{"version":"1.0.0","segments":[{"startTime":0.43,"endTime":4.01,"body":"- I'm going to start this talk"},{"startTime":0.43,"endTime":4.01,"body":"in a slightly unusual place"},{"startTime":4.01,"endTime":5.38,"body":"in a talk about sleep,"},{"startTime":5.38,"endTime":7.14,"body":"and I'm going to talk about this man."},{"startTime":7.14,"endTime":9.56,"body":"Some of you will recognize this man,"},{"startTime":9.56,"endTime":11.77,"body":"this chap is called Phineas Gage,"},{"startTime":11.77,"endTime":16.62,"body":"and he was a worker on a construction gang"},{"startTime":16.62,"endTime":19.8,"body":"in New Hampshire, in 1848,"},{"startTime":19.8,"endTime":22.01,"body":"when he had an unfortunate mishap."},{"startTime":22.01,"endTime":23.41,"body":"One of his responsibilities"},{"startTime":23.41,"endTime":28.41,"body":"whilst creating a cutting"},{"startTime":23.41,"endTime":28.41,"body":"for a railway line"},{"startTime":28.73,"endTime":32.15,"body":"was to drill holes and"},{"startTime":28.73,"endTime":32.15,"body":"tamp down explosives"},{"startTime":32.15,"endTime":34.98,"body":"before blasting the hillside away."},{"startTime":34.98,"endTime":36.93,"body":"And unfortunately, on this fateful day,"},{"startTime":36.93,"endTime":38.55,"body":"he was a little bit too vigorous"},{"startTime":38.55,"endTime":39.96,"body":"in terms of his tamping down,"},{"startTime":39.96,"endTime":42.28,"body":"and he must have ignited the explosive"},{"startTime":42.28,"endTime":43.98,"body":"at the bottom of the hole"},{"startTime":43.98,"endTime":45.93,"body":"as he pushed this tamping iron,"},{"startTime":45.93,"endTime":48.55,"body":"this very heavy piece of iron,"},{"startTime":48.55,"endTime":50.48,"body":"down into the hole."},{"startTime":50.48,"endTime":52.22,"body":"Unfortunately, the tamping iron,"},{"startTime":52.22,"endTime":54.17,"body":"having ignited the explosive,"},{"startTime":54.17,"endTime":58.85,"body":"then pierced through his jaw"},{"startTime":58.85,"endTime":61.5,"body":"and flew out of the top of his head,"},{"startTime":61.5,"endTime":64.02,"body":"and after a brief seizure,"},{"startTime":64.02,"endTime":67.47,"body":"with the tamping iron flying"},{"startTime":64.02,"endTime":67.47,"body":"several yards through the air,"},{"startTime":67.47,"endTime":69.24,"body":"he then sat up."},{"startTime":69.24,"endTime":70.58,"body":"And the first doctor on the scene"},{"startTime":70.58,"endTime":72.96,"body":"gave this absolutely"},{"startTime":70.58,"endTime":72.96,"body":"grotesque description,"},{"startTime":72.96,"endTime":75.717,"body":"which I'm going to read to"},{"startTime":72.96,"endTime":75.717,"body":"you in an abbreviated form:"},{"startTime":75.717,"endTime":77.517,"body":"\"I first noticed the wound upon the head"},{"startTime":77.517,"endTime":79.147,"body":"\"before I alighted from my carriage,"},{"startTime":79.147,"endTime":82.17,"body":"\"the pulsations of the"},{"startTime":79.147,"endTime":82.17,"body":"brain being very distinct,\""},{"startTime":82.17,"endTime":84.837,"body":"doctors love this kind"},{"startTime":82.17,"endTime":84.837,"body":"of thing, so apologies."},{"startTime":84.837,"endTime":85.67,"body":"\"The top of the head"},{"startTime":85.67,"endTime":88.127,"body":"\"appeared somewhat like"},{"startTime":85.67,"endTime":88.127,"body":"an inverted funnel,"},{"startTime":88.127,"endTime":92.377,"body":"\"as if some wedge-shaped body"},{"startTime":88.127,"endTime":92.377,"body":"had passed from below, upward."},{"startTime":92.377,"endTime":94.567,"body":"\"He was relating the manner"},{"startTime":92.377,"endTime":94.567,"body":"in which he was injured,"},{"startTime":94.567,"endTime":96.427,"body":"\"I did not believe his statement."},{"startTime":96.427,"endTime":98.517,"body":"\"He got up and vomited, and as he did so,"},{"startTime":98.517,"endTime":99.837,"body":"\"the effort of vomiting"},{"startTime":99.837,"endTime":102.457,"body":"\"pressed about half a"},{"startTime":99.837,"endTime":102.457,"body":"tea cup full of brain,"},{"startTime":102.457,"endTime":104.2,"body":"\"which fell upon the floor,\""},{"startTime":104.2,"endTime":105.34,"body":"quite remarkable,"},{"startTime":105.34,"endTime":107.34,"body":"firstly remarkable that he even survived"},{"startTime":107.34,"endTime":109.48,"body":"and was talking immediately afterwards,"},{"startTime":109.48,"endTime":112.24,"body":"in those days, in the"},{"startTime":109.48,"endTime":112.24,"body":"era before antibiotics,"},{"startTime":112.24,"endTime":115.24,"body":"even more remarkable that"},{"startTime":112.24,"endTime":115.24,"body":"he went on to survive."},{"startTime":115.24,"endTime":117.29,"body":"And this is the nature of his injury,"},{"startTime":117.29,"endTime":119.06,"body":"you can see this reconstruction,"},{"startTime":119.06,"endTime":122.74,"body":"it passed under his cheek bone"},{"startTime":122.74,"endTime":125.61,"body":"and basically destroyed"},{"startTime":122.74,"endTime":125.61,"body":"an area of the brain"},{"startTime":125.61,"endTime":127.11,"body":"called the left frontal lobe."},{"startTime":127.11,"endTime":130.23,"body":"The reason why I'm telling"},{"startTime":127.11,"endTime":130.23,"body":"you this is because Mr. Gage"},{"startTime":130.23,"endTime":133.21,"body":"is one of the most famous"},{"startTime":130.23,"endTime":133.21,"body":"examples of a concept"},{"startTime":133.21,"endTime":135.29,"body":"in clinical neurology,"},{"startTime":135.29,"endTime":137.35,"body":"which is localization,"},{"startTime":137.35,"endTime":138.81,"body":"demonstrating that,"},{"startTime":138.81,"endTime":142.19,"body":"far from being this"},{"startTime":138.81,"endTime":142.19,"body":"sort of gelatinous mass"},{"startTime":142.19,"endTime":143.54,"body":"that does everything,"},{"startTime":143.54,"endTime":144.59,"body":"different parts of the brain,"},{"startTime":144.59,"endTime":146.71,"body":"in fact, different parts"},{"startTime":144.59,"endTime":146.71,"body":"of the nervous system"},{"startTime":146.71,"endTime":150.09,"body":"perform very distinct"},{"startTime":146.71,"endTime":150.09,"body":"and discreet functions."},{"startTime":150.09,"endTime":152.1,"body":"And the reason why Mr. Gage"},{"startTime":152.1,"endTime":154.96,"body":"is such a good illustration"},{"startTime":152.1,"endTime":154.96,"body":"of that is because,"},{"startTime":154.96,"endTime":157.14,"body":"in many ways, he was completely unchanged,"},{"startTime":157.14,"endTime":158.52,"body":"he could walk, he could talk,"},{"startTime":158.52,"endTime":161.0,"body":"he could do everything"},{"startTime":158.52,"endTime":161.0,"body":"that he could do before."},{"startTime":161.0,"endTime":163.79,"body":"But what had previously"},{"startTime":161.0,"endTime":163.79,"body":"been a God-fearing man,"},{"startTime":163.79,"endTime":168.23,"body":"somebody who didn't smoke,"},{"startTime":163.79,"endTime":168.23,"body":"didn't drink, didn't swear,"},{"startTime":168.23,"endTime":170.563,"body":"became this, basically,"},{"startTime":172.179,"endTime":177.179,"body":"a completely uncontrollable,"},{"startTime":172.179,"endTime":177.179,"body":"whoring, drinking, gambling man"},{"startTime":177.28,"endTime":179.15,"body":"who became extremely unpleasant."},{"startTime":179.15,"endTime":183.92,"body":"And if you believe some of the"},{"startTime":179.15,"endTime":183.92,"body":"statements of his coworkers"},{"startTime":183.92,"endTime":185.01,"body":"after this accident,"},{"startTime":185.01,"endTime":187.56,"body":"he was completely transformed,"},{"startTime":187.56,"endTime":189.89,"body":"demonstrating, in his case,"},{"startTime":189.89,"endTime":191.87,"body":"that the frontal lobe of the brain"},{"startTime":191.87,"endTime":196.87,"body":"is really responsible for"},{"startTime":191.87,"endTime":196.87,"body":"maintaining our social control,"},{"startTime":197.71,"endTime":200.93,"body":"our regulation, our rational"},{"startTime":197.71,"endTime":200.93,"body":"thinking, our behavior,"},{"startTime":200.93,"endTime":203.15,"body":"and really being a very, very good example"},{"startTime":203.15,"endTime":206.1,"body":"of this concept of localization."},{"startTime":206.1,"endTime":208.3,"body":"Now, why am I telling you all of this?"},{"startTime":208.3,"endTime":210.71,"body":"Well, what I'm going to try"},{"startTime":208.3,"endTime":210.71,"body":"and show you in this lecture"},{"startTime":210.71,"endTime":212.97,"body":"is that sleep is of the brain,"},{"startTime":212.97,"endTime":214.53,"body":"so it's derived from the brain,"},{"startTime":214.53,"endTime":216.94,"body":"it's by the brain, so"},{"startTime":214.53,"endTime":216.94,"body":"regulated by the brain,"},{"startTime":216.94,"endTime":219.26,"body":"and it's largely for the brain."},{"startTime":219.26,"endTime":222.17,"body":"Now, I'm not the person who"},{"startTime":219.26,"endTime":222.17,"body":"first came up with that quote,"},{"startTime":222.17,"endTime":225.67,"body":"this relates to a very famous psychiatrist"},{"startTime":225.67,"endTime":226.9,"body":"in the world of sleep medicine"},{"startTime":226.9,"endTime":229.15,"body":"based in Harvard,"},{"startTime":229.15,"endTime":230.43,"body":"but what I'm going to show you"},{"startTime":230.43,"endTime":233.45,"body":"is that many of the sleep"},{"startTime":230.43,"endTime":233.45,"body":"disorders that we see"},{"startTime":234.52,"endTime":236.22,"body":"result from lesions of the brain,"},{"startTime":236.22,"endTime":237.65,"body":"and by lesions, once again,"},{"startTime":237.65,"endTime":241.33,"body":"I mean damage, or injury, or illness"},{"startTime":241.33,"endTime":244.07,"body":"that is related to a"},{"startTime":241.33,"endTime":244.07,"body":"particular part of the brain"},{"startTime":244.07,"endTime":245.93,"body":"or the nervous system."},{"startTime":245.93,"endTime":248.11,"body":"These lesions that we"},{"startTime":245.93,"endTime":248.11,"body":"see in sleep disorders"},{"startTime":248.11,"endTime":250.85,"body":"are not necessarily quite as striking"},{"startTime":250.85,"endTime":253.08,"body":"as a big, heavy tamping iron,"},{"startTime":253.08,"endTime":255.48,"body":"sometimes they are transient,"},{"startTime":255.48,"endTime":256.82,"body":"sometimes they're functional,"},{"startTime":256.82,"endTime":257.653,"body":"by which I mean"},{"startTime":257.653,"endTime":259.67,"body":"they're related to changes"},{"startTime":257.653,"endTime":259.67,"body":"in brain chemistry,"},{"startTime":259.67,"endTime":262.52,"body":"or changes in electrical"},{"startTime":259.67,"endTime":262.52,"body":"activity within the brain,"},{"startTime":262.52,"endTime":264.2,"body":"and sometimes they're microscopic,"},{"startTime":264.2,"endTime":265.9,"body":"but they are lesions nonetheless,"},{"startTime":265.9,"endTime":268.2,"body":"a little bit like that tamping iron."},{"startTime":268.2,"endTime":270.62,"body":"I'm also going to go on to show you"},{"startTime":270.62,"endTime":272.38,"body":"what lesioning of sleep itself,"},{"startTime":272.38,"endTime":275.73,"body":"so destroying sleep, or"},{"startTime":272.38,"endTime":275.73,"body":"somehow impairing sleep,"},{"startTime":275.73,"endTime":277.21,"body":"also does to the brain,"},{"startTime":277.21,"endTime":279.01,"body":"because that gives us some insights"},{"startTime":279.01,"endTime":280.77,"body":"into what the function of sleep,"},{"startTime":280.77,"endTime":284.123,"body":"or the functions of sleep really are."},{"startTime":287.01,"endTime":288.95,"body":"We used to think of wake and sleep"},{"startTime":288.95,"endTime":291.0,"body":"as being these entirely separate states."},{"startTime":291.0,"endTime":294.32,"body":"I've actually, rather"},{"startTime":291.0,"endTime":294.32,"body":"in a prescient manner,"},{"startTime":294.32,"endTime":295.91,"body":"I've put in a picture of the Berlin Wall,"},{"startTime":295.91,"endTime":297.46,"body":"which seems to be coming back,"},{"startTime":297.46,"endTime":300.73,"body":"separating the west of wake"},{"startTime":297.46,"endTime":300.73,"body":"from the east of sleep."},{"startTime":300.73,"endTime":302.69,"body":"And historically, it's been put about"},{"startTime":302.69,"endTime":305.06,"body":"that sleep is essentially a little death."},{"startTime":305.06,"endTime":305.893,"body":"But of course,"},{"startTime":305.893,"endTime":307.43,"body":"we've known that that's not the case,"},{"startTime":307.43,"endTime":311.03,"body":"it's not that everything"},{"startTime":307.43,"endTime":311.03,"body":"switches off when we go to sleep."},{"startTime":311.03,"endTime":313.55,"body":"In fact, this is one of"},{"startTime":311.03,"endTime":313.55,"body":"the earliest descriptions"},{"startTime":313.55,"endTime":315.18,"body":"that really gives us an illustration"},{"startTime":315.18,"endTime":318.47,"body":"of the knowledge that"},{"startTime":315.18,"endTime":318.47,"body":"something goes on in sleep."},{"startTime":318.47,"endTime":320.98,"body":"This is something called"},{"startTime":318.47,"endTime":320.98,"body":"the \"Egyptian Dream Book,\""},{"startTime":320.98,"endTime":324.26,"body":"it's a papyrus that resides"},{"startTime":320.98,"endTime":324.26,"body":"within the British Library"},{"startTime":324.26,"endTime":327.47,"body":"dating back to about 1220-1230 BC,"},{"startTime":327.47,"endTime":330.47,"body":"and in it are descriptions of 108 dreams"},{"startTime":330.47,"endTime":332.35,"body":"and their prophecies associated with them."},{"startTime":332.35,"endTime":335.43,"body":"So clearly, people were"},{"startTime":332.35,"endTime":335.43,"body":"already, at that stage,"},{"startTime":335.43,"endTime":338.6,"body":"interested in what the function of sleep,"},{"startTime":338.6,"endTime":340.62,"body":"or the function of dreaming was."},{"startTime":340.62,"endTime":342.28,"body":"It was actually this man, Sigmund Freud,"},{"startTime":342.28,"endTime":345.36,"body":"who tried to apply some"},{"startTime":342.28,"endTime":345.36,"body":"scientific rationale"},{"startTime":345.36,"endTime":348.223,"body":"to the functions of sleep or dreaming."},{"startTime":349.3,"endTime":351.09,"body":"He may not have been entirely correct,"},{"startTime":351.09,"endTime":352.38,"body":"but this, in many ways,"},{"startTime":352.38,"endTime":356.873,"body":"was a landmark in the"},{"startTime":352.38,"endTime":356.873,"body":"field of sleep research."},{"startTime":358.91,"endTime":360.5,"body":"What we now know about sleep"},{"startTime":360.5,"endTime":362.88,"body":"is that it's not simply wake and sleep,"},{"startTime":362.88,"endTime":363.713,"body":"but actually,"},{"startTime":363.713,"endTime":366.16,"body":"that sleep comprises of"},{"startTime":363.713,"endTime":366.16,"body":"multiple different stages,"},{"startTime":366.16,"endTime":368.99,"body":"and this is largely thanks"},{"startTime":366.16,"endTime":368.99,"body":"to work by this chap,"},{"startTime":368.99,"endTime":370.61,"body":"Eugene Aserinsky,"},{"startTime":370.61,"endTime":372.15,"body":"who, in the 1950s,"},{"startTime":372.15,"endTime":374.16,"body":"was undertaking a PhD,"},{"startTime":374.16,"endTime":375.81,"body":"and as many PhDs go,"},{"startTime":375.81,"endTime":377.343,"body":"it was rather successful."},{"startTime":378.319,"endTime":381.72,"body":"He kept on being sent"},{"startTime":378.319,"endTime":381.72,"body":"away by his supervisor,"},{"startTime":381.72,"endTime":383.63,"body":"failing to do the tasks that he was set,"},{"startTime":383.63,"endTime":387.28,"body":"until the supervisor, in"},{"startTime":383.63,"endTime":387.28,"body":"a degree of exasperation,"},{"startTime":387.28,"endTime":388.113,"body":"basically said,"},{"startTime":388.113,"endTime":390.66,"body":"well look, I'm doing some"},{"startTime":388.113,"endTime":390.66,"body":"studies on sleeping babies,"},{"startTime":390.66,"endTime":392.59,"body":"go and record their sleep."},{"startTime":392.59,"endTime":395.67,"body":"And he went away and started recording"},{"startTime":395.67,"endTime":398.95,"body":"the muscle activity and"},{"startTime":395.67,"endTime":398.95,"body":"the brainwaves of babies."},{"startTime":398.95,"endTime":401.96,"body":"And what he showed was"},{"startTime":398.95,"endTime":401.96,"body":"that, throughout the night,"},{"startTime":401.96,"endTime":404.33,"body":"the brainwaves of these sleeping babies"},{"startTime":404.33,"endTime":406.123,"body":"changed rather dramatically."},{"startTime":407.863,"endTime":410.25,"body":"At the bottom of the slide,"},{"startTime":410.25,"endTime":413.2,"body":"you'll see these rather large waves,"},{"startTime":413.2,"endTime":415.63,"body":"these slow brainwaves,"},{"startTime":415.63,"endTime":418.57,"body":"that really are a function"},{"startTime":415.63,"endTime":418.57,"body":"of the brain slowing down,"},{"startTime":418.57,"endTime":422.26,"body":"and represent what we now"},{"startTime":418.57,"endTime":422.26,"body":"know as non-REM sleep."},{"startTime":422.26,"endTime":426.0,"body":"But interspersed with this"},{"startTime":422.26,"endTime":426.0,"body":"slowing of the brain activity,"},{"startTime":426.0,"endTime":428.8,"body":"there were also these periods"},{"startTime":426.0,"endTime":428.8,"body":"of time where the brain,"},{"startTime":428.8,"endTime":430.83,"body":"and you can see right at the bottom there,"},{"startTime":430.83,"endTime":432.1,"body":"there is a slight flattening,"},{"startTime":432.1,"endTime":433.04,"body":"a slight increase"},{"startTime":433.04,"endTime":436.03,"body":"in the frequency of those"},{"startTime":433.04,"endTime":436.03,"body":"oscillations of the brainwaves,"},{"startTime":436.03,"endTime":438.78,"body":"that are a feature of what"},{"startTime":436.03,"endTime":438.78,"body":"we now term REM sleep,"},{"startTime":438.78,"endTime":440.09,"body":"rapid eye movement sleep,"},{"startTime":440.09,"endTime":441.35,"body":"which is the stage of sleep"},{"startTime":441.35,"endTime":443.44,"body":"that we most associate with dreaming."},{"startTime":443.44,"endTime":444.92,"body":"And it's during this stage of sleep"},{"startTime":444.92,"endTime":446.82,"body":"that the eyes move back and forth,"},{"startTime":446.82,"endTime":449.32,"body":"the brainwaves actually"},{"startTime":446.82,"endTime":449.32,"body":"look rather similar"},{"startTime":449.32,"endTime":451.18,"body":"to the brainwaves of somebody who's awake,"},{"startTime":451.18,"endTime":453.3,"body":"which is the top trace there."},{"startTime":453.3,"endTime":455.89,"body":"And whilst the brain appears to be awake,"},{"startTime":455.89,"endTime":458.99,"body":"physically, we are completely paralyzed,"},{"startTime":458.99,"endTime":460.73,"body":"so something happens in REM sleep"},{"startTime":460.73,"endTime":464.17,"body":"that makes all our"},{"startTime":460.73,"endTime":464.17,"body":"skeletal muscles paralyzed."},{"startTime":464.17,"endTime":466.89,"body":"The only muscles that"},{"startTime":464.17,"endTime":466.89,"body":"continue to have some activity"},{"startTime":466.89,"endTime":467.86,"body":"are the diaphragm,"},{"startTime":467.86,"endTime":469.15,"body":"which obviously is important"},{"startTime":469.15,"endTime":470.4,"body":"from an evolutionary perspective,"},{"startTime":470.4,"endTime":472.95,"body":"otherwise we would all stop"},{"startTime":470.4,"endTime":472.95,"body":"breathing in our sleep,"},{"startTime":474.68,"endTime":476.9,"body":"and the muscles that"},{"startTime":474.68,"endTime":476.9,"body":"control our eye movement,"},{"startTime":476.9,"endTime":479.96,"body":"hence the term rapid eye movement sleep."},{"startTime":479.96,"endTime":483.53,"body":"And what research has"},{"startTime":479.96,"endTime":483.53,"body":"subsequently demonstrated"},{"startTime":483.53,"endTime":485.76,"body":"is that we continuously cycle through"},{"startTime":485.76,"endTime":488.48,"body":"these various stages of"},{"startTime":485.76,"endTime":488.48,"body":"sleep throughout the night,"},{"startTime":488.48,"endTime":489.8,"body":"and that the average adult,"},{"startTime":489.8,"endTime":492.24,"body":"you can see there in the top,"},{"startTime":492.24,"endTime":493.89,"body":"this is something called a hypnogram,"},{"startTime":493.89,"endTime":495.53,"body":"which is a graphical representation"},{"startTime":495.53,"endTime":497.68,"body":"of an average adult's night sleep,"},{"startTime":497.68,"endTime":500.51,"body":"we tend to cycle through the"},{"startTime":497.68,"endTime":500.51,"body":"different stages of sleep"},{"startTime":500.51,"endTime":503.07,"body":"roughly once every 90 minutes,"},{"startTime":503.07,"endTime":504.59,"body":"entering into REM sleep"},{"startTime":504.59,"endTime":506.43,"body":"approximately an hour"},{"startTime":504.59,"endTime":506.43,"body":"to an hour and a half"},{"startTime":506.43,"endTime":507.97,"body":"after sleep onset,"},{"startTime":507.97,"endTime":510.05,"body":"and then dipping in and out of REM sleep,"},{"startTime":510.05,"endTime":513.01,"body":"with the majority of our"},{"startTime":510.05,"endTime":513.01,"body":"very deep non-REM sleep,"},{"startTime":513.01,"endTime":515.13,"body":"this is the stage at which the brainwaves"},{"startTime":515.13,"endTime":517.44,"body":"are the slowest and largest amplitude,"},{"startTime":517.44,"endTime":518.77,"body":"in the first half of the night,"},{"startTime":518.77,"endTime":520.63,"body":"and the majority of REM sleep,"},{"startTime":520.63,"endTime":522.63,"body":"what we term dreaming sleep,"},{"startTime":522.63,"endTime":523.73,"body":"somewhat incorrectly,"},{"startTime":523.73,"endTime":526.15,"body":"because we do dream in"},{"startTime":523.73,"endTime":526.15,"body":"other stages of sleep,"},{"startTime":526.15,"endTime":527.5,"body":"in the latter half of the night."},{"startTime":527.5,"endTime":529.9,"body":"And you can see that"},{"startTime":527.5,"endTime":529.9,"body":"those red bars get longer"},{"startTime":529.9,"endTime":532.8,"body":"and constitute a higher"},{"startTime":529.9,"endTime":532.8,"body":"proportion of sleep"},{"startTime":532.8,"endTime":534.403,"body":"in the latter half of the night."},{"startTime":535.78,"endTime":538.13,"body":"So we now have these three stages,"},{"startTime":538.13,"endTime":541.08,"body":"we have wake, we have non-REM sleep,"},{"startTime":541.08,"endTime":543.19,"body":"which is what we traditionally"},{"startTime":541.08,"endTime":543.19,"body":"think of as sleep,"},{"startTime":543.19,"endTime":545.54,"body":"where the brain is a"},{"startTime":543.19,"endTime":545.54,"body":"little bit less active,"},{"startTime":545.54,"endTime":546.87,"body":"and then we have REM sleep,"},{"startTime":546.87,"endTime":548.12,"body":"where we're asleep,"},{"startTime":548.12,"endTime":550.793,"body":"but the brain seems to"},{"startTime":548.12,"endTime":550.793,"body":"be very active indeed."