence their behaviour. Now the question always in my mind is well firstly does this reflect their own morality and it's quite clear that in those individuals it doesn't but what are the implications for all of us and as you already said you know if that is the case for if a brain tumour can suddenly cause a dramatic change in behavior if a stroke can if Parkinson's disease can if a chemical change

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  16. indeed and you know and that's a really important question which is you know how much free will do all of us have if we are all essentially machines that are doing the bidding of our brains then anything that affects our brain function defines our behavior and you know the the book that is out in November very much discusses the neurological and psychological conditions that can influence our behavior in really rather dramatic ways you know be that you know from the perspective of gluttony or wrath or pride or any of the other seven deadly sins

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  17. I think it does. I think you only need to have a look on Twitter to see how differently different people perceive exactly the same situation.

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  18. world as we understand it. And that model of the world is influenced by our experiences, by our genes, by the structure and function of our brain. So it's not necessarily surprising given that we all have very different experiences in life, that we have different genes, that we will have gone through different things, that our truth may be very different from the truths of others, and that our experiences, our perceptions of the reality of the world may be very different.

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  19. I think what it tells us is that our Our reality what we perceive truth to be is intimately linked with the structure and the function of our brain. And whilst we all assume that people's experiences of the world, and by the way, the way that we interpret those experiences of the world are all identical, that is very far from the truth. And I think it gives us some insight given the fact that how we perceive reality even in the context of an entirely normal and entirely functioning nervous system is so predicated upon our experiences, is so predicated on our model of the world that the brain works as a prediction system. So it works by assessing whether or not what our senses are telling us or in keeping with what our expectation of the world is. So we need a model of...

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  20. Yes, so that is a form of synesia, and we know that synesia is much more common in people with autistic spectrum disorder than it is in individuals without neurodevelopmental disorders.

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  21. Another woman in that book who has synesia, she's a musician, and when she plays music she will see colours washing in and out of her vision. And so for her, every time she hears a piece of music that will be accompanied by a visual phenomenon, sometimes even a sensory phenomenon. So certain pieces of music or certain sounds will precipitate certain sensory experiences.

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  22. he learnt how to read by looking at the tube map on the way to school, and each of those tube stations has got a particular taste associated with it, and that taster has remained fixed throughout his life. Now this sounds really very strange, but actually we know that some degree of synesthesia, some degree of melding, of our senses is actually quite common that up to about four percent of individuals exhibit some form of synesthesia. And it really, I think, illustrates how in all of us our minds and our brains and our nervous systems work in slightly different ways to define our reality. And it's an exploration of how our nervous system can influence how we perceive reality to be and that truth may not always be what we perceive. There's another patient in that not a patient.

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  23. So one of the individuals in that book is an individual who is not a patient, who doesn't have anything wrong with him. He's got a condition called synesthesia, which is the melding, the combining of certain senses. So when he sees objects or hears objects, he gets a taste associated with them. So he gives a really good example of his in childhood his friend had a girlfriend whose particular name in him gave him an awful taste and he every time his friend mentioned this girl's name his mouth was filled with a terrible taste so he will read words, he will hear words and all of those words will be associated with a particular taste that has lasted his entire life and it's been very fixed so as a kid when he started reading.

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  24. Yeah, up to, and these drugs do help. Some individuals, as I would stipulate again, I would stress that drugs need to be used cautiously in the right individuals. So, you know, as I said, the odds are in your favor.

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  25. Well, I think that if you extrapolate on the basis of CBT. CBT based approaches. We know that helps about eighty percent of individuals.

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  26. So I would say that the odds are in your favour that there are some very effective treatments for insomnia, that it not always straightforward because insomnia interacts with a whole range of other conditions that may be affecting you, like your mood, like your anxiety levels, like what's happened in your past, and sometimes it requires a multipronged approach, but for the majority of individuals we can make sleep better. You know, one of the real big issues that a lot of people are seeking for rapid or instant answers to their insomnia, which is why a lot of people end up on drugs. That may not necessarily be the right approach for you. I would really countenance that the treatment of insomnia can in some individuals take some time.

