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Balm of hurt minds: the search for a good night's sleep

The Doctor magazine
16 x 9

February 2020, Issue 18
LESCHZINER: The brain is 'the most incredible thing in the universe'

For Guy Leschziner’s patients, sleep is not a remission from their ills, but often where the trouble really starts. He tells Peter Blackburn about the things that go bump in the night in his study of sleep disorders

‘To be honest, I’ve seen most things.’

He’s right. Guy Leschziner’s patients include a woman who rode a motorbike while fast asleep, a man who would eat everything accessible, including blocks of lard, and wake up bloated and sick, and one who slit her own throat. Others have set their houses on fire, or committed crimes, all while supposedly restful and dreaming.

the doctor - sleep clinic

Dr Leschziner – the clinical lead at the sleep disorders centre, and clinical neurologist, at Guy’s and St Thomas’ NHS Foundation Trust – really has seen it all.

These experiences are now being shared with the wider world. Through a series of radio features, podcasts and books Dr Leschziner is helping to lift the veil of mystery around nocturnal habits.

 

Inspiration

Where did the draw to study sleep – and, ultimately, explain the science of sleep to thousands of readers and listeners – come from?

As a 14-year-old, Dr Leschziner set his heart on becoming a doctor: ‘As a kid I was always fascinated by science and biology. If I remember rightly, a cardiothoracic surgeon came into school and gave a lecture and I just thought, this is fascinating – this is a beautiful illustration of how the real world meets science, and this is something I want to do.’

It was Oliver Sacks – much-loved author of The Man Who Mistook His Wife For a Hat, who referred to the brain as ‘the most incredible thing in the universe’ – who inspired Dr Leschziner’s initial specialty of neurology.

‘I remember thinking it was absolutely fascinating how this lump of fatty tissue could define every aspect of us from a physical and psychological basis,’ Dr Leschziner says.

‘During my undergraduate degree I was asked to go away and write an essay on the functions of dreaming and it dawned on me that sleep had much more of a function than just making sure we aren’t tired in the morning.

‘After that I was lucky enough to train at Guy’s and St Thomas’ – one of the first sleep centres in the UK.’

 

Night rider

The sleep centre is a million miles from the daily chaos of emergency departments and hospital wards of most of the NHS in 2020. Every night, 10 patients are monitored – some for full polysomnography, where brainwaves, movements, heart rates and oxygen levels are tracked; their every move captured by infrared camera.

The diagnoses are varied and range from the common – sleep apnoea and narcolepsy – to the downright bizarre. In his book, The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep, Dr Leschziner vividly details the cases of patients such as Jackie who went for a moonlight motorbike ride, a woman who slit her throat and wrists with a kitchen knife and another young woman from Ireland who was found eight miles away from home with her handbag and keys, having walked all the way without shoes.

Dr Leschziner and others have recently discovered that being awake and being asleep is not an on-off situation – and, actually, while deep sleep and full wakefulness ‘lie at extremes of a spectrum… it is possible for us to be in both states at the same time’.

The Doctor magazine
16 x 9
February 2020, Issue 18

Some patients find their situations terrifying – and some amusing. Some of his cases involve gentle stories of sleepwalking kindness, such as Alex, who filled tumblers of water for each of his house mates, leaving them on their bedside tables, during the night. Some are more concerning, and can even involve perpetrating crimes.

There have been several cases where people have committed murder in their sleep. While Dr Leschziner admits in some cases the defence is a ‘convenient excuse’, he explains how the assessment is carried out.

‘You are looking for correlates on their sleep studies that at least suggest they have a propensity towards this type of event and then a lot of it is based on the history: have they gone to the doctor complaining about these issues and are there people in the family who say they do these kinds of things?’

 

The introspective society

It is a fascinating field – but much of the work is more common. And demand is booming thanks to a huge rise in the interest of the public in sleep – and the monetising of that interest by lots of companies that produce sleep trackers, or support services. ‘My own personal hope is there is a bit of a backlash to that,’ Dr Leschziner says.

The rise in interest correlates with a wider awareness of the importance of sleep, as well as an increasingly ‘introspective’ society. He says the anxiety that introspection brings can itself contribute to the deterioration in quality of sleep.

bed, sleep disorders

In recent years he has become a sounding board for thousands concerned about the quality of their sleep – or fascinated by the science behind what happens when we close our eyes and drift off.

Dr Leschziner presented a three-part radio series called Mysteries of Sleep, last year had his book on the secret world of sleep published and recently starred on a six-part podcast discussing sleep with comedian David Baddiel – ‘an extremely present, intelligent and likeable person’. He is also putting together a new three-part radio series for the BBC.

 

Provide answers

Talking about the topic in the public eye, and writing books, was never something Dr Leschziner had envisaged but nevertheless he says the process has been ‘extremely enjoyable’.

While that work continues, it is the work with patients that drives Dr Leschziner. Between 13,000 and 14,000 patients are admitted to the centre annually and they all need help with issues that may have dogged them for decades.

To an outsider it looks like a grim task – to put a label on night terrors or gripping insomnia – but while revelations about past trauma or diagnoses which require further treatment or life-changing equipment can be unhappy events, it is not a field where the news delivered is always bad.

As Dr Leschziner says: ‘There are lots of people who have been suffering greatly as a result of their conditions for many years. To find out it is a real condition and they have the prospect of treatment to improve their lives is often a major relief.’

 

An extract from Dr Leschziner’s book explains how the study of sleep disorders can improve everybody’s hours of slumber

We think of sleep as a tranquil act, when our minds are stilled and our brains are quiet. The act of sleeping is a passive one, and is associated with a blissful unconsciousness and the delight of waking refreshed. The only awareness we might have of something happening in the night are

the fragments of a dream. That is, at least, for most of us. But for many of the patients in my sleep clinic, their nights are anything but this. Rather, a night in the sleep laboratory, where I admit my patients to study their nocturnal behaviour, is punctuated by shouts, jerks, snores, twitches or even more dramatic goings-on, and the torture of poor or even no sleep at all.

The normal expectation of waking up feeling ready for the day ahead is rarely found among my patients, or indeed their partners. Their nights are tormented by a range of conditions, such as terrifying nocturnal hallucinations, sleep paralysis, acting out their dreams or debilitating insomnia.

The array of activities in sleep reflects the spectrum of human behaviour in our waking lives. Sometimes these medical problems have a biological explanation, at other times a psychological one, and the focus of the clinical work that I and my colleagues do is to unravel the causes for their sleep disorders and attempt to find a treatment or cure…

...So why is it that I’m writing about these patients? And, more importantly, why should you read about them?

Many of the stories that follow are about patients with extreme sleep disorders, at the very limits of the spectrum of human experience, and it is by studying these extremes that we can learn about the less severe end of the spectrum; by understanding how these patients are affected by their sleep disorders, we come to know a little about how we ourselves are affected by our sleep.

Doctors love stories; we love telling them and we love hearing them.

 

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