},{"startTime":552.22,"endTime":554.58,"body":"But it gets even more"},{"startTime":552.22,"endTime":554.58,"body":"complicated than that"},{"startTime":554.58,"endTime":559.17,"body":"because we have a series"},{"startTime":554.58,"endTime":559.17,"body":"of sleep disorders"},{"startTime":559.17,"endTime":561.32,"body":"that I think very much illustrate"},{"startTime":561.32,"endTime":563.6,"body":"that not all is quite so straightforward."},{"startTime":563.6,"endTime":566.94,"body":"I'm going to show you two"},{"startTime":563.6,"endTime":566.94,"body":"videos, of two individuals."},{"startTime":566.94,"endTime":569.99,"body":"It's important to stress that"},{"startTime":566.94,"endTime":569.99,"body":"both of these individuals"},{"startTime":569.99,"endTime":572.27,"body":"are in the deepest stages of sleep,"},{"startTime":572.27,"endTime":575.163,"body":"they're in what we term stage three sleep."},{"startTime":579.19,"endTime":582.35,"body":"The brainwaves in this"},{"startTime":579.19,"endTime":582.35,"body":"chap are very, very slow,"},{"startTime":582.35,"endTime":583.183,"body":"he clearly is,"},{"startTime":583.183,"endTime":586.29,"body":"on the basis of the brainwaves"},{"startTime":583.183,"endTime":586.29,"body":"that we're recording,"},{"startTime":586.29,"endTime":589.1,"body":"in the deepest stages of sleep,"},{"startTime":589.1,"endTime":591.883,"body":"but to all intents and"},{"startTime":589.1,"endTime":591.883,"body":"purposes, he looks awake,"},{"startTime":592.9,"endTime":593.853,"body":"he's moving around,"},{"startTime":595.69,"endTime":596.863,"body":"he's interacting with the wires"},{"startTime":596.863,"endTime":598.85,"body":"that are attached to his head,"},{"startTime":598.85,"endTime":601.05,"body":"he's interacting with the bed."},{"startTime":601.05,"endTime":603.28,"body":"I mean, he's clearly not"},{"startTime":601.05,"endTime":603.28,"body":"behaving entirely normally,"},{"startTime":603.28,"endTime":604.74,"body":"it's a bit of an odd thing to be doing"},{"startTime":604.74,"endTime":606.27,"body":"in the middle of the night,"},{"startTime":606.27,"endTime":608.093,"body":"but he is in very deep sleep."},{"startTime":610.16,"endTime":614.64,"body":"This next video is of a young child,"},{"startTime":614.64,"endTime":616.3,"body":"who is also in very deep sleep,"},{"startTime":616.3,"endTime":617.2,"body":"believe it or not."},{"startTime":618.05,"endTime":620.483,"body":"- No, mum, no!"},{"startTime":621.82,"endTime":623.167,"body":"Mum, stop,"},{"startTime":623.167,"endTime":625.59,"body":"mum, please, stop me!"},{"startTime":625.59,"endTime":628.895,"body":"If I press it, I'm going to die."},{"startTime":628.895,"endTime":629.728,"body":"- [Mother] No, you're not going to die."},{"startTime":629.728,"endTime":630.913,"body":"- No, yes I am!"},{"startTime":630.913,"endTime":632.085,"body":"- [Mother] No you're not, sweetheart."},{"startTime":632.085,"endTime":632.918,"body":"- No!"},{"startTime":634.92,"endTime":636.656,"body":"- [Guy] So he's clearly interacting"},{"startTime":636.656,"endTime":638.14,"body":"(child screams)"},{"startTime":638.14,"endTime":639.76,"body":"not in an entirely appropriate way."},{"startTime":639.76,"endTime":641.133,"body":"- Please stop it!"},{"startTime":642.73,"endTime":644.1,"body":"But his brainwaves, once again,"},{"startTime":644.1,"endTime":645.42,"body":"show that he's in very deep sleep."},{"startTime":645.42,"endTime":646.47,"body":"So how do we explain this,"},{"startTime":646.47,"endTime":647.98,"body":"how can we explain the fact"},{"startTime":647.98,"endTime":649.67,"body":"that people in very deep sleep"},{"startTime":649.67,"endTime":652.01,"body":"can exhibit these kinds of behaviors?"},{"startTime":652.01,"endTime":653.67,"body":"Well, what these represent"},{"startTime":653.67,"endTime":656.54,"body":"are a range of conditions"},{"startTime":653.67,"endTime":656.54,"body":"called non-REM parasomnias."},{"startTime":656.54,"endTime":658.74,"body":"These are a spectrum of behaviors"},{"startTime":658.74,"endTime":660.4,"body":"that arise from very deep sleep,"},{"startTime":660.4,"endTime":661.79,"body":"as I've already said,"},{"startTime":661.79,"endTime":663.41,"body":"and they can range dramatically."},{"startTime":663.41,"endTime":667.11,"body":"They include sleeptalking,"},{"startTime":663.41,"endTime":667.11,"body":"confusional arousal,"},{"startTime":667.11,"endTime":669.24,"body":"so that's the first video that we saw,"},{"startTime":669.24,"endTime":670.65,"body":"where that chap sat up"},{"startTime":670.65,"endTime":672.94,"body":"and started looking"},{"startTime":670.65,"endTime":672.94,"body":"around, with his eyes open,"},{"startTime":672.94,"endTime":673.84,"body":"sleep terrors,"},{"startTime":673.84,"endTime":676.223,"body":"which is what we saw in that young child,"},{"startTime":677.1,"endTime":679.14,"body":"people can sometimes sleep-eat,"},{"startTime":679.14,"endTime":680.96,"body":"so they can get up in"},{"startTime":679.14,"endTime":680.96,"body":"the middle of the night,"},{"startTime":680.96,"endTime":682.06,"body":"they can cook,"},{"startTime":682.06,"endTime":685.06,"body":"they can often eat things that"},{"startTime":682.06,"endTime":685.06,"body":"are completely inappropriate,"},{"startTime":686.14,"endTime":689.41,"body":"the things that come to mind"},{"startTime":686.14,"endTime":689.41,"body":"are raw food, or bird seed,"},{"startTime":689.41,"endTime":691.5,"body":"or sometimes things that they"},{"startTime":689.41,"endTime":691.5,"body":"shouldn't be eating at all"},{"startTime":691.5,"endTime":693.04,"body":"that are highly toxic,"},{"startTime":693.04,"endTime":694.53,"body":"sexual behaviors in sleep,"},{"startTime":694.53,"endTime":696.18,"body":"a condition called sexsomnias,"},{"startTime":696.18,"endTime":697.74,"body":"and of course sleepwalking,"},{"startTime":697.74,"endTime":699.99,"body":"occasionally even very complex behaviors"},{"startTime":699.99,"endTime":702.86,"body":"like sleep-driving or sleep-motorbiking,"},{"startTime":702.86,"endTime":705.75,"body":"I've had patients who have"},{"startTime":702.86,"endTime":705.75,"body":"rewired electrical gadgets"},{"startTime":705.75,"endTime":707.563,"body":"in the middle of the"},{"startTime":705.75,"endTime":707.563,"body":"night without any memory,"},{"startTime":708.52,"endTime":712.34,"body":"so these can be very,"},{"startTime":708.52,"endTime":712.34,"body":"very complex behaviors."},{"startTime":712.34,"endTime":714.29,"body":"They typically arise in the"},{"startTime":712.34,"endTime":714.29,"body":"first half of the night,"},{"startTime":714.29,"endTime":715.15,"body":"because that's when we do"},{"startTime":715.15,"endTime":717.15,"body":"the majority of our very deep sleep,"},{"startTime":717.15,"endTime":718.27,"body":"and as you've seen,"},{"startTime":718.27,"endTime":720.85,"body":"the eyes are typically open,"},{"startTime":718.27,"endTime":720.85,"body":"there's complex speech,"},{"startTime":720.85,"endTime":724.1,"body":"people often interact"},{"startTime":720.85,"endTime":724.1,"body":"with their environment,"},{"startTime":724.1,"endTime":725.04,"body":"or with people in the room,"},{"startTime":725.04,"endTime":727.82,"body":"not in an entirely appropriate way,"},{"startTime":727.82,"endTime":732.26,"body":"people often have no recollection"},{"startTime":727.82,"endTime":732.26,"body":"at all over these events,"},{"startTime":732.26,"endTime":733.573,"body":"they're difficult to wake,"},{"startTime":734.55,"endTime":735.383,"body":"although occasionally,"},{"startTime":735.383,"endTime":737.77,"body":"they will have some fragments of memory"},{"startTime":737.77,"endTime":739.41,"body":"that something is happening"},{"startTime":739.41,"endTime":741.5,"body":"that is appropriate to"},{"startTime":739.41,"endTime":741.5,"body":"what they were doing."},{"startTime":741.5,"endTime":744.653,"body":"So how do we explain"},{"startTime":741.5,"endTime":744.653,"body":"these kinds of events?"},{"startTime":745.96,"endTime":748.853,"body":"In a rather remarkable study from 2000,"},{"startTime":749.74,"endTime":752.97,"body":"some researchers in Switzerland"},{"startTime":752.97,"endTime":754.75,"body":"managed to get a sleepwalker"},{"startTime":754.75,"endTime":757.5,"body":"into a type of scanner"},{"startTime":754.75,"endTime":757.5,"body":"called a SPECT scanner."},{"startTime":757.5,"endTime":758.65,"body":"What this scanner involves"},{"startTime":758.65,"endTime":760.68,"body":"is giving somebody an injection"},{"startTime":760.68,"endTime":765.02,"body":"of a radioisotope-labeled tracer,"},{"startTime":765.02,"endTime":767.0,"body":"and whilst they're having"},{"startTime":765.02,"endTime":767.0,"body":"one of these events,"},{"startTime":767.0,"endTime":768.61,"body":"this tracer doesn't last for very long,"},{"startTime":768.61,"endTime":770.0,"body":"only a few seconds,"},{"startTime":770.0,"endTime":772.42,"body":"and they somehow managed to"},{"startTime":770.0,"endTime":772.42,"body":"get this chap into the scanner"},{"startTime":772.42,"endTime":773.36,"body":"and give him the injection"},{"startTime":773.36,"endTime":775.76,"body":"within a few seconds"},{"startTime":773.36,"endTime":775.76,"body":"of the event starting."},{"startTime":775.76,"endTime":778.21,"body":"And what they demonstrated"},{"startTime":775.76,"endTime":778.21,"body":"was rather remarkable,"},{"startTime":778.21,"endTime":780.21,"body":"that when you look at this tracer,"},{"startTime":780.21,"endTime":782.7,"body":"which is really a measure"},{"startTime":780.21,"endTime":782.7,"body":"of brain activity,"},{"startTime":782.7,"endTime":784.58,"body":"of metabolic activity of the brain,"},{"startTime":784.58,"endTime":787.1,"body":"what they demonstrated was that,"},{"startTime":787.1,"endTime":788.07,"body":"in the top slide,"},{"startTime":788.07,"endTime":791.06,"body":"they showed increased activity"},{"startTime":791.06,"endTime":792.97,"body":"in an area of the brain"},{"startTime":791.06,"endTime":792.97,"body":"called the cerebellum,"},{"startTime":792.97,"endTime":795.37,"body":"which is fundamental to movement,"},{"startTime":795.37,"endTime":797.16,"body":"and in a very deep part of the brain"},{"startTime":797.16,"endTime":800.17,"body":"which is called the cingulate cortex,"},{"startTime":800.17,"endTime":801.39,"body":"which is a part of the brain"},{"startTime":801.39,"endTime":803.56,"body":"that's responsible for emotions."},{"startTime":803.56,"endTime":804.87,"body":"So increased activity,"},{"startTime":804.87,"endTime":808.47,"body":"suggesting that there were"},{"startTime":804.87,"endTime":808.47,"body":"certain parts of the brain"},{"startTime":808.47,"endTime":811.2,"body":"that seemed to be more"},{"startTime":808.47,"endTime":811.2,"body":"awake than they should be."},{"startTime":811.2,"endTime":812.32,"body":"What they also demonstrated"},{"startTime":812.32,"endTime":813.92,"body":"was that other parts of the brain,"},{"startTime":813.92,"endTime":815.39,"body":"particularly the frontal lobes,"},{"startTime":815.39,"endTime":816.223,"body":"and you'll remember"},{"startTime":816.223,"endTime":818.81,"body":"the frontal lobes are responsible"},{"startTime":816.223,"endTime":818.81,"body":"for rational thinking,"},{"startTime":818.81,"endTime":822.41,"body":"for control, for planning,"},{"startTime":818.81,"endTime":822.41,"body":"for executive function,"},{"startTime":822.41,"endTime":823.82,"body":"seemed to be asleep,"},{"startTime":823.82,"endTime":827.59,"body":"really suggesting that what is"},{"startTime":823.82,"endTime":827.59,"body":"happening during these events"},{"startTime":827.59,"endTime":829.11,"body":"is that part of the brain"},{"startTime":829.11,"endTime":831.09,"body":"appears to be more"},{"startTime":829.11,"endTime":831.09,"body":"awake than it should be,"},{"startTime":831.09,"endTime":834.74,"body":"and other parts of the"},{"startTime":831.09,"endTime":834.74,"body":"brain maintain sleepiness,"},{"startTime":834.74,"endTime":836.37,"body":"suggesting that, actually,"},{"startTime":836.37,"endTime":841.37,"body":"sleep is not even a simple"},{"startTime":836.37,"endTime":841.37,"body":"case of non-REM sleep or wake,"},{"startTime":841.65,"endTime":844.29,"body":"but actually that different"},{"startTime":841.65,"endTime":844.29,"body":"parts of the brain can exist"},{"startTime":844.29,"endTime":848.37,"body":"in different stages of sleep"},{"startTime":844.29,"endTime":848.37,"body":"and wake simultaneously."},{"startTime":848.37,"endTime":850.57,"body":"And indeed, further"},{"startTime":848.37,"endTime":850.57,"body":"studies have been done."},{"startTime":850.57,"endTime":851.72,"body":"What we will sometimes do"},{"startTime":851.72,"endTime":854.4,"body":"in individuals with epilepsy, for example,"},{"startTime":854.4,"endTime":856.74,"body":"that we are considering doing surgery on,"},{"startTime":856.74,"endTime":859.46,"body":"we will implant electrodes"},{"startTime":856.74,"endTime":859.46,"body":"deep into their brain"},{"startTime":859.46,"endTime":861.1,"body":"in order to identify"},{"startTime":861.1,"endTime":864.14,"body":"precisely where the"},{"startTime":861.1,"endTime":864.14,"body":"epileptic seizure is arising"},{"startTime":864.14,"endTime":866.67,"body":"in order to guide further surgery."},{"startTime":866.67,"endTime":867.99,"body":"And in some studies"},{"startTime":867.99,"endTime":870.67,"body":"in individuals who've had"},{"startTime":867.99,"endTime":870.67,"body":"epilepsy and sleepwalking,"},{"startTime":870.67,"endTime":872.22,"body":"what they've clearly demonstrated"},{"startTime":872.22,"endTime":874.97,"body":"is that when you implant"},{"startTime":872.22,"endTime":874.97,"body":"electrodes deep into the brain,"},{"startTime":874.97,"endTime":876.64,"body":"you see something really similar."},{"startTime":876.64,"endTime":879.78,"body":"The SPECT scanner told us"},{"startTime":876.64,"endTime":879.78,"body":"about metabolic activity,"},{"startTime":879.78,"endTime":881.71,"body":"about physical activity,"},{"startTime":881.71,"endTime":883.49,"body":"the EEG, with those electrodes,"},{"startTime":883.49,"endTime":885.25,"body":"tells us about electrical activity."},{"startTime":885.25,"endTime":887.07,"body":"And what they've clearly demonstrated,"},{"startTime":887.07,"endTime":890.88,"body":"on the basis of the intracranial EEG,"},{"startTime":890.88,"endTime":892.85,"body":"is that something very similar occurs,"},{"startTime":892.85,"endTime":895.7,"body":"in that you can see,"},{"startTime":892.85,"endTime":895.7,"body":"on an electrical basis,"},{"startTime":895.7,"endTime":896.79,"body":"different parts of the brain"},{"startTime":896.79,"endTime":899.84,"body":"exist in different"},{"startTime":896.79,"endTime":899.84,"body":"stages of sleep and wake."},{"startTime":899.84,"endTime":902.96,"body":"So what we now think is going on"},{"startTime":904.0,"endTime":905.76,"body":"during these non-REM parasomnias,"},{"startTime":905.76,"endTime":908.5,"body":"is that there are particular"},{"startTime":905.76,"endTime":908.5,"body":"areas of the brain that,"},{"startTime":908.5,"endTime":910.41,"body":"in individuals who are predisposed"},{"startTime":910.41,"endTime":912.18,"body":"to these kinds of conditions,"},{"startTime":912.18,"endTime":913.41,"body":"and what you have to bear in mind"},{"startTime":913.41,"endTime":915.33,"body":"is that these conditions are very common,"},{"startTime":915.33,"endTime":917.13,"body":"about 20% of children"},{"startTime":917.13,"endTime":919.97,"body":"will have sleep terrors or sleepwalking,"},{"startTime":919.97,"endTime":923.54,"body":"this does not necessarily"},{"startTime":919.97,"endTime":923.54,"body":"demonstrate a pathological state,"},{"startTime":923.54,"endTime":926.29,"body":"it can be considered part"},{"startTime":923.54,"endTime":926.29,"body":"of normal brain development,"},{"startTime":926.29,"endTime":928.58,"body":"about 1% to 2% of individuals"},{"startTime":928.58,"endTime":932.33,"body":"continue to have these kinds"},{"startTime":928.58,"endTime":932.33,"body":"of events into adulthood,"},{"startTime":932.33,"endTime":935.6,"body":"but what we demonstrate"},{"startTime":935.6,"endTime":938.25,"body":"is that whilst the areas of the brain"},{"startTime":938.25,"endTime":940.04,"body":"that are responsible for consciousness,"},{"startTime":940.04,"endTime":941.98,"body":"for awareness, for judgment,"},{"startTime":941.98,"endTime":942.95,"body":"remain asleep,"},{"startTime":942.95,"endTime":944.15,"body":"different parts of the brain,"},{"startTime":944.15,"endTime":945.96,"body":"particularly those areas of the brain"},{"startTime":945.96,"endTime":947.5,"body":"that are responsible for movement,"},{"startTime":947.5,"endTime":950.11,"body":"that are responsible"},{"startTime":947.5,"endTime":950.11,"body":"for reward and emotions,"},{"startTime":950.11,"endTime":951.67,"body":"which is why, sometimes,"},{"startTime":951.67,"endTime":954.88,"body":"these events have a very, very"},{"startTime":951.67,"endTime":954.88,"body":"strong emotional component,"},{"startTime":954.88,"endTime":957.29,"body":"and the parts of the brain that"},{"startTime":954.88,"endTime":957.29,"body":"are responsible for memory,"},{"startTime":957.29,"endTime":958.69,"body":"like the hippocampus,"},{"startTime":958.69,"endTime":960.36,"body":"which is perhaps why"},{"startTime":960.36,"endTime":963.6,"body":"these events are very poorly remembered,"},{"startTime":963.6,"endTime":965.2,"body":"remain asleep."},{"startTime":965.2,"endTime":968.29,"body":"So sleep is not a universal brain state,"},{"startTime":968.29,"endTime":971.743,"body":"that's the first thing that"},{"startTime":968.29,"endTime":971.743,"body":"these kind of events tell us."},{"startTime":973.17,"endTime":975.94,"body":"So rather than thinking about"},{"startTime":975.94,"endTime":977.82,"body":"these three discrete brain states,"},{"startTime":977.82,"endTime":979.12,"body":"actually, what we should be thinking of"},{"startTime":979.12,"endTime":980.76,"body":"is that there is a degree of overlap"},{"startTime":980.76,"endTime":982.1,"body":"between these three brain states."},{"startTime":982.1,"endTime":984.61,"body":"And in fact, as I'm going"},{"startTime":982.1,"endTime":984.61,"body":"to go on to show you,"},{"startTime":984.61,"endTime":986.12,"body":"it's that these areas of overlap"},{"startTime":986.12,"endTime":988.57,"body":"that many of the sleep"},{"startTime":986.12,"endTime":988.57,"body":"disorders that we see,"},{"startTime":988.57,"endTime":990.53,"body":"and indeed many of the normal phenomena"},{"startTime":990.53,"endTime":993.4,"body":"that some of you may well have"},{"startTime":990.53,"endTime":993.4,"body":"experienced in your lives,"},{"startTime":993.4,"endTime":995.82,"body":"occur at these points"},{"startTime":993.4,"endTime":995.82,"body":"where there is an overlap"},{"startTime":995.82,"endTime":997.57,"body":"between the different brain states."},{"startTime":999.15,"endTime":1000.75,"body":"I use the term blurred lines"},{"startTime":1000.75,"endTime":1002.94,"body":"because we've actually known"},{"startTime":1002.94,"endTime":1006.78,"body":"that fairly complex organisms can exhibit"},{"startTime":1006.78,"endTime":1010.04,"body":"these kinds of different"},{"startTime":1006.78,"endTime":1010.04,"body":"brain states simultaneously"},{"startTime":1010.04,"endTime":1012.41,"body":"in that there are many animals,"},{"startTime":1012.41,"endTime":1014.01,"body":"particularly aquatic mammals,"},{"startTime":1014.01,"endTime":1017.02,"body":"and certain species of"},{"startTime":1014.01,"endTime":1017.02,"body":"birds and amphibians,"},{"startTime":1017.02,"endTime":1019.87,"body":"that demonstrate a phenomenon"},{"startTime":1017.02,"endTime":1019.87,"body":"called uni-hemispheric sleep,"},{"startTime":1019.87,"endTime":1022.47,"body":"so they can sleep with"},{"startTime":1019.87,"endTime":1022.47,"body":"one half of their brain"},{"startTime":1022.47,"endTime":1024.9,"body":"while the other half of"},{"startTime":1022.47,"endTime":1024.9,"body":"their brain is fully awake,"},{"startTime":1024.9,"endTime":1029.9,"body":"which allows animals to swim"},{"startTime":1024.9,"endTime":1029.9,"body":"and surface, to breathe,"},{"startTime":1030.2,"endTime":1031.97,"body":"particularly important"},{"startTime":1030.2,"endTime":1031.97,"body":"for aquatic mammals,"},{"startTime":1031.97,"endTime":1034.0,"body":"or to continue to fly"},{"startTime":1034.0,"endTime":1036.93,"body":"whilst sleeping with"},{"startTime":1034.0,"endTime":1036.93,"body":"one half of their brain."},{"startTime":1036.93,"endTime":1039.01,"body":"Uni-hemispheric sleep is"},{"startTime":1036.93,"endTime":1039.01,"body":"well recognized in animals,"},{"startTime":1039.01,"endTime":1042.28,"body":"it's never been recognized"},{"startTime":1039.01,"endTime":1042.28,"body":"in human beings,"},{"startTime":1042.28,"endTime":1043.41,"body":"but a recent paper"},{"startTime":1043.41,"endTime":1046.62,"body":"has suggested that we"},{"startTime":1043.41,"endTime":1046.62,"body":"do exhibit the ability"},{"startTime":1046.62,"endTime":1048.3,"body":"to be able to regulate sleep"},{"startTime":1048.3,"endTime":1051.23,"body":"in the different halves of"},{"startTime":1048.3,"endTime":1051.23,"body":"our brains differentially,"},{"startTime":1051.23,"endTime":1054.76,"body":"because if you take an"},{"startTime":1051.23,"endTime":1054.76,"body":"individual into a sleep lab,"},{"startTime":1054.76,"endTime":1058.17,"body":"which we do about 10 times"},{"startTime":1054.76,"endTime":1058.17,"body":"on every night of the week"},{"startTime":1058.17,"endTime":1059.8,"body":"over at Guy's Hospital,"},{"startTime":1059.8,"endTime":1061.65,"body":"people will invariably say,"},{"startTime":1061.65,"endTime":1063.81,"body":"I didn't sleep as I would at home"},{"startTime":1063.81,"endTime":1065.02,"body":"because I'm covered in wires"},{"startTime":1065.02,"endTime":1066.38,"body":"and I'm in a strange environment,"},{"startTime":1066.38,"endTime":1068.78,"body":"and this is termed the first-night effect,"},{"startTime":1068.78,"endTime":1070.99,"body":"people generally don't sleep quite as well"},{"startTime":1070.99,"endTime":1074.98,"body":"when they're in a new"},{"startTime":1070.99,"endTime":1074.98,"body":"environment for the first time,"},{"startTime":1074.98,"endTime":1077.16,"body":"but what this study demonstrated"},{"startTime":1077.16,"endTime":1080.72,"body":"is that individuals who are"},{"startTime":1077.16,"endTime":1080.72,"body":"brought into a sleep lab"},{"startTime":1080.72,"endTime":1081.94,"body":"for two nights"},{"startTime":1081.94,"endTime":1085.28,"body":"will differentially regulate"},{"startTime":1081.94,"endTime":1085.28,"body":"the depth of their sleep"},{"startTime":1085.28,"endTime":1087.28,"body":"in their dominant hemisphere."