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  27. Those make up the majority of individuals with insomnia, but there is a subgroup of individuals who say, well, you know, I sleep four hours a night or three hours a night, and they really do only sleep two or three hours a night. Now in those individuals who kind of have the feeling that they are sleeping very little, what we are actually beginning to understand is that there are some again some local changes in the way that the brain acts so that there are areas of the brain for example that might be responsible for awareness that don't switch off to the same extent at the rest of the brain. So whilst the majority of the brain may be sleeping those little areas of the brain that are responsible for our awareness at night for what's going on in our environment may not be switching off to quite the same extent. And so there's a sort of huge spectrum of what insomnia actually is.

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  28. So we know that, and going back to what I was saying about us being poor witnesses to our sleep, the majority of individuals who have insomnia, subjective insomnia, when you bring them into a sleep lab, they may be sleeping slightly shorter than normal based upon tracking of their brain waves, but probably don't sleep a huge amount less than normal individuals. It's their subjective experience of sleep that is impacted rather than the true duration of their sleep.

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  29. Yes, you know, I've got a patient who I don't see any more who I mention in my book who has driven several miles in her sleep and in fact has driven a motorbike in her youth in her sleep. And the only knowledge that she had was her landlady at the time said, where were you going at one o'clock in the morning, clutching your motorcle helmet? And she'd obviously been for a ride in the middle of the night without any recollection. I think this goes back to what we were talking about, which is, you know, are we half asleep? Are we a hundredth asleep? Are we a thousandth asleep? So in those kinds of situations, it's likely that actually the majority of the brain is probably awake because it's very hard to envisage how somebody may be able to do something quite so complicated when the majority of their brain is asleep. Crucially, the parts of the brain that remain asleep are the bits that are responsible for rational thinking. I mean, why would she have gone for a motorcycle ride in the middle of the night?

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  30. Long, long way. And apparently got a tyre iron out of the boot of his car, bludgeoned his mother-in-law to death and then tried to kill his father-in-law and ended up throwing him into a swimming pool. Now, this was made even more curious by the fact that there had been some evidence that he'd been having some financial difficulties and had had some discussions with his parents in law about financial issues, but it was deemed by a court of law that this happened whilst he was sleepwalking and he was actually acquitted. So this is a remarkable story. Now is it impossible for somebody to drive in their sleep no, I've seen it myself. It seems stretching credibility that somebody could have undertaken all of that whilst sleeping, but in accords of law he was found not guilty.

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  31. So, Kenneth Barks was a chap who was based in Ontario, who apparently in his sleep drove several miles to his parents in law's house twice.

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  32. I think both of those things. So first of all, is past behavior consistent with what has happened on that night in question? Secondly, are there any features about the event itself that suggests that there was an attempt to, for example, cover it up or a degree of pre-planning in order to commit that particular act? And also whether or not there can be evidence found by studying that individual sleep that they suffer from these kinds of sleep disorders.

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  33. is still in process. As I said, it's not in the UK, which is why I'm mentioning it. But there have been many examples of individuals who have been found not guilty as a result of a crime, including murder, having occurred in their sleep. Now, as I said, there is always a degree of uncertainty as to whether or not a particular event happened in sleep, but what in those individuals we can say is that there are many individuals who exhibit similar sorts of patterns of behaviour that have been clearly demonstrated to arise from sleep.

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  34. Were also some of the effects of these sleep disorders on people's lives is really dramatic, so I look after a large number of individuals with a condition called Klein Levin syndrome, which is a very poorly understood condition that often affects young kids and teenagers, and they will go through, they'll be fairly normal between episodes, and then during episodes they will be profoundly sleepy, sometimes sleeping 23, 24 hours a day, when they're awake, they're very confused, they exhibit very abnormal behavior, eating behavior, sexual behavior, and that can last for days or weeks out of the blue, which can have a massive impact on people's education, people's social lives, you know, how they're managing in the workplace. So these sorts of conditions can devastate people's lives.