},{"startTime":1087.28,"endTime":1088.96,"body":"On the first night,"},{"startTime":1088.96,"endTime":1091.29,"body":"their very deep sleep,"},{"startTime":1091.29,"endTime":1094.82,"body":"which will be much less deep"},{"startTime":1091.29,"endTime":1094.82,"body":"in their dominant hemisphere"},{"startTime":1094.82,"endTime":1096.05,"body":"than it would be on the second night,"},{"startTime":1096.05,"endTime":1098.14,"body":"and it tends to normalize"},{"startTime":1096.05,"endTime":1098.14,"body":"on the second night,"},{"startTime":1098.14,"endTime":1100.86,"body":"suggesting that there"},{"startTime":1098.14,"endTime":1100.86,"body":"are some mechanisms there"},{"startTime":1100.86,"endTime":1104.27,"body":"that enable us to regulate the"},{"startTime":1100.86,"endTime":1104.27,"body":"different halves of the brain"},{"startTime":1104.27,"endTime":1105.5,"body":"in a different way,"},{"startTime":1105.5,"endTime":1106.42,"body":"even in humans."},{"startTime":1106.42,"endTime":1107.53,"body":"And this may, of course,"},{"startTime":1107.53,"endTime":1109.28,"body":"be an evolutionary hangover,"},{"startTime":1109.28,"endTime":1112.85,"body":"although one can understand"},{"startTime":1109.28,"endTime":1112.85,"body":"why that would be important,"},{"startTime":1112.85,"endTime":1114.48,"body":"because when you're in"},{"startTime":1112.85,"endTime":1114.48,"body":"a strange environment,"},{"startTime":1114.48,"endTime":1115.86,"body":"there may be threats there,"},{"startTime":1115.86,"endTime":1119.047,"body":"and therefore there is an"},{"startTime":1115.86,"endTime":1119.047,"body":"evolutionary imperative"},{"startTime":1119.047,"endTime":1122.77,"body":"to retain some increased"},{"startTime":1119.047,"endTime":1122.77,"body":"awareness over your environment"},{"startTime":1122.77,"endTime":1123.923,"body":"on that first night."},{"startTime":1126.61,"endTime":1128.18,"body":"Actually, it goes even further than that,"},{"startTime":1128.18,"endTime":1132.833,"body":"because we now are beginning"},{"startTime":1128.18,"endTime":1132.833,"body":"to understand that sleep,"},{"startTime":1132.833,"endTime":1135.5,"body":"not only is it not a"},{"startTime":1132.833,"endTime":1135.5,"body":"universal brain state,"},{"startTime":1135.5,"endTime":1136.63,"body":"but actually, it can affect"},{"startTime":1136.63,"endTime":1139.81,"body":"very, very small parts"},{"startTime":1136.63,"endTime":1139.81,"body":"of the brain constantly,"},{"startTime":1139.81,"endTime":1142.21,"body":"very small parts of the cerebral cortex."},{"startTime":1142.21,"endTime":1145.63,"body":"And in this remarkable study"},{"startTime":1142.21,"endTime":1145.63,"body":"from about 10 years ago,"},{"startTime":1145.63,"endTime":1146.463,"body":"what they did"},{"startTime":1146.463,"endTime":1151.12,"body":"was they recorded directly"},{"startTime":1146.463,"endTime":1151.12,"body":"from neuronal units in rats,"},{"startTime":1152.8,"endTime":1154.47,"body":"and what they demonstrated"},{"startTime":1154.47,"endTime":1157.87,"body":"was that actually, even"},{"startTime":1154.47,"endTime":1157.87,"body":"during full wakefulness,"},{"startTime":1157.87,"endTime":1159.63,"body":"these little neuronal units,"},{"startTime":1159.63,"endTime":1162.52,"body":"these clusters of nerve"},{"startTime":1159.63,"endTime":1162.52,"body":"cells, essentially,"},{"startTime":1162.52,"endTime":1165.56,"body":"seemed to exhibit silence every so often."},{"startTime":1165.56,"endTime":1169.51,"body":"And as the rats become more tired,"},{"startTime":1169.51,"endTime":1171.12,"body":"as they're more sleep-deprived,"},{"startTime":1171.12,"endTime":1174.56,"body":"actually, these little neuronal silences"},{"startTime":1174.56,"endTime":1177.99,"body":"increase in duration and"},{"startTime":1174.56,"endTime":1177.99,"body":"they increase in extent,"},{"startTime":1177.99,"endTime":1179.8,"body":"really demonstrating that these rats"},{"startTime":1179.8,"endTime":1181.74,"body":"appear to be awake and"},{"startTime":1179.8,"endTime":1181.74,"body":"asleep at the same time."},{"startTime":1181.74,"endTime":1182.573,"body":"And in fact,"},{"startTime":1182.573,"endTime":1184.51,"body":"some of you might already"},{"startTime":1182.573,"endTime":1184.51,"body":"be starting to exhibit"},{"startTime":1184.51,"endTime":1188.987,"body":"little islands of silence"},{"startTime":1184.51,"endTime":1188.987,"body":"in your cerebral cortex."},{"startTime":1190.12,"endTime":1192.7,"body":"And indeed, when you look at the EEGs,"},{"startTime":1192.7,"endTime":1196.44,"body":"at the brainwaves of humans, in detail,"},{"startTime":1196.44,"endTime":1197.79,"body":"not necessarily in the way"},{"startTime":1197.79,"endTime":1200.18,"body":"that we study in a clinical setting,"},{"startTime":1200.18,"endTime":1204.182,"body":"what we see is we see some"},{"startTime":1200.18,"endTime":1204.182,"body":"changes that occur locally"},{"startTime":1204.182,"endTime":1207.07,"body":"in different parts of the brain of humans"},{"startTime":1207.07,"endTime":1208.81,"body":"as they get more tired."},{"startTime":1208.81,"endTime":1209.96,"body":"And it may be that, actually,"},{"startTime":1209.96,"endTime":1210.793,"body":"when we say,"},{"startTime":1210.793,"endTime":1213.03,"body":"I had a really bad night, I'm half-asleep,"},{"startTime":1213.03,"endTime":1214.83,"body":"it may not be that far"},{"startTime":1213.03,"endTime":1214.83,"body":"away from the truth,"},{"startTime":1214.83,"endTime":1216.04,"body":"you may not be a half asleep,"},{"startTime":1216.04,"endTime":1217.73,"body":"but you certainly could"},{"startTime":1216.04,"endTime":1217.73,"body":"be a hundredth asleep,"},{"startTime":1217.73,"endTime":1221.29,"body":"there are small islands"},{"startTime":1217.73,"endTime":1221.29,"body":"of your cerebral cortex"},{"startTime":1221.29,"endTime":1223.627,"body":"that are probably constantly"},{"startTime":1221.29,"endTime":1223.627,"body":"dipping in and out of sleep,"},{"startTime":1223.627,"endTime":1226.4,"body":"and that may well be a"},{"startTime":1223.627,"endTime":1226.4,"body":"very good explanation"},{"startTime":1226.4,"endTime":1229.48,"body":"for why our cognitive"},{"startTime":1226.4,"endTime":1229.48,"body":"function, why our performance"},{"startTime":1229.48,"endTime":1231.49,"body":"tends to worsen as we get tired,"},{"startTime":1231.49,"endTime":1234.24,"body":"because those areas of silence increase,"},{"startTime":1234.24,"endTime":1236.4,"body":"so this concept of local sleep"},{"startTime":1236.4,"endTime":1238.36,"body":"is really starting to percolate through"},{"startTime":1238.36,"endTime":1241.803,"body":"into a broad range of sleep research."},{"startTime":1243.49,"endTime":1245.15,"body":"I talked a little bit about blurred lines,"},{"startTime":1245.15,"endTime":1247.42,"body":"I'm going to give you another"},{"startTime":1245.15,"endTime":1247.42,"body":"example of blurred lines."},{"startTime":1247.42,"endTime":1249.15,"body":"In fact, what I'm going to show you is,"},{"startTime":1249.15,"endTime":1250.3,"body":"I'm going to show you"},{"startTime":1250.3,"endTime":1254.19,"body":"a really seminal piece of documentation"},{"startTime":1254.19,"endTime":1256.24,"body":"of a neurological disorder,"},{"startTime":1256.24,"endTime":1258.543,"body":"this really is a landmark study."},{"startTime":1261.04,"endTime":1262.79,"body":"Some of you may recognize this,"},{"startTime":1262.79,"endTime":1266.683,"body":"this is \"Cinderella,\" from 1950,"},{"startTime":1268.118,"endTime":1270.182,"body":"and the king is dreaming,"},{"startTime":1270.182,"endTime":1272.0,"body":"(the king snores and laughs)"},{"startTime":1272.0,"endTime":1274.618,"body":"and he's acting out his dreams."},{"startTime":1274.618,"endTime":1277.737,"body":"He's imaging his grandson"},{"startTime":1274.618,"endTime":1277.737,"body":"playing with him."},{"startTime":1279.873,"endTime":1282.75,"body":"(door bangs)"},{"startTime":1282.75,"endTime":1285.003,"body":"And then he wakes up"},{"startTime":1282.75,"endTime":1285.003,"body":"and tumbles out of bed."},{"startTime":1288.496,"endTime":1291.3,"body":"This is another example"},{"startTime":1288.496,"endTime":1291.3,"body":"from the same movie."},{"startTime":1291.3,"endTime":1294.8,"body":"(dog growls and whimpers)"},{"startTime":1297.88,"endTime":1298.713,"body":"- Bruno?"},{"startTime":1300.977,"endTime":1302.023,"body":"Bruno?"},{"startTime":1302.023,"endTime":1304.44,"body":"(dog growls)"},{"startTime":1309.23,"endTime":1312.56,"body":"Dreaming again? Chasing Lucifer?"},{"startTime":1313.582,"endTime":1315.556,"body":"Catch him this time?"},{"startTime":1315.556,"endTime":1316.473,"body":"That's bad."},{"startTime":1319.599,"endTime":1321.61,"body":"- So the reason why I refer to this"},{"startTime":1321.61,"endTime":1324.24,"body":"as a really seminal piece"},{"startTime":1321.61,"endTime":1324.24,"body":"of medical documentation"},{"startTime":1324.24,"endTime":1326.57,"body":"is that this film came out in 1950,"},{"startTime":1326.57,"endTime":1328.34,"body":"it describes a condition"},{"startTime":1328.34,"endTime":1330.85,"body":"that did not really enter"},{"startTime":1328.34,"endTime":1330.85,"body":"into the diagnostic manuals"},{"startTime":1330.85,"endTime":1332.86,"body":"until 1989,"},{"startTime":1332.86,"endTime":1336.64,"body":"so really, either Disney was"},{"startTime":1332.86,"endTime":1336.64,"body":"a keen observer of nature"},{"startTime":1336.64,"endTime":1338.04,"body":"or he was a great physician,"},{"startTime":1338.04,"endTime":1341.03,"body":"I suspect the former"},{"startTime":1338.04,"endTime":1341.03,"body":"rather than the latter."},{"startTime":1341.03,"endTime":1344.27,"body":"And what this really exhibits"},{"startTime":1344.27,"endTime":1346.6,"body":"is a condition called REM"},{"startTime":1344.27,"endTime":1346.6,"body":"sleep behavior disorder,"},{"startTime":1346.6,"endTime":1349.21,"body":"which essentially is the acting out"},{"startTime":1349.21,"endTime":1350.67,"body":"of the dreams of REM sleep."},{"startTime":1350.67,"endTime":1352.91,"body":"You may remember that I said"},{"startTime":1350.67,"endTime":1352.91,"body":"to you that in REM sleep,"},{"startTime":1352.91,"endTime":1355.08,"body":"normally, we're completely paralyzed,"},{"startTime":1355.08,"endTime":1358.62,"body":"that all our muscles"},{"startTime":1355.08,"endTime":1358.62,"body":"are completely weakened,"},{"startTime":1358.62,"endTime":1359.97,"body":"but in this condition,"},{"startTime":1359.97,"endTime":1362.27,"body":"for reasons that I'll go into,"},{"startTime":1362.27,"endTime":1365.95,"body":"that mechanism of paralysis"},{"startTime":1362.27,"endTime":1365.95,"body":"that is a feature of REM sleep"},{"startTime":1365.95,"endTime":1367.053,"body":"doesn't work properly."},{"startTime":1368.454,"endTime":1370.0,"body":"This is a condition that is often seen"},{"startTime":1370.0,"endTime":1371.52,"body":"in slightly older individuals,"},{"startTime":1371.52,"endTime":1373.66,"body":"although it can be seen"},{"startTime":1371.52,"endTime":1373.66,"body":"in younger individuals,"},{"startTime":1373.66,"endTime":1375.9,"body":"it usually occurs in the"},{"startTime":1373.66,"endTime":1375.9,"body":"latter half of the night,"},{"startTime":1375.9,"endTime":1378.41,"body":"you may recall that when I"},{"startTime":1375.9,"endTime":1378.41,"body":"showed you that hypnogram,"},{"startTime":1378.41,"endTime":1379.65,"body":"the majority of REM sleep"},{"startTime":1379.65,"endTime":1381.73,"body":"occurs in the latter half of the night,"},{"startTime":1381.73,"endTime":1383.98,"body":"and the way that it typically manifests"},{"startTime":1383.98,"endTime":1387.44,"body":"is people lashing out,"},{"startTime":1383.98,"endTime":1387.44,"body":"crying, swearing, or shouting,"},{"startTime":1387.44,"endTime":1389.593,"body":"it's not always violent, but it often is."},{"startTime":1391.998,"endTime":1392.831,"body":"And those behaviors"},{"startTime":1392.831,"endTime":1395.5,"body":"really represent the"},{"startTime":1392.831,"endTime":1395.5,"body":"context, the narrative"},{"startTime":1395.5,"endTime":1399.44,"body":"of the dreams that individuals"},{"startTime":1395.5,"endTime":1399.44,"body":"are having at the time."},{"startTime":1399.44,"endTime":1400.273,"body":"The speech,"},{"startTime":1400.273,"endTime":1402.38,"body":"unlike those non-REM"},{"startTime":1400.273,"endTime":1402.38,"body":"parasomnias that I showed you,"},{"startTime":1402.38,"endTime":1403.83,"body":"is usually unintelligible,"},{"startTime":1403.83,"endTime":1407.27,"body":"there's often a few swear words"},{"startTime":1403.83,"endTime":1407.27,"body":"that you hear, or shouting,"},{"startTime":1407.27,"endTime":1409.35,"body":"unlike the non-REM parasomnias,"},{"startTime":1409.35,"endTime":1411.28,"body":"people don't tend to leave the bed,"},{"startTime":1411.28,"endTime":1412.15,"body":"if they are woken,"},{"startTime":1412.15,"endTime":1413.79,"body":"they'll often have that dream recall"},{"startTime":1413.79,"endTime":1415.78,"body":"that's appropriate to the"},{"startTime":1413.79,"endTime":1415.78,"body":"actions that have been witnessed,"},{"startTime":1415.78,"endTime":1416.7,"body":"as I've said,"},{"startTime":1416.7,"endTime":1419.78,"body":"and these can occur every"},{"startTime":1416.7,"endTime":1419.78,"body":"night, several times a night,"},{"startTime":1419.78,"endTime":1423.01,"body":"and can result in really"},{"startTime":1419.78,"endTime":1423.01,"body":"quite significant injuries,"},{"startTime":1423.01,"endTime":1424.77,"body":"injuries to oneself,"},{"startTime":1424.77,"endTime":1426.38,"body":"but also injuries to the bed partner,"},{"startTime":1426.38,"endTime":1429.56,"body":"and there have been"},{"startTime":1426.38,"endTime":1429.56,"body":"well-documented cases of homicide"},{"startTime":1429.56,"endTime":1431.34,"body":"related to this condition,"},{"startTime":1431.34,"endTime":1433.393,"body":"so it is a real problem."},{"startTime":1436.26,"endTime":1438.173,"body":"What we see in these individuals,"},{"startTime":1439.44,"endTime":1440.85,"body":"without going into too much detail,"},{"startTime":1440.85,"endTime":1444.14,"body":"the bottom traces are"},{"startTime":1440.85,"endTime":1444.14,"body":"measures of muscle activity,"},{"startTime":1444.14,"endTime":1446.89,"body":"and that muscle activity"},{"startTime":1444.14,"endTime":1446.89,"body":"should be completely flat"},{"startTime":1446.89,"endTime":1447.723,"body":"in REM sleep,"},{"startTime":1447.723,"endTime":1449.25,"body":"and what you see in this individual"},{"startTime":1449.25,"endTime":1452.83,"body":"is you see these really big"},{"startTime":1449.25,"endTime":1452.83,"body":"spikes of muscle activity"},{"startTime":1452.83,"endTime":1454.0,"body":"that shouldn't be there,"},{"startTime":1454.0,"endTime":1458.1,"body":"really demonstrating that"},{"startTime":1454.0,"endTime":1458.1,"body":"paralysis is not there"},{"startTime":1458.1,"endTime":1459.843,"body":"during those stages of sleep."},{"startTime":1461.15,"endTime":1463.14,"body":"This is a non-cartoon version"},{"startTime":1463.14,"endTime":1465.14,"body":"of a REM sleep behavior disorder,"},{"startTime":1465.14,"endTime":1470.14,"body":"just to give you a flavor of"},{"startTime":1465.14,"endTime":1470.14,"body":"what we see in the sleep lab."},{"startTime":1474.9,"endTime":1475.733,"body":"You can see"},{"startTime":1475.733,"endTime":1477.91,"body":"that chap lashes out"},{"startTime":1475.733,"endTime":1477.91,"body":"against the bedside cabinet."},{"startTime":1477.91,"endTime":1480.04,"body":"That bedside cabinet"},{"startTime":1477.91,"endTime":1480.04,"body":"weighs about 50 kilos,"},{"startTime":1480.04,"endTime":1482.11,"body":"so to almost topple it over"},{"startTime":1482.11,"endTime":1484.8,"body":"requires really quite"},{"startTime":1482.11,"endTime":1484.8,"body":"significant strength."},{"startTime":1484.8,"endTime":1488.203,"body":"And if you watch this"},{"startTime":1484.8,"endTime":1488.203,"body":"chap's arms and legs,"},{"startTime":1494.49,"endTime":1496.07,"body":"he is dreaming at the time,"},{"startTime":1496.07,"endTime":1498.98,"body":"he kicks out and then"},{"startTime":1496.07,"endTime":1498.98,"body":"starts waving his arms,"},{"startTime":1498.98,"endTime":1500.33,"body":"and he remembers being on a beach,"},{"startTime":1500.33,"endTime":1502.493,"body":"and being attacked physically."},{"startTime":1503.6,"endTime":1505.963,"body":"As I said, they're not always violent,"},{"startTime":1507.15,"endTime":1509.81,"body":"and you can see him"},{"startTime":1507.15,"endTime":1509.81,"body":"trying to defend himself"},{"startTime":1509.81,"endTime":1511.793,"body":"with these movements of the arms."},{"startTime":1514.98,"endTime":1517.0,"body":"This chap is having a dream,"},{"startTime":1517.0,"endTime":1518.9,"body":"I'll let you guess what the dream was."},{"startTime":1520.47,"endTime":1521.303,"body":"Anybody guess?"},{"startTime":1522.75,"endTime":1525.03,"body":"Gun fight, he was having"},{"startTime":1522.75,"endTime":1525.03,"body":"a gun fight in his dream,"},{"startTime":1525.03,"endTime":1526.223,"body":"so kind of violent."},{"startTime":1527.37,"endTime":1532.213,"body":"So that's how these kinds of"},{"startTime":1527.37,"endTime":1532.213,"body":"phenomena exhibit themselves."},{"startTime":1534.229,"endTime":1535.48,"body":"We used to think of this"},{"startTime":1535.48,"endTime":1538.36,"body":"as being what we term"},{"startTime":1535.48,"endTime":1538.36,"body":"an idiopathic condition."},{"startTime":1538.36,"endTime":1539.193,"body":"the term idiopathic"},{"startTime":1539.193,"endTime":1541.03,"body":"means we don't really know what causes it,"},{"startTime":1541.03,"endTime":1542.91,"body":"it's not associated with anything."},{"startTime":1542.91,"endTime":1545.88,"body":"But actually, what we've"},{"startTime":1542.91,"endTime":1545.88,"body":"learned over the last few years"},{"startTime":1545.88,"endTime":1548.36,"body":"is that, particularly in older age groups,"},{"startTime":1548.36,"endTime":1550.9,"body":"this can sometimes be a feature,"},{"startTime":1550.9,"endTime":1554.24,"body":"a very early feature of"},{"startTime":1550.9,"endTime":1554.24,"body":"a group of conditions"},{"startTime":1554.24,"endTime":1557.15,"body":"that represent degeneration"},{"startTime":1554.24,"endTime":1557.15,"body":"of the nervous system,"},{"startTime":1557.15,"endTime":1560.65,"body":"in particular conditions"},{"startTime":1557.15,"endTime":1560.65,"body":"like Parkinson's disease."},{"startTime":1560.65,"endTime":1561.483,"body":"And in fact,"},{"startTime":1561.483,"endTime":1562.78,"body":"there have been documented cases"},{"startTime":1562.78,"endTime":1564.8,"body":"of people having REM"},{"startTime":1562.78,"endTime":1564.8,"body":"sleep behavior disorder"},{"startTime":1564.8,"endTime":1568.33,"body":"up to 35 years before they"},{"startTime":1564.8,"endTime":1568.33,"body":"develop Parkinson's disease."},{"startTime":1568.33,"endTime":1569.163,"body":"And in this study,"},{"startTime":1569.163,"endTime":1572.81,"body":"which was by one of my"},{"startTime":1569.163,"endTime":1572.81,"body":"colleagues in Barcelona,"},{"startTime":1572.81,"endTime":1575.65,"body":"they followed up a group"},{"startTime":1572.81,"endTime":1575.65,"body":"of older individuals"},{"startTime":1575.65,"endTime":1579.29,"body":"who presented with REM sleep"},{"startTime":1575.65,"endTime":1579.29,"body":"behavior disorder for 15 years,"},{"startTime":1579.29,"endTime":1581.39,"body":"and what they demonstrated"},{"startTime":1579.29,"endTime":1581.39,"body":"was, after 15 years,"},{"startTime":1581.39,"endTime":1583.49,"body":"91% of those individuals"},{"startTime":1583.49,"endTime":1585.54,"body":"began to exhibit frank features"},{"startTime":1585.54,"endTime":1587.35,"body":"of conditions like Parkinson's disease,"},{"startTime":1587.35,"endTime":1588.9,"body":"or related disorders."},{"startTime":1588.9,"endTime":1591.64,"body":"So to consider it an idiopathic condition"},{"startTime":1591.64,"endTime":1593.74,"body":"is perhaps not correct,"},{"startTime":1593.74,"endTime":1595.34,"body":"we may want to consider it"},{"startTime":1595.34,"endTime":1598.81,"body":"as part and parcel of"},{"startTime":1595.34,"endTime":1598.81,"body":"this group of conditions,"},{"startTime":1598.81,"endTime":1601.37,"body":"at least for the majority of individuals."},{"startTime":1601.37,"endTime":1602.813,"body":"Why should this be the case?"},{"startTime":1603.94,"endTime":1605.96,"body":"We know that the areas of the brain"},{"startTime":1605.96,"endTime":1608.92,"body":"that are responsible for"},{"startTime":1605.96,"endTime":1608.92,"body":"generating muscle paralysis"},{"startTime":1608.92,"endTime":1612.17,"body":"reside in this area of the"},{"startTime":1608.92,"endTime":1612.17,"body":"brain, called the brainstem."},{"startTime":1612.17,"endTime":1614.79,"body":"It's very far away from"},{"startTime":1612.17,"endTime":1614.79,"body":"the parts of the brain"},{"startTime":1614.79,"endTime":1617.22,"body":"that are responsible for"},{"startTime":1614.79,"endTime":1617.22,"body":"the changes in movement"},{"startTime":1617.22,"endTime":1619.21,"body":"that we see in Parkinson's disease,"},{"startTime":1619.21,"endTime":1620.44,"body":"which are up here."},{"startTime":1620.44,"endTime":1625.44,"body":"So why should people with"},{"startTime":1620.44,"endTime":1625.44,"body":"very early Parkinson's disease"},{"startTime":1626.1,"endTime":1628.89,"body":"develop REM sleep behavior disorder?"},{"startTime":1628.89,"endTime":1631.2,"body":"What we are now beginning to understand"},{"startTime":1631.2,"endTime":1634.81,"body":"is that as well as having"},{"startTime":1631.2,"endTime":1634.81,"body":"REM sleep behavior disorder,"},{"startTime":1634.81,"endTime":1637.79,"body":"one of the very early precursor features"},{"startTime":1637.79,"endTime":1638.9,"body":"of Parkinson's disease"},{"startTime":1638.9,"endTime":1640.56,"body":"is loss of sense of smell."},{"startTime":1640.56,"endTime":1641.69,"body":"Of course, nowadays,"},{"startTime":1641.69,"endTime":1643.988,"body":"we're all very familiar with"},{"startTime":1641.69,"endTime":1643.988,"body":"the loss of sense of smell,"},{"startTime":1643.988,"endTime":1646.78,"body":"and it's not particularly sensitive"},{"startTime":1646.78,"endTime":1649.11,"body":"as a predictor of Parkinson's disease,"},{"startTime":1649.11,"endTime":1650.94,"body":"particularly post COVID,"},{"startTime":1650.94,"endTime":1652.53,"body":"but when you look at the changes"},{"startTime":1652.53,"endTime":1654.25,"body":"that occur within the nervous system"},{"startTime":1654.25,"endTime":1656.88,"body":"within conditions like"},{"startTime":1654.25,"endTime":1656.88,"body":"Parkinson's disease,"},{"startTime":1656.88,"endTime":1659.0,"body":"we see changes in the nervous system"},{"startTime":1659.0,"endTime":1662.79,"body":"that are actually far"},{"startTime":1659.0,"endTime":1662.79,"body":"beyond the basal ganglia,"},{"startTime":1662.79,"endTime":1663.623,"body":"the area of the brain"},{"startTime":1663.623,"endTime":1665.897,"body":"that we associate with"},{"startTime":1663.623,"endTime":1665.897,"body":"Parkinson's disease,"},{"startTime":1665.897,"endTime":1668.18,"body":"and we see changes in the olfactory bulb,"},{"startTime":1668.18,"endTime":1670.7,"body":"which is responsible for smell,"},{"startTime":1670.7,"endTime":1673.52,"body":"we see changes in terms of"},{"startTime":1670.7,"endTime":1673.52,"body":"looking down a microscope"},{"startTime":1673.52,"endTime":1677.68,"body":"and seeing the histological"},{"startTime":1673.52,"endTime":1677.68,"body":"change, the cellular changes"},{"startTime":1677.68,"endTime":1678.56,"body":"in the gut,"},{"startTime":1678.56,"endTime":1681.64,"body":"which is why many people"},{"startTime":1678.56,"endTime":1681.64,"body":"with Parkinson's disease"},{"startTime":1681.64,"endTime":1684.46,"body":"complain of constipation"},{"startTime":1681.64,"endTime":1684.46,"body":"for many years beforehand,"},{"startTime":1684.46,"endTime":1687.97,"body":"and also in this part of the"},{"startTime":1684.46,"endTime":1687.97,"body":"brain here, the brainstem,"},{"startTime":1687.97,"endTime":1688.9,"body":"which is where"},{"startTime":1688.9,"endTime":1692.68,"body":"those mechanisms of paralysis"},{"startTime":1688.9,"endTime":1692.68,"body":"in REM sleep reside,"},{"startTime":1692.68,"endTime":1695.29,"body":"so really giving us a very clear example"},{"startTime":1695.29,"endTime":1698.47,"body":"of why these kinds of conditions may arise"},{"startTime":1698.47,"endTime":1700.44,"body":"many years before the development"},{"startTime":1700.44,"endTime":1702.28,"body":"of other features of Parkinson's disease."},{"startTime":1702.28,"endTime":1703.26,"body":"And in fact, we now know"},{"startTime":1703.26,"endTime":1705.93,"body":"that if we look at people with"},{"startTime":1703.26,"endTime":1705.93,"body":"REM sleep behavior disorder"},{"startTime":1705.93,"endTime":1706.83,"body":"in isolation,"},{"startTime":1706.83,"endTime":1710.75,"body":"they exhibit lots of changes"},{"startTime":1706.83,"endTime":1710.75,"body":"that suggest, subtly,"},{"startTime":1710.75,"endTime":1711.99,"body":"that they may be exhibiting"},{"startTime":1711.99,"endTime":1713.72,"body":"one of these neurological problems,"},{"startTime":1713.72,"endTime":1717.07,"body":"so we see abnormalities in"},{"startTime":1713.72,"endTime":1717.07,"body":"smell, in bladder function,"},{"startTime":1717.07,"endTime":1720.71,"body":"in gut function, in the"},{"startTime":1717.07,"endTime":1720.71,"body":"function of the heart."},{"startTime":1720.71,"endTime":1724.94,"body":"If we do tissue biopsies of"},{"startTime":1720.71,"endTime":1724.94,"body":"various bits of the body,"},{"startTime":1724.94,"endTime":1728.92,"body":"we see deposits of this"},{"startTime":1724.94,"endTime":1728.92,"body":"protein called alpha-synuclein,"},{"startTime":1728.92,"endTime":1730.98,"body":"which is the protein hallmark"},{"startTime":1730.98,"endTime":1733.38,"body":"of Parkinson's disease"},{"startTime":1730.98,"endTime":1733.38,"body":"and related conditions,"},{"startTime":1733.38,"endTime":1736.0,"body":"in the gut, in salivary glands,"},{"startTime":1736.0,"endTime":1738.17,"body":"in various other bits of the body."},{"startTime":1738.17,"endTime":1742.06,"body":"And so we are perhaps incorrect"},{"startTime":1742.06,"endTime":1745.41,"body":"to consider RBD as idiopathic,"},{"startTime":1745.41,"endTime":1748.17,"body":"we're perhaps even not entirely correct"},{"startTime":1748.17,"endTime":1751.19,"body":"to consider REM sleep behavior"},{"startTime":1748.17,"endTime":1751.19,"body":"disorder as being isolated,"},{"startTime":1751.19,"endTime":1753.97,"body":"and that perhaps we should"},{"startTime":1751.19,"endTime":1753.97,"body":"be considering this condition"},{"startTime":1753.97,"endTime":1756.55,"body":"as part and parcel of"},{"startTime":1753.97,"endTime":1756.55,"body":"the very early stages"},{"startTime":1756.55,"endTime":1758.96,"body":"of some of these neurological disorders."},{"startTime":1758.96,"endTime":1761.11,"body":"Of course, that's very bad news"},{"startTime":1761.11,"endTime":1762.81,"body":"if you are one of those individuals"},{"startTime":1762.81,"endTime":1763.92,"body":"who exhibits this condition,"},{"startTime":1763.92,"endTime":1766.18,"body":"but actually, it's also"},{"startTime":1763.92,"endTime":1766.18,"body":"a real opportunity,"},{"startTime":1766.18,"endTime":1767.52,"body":"because at the moment,"},{"startTime":1767.52,"endTime":1768.71,"body":"there are ongoing trials"},{"startTime":1768.71,"endTime":1771.4,"body":"looking at drugs that"},{"startTime":1768.71,"endTime":1771.4,"body":"might modify the risk"},{"startTime":1771.4,"endTime":1772.97,"body":"of developing Parkinson's disease,"},{"startTime":1772.97,"endTime":1775.59,"body":"that might slow the progression"},{"startTime":1772.97,"endTime":1775.59,"body":"of Parkinson's disease,"},{"startTime":1775.59,"endTime":1777.97,"body":"and if this is a very strong"},{"startTime":1775.59,"endTime":1777.97,"body":"marker for Parkinson's disease,"},{"startTime":1777.97,"endTime":1780.39,"body":"before you've got any"},{"startTime":1777.97,"endTime":1780.39,"body":"of the other features,"},{"startTime":1780.39,"endTime":1784.21,"body":"then you might be an ideal"},{"startTime":1780.39,"endTime":1784.21,"body":"candidate for this kind of drug,"},{"startTime":1784.21,"endTime":1786.61,"body":"and actually, this gives"},{"startTime":1784.21,"endTime":1786.61,"body":"us a huge opportunity"},{"startTime":1786.61,"endTime":1789.1,"body":"to at least see whether"},{"startTime":1786.61,"endTime":1789.1,"body":"or not some of these drugs"},{"startTime":1789.1,"endTime":1792.613,"body":"may reduce the risk of developing"},{"startTime":1789.1,"endTime":1792.613,"body":"these kinds of conditions."},{"startTime":1794.95,"endTime":1799.45,"body":"I'm going to move on to another"},{"startTime":1794.95,"endTime":1799.45,"body":"neurological disorder now."},{"startTime":1799.45,"endTime":1801.67,"body":"I'm just going to introduce"},{"startTime":1799.45,"endTime":1801.67,"body":"you to one of my patients,"},{"startTime":1801.67,"endTime":1805.14,"body":"who was involved in a TV program."},{"speaker":"- There's two sides to it","startTime":1806.27,"endTime":1809.92,"body":"the narcolepsy bit is"},{"speaker":"- There's two sides to it","startTime":1806.27,"endTime":1809.92,"body":"I'm chronically tired,"},{"speaker":"- There's two sides to it","startTime":1809.92,"endTime":1811.52,"body":"and then the cataplexy,"},{"speaker":"- There's two sides to it","startTime":1811.52,"endTime":1814.45,"body":"it can manifest itself in"},{"speaker":"- There's two sides to it","startTime":1811.52,"endTime":1814.45,"body":"me falling to the floor"},{"speaker":"- There's two sides to it","startTime":1814.45,"endTime":1816.85,"body":"if I experience a strong"},{"speaker":"- There's two sides to it","startTime":1814.45,"endTime":1816.85,"body":"emotion, like laughing."},{"speaker":"- There's two sides to it","startTime":1817.86,"endTime":1821.19,"body":"It's any event that I feel is funny,"},{"speaker":"- There's two sides to it","startTime":1821.19,"endTime":1824.03,"body":"so it's an emotional connection."},{"speaker":"- There's two sides to it","startTime":1824.03,"endTime":1825.55,"body":"The first event that ever happened"},{"speaker":"- There's two sides to it","startTime":1825.55,"endTime":1827.01,"body":"was trying to put the children to bed,"},{"speaker":"- There's two sides to it","startTime":1827.01,"endTime":1830.76,"body":"I fell to the floor and"},{"speaker":"- There's two sides to it","startTime":1827.01,"endTime":1830.76,"body":"wasn't able to get up."},{"speaker":"- There's two sides to it","startTime":1830.76,"endTime":1831.593,"body":"The kids were laughing,"},{"speaker":"- There's two sides to it","startTime":1831.593,"endTime":1833.24,"body":"they thought I was just play acting,"},{"speaker":"- There's two sides to it","startTime":1833.24,"endTime":1835.12,"body":"and I was just lying there."},{"speaker":"- There's two sides to it","startTime":1835.12,"endTime":1837.25,"body":"I could hear them, and I could see them,"},{"speaker":"- There's two sides to it","startTime":1837.25,"endTime":1839.0,"body":"but I was unable to speak or move,"},{"speaker":"- There's two sides to it","startTime":1839.0,"endTime":1839.85,"body":"it was bizarre,"},{"speaker":"- There's two sides to it","startTime":1839.85,"endTime":1841.6,"body":"and I just didn't know what it was."},{"speaker":"- There's two sides to it","startTime":1843.11,"endTime":1846.14,"body":"- Narcolepsy is a neurological disorder"},{"speaker":"- There's two sides to it","startTime":1846.14,"endTime":1849.43,"body":"that is characterized by a"},{"speaker":"- There's two sides to it","startTime":1846.14,"endTime":1849.43,"body":"number of specific features:"},{"speaker":"- There's two sides to it","startTime":1849.43,"endTime":1851.16,"body":"people are profoundly sleepy,"},{"speaker":"- There's two sides to it","startTime":1851.16,"endTime":1853.78,"body":"often to the extent that they"},{"speaker":"- There's two sides to it","startTime":1851.16,"endTime":1853.78,"body":"will fall asleep sometimes"},{"speaker":"- There's two sides to it","startTime":1853.78,"endTime":1855.46,"body":"even whilst doing relatively active things"},{"speaker":"- There's two sides to it","startTime":1855.46,"endTime":1858.95,"body":"like playing football, or at work,"},{"speaker":"- There's two sides to it","startTime":1858.95,"endTime":1861.44,"body":"in fairly stimulated"},{"speaker":"- There's two sides to it","startTime":1858.95,"endTime":1861.44,"body":"environments sometimes,"},{"speaker":"- There's two sides to it","startTime":1861.44,"endTime":1863.78,"body":"and those sleep attacks"},{"speaker":"- There's two sides to it","startTime":1861.44,"endTime":1863.78,"body":"are relatively brief,"},{"speaker":"- There's two sides to it","startTime":1863.78,"endTime":1866.59,"body":"they're often associated"},{"speaker":"- There's two sides to it","startTime":1863.78,"endTime":1866.59,"body":"with very vivid dreaming,"},{"speaker":"- There's two sides to it","startTime":1866.59,"endTime":1868.66,"body":"people go into REM sleep very early on"},{"speaker":"- There's two sides to it","startTime":1868.66,"endTime":1871.443,"body":"in those daytime naps."},{"speaker":"- There's two sides to it","startTime":1872.38,"endTime":1874.73,"body":"As a result of the REM sleep"},{"speaker":"- There's two sides to it","startTime":1874.73,"endTime":1876.1,"body":"coming on inappropriately early,"},{"speaker":"- There's two sides to it","startTime":1876.1,"endTime":1877.08,"body":"they often hallucinate,"},{"speaker":"- There's two sides to it","startTime":1877.08,"endTime":1879.88,"body":"so that their dream mentation,"},{"speaker":"- There's two sides to it","startTime":1877.08,"endTime":1879.88,"body":"their dream narrative"},{"speaker":"- There's two sides to it","startTime":1879.88,"endTime":1881.51,"body":"often enters into wakefulness,"},{"speaker":"- There's two sides to it","startTime":1881.51,"endTime":1883.83,"body":"another example of one"},{"speaker":"- There's two sides to it","startTime":1881.51,"endTime":1883.83,"body":"of these blurred lines."},{"speaker":"- There's two sides to it","startTime":1883.83,"endTime":1885.32,"body":"So they will often hallucinate"},{"speaker":"- There's two sides to it","startTime":1885.32,"endTime":1886.96,"body":"as they drift off to sleep or wake up,"},{"speaker":"- There's two sides to it","startTime":1886.96,"endTime":1888.93,"body":"often seeing people in the room,"},{"speaker":"- There's two sides to it","startTime":1888.93,"endTime":1890.83,"body":"or having out-of-body experiences,"},{"speaker":"- There's two sides to it","startTime":1890.83,"endTime":1893.54,"body":"as if they're floating above themselves."},{"speaker":"- There's two sides to it","startTime":1893.54,"endTime":1895.31,"body":"They'll often experience sleep paralysis,"},{"speaker":"- There's two sides to it","startTime":1895.31,"endTime":1897.56,"body":"which is almost the polar opposite"},{"speaker":"- There's two sides to it","startTime":1897.56,"endTime":1899.13,"body":"of REM sleep behavior disorder,"},{"speaker":"- There's two sides to it","startTime":1899.13,"endTime":1900.92,"body":"that they will wake up"},{"speaker":"- There's two sides to it","startTime":1900.92,"endTime":1902.9,"body":"and feel completely paralyzed,"},{"speaker":"- There's two sides to it","startTime":1902.9,"endTime":1904.82,"body":"because the mechanism of paralysis"},{"speaker":"- There's two sides to it","startTime":1904.82,"endTime":1906.26,"body":"that is a feature of a REM sleep"},{"speaker":"- There's two sides to it","startTime":1906.26,"endTime":1907.233,"body":"doesn't switch off."},{"speaker":"- There's two sides to it","startTime":1908.18,"endTime":1910.48,"body":"These hallucinations and sleep paralysis"},{"speaker":"- There's two sides to it","startTime":1910.48,"endTime":1912.21,"body":"are also normal phenomena,"},{"speaker":"- There's two sides to it","startTime":1912.21,"endTime":1914.94,"body":"a lot of especially the"},{"speaker":"- There's two sides to it","startTime":1912.21,"endTime":1914.94,"body":"younger people in the crowd"},{"speaker":"- There's two sides to it","startTime":1914.94,"endTime":1916.86,"body":"will often report"},{"speaker":"- There's two sides to it","startTime":1916.86,"endTime":1920.72,"body":"experiencing sleep"},{"speaker":"- There's two sides to it","startTime":1916.86,"endTime":1920.72,"body":"paralysis or hallucinations,"},{"speaker":"- There's two sides to it","startTime":1920.72,"endTime":1923.3,"body":"it's often related to sleep restriction"},{"speaker":"- There's two sides to it","startTime":1923.3,"endTime":1925.0,"body":"or chronic sleep deprivation."},{"speaker":"- There's two sides to it","startTime":1925.0,"endTime":1927.16,"body":"But in the context of"},{"speaker":"- There's two sides to it","startTime":1925.0,"endTime":1927.16,"body":"these other features,"},{"speaker":"- There's two sides to it","startTime":1927.16,"endTime":1930.14,"body":"it's highly suggestive of narcolepsy."},{"speaker":"- There's two sides to it","startTime":1930.14,"endTime":1931.81,"body":"And the final feature is cataplexy,"},{"speaker":"- There's two sides to it","startTime":1931.81,"endTime":1933.78,"body":"which Phil exhibited very clearly there,"},{"speaker":"- There's two sides to it","startTime":1933.78,"endTime":1936.9,"body":"which is the sudden"},{"speaker":"- There's two sides to it","startTime":1933.78,"endTime":1936.9,"body":"loss of muscle strength,"},{"speaker":"- There's two sides to it","startTime":1936.9,"endTime":1939.13,"body":"usually associated with strong emotion,"},{"speaker":"- There's two sides to it","startTime":1939.13,"endTime":1942.03,"body":"which may represent that"},{"speaker":"- There's two sides to it","startTime":1939.13,"endTime":1942.03,"body":"mechanism of paralysis"},{"speaker":"- There's two sides to it","startTime":1942.03,"endTime":1944.93,"body":"being switched on"},{"speaker":"- There's two sides to it","startTime":1942.03,"endTime":1944.93,"body":"inappropriately during the day,"},{"speaker":"- There's two sides to it","startTime":1944.93,"endTime":1948.12,"body":"and I'll come on to try and explain"},{"speaker":"- There's two sides to it","startTime":1948.12,"endTime":1950.16,"body":"why that might be the case."},{"speaker":"- There's two sides to it","startTime":1950.16,"endTime":1952.983,"body":"So what do we know about"},{"speaker":"- There's two sides to it","startTime":1950.16,"endTime":1952.983,"body":"the origins of narcolepsy?"},{"speaker":"- There's two sides to it","startTime":1953.85,"endTime":1955.96,"body":"Until recently, not a lot."},{"speaker":"- There's two sides to it","startTime":1955.96,"endTime":1959.36,"body":"These scans on the left"},{"speaker":"- There's two sides to it","startTime":1959.36,"endTime":1961.04,"body":"are the scans of a patient"},{"speaker":"- There's two sides to it","startTime":1961.04,"endTime":1963.33,"body":"with a condition called called"},{"speaker":"- There's two sides to it","startTime":1961.04,"endTime":1963.33,"body":"encephalitis lethargica,"},{"speaker":"- There's two sides to it","startTime":1963.33,"endTime":1965.72,"body":"some of you may well be"},{"speaker":"- There's two sides to it","startTime":1963.33,"endTime":1965.72,"body":"familiar with this condition."},{"speaker":"- There's two sides to it","startTime":1965.72,"endTime":1966.553,"body":"This is a condition"},{"speaker":"- There's two sides to it","startTime":1966.553,"endTime":1968.84,"body":"that essentially presented as an epidemic"},{"speaker":"- There's two sides to it","startTime":1968.84,"endTime":1971.07,"body":"shortly after the First World war,"},{"speaker":"- There's two sides to it","startTime":1971.07,"endTime":1973.882,"body":"and resulted in features"},{"speaker":"- There's two sides to it","startTime":1973.882,"endTime":1976.69,"body":"of conditions similar"},{"speaker":"- There's two sides to it","startTime":1973.882,"endTime":1976.69,"body":"to Parkinson's disease,"},{"speaker":"- There's two sides to it","startTime":1976.69,"endTime":1978.61,"body":"but also profound sleepiness,"},{"speaker":"- There's two sides to it","startTime":1978.61,"endTime":1981.32,"body":"and some of the other"},{"speaker":"- There's two sides to it","startTime":1978.61,"endTime":1981.32,"body":"features of narcolepsy."},{"speaker":"- There's two sides to it","startTime":1981.32,"endTime":1982.22,"body":"We think now"},{"speaker":"- There's two sides to it","startTime":1982.22,"endTime":1987.22,"body":"that this may well have been"},{"speaker":"- There's two sides to it","startTime":1982.22,"endTime":1987.22,"body":"a response to the Spanish flu,"},{"speaker":"- There's two sides to it","startTime":1988.4,"endTime":1990.01,"body":"a post-infectious phenomenon,"},{"speaker":"- There's two sides to it","startTime":1990.01,"endTime":1992.75,"body":"although its origins"},{"speaker":"- There's two sides to it","startTime":1990.01,"endTime":1992.75,"body":"still remain a mystery."},{"speaker":"- There's two sides to it","startTime":1992.75,"endTime":1993.87,"body":"At that time,"},{"speaker":"- There's two sides to it","startTime":1993.87,"endTime":1995.7,"body":"famous neurologists"},{"speaker":"- There's two sides to it","startTime":1993.87,"endTime":1995.7,"body":"and psychiatrists said,"},{"speaker":"- There's two sides to it","startTime":1995.7,"endTime":1997.827,"body":"well look, actually, narcolepsy,"},{"speaker":"- There's two sides to it","startTime":1997.827,"endTime":1998.66,"body":"there are features of narcolepsy"},{"speaker":"- There's two sides to it","startTime":1998.66,"endTime":2001.5,"body":"that a look a little bit similar"},{"speaker":"- There's two sides to it","startTime":1998.66,"endTime":2001.5,"body":"to encephalitis lethargica,"},{"speaker":"- There's two sides to it","startTime":2001.5,"endTime":2004.06,"body":"but when we look at the brains"},{"speaker":"- There's two sides to it","startTime":2001.5,"endTime":2004.06,"body":"of people with narcolepsy,"},{"speaker":"- There's two sides to it","startTime":2004.06,"endTime":2005.29,"body":"they look normal."},{"speaker":"- There's two sides to it","startTime":2005.29,"endTime":2008.13,"body":"But could this be a"},{"speaker":"- There's two sides to it","startTime":2005.29,"endTime":2008.13,"body":"similar area of the brain,"},{"speaker":"- There's two sides to it","startTime":2008.13,"endTime":2010.64,"body":"these very deep structures"},{"speaker":"- There's two sides to it","startTime":2008.13,"endTime":2010.64,"body":"within the brain,"},{"speaker":"- There's two sides to it","startTime":2010.64,"endTime":2013.58,"body":"that might be damaged in narcolepsy?"},{"speaker":"- There's two sides to it","startTime":2013.58,"endTime":2015.73,"body":"The story didn't progress much,"},{"speaker":"- There's two sides to it","startTime":2015.73,"endTime":2019.893,"body":"until this dog and his"},{"speaker":"- There's two sides to it","startTime":2015.73,"endTime":2019.893,"body":"friends came along to help."},{"speaker":"- There's two sides to it","startTime":2021.12,"endTime":2022.95,"body":"- [Narrator] Skeeter is a small dog"},{"speaker":"with a very big problem","startTime":2024.74,"endTime":2027.68,"body":"no matter how much he"},{"speaker":"with a very big problem","startTime":2024.74,"endTime":2027.68,"body":"struggles to stay awake,"},{"speaker":"with a very big problem","startTime":2027.68,"endTime":2028.84,"body":"he can't."},{"speaker":"with a very big problem","startTime":2028.84,"endTime":2031.05,"body":"For this 11 pound toy poodle,"},{"speaker":"with a very big problem","startTime":2031.05,"endTime":2034.88,"body":"almost every moment is a"},{"speaker":"with a very big problem","startTime":2031.05,"endTime":2034.88,"body":"disturbing losing battle"},{"speaker":"with a very big problem","startTime":2034.88,"endTime":2036.85,"body":"with the urge to sleep."