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  35. I mean, I've seen a lot of very upsetting cases. I've seen individuals who have committed crimes in their sleep. So I was involved with somebody who, not in the UK, I would stress, who shot a family member in their sleep. I've seen individuals who have committed sexual assault in their sleep, but also Yes, somebody who was convicted for rape as a result of a sleep disorder. Now obviously, you know, one of the great difficulties is that you can never be absolutely sure whether during that particular episode they were in that that occurred during their sleep disorder, but what you can certainly say with a degree of certainty is that there is clear evidence that they have exhibited similar things that have definitively occurred out of their sleep.

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  36. From an evolutionary perspective, okay, so if you've had a traumatic event, say you were attacked by a lion. out in the wilds then obviously having a very very strong emotional association with the terror of being attacked by a lion is very important for you to avoid that again and to learn from that event but what you don't want is you don't want in the next time you see that lion to have such a strong emotional response to it that you can't do anything about it that you that you freeze That's not very good for your survival. So you want to learn from these very strong emotional events, but you don't want that emotion to be heightened to the same extent that it was during that original experience. So from an evolutionary perspective there is some rationale to that.

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  37. I think that's another unanswered question, but it's quite clear that that rapid transition between REM sleep and wake means that the memory of whatever it is that we've been experiencing has not been fully cleansed, has not been removed. Now that goes back to Matthew Walker's theory of REM, of dreaming as an emotional therapy, because the argument is that if you've experienced something that is so strongly driven by emotion, you know, you've had a very traumatic experience. And one of the reasons why you don't recover from that is because you are, when you're dreaming about that event, you will invariably wake up because the emotional content of that dream is so high, which is why these kind of recurrent nightmares are part and parcel of post traumatic stress disorder. You're never completing that process and you're never allowing.

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  38. I'm not sure that we're evolutionarily driven to have nightmares. I think that what nightmares represent is the fact that we've had these kind of mental experiences, but we've woken up to the extent that that nightmare has never been completed. Because usually we forget our dreams. You know, we all, almost all of us, go through four or five cycles of REM sleep a night. And so we're probably having dreams throughout the night, but most of us don't remember the vast majority of our dreams. We remember the dreams whereby we've woken directly out of REM's sleep.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  39. So Rem sleep is the stage of sleep that we most associate with dreaming, and it's the stage of sleep that is most associated with dreams of a narrative structure, so these kind of stories that evolve that have a plot. But actually, we know that lots of people dream in non-rem sleep as well. And you can see that in, for example, people who sleepwalk or have night terrors, they will often very clearly be able to remember dreams, but those events will have arisen from very deep non REM sleep. So we do dream in other stages as well.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  40. We spend a third of our lives in Rem sleep, and yet, and that drops off significantly as we get older, to the point where by the time, you know, we are elderly, we're doing very little REM sleep at all overnight. So this kind of rapid decline in the proportion and the amount of REM sleep that we are exhibiting has been explained by some individuals as it being fundamental to the development of consciousness, for example. So there's a chap called Hobson who is based in one of the Ivy League colleges in the States who was very keen on this idea that REM sleep is part of the early development of consciousness as we are inside our mother's womb and maybe fundamental subsequently to learning new things, to learning new motor tasks. The honest answer is I think that there's probably more than one function in fact many functions of REM sleep.

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  41. The short answer is I think we still don't know. I think there are lots and lots of theories about why we dream that those range from dreaming sleep being fundamental for memory, for reinforcing memories, for regulation. This view that dreaming sleep is sort of emotional rehabilitation, a form of emotional therapy. There are one of the unanswered questions is, for example, why when we are born or when we're in our mother's womb,