},{"speaker":"with a very big problem","startTime":2036.85,"endTime":2039.56,"body":"- Actually, the commentary is wrong there,"},{"speaker":"with a very big problem","startTime":2039.56,"endTime":2042.263,"body":"what this dog is exhibiting is cataplexy,"},{"speaker":"with a very big problem","startTime":2042.263,"endTime":2045.712,"body":"that loss of muscle strength"},{"speaker":"with a very big problem","startTime":2042.263,"endTime":2045.712,"body":"associated with strong emotion."},{"speaker":"with a very big problem","startTime":2045.712,"endTime":2047.268,"body":"The dog is happy to see its owner,"},{"speaker":"with a very big problem","startTime":2047.268,"endTime":2048.984,"body":"if it's presented with food,"},{"speaker":"with a very big problem","startTime":2048.984,"endTime":2052.34,"body":"it will start collapsing."},{"speaker":"with a very big problem","startTime":2052.34,"endTime":2055.903,"body":"So why is this of relevance?"},{"speaker":"with a very big problem","startTime":2055.903,"endTime":2057.74,"body":"In the 1970s and '80s,"},{"speaker":"with a very big problem","startTime":2057.74,"endTime":2059.27,"body":"Stanford University, in California,"},{"speaker":"with a very big problem","startTime":2059.27,"endTime":2061.13,"body":"began a breeding program of dogs,"},{"speaker":"with a very big problem","startTime":2061.13,"endTime":2063.14,"body":"because there appeared to be"},{"speaker":"with a very big problem","startTime":2063.14,"endTime":2065.92,"body":"a genetic form of narcolepsy in dogs."},{"speaker":"with a very big problem","startTime":2065.92,"endTime":2067.78,"body":"And after many, many years,"},{"speaker":"with a very big problem","startTime":2067.78,"endTime":2070.56,"body":"what they identified"},{"speaker":"with a very big problem","startTime":2067.78,"endTime":2070.56,"body":"was that in these dogs,"},{"speaker":"with a very big problem","startTime":2070.56,"endTime":2073.33,"body":"there was a mutation in a particular gene,"},{"speaker":"with a very big problem","startTime":2073.33,"endTime":2075.6,"body":"the function of which was not known."},{"speaker":"with a very big problem","startTime":2075.6,"endTime":2077.58,"body":"And at about the same time,"},{"speaker":"with a very big problem","startTime":2077.58,"endTime":2080.48,"body":"a chemical within the brain"},{"speaker":"with a very big problem","startTime":2077.58,"endTime":2080.48,"body":"called hypocretin, or orexin,"},{"speaker":"with a very big problem","startTime":2080.48,"endTime":2081.68,"body":"was discovered,"},{"speaker":"with a very big problem","startTime":2081.68,"endTime":2086.28,"body":"and so it was thought that these mutations"},{"speaker":"with a very big problem","startTime":2086.28,"endTime":2089.5,"body":"prevented this chemical,"},{"speaker":"with a very big problem","startTime":2086.28,"endTime":2089.5,"body":"this neurotransmitter"},{"speaker":"with a very big problem","startTime":2089.5,"endTime":2090.63,"body":"from functioning normally"},{"speaker":"with a very big problem","startTime":2090.63,"endTime":2093.09,"body":"within the brains of"},{"speaker":"with a very big problem","startTime":2090.63,"endTime":2093.09,"body":"individuals with narcolepsy."},{"speaker":"with a very big problem","startTime":2093.09,"endTime":2094.79,"body":"But when they looked in"},{"speaker":"with a very big problem","startTime":2093.09,"endTime":2094.79,"body":"humans with narcolepsy,"},{"speaker":"with a very big problem","startTime":2094.79,"endTime":2098.19,"body":"none of them had these mutations."},{"speaker":"with a very big problem","startTime":2098.19,"endTime":2101.45,"body":"There has now been one"},{"speaker":"with a very big problem","startTime":2098.19,"endTime":2101.45,"body":"pair of very young children"},{"speaker":"with a very big problem","startTime":2101.45,"endTime":2102.45,"body":"who have been identified"},{"speaker":"with a very big problem","startTime":2102.45,"endTime":2104.4,"body":"who have mutations in"},{"speaker":"with a very big problem","startTime":2102.45,"endTime":2104.4,"body":"this particular gene,"},{"speaker":"with a very big problem","startTime":2104.4,"endTime":2106.52,"body":"but it really focused attention"},{"speaker":"with a very big problem","startTime":2106.52,"endTime":2107.85,"body":"on this particular chemical,"},{"speaker":"with a very big problem","startTime":2107.85,"endTime":2109.53,"body":"this particular neurotransmitter,"},{"speaker":"with a very big problem","startTime":2109.53,"endTime":2111.19,"body":"called hypocretin."},{"speaker":"with a very big problem","startTime":2111.19,"endTime":2113.2,"body":"And when one looks at the brains"},{"speaker":"with a very big problem","startTime":2113.2,"endTime":2116.23,"body":"of individuals with narcolepsy,"},{"speaker":"with a very big problem","startTime":2116.23,"endTime":2119.64,"body":"and you stain them for"},{"speaker":"with a very big problem","startTime":2116.23,"endTime":2119.64,"body":"this neurotransmitter,"},{"speaker":"with a very big problem","startTime":2119.64,"endTime":2123.237,"body":"what you see is that what should light up,"},{"speaker":"with a very big problem","startTime":2123.237,"endTime":2124.93,"body":"the particular region of the brain,"},{"speaker":"with a very big problem","startTime":2124.93,"endTime":2126.71,"body":"which is called the hypothalamus,"},{"speaker":"with a very big problem","startTime":2126.71,"endTime":2129.13,"body":"in individuals with narcolepsy,"},{"speaker":"with a very big problem","startTime":2129.13,"endTime":2132.96,"body":"all of those neurons producing"},{"speaker":"with a very big problem","startTime":2129.13,"endTime":2132.96,"body":"this particular chemical"},{"speaker":"with a very big problem","startTime":2132.96,"endTime":2135.53,"body":"have disappeared, they've vanished."},{"speaker":"with a very big problem","startTime":2135.53,"endTime":2137.58,"body":"And in fact, subsequently,"},{"speaker":"with a very big problem","startTime":2137.58,"endTime":2139.21,"body":"it's been demonstrated that, actually,"},{"speaker":"with a very big problem","startTime":2139.21,"endTime":2140.63,"body":"if you measure the spinal fluid"},{"speaker":"with a very big problem","startTime":2140.63,"endTime":2142.66,"body":"of individuals with narcolepsy"},{"speaker":"with a very big problem","startTime":2142.66,"endTime":2144.296,"body":"for this particular chemical,"},{"speaker":"with a very big problem","startTime":2144.296,"endTime":2146.56,"body":"they often have very, very low levels"},{"speaker":"with a very big problem","startTime":2146.56,"endTime":2149.49,"body":"or are completely"},{"speaker":"with a very big problem","startTime":2146.56,"endTime":2149.49,"body":"deficient in this chemical."},{"speaker":"with a very big problem","startTime":2149.49,"endTime":2151.573,"body":"So why should this arise?"},{"speaker":"with a very big problem","startTime":2153.32,"endTime":2156.35,"body":"Many of you will be increasingly"},{"speaker":"with a very big problem","startTime":2153.32,"endTime":2156.35,"body":"familiar with these,"},{"speaker":"with a very big problem","startTime":2156.35,"endTime":2159.87,"body":"not necessarily this particular diagram,"},{"speaker":"with a very big problem","startTime":2159.87,"endTime":2162.87,"body":"but with the concept"},{"speaker":"with a very big problem","startTime":2159.87,"endTime":2162.87,"body":"of B-cells and T-cells."},{"speaker":"with a very big problem","startTime":2162.87,"endTime":2164.38,"body":"These are white cells"},{"speaker":"with a very big problem","startTime":2164.38,"endTime":2167.92,"body":"that constitute the core"},{"speaker":"with a very big problem","startTime":2164.38,"endTime":2167.92,"body":"of our immune response."},{"speaker":"with a very big problem","startTime":2167.92,"endTime":2169.53,"body":"And what we also now know"},{"speaker":"with a very big problem","startTime":2169.53,"endTime":2174.49,"body":"is that in 99% of individuals"},{"speaker":"with a very big problem","startTime":2169.53,"endTime":2174.49,"body":"with narcolepsy and cataplexy,"},{"speaker":"with a very big problem","startTime":2174.49,"endTime":2177.3,"body":"they have a particular genetic marker"},{"speaker":"with a very big problem","startTime":2177.3,"endTime":2179.4,"body":"for something called the HLA type,"},{"speaker":"with a very big problem","startTime":2179.4,"endTime":2182.67,"body":"which is at the core of how"},{"speaker":"with a very big problem","startTime":2179.4,"endTime":2182.67,"body":"our immune system functions."},{"speaker":"with a very big problem","startTime":2182.67,"endTime":2185.7,"body":"The HLA type defines the way"},{"speaker":"with a very big problem","startTime":2185.7,"endTime":2189.9,"body":"that the immune system presents epitopes,"},{"speaker":"with a very big problem","startTime":2189.9,"endTime":2194.9,"body":"presents bacterial or viral"},{"speaker":"with a very big problem","startTime":2189.9,"endTime":2194.9,"body":"markers to the immune system"},{"speaker":"with a very big problem","startTime":2196.56,"endTime":2198.86,"body":"to generate an immune response."},{"speaker":"with a very big problem","startTime":2198.86,"endTime":2201.69,"body":"And so what we now think is happening"},{"speaker":"with a very big problem","startTime":2201.69,"endTime":2204.69,"body":"is that individuals with this"},{"speaker":"with a very big problem","startTime":2201.69,"endTime":2204.69,"body":"particular genetic marker,"},{"speaker":"with a very big problem","startTime":2204.69,"endTime":2207.28,"body":"that defines how their"},{"speaker":"with a very big problem","startTime":2204.69,"endTime":2207.28,"body":"immune system works,"},{"speaker":"with a very big problem","startTime":2207.28,"endTime":2209.53,"body":"seem to be at very high risk"},{"speaker":"with a very big problem","startTime":2209.53,"endTime":2211.47,"body":"of generating an immune response"},{"speaker":"with a very big problem","startTime":2211.47,"endTime":2213.92,"body":"to a particular environmental trigger"},{"speaker":"with a very big problem","startTime":2213.92,"endTime":2217.33,"body":"that looks very similar"},{"speaker":"with a very big problem","startTime":2213.92,"endTime":2217.33,"body":"to hypocretin, or orexin,"},{"speaker":"with a very big problem","startTime":2217.33,"endTime":2220.4,"body":"and that the immune system is"},{"speaker":"with a very big problem","startTime":2217.33,"endTime":2220.4,"body":"actually attacking the brain"},{"speaker":"with a very big problem","startTime":2220.4,"endTime":2222.34,"body":"and causing this damage."},{"speaker":"with a very big problem","startTime":2222.34,"endTime":2227.26,"body":"And in fact, what we have"},{"speaker":"with a very big problem","startTime":2222.34,"endTime":2227.26,"body":"now clearly demonstrated"},{"speaker":"with a very big problem","startTime":2227.26,"endTime":2229.55,"body":"is that the H1N1 swine flue,"},{"speaker":"with a very big problem","startTime":2229.55,"endTime":2232.59,"body":"which was around in 2009-2010,"},{"speaker":"with a very big problem","startTime":2232.59,"endTime":2234.58,"body":"is one of those environmental triggers"},{"speaker":"with a very big problem","startTime":2234.58,"endTime":2236.14,"body":"that seems to be particularly good"},{"speaker":"with a very big problem","startTime":2236.14,"endTime":2238.62,"body":"at generating this kind"},{"speaker":"with a very big problem","startTime":2236.14,"endTime":2238.62,"body":"of immune response."},{"speaker":"with a very big problem","startTime":2238.62,"endTime":2239.453,"body":"And in fact,"},{"speaker":"with a very big problem","startTime":2239.453,"endTime":2242.76,"body":"both the the flu itself and"},{"speaker":"with a very big problem","startTime":2239.453,"endTime":2242.76,"body":"the vaccine for that flu,"},{"speaker":"with a very big problem","startTime":2242.76,"endTime":2244.37,"body":"a vaccine called Pandemrix,"},{"speaker":"with a very big problem","startTime":2244.37,"endTime":2246.46,"body":"has been very strongly associated"},{"speaker":"with a very big problem","startTime":2246.46,"endTime":2249.813,"body":"with new cases of"},{"speaker":"with a very big problem","startTime":2246.46,"endTime":2249.813,"body":"narcolepsy with cataplexy."},{"speaker":"with a very big problem","startTime":2252.09,"endTime":2254.61,"body":"So what does this substance do?"},{"speaker":"with a very big problem","startTime":2254.61,"endTime":2258.37,"body":"It has very wide projections, this system,"},{"speaker":"with a very big problem","startTime":2258.37,"endTime":2260.411,"body":"that really is largely responsible"},{"speaker":"with a very big problem","startTime":2260.411,"endTime":2263.22,"body":"for making wake stable,"},{"speaker":"with a very big problem","startTime":2263.22,"endTime":2266.31,"body":"so it's a wake-promoting neurotransmitter,"},{"speaker":"with a very big problem","startTime":2266.31,"endTime":2268.8,"body":"but it also stabilizes non-REM sleep,"},{"speaker":"with a very big problem","startTime":2268.8,"endTime":2272.32,"body":"so it prevents people"},{"speaker":"with a very big problem","startTime":2268.8,"endTime":2272.32,"body":"from going into REM sleep."},{"speaker":"with a very big problem","startTime":2272.32,"endTime":2275.14,"body":"So what happened in"},{"speaker":"with a very big problem","startTime":2272.32,"endTime":2275.14,"body":"individuals with narcolepsy?"},{"speaker":"with a very big problem","startTime":2275.14,"endTime":2275.973,"body":"You can see here,"},{"speaker":"with a very big problem","startTime":2275.973,"endTime":2278.02,"body":"this is a hypnogram of"},{"speaker":"with a very big problem","startTime":2275.973,"endTime":2278.02,"body":"somebody with narcolepsy,"},{"speaker":"with a very big problem","startTime":2278.02,"endTime":2281.5,"body":"this purply-pink bar is REM sleep,"},{"speaker":"with a very big problem","startTime":2281.5,"endTime":2283.81,"body":"and you can see that in this"},{"speaker":"with a very big problem","startTime":2281.5,"endTime":2283.81,"body":"individual with narcolepsy,"},{"speaker":"with a very big problem","startTime":2283.81,"endTime":2287.04,"body":"they're constantly flicking"},{"speaker":"with a very big problem","startTime":2283.81,"endTime":2287.04,"body":"in and out of dreaming sleep,"},{"speaker":"with a very big problem","startTime":2287.04,"endTime":2289.73,"body":"from wake, from deeper stages of sleep,"},{"speaker":"with a very big problem","startTime":2289.73,"endTime":2291.6,"body":"but it's very fragmented."},{"speaker":"with a very big problem","startTime":2291.6,"endTime":2293.51,"body":"And so in these individuals,"},{"speaker":"with a very big problem","startTime":2293.51,"endTime":2296.01,"body":"because they are flicking in"},{"speaker":"with a very big problem","startTime":2293.51,"endTime":2296.01,"body":"and out of dreaming sleep,"},{"speaker":"with a very big problem","startTime":2296.01,"endTime":2297.24,"body":"because those switches"},{"speaker":"with a very big problem","startTime":2297.24,"endTime":2299.48,"body":"between wake, and sleep,"},{"speaker":"with a very big problem","startTime":2299.48,"endTime":2301.1,"body":"and REM sleep, and non-REM sleep"},{"speaker":"with a very big problem","startTime":2301.1,"endTime":2304.03,"body":"are unstable, and the whole"},{"speaker":"with a very big problem","startTime":2301.1,"endTime":2304.03,"body":"of sleep is destabilized,"},{"speaker":"with a very big problem","startTime":2304.03,"endTime":2306.67,"body":"that explains many of the"},{"speaker":"with a very big problem","startTime":2304.03,"endTime":2306.67,"body":"phenomena that they experience."},{"speaker":"with a very big problem","startTime":2306.67,"endTime":2309.64,"body":"So they experience these hallucinations,"},{"speaker":"with a very big problem","startTime":2309.64,"endTime":2312.62,"body":"they experience this sleep paralysis,"},{"speaker":"with a very big problem","startTime":2312.62,"endTime":2315.81,"body":"they often experience"},{"speaker":"with a very big problem","startTime":2312.62,"endTime":2315.81,"body":"very vivid dreams indeed,"},{"speaker":"with a very big problem","startTime":2315.81,"endTime":2318.153,"body":"and they experience these sleep attacks."},{"speaker":"with a very big problem","startTime":2319.09,"endTime":2320.62,"body":"Well what about cataplexy?"},{"speaker":"with a very big problem","startTime":2320.62,"endTime":2321.64,"body":"The honest answer is"},{"speaker":"with a very big problem","startTime":2321.64,"endTime":2324.69,"body":"we don't know why these"},{"speaker":"with a very big problem","startTime":2321.64,"endTime":2324.69,"body":"individuals get cataplexy,"},{"speaker":"with a very big problem","startTime":2324.69,"endTime":2325.523,"body":"but we think"},{"speaker":"with a very big problem","startTime":2325.523,"endTime":2329.68,"body":"that this may well be an"},{"speaker":"with a very big problem","startTime":2325.523,"endTime":2329.68,"body":"evolutionary throwback,"},{"speaker":"with a very big problem","startTime":2329.68,"endTime":2331.02,"body":"in that there are many species"},{"speaker":"with a very big problem","startTime":2331.02,"endTime":2333.87,"body":"that play dead when they're under threat,"},{"speaker":"with a very big problem","startTime":2333.87,"endTime":2336.66,"body":"they exhibit something"},{"speaker":"with a very big problem","startTime":2333.87,"endTime":2336.66,"body":"called tonic immobility,"},{"speaker":"with a very big problem","startTime":2336.66,"endTime":2339.54,"body":"possums, snakes, amphibians, birds,"},{"speaker":"with a very big problem","startTime":2339.54,"endTime":2343.69,"body":"and some researchers have speculated"},{"speaker":"with a very big problem","startTime":2343.69,"endTime":2345.84,"body":"that the reason why strong emotions,"},{"speaker":"with a very big problem","startTime":2345.84,"endTime":2347.08,"body":"and even things like laughter,"},{"speaker":"with a very big problem","startTime":2347.08,"endTime":2349.56,"body":"which has its origins"},{"speaker":"with a very big problem","startTime":2347.08,"endTime":2349.56,"body":"in a response to threat"},{"speaker":"with a very big problem","startTime":2349.56,"endTime":2351.67,"body":"if one looks at primates,"},{"speaker":"with a very big problem","startTime":2351.67,"endTime":2356.07,"body":"may be triggering these vestigial pathways"},{"speaker":"with a very big problem","startTime":2356.07,"endTime":2358.99,"body":"that mediate this process"},{"speaker":"with a very big problem","startTime":2356.07,"endTime":2358.99,"body":"of losing muscle strength,"},{"speaker":"with a very big problem","startTime":2358.99,"endTime":2360.17,"body":"of playing dead,"},{"speaker":"with a very big problem","startTime":2360.17,"endTime":2361.54,"body":"and that somehow,"},{"speaker":"with a very big problem","startTime":2361.54,"endTime":2363.89,"body":"this loss of this chemical"},{"speaker":"with a very big problem","startTime":2363.89,"endTime":2368.37,"body":"unveils, or unmasks these"},{"speaker":"with a very big problem","startTime":2363.89,"endTime":2368.37,"body":"evolutionary-old circuits,"},{"speaker":"with a very big problem","startTime":2368.37,"endTime":2369.77,"body":"but that's very speculative."},{"speaker":"with a very big problem","startTime":2371.67,"endTime":2372.69,"body":"The other thing"},{"speaker":"with a very big problem","startTime":2372.69,"endTime":2375.21,"body":"that people with narcolepsy"},{"speaker":"with a very big problem","startTime":2372.69,"endTime":2375.21,"body":"experience a lot of"},{"speaker":"with a very big problem","startTime":2375.21,"endTime":2376.22,"body":"is lucid dreaming."},{"speaker":"with a very big problem","startTime":2376.22,"endTime":2378.47,"body":"Some of you may well have"},{"speaker":"with a very big problem","startTime":2376.22,"endTime":2378.47,"body":"lucid dreamed yourself,"},{"speaker":"with a very big problem","startTime":2378.47,"endTime":2381.46,"body":"this describes the phenomenon of dreaming,"},{"speaker":"with a very big problem","startTime":2381.46,"endTime":2383.06,"body":"but being aware that you're dreaming,"},{"speaker":"with a very big problem","startTime":2383.06,"endTime":2385.73,"body":"sometimes even being able"},{"speaker":"with a very big problem","startTime":2383.06,"endTime":2385.73,"body":"to control your dreams,"},{"speaker":"with a very big problem","startTime":2385.73,"endTime":2387.09,"body":"which must be a magical thing,"},{"speaker":"with a very big problem","startTime":2387.09,"endTime":2390.04,"body":"if you can actually decide"},{"speaker":"with a very big problem","startTime":2387.09,"endTime":2390.04,"body":"where you go and what you do"},{"speaker":"with a very big problem","startTime":2390.04,"endTime":2391.57,"body":"in your dreams."},{"speaker":"with a very big problem","startTime":2391.57,"endTime":2394.9,"body":"This used to be thought of"},{"speaker":"with a very big problem","startTime":2391.57,"endTime":2394.9,"body":"as being a bit of a figment"},{"speaker":"with a very big problem","startTime":2394.9,"endTime":2398.55,"body":"of people's overactive imaginations,"},{"speaker":"with a very big problem","startTime":2398.55,"endTime":2402.3,"body":"but actually, we now have some"},{"speaker":"with a very big problem","startTime":2398.55,"endTime":2402.3,"body":"really quite amazing evidence"},{"speaker":"with a very big problem","startTime":2402.3,"endTime":2405.18,"body":"that lucid dreaming is a real phenomenon."},{"speaker":"with a very big problem","startTime":2405.18,"endTime":2408.41,"body":"In this study that was done"},{"speaker":"with a very big problem","startTime":2405.18,"endTime":2408.41,"body":"in Germany a few years ago,"},{"speaker":"with a very big problem","startTime":2408.41,"endTime":2411.4,"body":"they got a few people who said"},{"speaker":"with a very big problem","startTime":2408.41,"endTime":2411.4,"body":"that they could lucid dream"},{"speaker":"with a very big problem","startTime":2411.4,"endTime":2413.18,"body":"into a scanner."},{"speaker":"with a very big problem","startTime":2413.18,"endTime":2414.64,"body":"And they asked them to"},{"speaker":"with a very big problem","startTime":2413.18,"endTime":2414.64,"body":"lie in this scanner,"},{"speaker":"with a very big problem","startTime":2414.64,"endTime":2416.48,"body":"something called a functional MRI scanner,"},{"speaker":"with a very big problem","startTime":2416.48,"endTime":2417.45,"body":"which tells us a little bit"},{"speaker":"with a very big problem","startTime":2417.45,"endTime":2419.33,"body":"about the activity within the brain,"},{"speaker":"with a very big problem","startTime":2419.33,"endTime":2422.67,"body":"and they asked them to"},{"speaker":"with a very big problem","startTime":2419.33,"endTime":2422.67,"body":"clench their left hand"},{"speaker":"with a very big problem","startTime":2422.67,"endTime":2424.09,"body":"for 10 seconds,"},{"speaker":"with a very big problem","startTime":2424.09,"endTime":2426.64,"body":"then make a particular"},{"speaker":"with a very big problem","startTime":2424.09,"endTime":2426.64,"body":"sequence of eye movements"},{"speaker":"with a very big problem","startTime":2426.64,"endTime":2430.23,"body":"to signal that they were switching sides,"},{"speaker":"with a very big problem","startTime":2430.23,"endTime":2431.62,"body":"and then clench their other side,"},{"speaker":"with a very big problem","startTime":2431.62,"endTime":2432.87,"body":"and do that repeatedly."},{"speaker":"with a very big problem","startTime":2432.87,"endTime":2434.07,"body":"And what they showed was that,"},{"speaker":"with a very big problem","startTime":2434.07,"endTime":2436.42,"body":"obviously, when they"},{"speaker":"with a very big problem","startTime":2434.07,"endTime":2436.42,"body":"clenched their right hand,"},{"speaker":"with a very big problem","startTime":2436.42,"endTime":2437.61,"body":"this area of the brain,"},{"speaker":"with a very big problem","startTime":2437.61,"endTime":2441.48,"body":"which is the hand area on the other side,"},{"speaker":"with a very big problem","startTime":2441.48,"endTime":2442.72,"body":"because, of course,"},{"speaker":"with a very big problem","startTime":2442.72,"endTime":2445.3,"body":"our representation of"},{"speaker":"with a very big problem","startTime":2442.72,"endTime":2445.3,"body":"our bodies is crossed,"},{"speaker":"with a very big problem","startTime":2445.3,"endTime":2446.133,"body":"lit up,"},{"speaker":"with a very big problem","startTime":2446.133,"endTime":2447.34,"body":"when they switched over,"},{"speaker":"with a very big problem","startTime":2447.34,"endTime":2451.76,"body":"the hand area on the other side lit up."},{"speaker":"with a very big problem","startTime":2451.76,"endTime":2453.24,"body":"They then got them to get in the scanner,"},{"speaker":"with a very big problem","startTime":2453.24,"endTime":2454.19,"body":"and while they were awake,"},{"speaker":"with a very big problem","startTime":2454.19,"endTime":2455.73,"body":"to imagine that they were doing this"},{"speaker":"with a very big problem","startTime":2455.73,"endTime":2456.93,"body":"rather then physically doing this,"},{"speaker":"with a very big problem","startTime":2456.93,"endTime":2457.9,"body":"and once again,"},{"speaker":"with a very big problem","startTime":2457.9,"endTime":2460.58,"body":"those same areas of the brain lit up."},{"speaker":"with a very big problem","startTime":2460.58,"endTime":2464.24,"body":"They then got these people to"},{"speaker":"with a very big problem","startTime":2460.58,"endTime":2464.24,"body":"fall asleep in the scanner,"},{"speaker":"with a very big problem","startTime":2464.24,"endTime":2467.05,"body":"to signal with this prearranged"},{"speaker":"with a very big problem","startTime":2464.24,"endTime":2467.05,"body":"sequence of eye movements"},{"speaker":"with a very big problem","startTime":2467.05,"endTime":2469.17,"body":"when they had begun to lucid dream,"},{"speaker":"with a very big problem","startTime":2469.17,"endTime":2471.72,"body":"and in their dream, to clench their hand,"},{"speaker":"with a very big problem","startTime":2471.72,"endTime":2473.66,"body":"their left hand, then their right hand."},{"speaker":"with a very big problem","startTime":2473.66,"endTime":2475.85,"body":"And sure enough, once again,"},{"speaker":"with a very big problem","startTime":2475.85,"endTime":2477.76,"body":"similar areas of the brain lit up,"},{"speaker":"with a very big problem","startTime":2477.76,"endTime":2481.22,"body":"really demonstrating very"},{"speaker":"with a very big problem","startTime":2477.76,"endTime":2481.22,"body":"clearly that lucid dreaming"},{"speaker":"with a very big problem","startTime":2481.22,"endTime":2484.19,"body":"has an underlying neurobiological origin."},{"speaker":"with a very big problem","startTime":2484.19,"endTime":2486.613,"body":"It's quite a remarkable"},{"speaker":"with a very big problem","startTime":2484.19,"endTime":2486.613,"body":"study, if you think about it."},{"speaker":"with a very big problem","startTime":2488.04,"endTime":2488.873,"body":"And in fact,"},{"speaker":"with a very big problem","startTime":2488.873,"endTime":2490.86,"body":"when people have looked at lucid dreamers,"},{"speaker":"with a very big problem","startTime":2490.86,"endTime":2492.07,"body":"what they've demonstrated"},{"speaker":"with a very big problem","startTime":2492.07,"endTime":2494.41,"body":"is that there are areas of the brain"},{"speaker":"with a very big problem","startTime":2494.41,"endTime":2499.41,"body":"that seem to be in slightly"},{"speaker":"with a very big problem","startTime":2494.41,"endTime":2499.41,"body":"less consistent REM sleep"},{"speaker":"with a very big problem","startTime":2499.81,"endTime":2500.643,"body":"than others."},{"speaker":"with a very big problem","startTime":2502.503,"endTime":2505.15,"body":"The frontal area of the brain"},{"speaker":"with a very big problem","startTime":2502.503,"endTime":2505.15,"body":"comes up a lot in this talk,"},{"speaker":"with a very big problem","startTime":2505.15,"endTime":2507.97,"body":"but areas of the frontal lobes"},{"speaker":"with a very big problem","startTime":2507.97,"endTime":2512.36,"body":"that seem to demonstrate"},{"speaker":"with a very big problem","startTime":2507.97,"endTime":2512.36,"body":"some wakeful-type behavior"},{"speaker":"with a very big problem","startTime":2512.36,"endTime":2514.24,"body":"within lucid dreaming,"},{"speaker":"with a very big problem","startTime":2514.24,"endTime":2515.9,"body":"implying that, perhaps,"},{"speaker":"with a very big problem","startTime":2515.9,"endTime":2518.64,"body":"these areas of the brain"},{"speaker":"with a very big problem","startTime":2515.9,"endTime":2518.64,"body":"in the frontal region"},{"speaker":"with a very big problem","startTime":2518.64,"endTime":2522.21,"body":"might be important in"},{"speaker":"with a very big problem","startTime":2518.64,"endTime":2522.21,"body":"awareness, in consciousness,"},{"speaker":"with a very big problem","startTime":2522.21,"endTime":2523.79,"body":"although a very recent study"},{"speaker":"with a very big problem","startTime":2523.79,"endTime":2526.74,"body":"has thrown some doubt onto these studies."},{"speaker":"with a very big problem","startTime":2526.74,"endTime":2528.693,"body":"Why is this relevant to insomnia?"},{"speaker":"with a very big problem","startTime":2529.54,"endTime":2531.54,"body":"Many people with insomnia,"},{"speaker":"with a very big problem","startTime":2531.54,"endTime":2532.8,"body":"many people who say,"},{"speaker":"with a very big problem","startTime":2532.8,"endTime":2533.77,"body":"I didn't sleep a wink,"},{"speaker":"with a very big problem","startTime":2533.77,"endTime":2536.0,"body":"when you bring them into"},{"speaker":"with a very big problem","startTime":2533.77,"endTime":2536.0,"body":"the sleep laboratory,"},{"speaker":"with a very big problem","startTime":2536.0,"endTime":2537.15,"body":"actually, what you record"},{"speaker":"with a very big problem","startTime":2537.15,"endTime":2540.01,"body":"is seven or eight hours"},{"speaker":"with a very big problem","startTime":2537.15,"endTime":2540.01,"body":"of fantastic sleep."},{"speaker":"with a very big problem","startTime":2540.01,"endTime":2541.56,"body":"And this is a phenomenon"},{"speaker":"with a very big problem","startTime":2541.56,"endTime":2544.23,"body":"that used to called sleep"},{"speaker":"with a very big problem","startTime":2541.56,"endTime":2544.23,"body":"state misperception,"},{"speaker":"with a very big problem","startTime":2544.23,"endTime":2548.59,"body":"it's now termed paradoxical insomnia,"},{"speaker":"with a very big problem","startTime":2548.59,"endTime":2551.71,"body":"so individuals who complain"},{"speaker":"with a very big problem","startTime":2548.59,"endTime":2551.71,"body":"of very bad insomnia,"},{"speaker":"with a very big problem","startTime":2551.71,"endTime":2555.32,"body":"but actually, when their"},{"speaker":"with a very big problem","startTime":2551.71,"endTime":2555.32,"body":"sleep is objectively measured,"},{"speaker":"with a very big problem","startTime":2555.32,"endTime":2558.72,"body":"they demonstrate very good quality sleep."},{"speaker":"with a very big problem","startTime":2558.72,"endTime":2561.56,"body":"But actually, rather than"},{"speaker":"with a very big problem","startTime":2558.72,"endTime":2561.56,"body":"this being psychological,"},{"speaker":"with a very big problem","startTime":2561.56,"endTime":2564.94,"body":"as was previously termed,"},{"speaker":"with a very big problem","startTime":2564.94,"endTime":2566.31,"body":"what we now know"},{"speaker":"with a very big problem","startTime":2566.31,"endTime":2568.87,"body":"is that individuals with"},{"speaker":"with a very big problem","startTime":2566.31,"endTime":2568.87,"body":"paradoxical insomnia,"},{"speaker":"with a very big problem","startTime":2568.87,"endTime":2570.92,"body":"with this sleep state misperception,"},{"speaker":"with a very big problem","startTime":2570.92,"endTime":2573.4,"body":"also exhibit some changes on their EEG,"},{"speaker":"with a very big problem","startTime":2573.4,"endTime":2575.01,"body":"on the electrical activity of their brain,"},{"speaker":"with a very big problem","startTime":2575.01,"endTime":2577.25,"body":"demonstrating that"},{"speaker":"with a very big problem","startTime":2575.01,"endTime":2577.25,"body":"different parts of the brain"},{"speaker":"with a very big problem","startTime":2577.25,"endTime":2579.65,"body":"demonstrate some slightly"},{"speaker":"with a very big problem","startTime":2577.25,"endTime":2579.65,"body":"more waking behavior"},{"speaker":"with a very big problem","startTime":2579.65,"endTime":2580.61,"body":"than the rest of the brain,"},{"speaker":"with a very big problem","startTime":2580.61,"endTime":2583.363,"body":"so another example of these blurred lines."},{"speaker":"with a very big problem","startTime":2585.87,"endTime":2588.173,"body":"What about lesioning of sleep itself?"},{"speaker":"with a very big problem","startTime":2589.07,"endTime":2590.66,"body":"There are a wide range of conditions"},{"speaker":"with a very big problem","startTime":2590.66,"endTime":2592.73,"body":"that damage, or lesion sleep,"},{"speaker":"with a very big problem","startTime":2592.73,"endTime":2595.79,"body":"chronic sleep deprivation"},{"speaker":"with a very big problem","startTime":2592.73,"endTime":2595.79,"body":"is probably the commonest,"},{"speaker":"with a very big problem","startTime":2595.79,"endTime":2598.29,"body":"but one of the very common conditions"},{"speaker":"with a very big problem","startTime":2598.29,"endTime":2601.63,"body":"that we see in a clinical sleep setting"},{"speaker":"with a very big problem","startTime":2601.63,"endTime":2604.33,"body":"is a condition called"},{"speaker":"with a very big problem","startTime":2601.63,"endTime":2604.33,"body":"obstructive sleep apnea."},{"speaker":"with a very big problem","startTime":2604.33,"endTime":2606.84,"body":"This is a condition whereby,"},{"speaker":"with a very big problem","startTime":2606.84,"endTime":2609.02,"body":"usually for anatomical reasons,"},{"speaker":"with a very big problem","startTime":2609.02,"endTime":2612.29,"body":"the airway, in sleep, obstructs."},{"speaker":"with a very big problem","startTime":2612.29,"endTime":2616.09,"body":"Our airway is kept patent"},{"speaker":"with a very big problem","startTime":2612.29,"endTime":2616.09,"body":"by multiple muscles"},{"speaker":"with a very big problem","startTime":2616.09,"endTime":2617.73,"body":"that maintain the rigidity of the airway,"},{"speaker":"with a very big problem","startTime":2617.73,"endTime":2619.28,"body":"and as we drift off to sleep,"},{"speaker":"with a very big problem","startTime":2619.28,"endTime":2620.76,"body":"the airway becomes a bit more floppy,"},{"speaker":"with a very big problem","startTime":2620.76,"endTime":2621.93,"body":"and it begins to reverberate,"},{"speaker":"with a very big problem","startTime":2621.93,"endTime":2624.53,"body":"which is why most of us snore."},{"speaker":"with a very big problem","startTime":2624.53,"endTime":2627.02,"body":"But if your airway is a"},{"speaker":"with a very big problem","startTime":2624.53,"endTime":2627.02,"body":"little bit more narrowed,"},{"speaker":"with a very big problem","startTime":2627.02,"endTime":2628.56,"body":"or a little bit more floppy,"},{"speaker":"with a very big problem","startTime":2628.56,"endTime":2630.35,"body":"then it can sometimes"},{"speaker":"with a very big problem","startTime":2628.56,"endTime":2630.35,"body":"collapse in on itself"},{"speaker":"with a very big problem","startTime":2630.35,"endTime":2631.74,"body":"and completely obstruct,"},{"speaker":"with a very big problem","startTime":2631.74,"endTime":2633.16,"body":"and that disrupts sleep"},{"speaker":"with a very big problem","startTime":2633.16,"endTime":2635.7,"body":"because your oxygen levels drop,"},{"speaker":"with a very big problem","startTime":2635.7,"endTime":2637.163,"body":"your brain detects the fact"},{"speaker":"with a very big problem","startTime":2637.163,"endTime":2639.73,"body":"that there is increased"},{"speaker":"with a very big problem","startTime":2637.163,"endTime":2639.73,"body":"resistance to sleeping,"},{"speaker":"with a very big problem","startTime":2639.73,"endTime":2642.43,"body":"your depth of sleep rises,"},{"speaker":"with a very big problem","startTime":2642.43,"endTime":2644.31,"body":"and then the muscle strength returns"},{"speaker":"with a very big problem","startTime":2644.31,"endTime":2645.82,"body":"and the airway becomes more patent."},{"speaker":"with a very big problem","startTime":2645.82,"endTime":2647.94,"body":"And in people with very bad sleep apnea,"},{"speaker":"with a very big problem","startTime":2647.94,"endTime":2651.15,"body":"they can obstruct sometimes"},{"speaker":"with a very big problem","startTime":2647.94,"endTime":2651.15,"body":"as often as 120 times an hour"},{"speaker":"with a very big problem","startTime":2651.15,"endTime":2652.35,"body":"throughout the night,"},{"speaker":"with a very big problem","startTime":2652.35,"endTime":2653.183,"body":"so you can imagine"},{"speaker":"with a very big problem","startTime":2653.183,"endTime":2656.483,"body":"that this is very, very"},{"speaker":"with a very big problem","startTime":2653.183,"endTime":2656.483,"body":"disruptive to sleep itself."},{"speaker":"with a very big problem","startTime":2658.31,"endTime":2659.41,"body":"And we now know"},{"speaker":"with a very big problem","startTime":2659.41,"endTime":2661.72,"body":"that conditions like"},{"speaker":"with a very big problem","startTime":2659.41,"endTime":2661.72,"body":"obstructive sleep apnea,"},{"speaker":"with a very big problem","startTime":2661.72,"endTime":2663.55,"body":"and some forms of insomnia,"},{"speaker":"with a very big problem","startTime":2663.55,"endTime":2665.51,"body":"although not all forms of insomnia,"},{"speaker":"with a very big problem","startTime":2665.51,"endTime":2667.406,"body":"are associated with a whole range"},{"speaker":"with a very big problem","startTime":2667.406,"endTime":2671.13,"body":"of negative health consequences,"},{"speaker":"with a very big problem","startTime":2671.13,"endTime":2673.51,"body":"conditions like high blood pressure,"},{"speaker":"with a very big problem","startTime":2673.51,"endTime":2676.99,"body":"conditions like heart disease, stroke,"},{"speaker":"with a very big problem","startTime":2676.99,"endTime":2680.24,"body":"and importantly, cognitive decline,"},{"speaker":"with a very big problem","startTime":2680.24,"endTime":2681.653,"body":"conditions like dementia."},{"speaker":"with a very big problem","startTime":2682.939,"endTime":2684.683,"body":"Why should that be the case?"},{"speaker":"with a very big problem","startTime":2686.56,"endTime":2689.6,"body":"If you look at the protein"},{"speaker":"with a very big problem","startTime":2686.56,"endTime":2689.6,"body":"that is deposited in the brain"},{"speaker":"with a very big problem","startTime":2689.6,"endTime":2691.05,"body":"in conditions like Alzheimer's,"},{"speaker":"with a very big problem","startTime":2691.05,"endTime":2693.38,"body":"a protein called beta-amyloid,"},{"speaker":"with a very big problem","startTime":2693.38,"endTime":2695.36,"body":"and you measure beta-amyloid"},{"speaker":"with a very big problem","startTime":2695.36,"endTime":2697.45,"body":"in the spinal fluid of individuals,"},{"speaker":"with a very big problem","startTime":2697.45,"endTime":2700.91,"body":"even after a single night"},{"speaker":"with a very big problem","startTime":2697.45,"endTime":2700.91,"body":"of sleep deprivation,"},{"speaker":"with a very big problem","startTime":2700.91,"endTime":2703.24,"body":"you see a fundamental alteration"},{"speaker":"with a very big problem","startTime":2703.24,"endTime":2706.54,"body":"in terms of levels of"},{"speaker":"with a very big problem","startTime":2703.24,"endTime":2706.54,"body":"beta-amyloid in the spinal fluid."},{"speaker":"with a very big problem","startTime":2706.54,"endTime":2707.373,"body":"You can see here,"},{"speaker":"with a very big problem","startTime":2707.373,"endTime":2708.79,"body":"this is somebody who's left to sleep,"},{"speaker":"with a very big problem","startTime":2708.79,"endTime":2711.17,"body":"their beta-amyloid is a little bit lower,"},{"speaker":"with a very big problem","startTime":2711.17,"endTime":2713.44,"body":"and then they're left to"},{"speaker":"with a very big problem","startTime":2711.17,"endTime":2713.44,"body":"sleep throughout the night,"},{"speaker":"with a very big problem","startTime":2713.44,"endTime":2714.35,"body":"and in the morning,"},{"speaker":"with a very big problem","startTime":2714.35,"endTime":2716.4,"body":"their beta-amyloid levels drop down."},{"speaker":"with a very big problem","startTime":2716.4,"endTime":2717.25,"body":"In this individual,"},{"speaker":"with a very big problem","startTime":2717.25,"endTime":2718.86,"body":"who clearly has been kept awake all night"},{"speaker":"with a very big problem","startTime":2718.86,"endTime":2721.27,"body":"because they've had spinal taps"},{"speaker":"with a very big problem","startTime":2721.27,"endTime":2722.89,"body":"all the way through the night,"},{"speaker":"with a very big problem","startTime":2722.89,"endTime":2725.54,"body":"what you see is you see"},{"speaker":"with a very big problem","startTime":2722.89,"endTime":2725.54,"body":"a dramatic deviation"},{"speaker":"with a very big problem","startTime":2725.54,"endTime":2727.46,"body":"in terms of their levels of beta-amyloid"},{"speaker":"with a very big problem","startTime":2727.46,"endTime":2728.603,"body":"in their spinal fluid,"},{"speaker":"with a very big problem","startTime":2729.86,"endTime":2731.96,"body":"it's much higher than it would have been"},{"speaker":"with a very big problem","startTime":2731.96,"endTime":2733.76,"body":"if they had been left to sleep."},{"speaker":"with a very big problem","startTime":2733.76,"endTime":2734.593,"body":"And in fact,"},{"speaker":"with a very big problem","startTime":2734.593,"endTime":2736.24,"body":"when imaging studies have been done"},{"speaker":"with a very big problem","startTime":2736.24,"endTime":2738.96,"body":"looking at markers of"},{"speaker":"with a very big problem","startTime":2736.24,"endTime":2738.96,"body":"beta-amyloid in the brain,"},{"speaker":"with a very big problem","startTime":2738.96,"endTime":2742.09,"body":"even after a single night"},{"speaker":"with a very big problem","startTime":2738.96,"endTime":2742.09,"body":"of sleep deprivation,"},{"speaker":"with a very big problem","startTime":2742.09,"endTime":2743.37,"body":"levels of this protein,"},{"speaker":"with a very big problem","startTime":2743.37,"endTime":2744.45,"body":"and once again, I would stress"},{"speaker":"with a very big problem","startTime":2744.45,"endTime":2749.28,"body":"that this protein is one"},{"speaker":"with a very big problem","startTime":2744.45,"endTime":2749.28,"body":"of the fundamental culprits"},{"speaker":"with a very big problem","startTime":2749.28,"endTime":2752.073,"body":"that are thought to underlie"},{"speaker":"with a very big problem","startTime":2749.28,"endTime":2752.073,"body":"Alzheimer's disease,"},{"speaker":"with a very big problem","startTime":2753.1,"endTime":2754.73,"body":"change within areas of the brain"},{"speaker":"with a very big problem","startTime":2754.73,"endTime":2756.67,"body":"that are implicated in"},{"speaker":"with a very big problem","startTime":2754.73,"endTime":2756.67,"body":"Alzheimer's disease,"},{"speaker":"with a very big problem","startTime":2756.67,"endTime":2757.82,"body":"like the hippocampus,"},{"speaker":"with a very big problem","startTime":2757.82,"endTime":2761.27,"body":"which is fundamental to memory,"},{"speaker":"with a very big problem","startTime":2761.27,"endTime":2764.95,"body":"so suggesting at least one explanation"},{"speaker":"with a very big problem","startTime":2764.95,"endTime":2768.8,"body":"for why sleep disruption"},{"speaker":"with a very big problem","startTime":2764.95,"endTime":2768.8,"body":"or sleep deprivation"},{"speaker":"with a very big problem","startTime":2768.8,"endTime":2770.8,"body":"may be associated with these conditions."},{"speaker":"with a very big problem","startTime":2771.8,"endTime":2775.26,"body":"And in fact, why this may be the case"},{"speaker":"with a very big problem","startTime":2775.26,"endTime":2777.75,"body":"has become apparent in"},{"speaker":"with a very big problem","startTime":2775.26,"endTime":2777.75,"body":"recent years as well."