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  42. apostrophic hippocampus, whereas actually in these events there are other areas of the brain like the areas responsible for movement or for vision or emotion demonstrate waking activity both on an electrical basis but also on a metabolic basis as well.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  43. We may not be half asleep, but we could be a thousandth asleep or a hundredth asleep. And, you know, this idea that the brain can exist in different stages of sleep or wake at the same time, by the way, also extends to the nighttime. So, for example, in people who sleepwalk, who do really rather dramatic things, and I've seen patients, for example, who've driven in their sleep, one patient who rode a motorbike in her sleep. I've seen people do some incredibly complicated things like cooking a meal in their sleep. All of these sleepwalking type events relate to the fact that certain parts of the brain are in very deep sleep, whereas other parts of the brain actually demonstrate waking activity. So the bits of the brain that remain asleep are the frontal lobes, which are basically where our rational thinking, where our decision making occurs, and the pots of the brain that are responsible for memory.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  44. This is really significant not just on a day to day basis for all of us, but also in clinical medicine and clinical psychiatry.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  45. So, I don't think we can fully explain it. I think that there are certainly the areas of the brain that are responsible for emotion and emotional cognition are more metabolically active, and so may be more vulnerable to the effects of sleep deprivation. I think it is likely that when you're sleep deprived, there are some changes in terms of certain neurotransmitters within the brain that may exacerbate that. But what's very, very clear is that that association between sleep, mood, anxiety levels is very, very clear. And in fact, we see that, for example, in people with clinically significant anxiety or clinically significant depression, that actually treating anxiety or depression in somebody who is sleep deprived or has insomnia as much more difficult, that treating the insomnia in somebody who is anxious or depressed is much more difficult without addressing the anxiety and depression. And so this is

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  46. That particular bit of our brain, those islands tend to get slightly longer, the periods of silence get longer, and those islands become more widespread. So we're continent, even if you and I are talking, there are little areas of our brain that are constantly dipping in and out of sleep. But if we're very sleep deprived, actually that electrical silence of our cerebral cortex gets more extensive and more widespread, which is probably why, or at least one of the reasons why we decline from a cognitive perspective when we are very sleep deprived.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  47. So we would see on a gross level, on a sort of macro level, we would see that your brain is prioritizing very deep sleep over other stages of sleep at night. During the day, if you're chronically sleep deprived, using the techniques that we use in clinical practice, you would see very little. There is some increasing evidence that actually what is happening within our brains is that we are constantly showing little areas of our cerebral cortex, the outer lining of our brain, the bit of the brain that's responsible for our cognitive abilities, for example, that dip in and out of electrical silence, what has been termed local sleep, so that there are little islands of local sleep that are constantly occurring over our cerebral cortex whilst we're awake. And as we get more and more sleep deprived and depending on how much we use.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  48. So anecdotally magnesium can help some individuals. And anecdotally also magnesium is a very good treatment as testified to by some of my patients for conditions like restless leg syndrome. Brestus Leg syndrome is this sort of neurological disorder whereby people, and it's often associated with things like pregnancy or low iron levels, but it's under genetic control as well. People experience a number of different things. So the first thing is that they get an urge to move at night and it's typically at night rather than during the day, often associated with unpleasant sensations, that if they try and keep still that sensation builds and builds and builds until they have to move, that if they do move, they get some transient relief, and it's often associated with kicking at night in your sleep. It's very common, very common in pregnancy, very common in people who are anemic who've got problems with their kidneys, but it's common in the general population as well. And so for people with restless leg syndrome, magnesium does

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  49. What they can do in some individuals is they can encourage them to people to breathe through their mouth and breathe with their mouths open, which alters the position of the jaw and can create a bit more narrowing in the back of the throat. So for some individuals who have very prominent nasal congestion at night and who have evidence of sleep apnea sorting out their nasal congestion and correcting a deviated scepter may be one way of doing that, there is undoubtedly a rationale for sorting that out. I think that there are probably quite a few individuals who are having unnecessary operations.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT

  50. I think it's normal for us to have some asymmetry in our noses, and a lot of people have a deviated septum as a result of having broken their nose, for example. You know, I'm a little bit suspicious about operations for that kind of thing, unless there are very clear abnormalities that might be responsible for sleeping poorly. So one of the major issues, for example, in sleep apnea is sleep apnea, the obstruction is in the throat, it's not in the nose. And so issues with nasal pain.

    2024-07-01 · The Diary of a CEO · The Sleep Scientist (NEW RESEARCH): Sleeping Patterns Can Predict Future Diseases! Sleep Deprivation Is A Silent Killer! The Painful Trick To Fix Poor Sleep - Dr Guy Leschziner · IDENTIFIED FROM THE TRANSCRIPT