},{"speaker":"with a very big problem","startTime":2777.75,"endTime":2778.78,"body":"When I was at medical school,"},{"speaker":"with a very big problem","startTime":2778.78,"endTime":2782.82,"body":"we were taught that the lymphatic system,"},{"speaker":"with a very big problem","startTime":2782.82,"endTime":2784.95,"body":"which is a drainage system"},{"speaker":"with a very big problem","startTime":2784.95,"endTime":2788.27,"body":"that brings extracellular fluid"},{"speaker":"with a very big problem","startTime":2784.95,"endTime":2788.27,"body":"back into the circulation,"},{"speaker":"with a very big problem","startTime":2788.27,"endTime":2791.23,"body":"exists everywhere apart from the brain,"},{"speaker":"with a very big problem","startTime":2791.23,"endTime":2794.59,"body":"but in the early 2010s,"},{"speaker":"with a very big problem","startTime":2794.59,"endTime":2795.93,"body":"actually, it was demonstrated"},{"speaker":"with a very big problem","startTime":2795.93,"endTime":2799.18,"body":"that whilst there isn't a"},{"speaker":"with a very big problem","startTime":2795.93,"endTime":2799.18,"body":"lymphatic system within the brain,"},{"speaker":"with a very big problem","startTime":2799.18,"endTime":2802.55,"body":"there is a very, very similar"},{"speaker":"with a very big problem","startTime":2799.18,"endTime":2802.55,"body":"system on a microscopic level,"},{"speaker":"with a very big problem","startTime":2802.55,"endTime":2805.97,"body":"and they demonstrated that"},{"speaker":"with a very big problem","startTime":2802.55,"endTime":2805.97,"body":"there are a series of channels,"},{"speaker":"with a very big problem","startTime":2805.97,"endTime":2807.36,"body":"microscopic channels,"},{"speaker":"with a very big problem","startTime":2807.36,"endTime":2809.45,"body":"that run through the brain,"},{"speaker":"with a very big problem","startTime":2809.45,"endTime":2812.67,"body":"whose function is actually"},{"speaker":"with a very big problem","startTime":2809.45,"endTime":2812.67,"body":"to cleanse the brain"},{"speaker":"with a very big problem","startTime":2812.67,"endTime":2814.23,"body":"of toxins or metabolites"},{"speaker":"with a very big problem","startTime":2814.23,"endTime":2816.88,"body":"that have accrued over"},{"speaker":"with a very big problem","startTime":2814.23,"endTime":2816.88,"body":"the course of the day,"},{"speaker":"with a very big problem","startTime":2816.88,"endTime":2817.87,"body":"and that, actually,"},{"speaker":"with a very big problem","startTime":2817.87,"endTime":2822.08,"body":"these channels open up by"},{"speaker":"with a very big problem","startTime":2817.87,"endTime":2822.08,"body":"about 60% in deep sleep"},{"speaker":"with a very big problem","startTime":2822.08,"endTime":2825.1,"body":"or under conditions of anesthesia."},{"speaker":"with a very big problem","startTime":2825.1,"endTime":2829.89,"body":"And the degree to which,"},{"speaker":"with a very big problem","startTime":2825.1,"endTime":2829.89,"body":"the speed at which"},{"speaker":"with a very big problem","startTime":2829.89,"endTime":2834.8,"body":"beta-amyloid, and other associated"},{"speaker":"with a very big problem","startTime":2829.89,"endTime":2834.8,"body":"byproducts of wakefulness"},{"speaker":"with a very big problem","startTime":2834.8,"endTime":2836.2,"body":"are cleansed from the brain"},{"speaker":"with a very big problem","startTime":2836.2,"endTime":2839.53,"body":"is fundamentally altered"},{"speaker":"with a very big problem","startTime":2836.2,"endTime":2839.53,"body":"by disruption of sleep,"},{"speaker":"with a very big problem","startTime":2839.53,"endTime":2843.43,"body":"giving us a very clear idea"},{"speaker":"with a very big problem","startTime":2839.53,"endTime":2843.43,"body":"of why sleep disturbance"},{"speaker":"with a very big problem","startTime":2843.43,"endTime":2846.98,"body":"might result in conditions"},{"speaker":"with a very big problem","startTime":2843.43,"endTime":2846.98,"body":"like Alzheimer's disease."},{"speaker":"with a very big problem","startTime":2846.98,"endTime":2848.01,"body":"And in fact, in sleep apnea,"},{"speaker":"with a very big problem","startTime":2848.01,"endTime":2848.93,"body":"it's a bit more complicated,"},{"speaker":"with a very big problem","startTime":2848.93,"endTime":2850.82,"body":"because in sleep apnea, essentially,"},{"speaker":"with a very big problem","startTime":2850.82,"endTime":2853.86,"body":"you're being strangled"},{"speaker":"with a very big problem","startTime":2850.82,"endTime":2853.86,"body":"up to 120 times an hour,"},{"speaker":"with a very big problem","startTime":2853.86,"endTime":2856.45,"body":"so your oxygen levels"},{"speaker":"with a very big problem","startTime":2853.86,"endTime":2856.45,"body":"are bouncing up and down,"},{"speaker":"with a very big problem","startTime":2856.45,"endTime":2859.05,"body":"and so your brain not only is vulnerable"},{"speaker":"with a very big problem","startTime":2859.05,"endTime":2863.25,"body":"to the effects of your"},{"speaker":"with a very big problem","startTime":2859.05,"endTime":2863.25,"body":"sleep being disrupted,"},{"speaker":"with a very big problem","startTime":2863.25,"endTime":2864.14,"body":"but it's also vulnerable"},{"speaker":"with a very big problem","startTime":2864.14,"endTime":2866.67,"body":"to the effects of being"},{"speaker":"with a very big problem","startTime":2864.14,"endTime":2866.67,"body":"starved of oxygen repeatedly"},{"speaker":"with a very big problem","startTime":2866.67,"endTime":2867.7,"body":"throughout the night,"},{"speaker":"with a very big problem","startTime":2867.7,"endTime":2870.5,"body":"and that may well generate"},{"speaker":"with a very big problem","startTime":2867.7,"endTime":2870.5,"body":"some inflammatory changes"},{"speaker":"with a very big problem","startTime":2870.5,"endTime":2871.57,"body":"within the brain."},{"speaker":"with a very big problem","startTime":2871.57,"endTime":2873.72,"body":"So sleep apnea in particular"},{"speaker":"with a very big problem","startTime":2873.72,"endTime":2877.44,"body":"may be a very important"},{"speaker":"with a very big problem","startTime":2873.72,"endTime":2877.44,"body":"modifiable risk factor"},{"speaker":"with a very big problem","startTime":2877.44,"endTime":2878.81,"body":"for conditions like dementia,"},{"speaker":"with a very big problem","startTime":2878.81,"endTime":2880.4,"body":"which, in the current climate,"},{"speaker":"with a very big problem","startTime":2880.4,"endTime":2883.123,"body":"is gaining increasing attention."},{"speaker":"with a very big problem","startTime":2884.84,"endTime":2886.11,"body":"I'm going to stop there."},{"speaker":"with a very big problem","startTime":2886.11,"endTime":2887.98,"body":"I hope that I've demonstrated to you"},{"speaker":"with a very big problem","startTime":2887.98,"endTime":2891.06,"body":"that sleep is not a single brain state,"},{"speaker":"with a very big problem","startTime":2891.06,"endTime":2894.023,"body":"that sleep is not even"},{"speaker":"with a very big problem","startTime":2891.06,"endTime":2894.023,"body":"a global brain state,"},{"speaker":"with a very big problem","startTime":2894.9,"endTime":2898.56,"body":"that when you look at the"},{"speaker":"with a very big problem","startTime":2894.9,"endTime":2898.56,"body":"conditions that afflict us,"},{"speaker":"with a very big problem","startTime":2898.56,"endTime":2901.14,"body":"or indeed, some of the"},{"speaker":"with a very big problem","startTime":2898.56,"endTime":2901.14,"body":"phenomena that afflict us,"},{"speaker":"with a very big problem","startTime":2901.14,"endTime":2903.97,"body":"even if we don't have any"},{"speaker":"with a very big problem","startTime":2901.14,"endTime":2903.97,"body":"particular health issues,"},{"speaker":"with a very big problem","startTime":2903.97,"endTime":2906.63,"body":"then these give us some"},{"speaker":"with a very big problem","startTime":2903.97,"endTime":2906.63,"body":"really important insights"},{"speaker":"with a very big problem","startTime":2906.63,"endTime":2909.063,"body":"into the regulation and"},{"speaker":"with a very big problem","startTime":2906.63,"endTime":2909.063,"body":"the functions of sleep,"},{"speaker":"with a very big problem","startTime":2910.18,"endTime":2912.7,"body":"and that these phenomena"},{"speaker":"with a very big problem","startTime":2910.18,"endTime":2912.7,"body":"can very much be explained"},{"speaker":"with a very big problem","startTime":2912.7,"endTime":2914.72,"body":"in terms of blurred lines."},{"speaker":"with a very big problem","startTime":2914.72,"endTime":2915.961,"body":"Thank you."},{"speaker":"with a very big problem","startTime":2915.961,"endTime":2918.961,"body":"(audience applauds)"},{"speaker":"with a very big problem","startTime":2926.39,"endTime":2927.26,"body":"- Thank you, Guy, thank you."},{"speaker":"with a very big problem","startTime":2927.26,"endTime":2928.9,"body":"We've got some time for questions,"},{"speaker":"with a very big problem","startTime":2928.9,"endTime":2930.08,"body":"about 10 minutes for questions."},{"speaker":"with a very big problem","startTime":2930.08,"endTime":2933.33,"body":"I'm going to take a few questions"},{"speaker":"with a very big problem","startTime":2930.08,"endTime":2933.33,"body":"from the online audience,"},{"speaker":"with a very big problem","startTime":2933.33,"endTime":2935.243,"body":"and then a few questions in the hall."},{"speaker":"with a very big problem","startTime":2936.25,"endTime":2938.49,"body":"The most popular question"},{"speaker":"with a very big problem","startTime":2936.25,"endTime":2938.49,"body":"we have online is"},{"speaker":"with a very big problem","startTime":2938.49,"endTime":2939.95,"body":"what can we do ourselves"},{"speaker":"with a very big problem","startTime":2939.95,"endTime":2943.163,"body":"to manage apnea and combat"},{"speaker":"with a very big problem","startTime":2939.95,"endTime":2943.163,"body":"drowsiness during the day?"},{"speaker":"with a very big problem","startTime":2944.39,"endTime":2946.793,"body":"- Specifically to apnea,"},{"speaker":"with a very big problem","startTime":2947.82,"endTime":2951.58,"body":"sleep apnea is associated,"},{"speaker":"with a very big problem","startTime":2947.82,"endTime":2951.58,"body":"in some individuals,"},{"speaker":"with a very big problem","startTime":2951.58,"endTime":2952.893,"body":"with increased weight."},{"speaker":"with a very big problem","startTime":2953.73,"endTime":2955.063,"body":"When we put on weight,"},{"speaker":"with a very big problem","startTime":2956.62,"endTime":2958.07,"body":"first of all, it causes some changes"},{"speaker":"with a very big problem","startTime":2958.07,"endTime":2960.31,"body":"in terms of the movement of our chest,"},{"speaker":"with a very big problem","startTime":2960.31,"endTime":2963.2,"body":"but fat is deposited in our neck,"},{"speaker":"with a very big problem","startTime":2963.2,"endTime":2965.68,"body":"and also in the muscles of our neck,"},{"speaker":"with a very big problem","startTime":2965.68,"endTime":2970.29,"body":"and so obesity has a"},{"speaker":"with a very big problem","startTime":2965.68,"endTime":2970.29,"body":"very strong association"},{"speaker":"with a very big problem","startTime":2970.29,"endTime":2971.38,"body":"with obstructive sleep apnea."},{"speaker":"with a very big problem","startTime":2971.38,"endTime":2973.81,"body":"That's not to say that if you are slim,"},{"speaker":"with a very big problem","startTime":2973.81,"endTime":2975.08,"body":"you can't have sleep apnea,"},{"speaker":"with a very big problem","startTime":2975.08,"endTime":2978.129,"body":"because if you have a specific"},{"speaker":"with a very big problem","startTime":2975.08,"endTime":2978.129,"body":"anatomical abnormality,"},{"speaker":"with a very big problem","startTime":2978.129,"endTime":2979.61,"body":"then you can,"},{"speaker":"with a very big problem","startTime":2979.61,"endTime":2980.48,"body":"but certainly,"},{"speaker":"with a very big problem","startTime":2980.48,"endTime":2984.25,"body":"losing weight would"},{"speaker":"with a very big problem","startTime":2980.48,"endTime":2984.25,"body":"significantly help sleep apnea."},{"speaker":"with a very big problem","startTime":2984.25,"endTime":2987.72,"body":"There are a number of different"},{"speaker":"with a very big problem","startTime":2984.25,"endTime":2987.72,"body":"strategies that also help,"},{"speaker":"with a very big problem","startTime":2987.72,"endTime":2989.57,"body":"there is a treatment called APAP,"},{"speaker":"with a very big problem","startTime":2989.57,"endTime":2991.27,"body":"which is a mask-like device"},{"speaker":"with a very big problem","startTime":2991.27,"endTime":2992.78,"body":"that generates positive pressure,"},{"speaker":"with a very big problem","startTime":2992.78,"endTime":2994.79,"body":"and it stops the airway"},{"speaker":"with a very big problem","startTime":2992.78,"endTime":2994.79,"body":"from collapsing down,"},{"speaker":"with a very big problem","startTime":2994.79,"endTime":2997.79,"body":"and this is an extremely good"},{"speaker":"with a very big problem","startTime":2994.79,"endTime":2997.79,"body":"treatment for sleep apnea,"},{"speaker":"with a very big problem","startTime":2997.79,"endTime":2999.96,"body":"and can transform lives, actually,"},{"speaker":"with a very big problem","startTime":2999.96,"endTime":3001.19,"body":"when it comes to people"},{"speaker":"with a very big problem","startTime":3001.19,"endTime":3005.68,"body":"who are really very severely"},{"speaker":"with a very big problem","startTime":3001.19,"endTime":3005.68,"body":"afflicted by sleepiness."},{"speaker":"with a very big problem","startTime":3005.68,"endTime":3007.19,"body":"- What happens to brain chemistry"},{"speaker":"with a very big problem","startTime":3007.19,"endTime":3009.83,"body":"after long periods of wakefulness,"},{"speaker":"with a very big problem","startTime":3009.83,"endTime":3012.69,"body":"building up so-called sleep debt?"},{"speaker":"with a very big problem","startTime":3012.69,"endTime":3016.61,"body":"- There are a number"},{"speaker":"with a very big problem","startTime":3012.69,"endTime":3016.61,"body":"of different chemicals"},{"speaker":"with a very big problem","startTime":3016.61,"endTime":3021.08,"body":"that regulate sleepiness."},{"speaker":"with a very big problem","startTime":3021.08,"endTime":3024.323,"body":"There are two processes that"},{"speaker":"with a very big problem","startTime":3021.08,"endTime":3024.323,"body":"define how sleepy you are,"},{"speaker":"with a very big problem","startTime":3024.323,"endTime":3027.7,"body":"there's something called"},{"speaker":"with a very big problem","startTime":3024.323,"endTime":3027.7,"body":"the homeostatic mechanism,"},{"speaker":"with a very big problem","startTime":3027.7,"endTime":3029.72,"body":"which is essentially a"},{"speaker":"with a very big problem","startTime":3027.7,"endTime":3029.72,"body":"glorified way of saying"},{"speaker":"with a very big problem","startTime":3029.72,"endTime":3032.955,"body":"the longer you've been awake,"},{"speaker":"with a very big problem","startTime":3029.72,"endTime":3032.955,"body":"the more sleepy you are,"},{"speaker":"with a very big problem","startTime":3032.955,"endTime":3034.26,"body":"and we think that that is mediated"},{"speaker":"with a very big problem","startTime":3034.26,"endTime":3035.91,"body":"by a chemical called adenosine,"},{"speaker":"with a very big problem","startTime":3035.91,"endTime":3037.56,"body":"which is how caffeine works,"},{"speaker":"with a very big problem","startTime":3037.56,"endTime":3041.7,"body":"because caffeine interacts"},{"speaker":"with a very big problem","startTime":3037.56,"endTime":3041.7,"body":"with the adenosine system."},{"speaker":"with a very big problem","startTime":3041.7,"endTime":3044.01,"body":"But there's also the circadian rhythms."},{"speaker":"with a very big problem","startTime":3044.01,"endTime":3046.06,"body":"We all, within us, have a master clock"},{"speaker":"with a very big problem","startTime":3046.06,"endTime":3049.07,"body":"in a part of the brain called"},{"speaker":"with a very big problem","startTime":3046.06,"endTime":3049.07,"body":"the suprachiasmatic nucleus"},{"speaker":"with a very big problem","startTime":3049.07,"endTime":3050.98,"body":"that defines when we want to go to sleep"},{"speaker":"with a very big problem","startTime":3050.98,"endTime":3052.65,"body":"and when we want to wake up."},{"speaker":"with a very big problem","startTime":3052.65,"endTime":3055.28,"body":"And so, when our homeostatic mechanism,"},{"speaker":"with a very big problem","startTime":3055.28,"endTime":3057.0,"body":"so how long we've been awake for,"},{"speaker":"with a very big problem","startTime":3057.0,"endTime":3059.42,"body":"and our circadian rhythm are aligned,"},{"speaker":"with a very big problem","startTime":3059.42,"endTime":3061.41,"body":"that's when we sleep"},{"speaker":"with a very big problem","startTime":3059.42,"endTime":3061.41,"body":"at an appropriate time"},{"speaker":"with a very big problem","startTime":3061.41,"endTime":3063.05,"body":"and wake up at an appropriate time,"},{"speaker":"with a very big problem","startTime":3063.05,"endTime":3065.0,"body":"and perhaps feel a bit drowsy after lunch,"},{"speaker":"with a very big problem","startTime":3065.0,"endTime":3069.18,"body":"because that's part of the"},{"speaker":"with a very big problem","startTime":3065.0,"endTime":3069.18,"body":"circadian rhythm as well,"},{"speaker":"with a very big problem","startTime":3069.18,"endTime":3071.033,"body":"but it's when those are misaligned,"},{"speaker":"with a very big problem","startTime":3071.033,"endTime":3073.64,"body":"then sleep can really go awry."},{"speaker":"with a very big problem","startTime":3073.64,"endTime":3075.48,"body":"- [Questioner] Thanks"},{"speaker":"with a very big problem","startTime":3073.64,"endTime":3075.48,"body":"for the interesting talk."},{"speaker":"with a very big problem","startTime":3075.48,"endTime":3079.42,"body":"I've got a question about the"},{"speaker":"with a very big problem","startTime":3075.48,"endTime":3079.42,"body":"impact of exercise on sleep,"},{"speaker":"with a very big problem","startTime":3079.42,"endTime":3080.253,"body":"because usually,"},{"speaker":"with a very big problem","startTime":3080.253,"endTime":3082.91,"body":"I've read many positive things,"},{"speaker":"with a very big problem","startTime":3082.91,"endTime":3084.63,"body":"but personally, if I"},{"speaker":"with a very big problem","startTime":3082.91,"endTime":3084.63,"body":"exercise in the evening,"},{"speaker":"with a very big problem","startTime":3084.63,"endTime":3087.83,"body":"I would, after half an"},{"speaker":"with a very big problem","startTime":3084.63,"endTime":3087.83,"body":"hour after falling asleep,"},{"speaker":"with a very big problem","startTime":3087.83,"endTime":3089.85,"body":"have the hallucinations you described,"},{"speaker":"with a very big problem","startTime":3089.85,"endTime":3092.14,"body":"so I guess in this kind of overlap time,"},{"speaker":"with a very big problem","startTime":3092.14,"endTime":3095.773,"body":"and I wonder if there's"},{"speaker":"with a very big problem","startTime":3092.14,"endTime":3095.773,"body":"anything chemical happening?"},{"speaker":"with a very big problem","startTime":3098.48,"endTime":3102.96,"body":"- There is evidence that"},{"speaker":"with a very big problem","startTime":3098.48,"endTime":3102.96,"body":"aerobic exercise improves sleep,"},{"speaker":"with a very big problem","startTime":3102.96,"endTime":3105.55,"body":"it increases the proportion of deep sleep,"},{"speaker":"with a very big problem","startTime":3105.55,"endTime":3106.773,"body":"of slow wave sleep,"},{"speaker":"with a very big problem","startTime":3107.73,"endTime":3111.47,"body":"and perhaps improves the"},{"speaker":"with a very big problem","startTime":3107.73,"endTime":3111.47,"body":"quality of sleep as well."},{"speaker":"with a very big problem","startTime":3113.93,"endTime":3115.3,"body":"Whether it disrupts your sleep"},{"speaker":"with a very big problem","startTime":3115.3,"endTime":3116.8,"body":"if you exercise late in the evening"},{"speaker":"with a very big problem","startTime":3116.8,"endTime":3118.21,"body":"is very much a personal thing,"},{"speaker":"with a very big problem","startTime":3118.21,"endTime":3119.9,"body":"but by and large,"},{"speaker":"with a very big problem","startTime":3119.9,"endTime":3121.59,"body":"what, historically,"},{"speaker":"with a very big problem","startTime":3119.9,"endTime":3121.59,"body":"people have recommended"},{"speaker":"with a very big problem","startTime":3121.59,"endTime":3122.91,"body":"is that you shouldn't really exercise"},{"speaker":"with a very big problem","startTime":3122.91,"endTime":3125.5,"body":"within an hour or two"},{"speaker":"with a very big problem","startTime":3122.91,"endTime":3125.5,"body":"of going off to sleep,"},{"speaker":"with a very big problem","startTime":3125.5,"endTime":3127.38,"body":"because what exercise does, obviously,"},{"speaker":"with a very big problem","startTime":3127.38,"endTime":3129.67,"body":"it creates lots of chemicals, endorphins,"},{"speaker":"with a very big problem","startTime":3129.67,"endTime":3132.47,"body":"but also things like"},{"speaker":"with a very big problem","startTime":3129.67,"endTime":3132.47,"body":"adrenaline, and noradrenaline,"},{"speaker":"with a very big problem","startTime":3132.47,"endTime":3135.07,"body":"your heart rate goes up, your"},{"speaker":"with a very big problem","startTime":3132.47,"endTime":3135.07,"body":"body temperature goes up,"},{"speaker":"with a very big problem","startTime":3135.07,"endTime":3138.6,"body":"and therefore all of that can be conducive"},{"speaker":"with a very big problem","startTime":3138.6,"endTime":3141.55,"body":"to poor sleep initiation."},{"speaker":"with a very big problem","startTime":3141.55,"endTime":3143.24,"body":"So if you are one of those individuals,"},{"speaker":"with a very big problem","startTime":3143.24,"endTime":3145.63,"body":"then certainly, exercising"},{"speaker":"with a very big problem","startTime":3143.24,"endTime":3145.63,"body":"within the hour or two before bed"},{"speaker":"with a very big problem","startTime":3145.63,"endTime":3148.14,"body":"is perhaps something that"},{"speaker":"with a very big problem","startTime":3145.63,"endTime":3148.14,"body":"you might like to avoid."},{"speaker":"with a very big problem","startTime":3148.14,"endTime":3149.62,"body":"- [Questioner] Thank you, professor."},{"speaker":"with a very big problem","startTime":3149.62,"endTime":3151.87,"body":"Here we are in electric light,"},{"speaker":"with a very big problem","startTime":3151.87,"endTime":3152.703,"body":"does the fact"},{"speaker":"with a very big problem","startTime":3152.703,"endTime":3154.86,"body":"that we don't live by"},{"speaker":"with a very big problem","startTime":3152.703,"endTime":3154.86,"body":"daylight and nighttime anymore"},{"speaker":"with a very big problem","startTime":3154.86,"endTime":3156.65,"body":"affect our sleep generally,"},{"speaker":"with a very big problem","startTime":3156.65,"endTime":3158.56,"body":"and lead to more of the sleep disorders"},{"speaker":"with a very big problem","startTime":3158.56,"endTime":3160.943,"body":"that you've been talking about?"},{"speaker":"with a very big problem","startTime":3160.943,"endTime":3164.123,"body":"- This is a rather controversial area."},{"speaker":"with a very big problem","startTime":3165.66,"endTime":3166.77,"body":"Historically, it was said"},{"speaker":"with a very big problem","startTime":3166.77,"endTime":3170.92,"body":"that if you expose yourself"},{"speaker":"with a very big problem","startTime":3166.77,"endTime":3170.92,"body":"to environmental light"},{"speaker":"with a very big problem","startTime":3170.92,"endTime":3172.63,"body":"at inappropriate times,"},{"speaker":"with a very big problem","startTime":3172.63,"endTime":3175.7,"body":"then it can generate insomnia,"},{"speaker":"with a very big problem","startTime":3175.7,"endTime":3177.07,"body":"it can generate difficulty sleeping,"},{"speaker":"with a very big problem","startTime":3177.07,"endTime":3177.903,"body":"because we know"},{"speaker":"with a very big problem","startTime":3177.903,"endTime":3180.03,"body":"that if you expose yourself"},{"speaker":"with a very big problem","startTime":3177.903,"endTime":3180.03,"body":"to very bright light,"},{"speaker":"with a very big problem","startTime":3180.03,"endTime":3182.65,"body":"then that interferes with"},{"speaker":"with a very big problem","startTime":3180.03,"endTime":3182.65,"body":"your circadian clock,"},{"speaker":"with a very big problem","startTime":3182.65,"endTime":3185.53,"body":"it suppresses a chemical called melatonin,"},{"speaker":"with a very big problem","startTime":3185.53,"endTime":3187.4,"body":"which is a chemical signal"},{"speaker":"with a very big problem","startTime":3187.4,"endTime":3190.12,"body":"that a part of your brain"},{"speaker":"with a very big problem","startTime":3187.4,"endTime":3190.12,"body":"called your pineal gland"},{"speaker":"with a very big problem","startTime":3190.12,"endTime":3191.02,"body":"pushes out,"},{"speaker":"with a very big problem","startTime":3191.02,"endTime":3194.94,"body":"that is a signal to the rest"},{"speaker":"with a very big problem","startTime":3191.02,"endTime":3194.94,"body":"of the brain to go to sleep."},{"speaker":"with a very big problem","startTime":3194.94,"endTime":3197.27,"body":"Actually, it's probably not the case"},{"speaker":"with a very big problem","startTime":3197.27,"endTime":3201.17,"body":"that a quick burst of"},{"speaker":"with a very big problem","startTime":3197.27,"endTime":3201.17,"body":"playing on your mobile phone"},{"speaker":"with a very big problem","startTime":3201.17,"endTime":3204.29,"body":"necessarily does that on"},{"speaker":"with a very big problem","startTime":3201.17,"endTime":3204.29,"body":"a night by night basis,"},{"speaker":"with a very big problem","startTime":3204.29,"endTime":3205.123,"body":"but certainly,"},{"speaker":"with a very big problem","startTime":3205.123,"endTime":3207.35,"body":"if you expose yourself"},{"speaker":"with a very big problem","startTime":3205.123,"endTime":3207.35,"body":"regularly to bright light"},{"speaker":"with a very big problem","startTime":3207.35,"endTime":3208.31,"body":"in the evenings,"},{"speaker":"with a very big problem","startTime":3208.31,"endTime":3209.143,"body":"what that can do"},{"speaker":"with a very big problem","startTime":3209.143,"endTime":3210.78,"body":"is it can shift your body clock back,"},{"speaker":"with a very big problem","startTime":3210.78,"endTime":3212.88,"body":"it can cause something"},{"speaker":"with a very big problem","startTime":3210.78,"endTime":3212.88,"body":"called a delayed sleep phase,"},{"speaker":"with a very big problem","startTime":3212.88,"endTime":3215.75,"body":"where you start wanting to go to bed later"},{"speaker":"with a very big problem","startTime":3215.75,"endTime":3217.24,"body":"and wake up later."},{"speaker":"with a very big problem","startTime":3217.24,"endTime":3218.19,"body":"And that's fine"},{"speaker":"with a very big problem","startTime":3218.19,"endTime":3220.92,"body":"if you don't have to get"},{"speaker":"with a very big problem","startTime":3218.19,"endTime":3220.92,"body":"up for work, or school,"},{"speaker":"with a very big problem","startTime":3220.92,"endTime":3221.753,"body":"or anything else,"},{"speaker":"with a very big problem","startTime":3221.753,"endTime":3223.87,"body":"because you go to bed later"},{"speaker":"with a very big problem","startTime":3221.753,"endTime":3223.87,"body":"and you wake up later,"},{"speaker":"with a very big problem","startTime":3223.87,"endTime":3224.96,"body":"but for most of us,"},{"speaker":"with a very big problem","startTime":3224.96,"endTime":3226.83,"body":"we have to get up in"},{"speaker":"with a very big problem","startTime":3224.96,"endTime":3226.83,"body":"order to get to school,"},{"speaker":"with a very big problem","startTime":3226.83,"endTime":3228.53,"body":"to get to university, to get to work,"},{"speaker":"with a very big problem","startTime":3228.53,"endTime":3230.89,"body":"and that can result in"},{"speaker":"with a very big problem","startTime":3228.53,"endTime":3230.89,"body":"chronic sleep deprivation."},{"speaker":"with a very big problem","startTime":3230.89,"endTime":3233.15,"body":"- [Questioner] How reversible"},{"speaker":"with a very big problem","startTime":3230.89,"endTime":3233.15,"body":"is this sleep damage,"},{"speaker":"with a very big problem","startTime":3233.15,"endTime":3234.8,"body":"as to speak,"},{"speaker":"with a very big problem","startTime":3234.8,"endTime":3236.163,"body":"is it permanent?"},{"speaker":"with a very big problem","startTime":3237.4,"endTime":3240.74,"body":"- I think the answer to"},{"speaker":"with a very big problem","startTime":3237.4,"endTime":3240.74,"body":"that is we don't know yet,"},{"speaker":"with a very big problem","startTime":3240.74,"endTime":3242.73,"body":"is a very short answer."},{"speaker":"with a very big problem","startTime":3242.73,"endTime":3245.17,"body":"I think there are many areas of this"},{"speaker":"with a very big problem","startTime":3245.17,"endTime":3247.24,"body":"that we don't fully understand,"},{"speaker":"with a very big problem","startTime":3247.24,"endTime":3248.29,"body":"I think the relationship"},{"speaker":"with a very big problem","startTime":3248.29,"endTime":3250.93,"body":"between sleep disruption or deprivation"},{"speaker":"with a very big problem","startTime":3250.93,"endTime":3253.44,"body":"and conditions like Alzheimer's disease"},{"speaker":"with a very big problem","startTime":3253.44,"endTime":3256.04,"body":"is just in its infancy"},{"speaker":"with a very big problem","startTime":3256.04,"endTime":3257.61,"body":"in terms of our understanding of it,"},{"speaker":"with a very big problem","startTime":3257.61,"endTime":3261.49,"body":"because we also know that, for example,"},{"speaker":"with a very big problem","startTime":3261.49,"endTime":3264.29,"body":"those circuits that regulate sleep"},{"speaker":"with a very big problem","startTime":3264.29,"endTime":3267.64,"body":"probably degenerate quite early"},{"speaker":"with a very big problem","startTime":3264.29,"endTime":3267.64,"body":"on in Alzheimer's disease,"},{"speaker":"with a very big problem","startTime":3267.64,"endTime":3270.82,"body":"so some of the associations"},{"speaker":"with a very big problem","startTime":3267.64,"endTime":3270.82,"body":"may be related."},{"speaker":"with a very big problem","startTime":3270.82,"endTime":3272.9,"body":"In the same way that REM"},{"speaker":"with a very big problem","startTime":3270.82,"endTime":3272.9,"body":"sleep behavior disorder"},{"speaker":"with a very big problem","startTime":3272.9,"endTime":3275.8,"body":"might be part of the prodrome"},{"speaker":"with a very big problem","startTime":3272.9,"endTime":3275.8,"body":"of Parkinson's disease,"},{"speaker":"with a very big problem","startTime":3275.8,"endTime":3279.8,"body":"sleep disruption may"},{"speaker":"with a very big problem","startTime":3275.8,"endTime":3279.8,"body":"be part of the prodrome"},{"speaker":"with a very big problem","startTime":3279.8,"endTime":3281.58,"body":"of Alzheimer's disease."},{"speaker":"with a very big problem","startTime":3281.58,"endTime":3284.53,"body":"And so these are all works in progress,"},{"speaker":"with a very big problem","startTime":3284.53,"endTime":3287.09,"body":"and I think that we'll hopefully"},{"speaker":"with a very big problem","startTime":3284.53,"endTime":3287.09,"body":"have those kind of answers"},{"speaker":"with a very big problem","startTime":3287.09,"endTime":3288.61,"body":"in the next 10 to 20 years,"},{"speaker":"with a very big problem","startTime":3288.61,"endTime":3291.74,"body":"but we don't have those"},{"speaker":"with a very big problem","startTime":3288.61,"endTime":3291.74,"body":"answers now I'm afraid."},{"speaker":"with a very big problem","startTime":3291.74,"endTime":3292.59,"body":"- [Questioner] You mentioned briefly"},{"speaker":"with a very big problem","startTime":3292.59,"endTime":3294.88,"body":"about circadian rhythms,"},{"speaker":"with a very big problem","startTime":3292.59,"endTime":3294.88,"body":"can you just say a bit more"},{"speaker":"with a very big problem","startTime":3294.88,"endTime":3299.81,"body":"about whether the Mediterranean"},{"speaker":"with a very big problem","startTime":3294.88,"endTime":3299.81,"body":"pattern of having a siesta,"},{"speaker":"with a very big problem","startTime":3299.81,"endTime":3302.59,"body":"and a bit of sleep of a"},{"speaker":"with a very big problem","startTime":3299.81,"endTime":3302.59,"body":"reasonably substantial length"},{"speaker":"with a very big problem","startTime":3302.59,"endTime":3303.423,"body":"in the afternoon"},{"speaker":"with a very big problem","startTime":3303.423,"endTime":3305.52,"body":"and a shorter sleep in the night,"},{"speaker":"with a very big problem","startTime":3305.52,"endTime":3306.73,"body":"both in terms of quality of sleep,"},{"speaker":"with a very big problem","startTime":3306.73,"endTime":3308.36,"body":"and also whether the conclusions"},{"speaker":"with a very big problem","startTime":3308.36,"endTime":3309.79,"body":"around some of these conditions"},{"speaker":"with a very big problem","startTime":3309.79,"endTime":3311.93,"body":"are any different in"},{"speaker":"with a very big problem","startTime":3309.79,"endTime":3311.93,"body":"that sort of environment"},{"speaker":"with a very big problem","startTime":3311.93,"endTime":3315.23,"body":"compared to the Western European pattern"},{"speaker":"with a very big problem","startTime":3315.23,"endTime":3317.16,"body":"of having one long sleep?"},{"speaker":"with a very big problem","startTime":3317.16,"endTime":3322.16,"body":"- I think that it's always"},{"speaker":"with a very big problem","startTime":3317.16,"endTime":3322.16,"body":"difficult to unravel the effect"},{"speaker":"with a very big problem","startTime":3323.13,"endTime":3326.83,"body":"of changes in lifestyle related to sleep"},{"speaker":"with a very big problem","startTime":3326.83,"endTime":3329.0,"body":"from other aspects of lifestyle."},{"speaker":"with a very big problem","startTime":3329.0,"endTime":3329.833,"body":"What we do know,"},{"speaker":"with a very big problem","startTime":3329.833,"endTime":3330.76,"body":"there was a very recent study"},{"speaker":"with a very big problem","startTime":3330.76,"endTime":3331.86,"body":"that was done in Greece, I think,"},{"speaker":"with a very big problem","startTime":3331.86,"endTime":3333.25,"body":"which demonstrated that, actually,"},{"speaker":"with a very big problem","startTime":3333.25,"endTime":3335.33,"body":"after a siesta-type nap,"},{"speaker":"with a very big problem","startTime":3335.33,"endTime":3338.7,"body":"your blood pressure in the"},{"speaker":"with a very big problem","startTime":3335.33,"endTime":3338.7,"body":"afternoon is significantly lower,"},{"speaker":"with a very big problem","startTime":3338.7,"endTime":3343.7,"body":"so there is some rationale"},{"speaker":"with a very big problem","startTime":3338.7,"endTime":3343.7,"body":"for that kind of pattern."},{"speaker":"with a very big problem","startTime":3348.78,"endTime":3351.61,"body":"People often say, should I"},{"speaker":"with a very big problem","startTime":3348.78,"endTime":3351.61,"body":"be having an afternoon nap,"},{"speaker":"with a very big problem","startTime":3351.61,"endTime":3352.6,"body":"and the question is, really,"},{"speaker":"with a very big problem","startTime":3352.6,"endTime":3355.06,"body":"why are you having an afternoon nap."},{"speaker":"with a very big problem","startTime":3355.06,"endTime":3356.44,"body":"Because if you're having an afternoon nap"},{"speaker":"with a very big problem","startTime":3356.44,"endTime":3358.06,"body":"because you're getting"},{"speaker":"with a very big problem","startTime":3356.44,"endTime":3358.06,"body":"eight hours a night of sleep"},{"speaker":"with a very big problem","startTime":3358.06,"endTime":3360.41,"body":"but you're waking up feeling"},{"speaker":"with a very big problem","startTime":3358.06,"endTime":3360.41,"body":"completely exhausted,"},{"speaker":"with a very big problem","startTime":3360.41,"endTime":3361.68,"body":"then you should probably be looking at"},{"speaker":"with a very big problem","startTime":3361.68,"endTime":3363.51,"body":"why you're feeling so exhausted;"},{"speaker":"with a very big problem","startTime":3363.51,"endTime":3366.97,"body":"if you are living life to the full"},{"speaker":"with a very big problem","startTime":3366.97,"endTime":3368.74,"body":"in a Mediterranean style"},{"speaker":"with a very big problem","startTime":3368.74,"endTime":3370.18,"body":"and going to bed at two a.m.,"},{"speaker":"with a very big problem","startTime":3370.18,"endTime":3371.9,"body":"getting six hours at night,"},{"speaker":"with a very big problem","startTime":3371.9,"endTime":3374.34,"body":"but then getting an extra"},{"speaker":"with a very big problem","startTime":3371.9,"endTime":3374.34,"body":"two hours at lunchtime,"},{"speaker":"with a very big problem","startTime":3374.34,"endTime":3375.45,"body":"then certainly,"},{"speaker":"with a very big problem","startTime":3375.45,"endTime":3378.713,"body":"some evidence points to"},{"speaker":"with a very big problem","startTime":3375.45,"endTime":3378.713,"body":"that as being quite helpful."},{"speaker":"with a very big problem","startTime":3380.39,"endTime":3381.223,"body":"- [Questioner] You said that"},{"speaker":"with a very big problem","startTime":3381.223,"endTime":3383.72,"body":"the CD4 proteins and CD8 proteins"},{"speaker":"with a very big problem","startTime":3383.72,"endTime":3385.49,"body":"are involved in the genetic mutations,"},{"speaker":"with a very big problem","startTime":3385.49,"endTime":3387.81,"body":"and I know that HIV"},{"speaker":"with a very big problem","startTime":3385.49,"endTime":3387.81,"body":"patients and AIDS sufferers"},{"speaker":"with a very big problem","startTime":3387.81,"endTime":3390.89,"body":"have lower levels of CD4 proteins,"},{"speaker":"with a very big problem","startTime":3390.89,"endTime":3392.72,"body":"so does that mean that"},{"speaker":"with a very big problem","startTime":3390.89,"endTime":3392.72,"body":"people who've got HIV"},{"speaker":"with a very big problem","startTime":3392.72,"endTime":3395.49,"body":"typically have sleep problems?"},{"speaker":"with a very big problem","startTime":3395.49,"endTime":3398.31,"body":"And also, I know that some"},{"speaker":"with a very big problem","startTime":3395.49,"endTime":3398.31,"body":"people are on antipsychotics,"},{"speaker":"with a very big problem","startTime":3398.31,"endTime":3400.76,"body":"such as chlorpromazine,"},{"speaker":"with a very big problem","startTime":3400.76,"endTime":3403.6,"body":"results in agranulocytosis,"},{"speaker":"with a very big problem","startTime":3403.6,"endTime":3406.46,"body":"which again lowers levels of"},{"speaker":"with a very big problem","startTime":3403.6,"endTime":3406.46,"body":"eosinophils and CD4 proteins-"},{"speaker":"with a very big problem","startTime":3406.46,"endTime":3410.95,"body":"- I think the immune mechanisms"},{"speaker":"with a very big problem","startTime":3406.46,"endTime":3410.95,"body":"that undermine narcolepsy"},{"speaker":"with a very big problem","startTime":3410.95,"endTime":3413.9,"body":"are rather different"},{"speaker":"with a very big problem","startTime":3410.95,"endTime":3413.9,"body":"from what is seen in HIV,"},{"speaker":"with a very big problem","startTime":3413.9,"endTime":3416.49,"body":"but it's important to"},{"speaker":"with a very big problem","startTime":3413.9,"endTime":3416.49,"body":"understand that, obviously,"},{"speaker":"with a very big problem","startTime":3416.49,"endTime":3418.35,"body":"your specific question, which was,"},{"speaker":"with a very big problem","startTime":3418.35,"endTime":3419.53,"body":"do people with HIV"},{"speaker":"with a very big problem","startTime":3419.53,"endTime":3423.82,"body":"have an increased risk of sleep disorders,"},{"speaker":"with a very big problem","startTime":3423.82,"endTime":3424.7,"body":"yes they do,"},{"speaker":"with a very big problem","startTime":3424.7,"endTime":3426.12,"body":"but they have multiple reasons"},{"speaker":"with a very big problem","startTime":3426.12,"endTime":3427.46,"body":"as to why that might be the case,"},{"speaker":"with a very big problem","startTime":3427.46,"endTime":3429.79,"body":"the effect of the medication"},{"speaker":"with a very big problem","startTime":3427.46,"endTime":3429.79,"body":"that they're taking,"},{"speaker":"with a very big problem","startTime":3429.79,"endTime":3430.95,"body":"pain, which is associated"},{"speaker":"with a very big problem","startTime":3430.95,"endTime":3433.69,"body":"with some of the older antiviral drugs,"},{"speaker":"with a very big problem","startTime":3433.69,"endTime":3434.89,"body":"so a lot of patients"},{"speaker":"with a very big problem","startTime":3434.89,"endTime":3437.18,"body":"who have been on antiviral"},{"speaker":"with a very big problem","startTime":3434.89,"endTime":3437.18,"body":"drugs for a long time"},{"speaker":"with a very big problem","startTime":3437.18,"endTime":3439.3,"body":"have a painful neuropathy,"},{"speaker":"with a very big problem","startTime":3439.3,"endTime":3442.01,"body":"there's obviously the"},{"speaker":"with a very big problem","startTime":3439.3,"endTime":3442.01,"body":"psychological consequences"},{"speaker":"with a very big problem","startTime":3442.01,"endTime":3444.22,"body":"of being diagnosed with HIV,"},{"speaker":"with a very big problem","startTime":3444.22,"endTime":3446.79,"body":"so that's a little bit"},{"speaker":"with a very big problem","startTime":3444.22,"endTime":3446.79,"body":"more difficult to unravel."},{"speaker":"with a very big problem","startTime":3446.79,"endTime":3448.313,"body":"Similarly, actually,"},{"speaker":"with a very big problem","startTime":3449.29,"endTime":3451.472,"body":"agranulocytosis with antipsychotic drugs"},{"speaker":"with a very big problem","startTime":3451.472,"endTime":3453.493,"body":"is quite a rare phenomenon,"},{"speaker":"with a very big problem","startTime":3454.33,"endTime":3457.39,"body":"but certainly, people who"},{"speaker":"with a very big problem","startTime":3454.33,"endTime":3457.39,"body":"are on antipsychotic drugs"},{"speaker":"with a very big problem","startTime":3457.39,"endTime":3460.09,"body":"have a very wide range of sleep disorders,"},{"speaker":"with a very big problem","startTime":3460.09,"endTime":3463.09,"body":"in part related to their underlying reason"},{"speaker":"with a very big problem","startTime":3463.09,"endTime":3464.56,"body":"for being on those drugs,"},{"speaker":"with a very big problem","startTime":3464.56,"endTime":3466.25,"body":"and in part related to the fact"},{"speaker":"with a very big problem","startTime":3466.25,"endTime":3467.31,"body":"that a lot of these drugs"},{"speaker":"with a very big problem","startTime":3467.31,"endTime":3469.62,"body":"do cause conditions like"},{"speaker":"with a very big problem","startTime":3467.31,"endTime":3469.62,"body":"restless leg syndrome"},{"speaker":"with a very big problem","startTime":3469.62,"endTime":3471.19,"body":"and an associated condition"},{"speaker":"with a very big problem","startTime":3471.19,"endTime":3473.14,"body":"called periodic limb movement disorder."},{"speaker":"with a very big problem","startTime":3473.14,"endTime":3474.81,"body":"So there are multiple reasons, once again,"},{"speaker":"with a very big problem","startTime":3474.81,"endTime":3477.0,"body":"why people on these drugs"},{"speaker":"with a very big problem","startTime":3474.81,"endTime":3477.0,"body":"might have sleep issues,"},{"speaker":"with a very big problem","startTime":3477.0,"endTime":3479.68,"body":"but it is separate from narcolepsy."},{"speaker":"with a very big problem","startTime":3479.68,"endTime":3480.94,"body":"- Thank you, Professor Leschzhner,"},{"speaker":"with a very big problem","startTime":3480.94,"endTime":3482.24,"body":"for a really interesting lecture,"},{"speaker":"with a very big problem","startTime":3482.24,"endTime":3484.48,"body":"and thank you to the audience for coming."},{"speaker":"with a very big problem","startTime":3484.48,"endTime":3487.77,"body":"Do join us on Tuesday, the"},{"speaker":"with a very big problem","startTime":3484.48,"endTime":3487.77,"body":"5th of April at 6 o'clock"},{"speaker":"with a very big problem","startTime":3487.77,"endTime":3490.38,"body":"for the last lecture in"},{"speaker":"with a very big problem","startTime":3487.77,"endTime":3490.38,"body":"this neuroscience series,"},{"speaker":"with a very big problem","startTime":3490.38,"endTime":3491.63,"body":"Is Dementia Inevitable,"},{"speaker":"with a very big problem","startTime":3491.63,"endTime":3493.54,"body":"from Professor Martin Rossor,"},{"speaker":"with a very big problem","startTime":3493.54,"endTime":3496.14,"body":"and the last thing to do is"},{"speaker":"with a very big problem","startTime":3493.54,"endTime":3496.14,"body":"to thank Professor Leschzhner,"},{"speaker":"with a very big problem","startTime":3496.14,"endTime":3497.968,"body":"so thank you very much."},{"speaker":"with a very big problem","startTime":3497.968,"endTime":3500.544,"body":"(audience applauds)"}]}