{"version":"1.0.0","segments":[{"startTime":0.25,"endTime":2.5,"body":"(swooshes)"},{"startTime":4.83,"endTime":8.22,"body":"- I think everybody will be"},{"startTime":4.83,"endTime":8.22,"body":"very familiar with this feeling,"},{"startTime":8.22,"endTime":11.19,"body":"the feeling of when you've"},{"startTime":8.22,"endTime":11.19,"body":"had a very bad night's sleep"},{"startTime":11.19,"endTime":12.99,"body":"and you feel tired, obviously,"},{"startTime":12.99,"endTime":14.637,"body":"but you also feel slightly grumpy,"},{"startTime":14.637,"endTime":16.56,"body":"a little bit more irritable."},{"startTime":16.56,"endTime":20.345,"body":"So it's very intuitive to imagine"},{"startTime":20.345,"endTime":23.91,"body":"that sleep may affect our mental health"},{"startTime":23.91,"endTime":25.89,"body":"at least on a short term basis,"},{"startTime":25.89,"endTime":27.09,"body":"on those nights when you've had"},{"startTime":27.09,"endTime":28.863,"body":"a particularly bad night's sleep."},{"startTime":30.15,"endTime":34.833,"body":"But when it comes to sleep"},{"startTime":30.15,"endTime":34.833,"body":"issues and mental health,"},{"startTime":35.7,"endTime":38.73,"body":"we know that both of these"},{"startTime":35.7,"endTime":38.73,"body":"problems are very common."},{"startTime":38.73,"endTime":41.16,"body":"So from a sleep perspective,"},{"startTime":41.16,"endTime":44.321,"body":"about 20 to 30% of adults in any one year"},{"startTime":44.321,"endTime":46.53,"body":"will experience insomnia."},{"startTime":46.53,"endTime":48.297,"body":"About 10% of the adult population"},{"startTime":48.297,"endTime":50.79,"body":"will experience chronic insomnia."},{"startTime":50.79,"endTime":53.37,"body":"And there are a whole range"},{"startTime":50.79,"endTime":53.37,"body":"of other sleep disorders"},{"startTime":53.37,"endTime":55.38,"body":"that are really surprisingly common,"},{"startTime":55.38,"endTime":58.02,"body":"conditions like obstructive sleep apnea,"},{"startTime":58.02,"endTime":61.56,"body":"which is where snoring results"},{"startTime":58.02,"endTime":61.56,"body":"in obstruction of the airway."},{"startTime":61.56,"endTime":65.64,"body":"That's thought to affect up"},{"startTime":61.56,"endTime":65.64,"body":"to about 25% of adult men"},{"startTime":65.64,"endTime":70.44,"body":"and a slightly smaller proportion"},{"startTime":65.64,"endTime":70.44,"body":"of adult women as well."},{"startTime":70.44,"endTime":74.4,"body":"But when you look at the"},{"startTime":70.44,"endTime":74.4,"body":"presence of sleep disorders"},{"startTime":74.4,"endTime":76.59,"body":"and mental health, the co-occurrence,"},{"startTime":76.59,"endTime":80.49,"body":"so seeing both sleep issues"},{"startTime":76.59,"endTime":80.49,"body":"and mental health issues"},{"startTime":80.49,"endTime":84.15,"body":"in the same individuals is much"},{"startTime":80.49,"endTime":84.15,"body":"higher than by chance alone."},{"startTime":84.15,"endTime":85.47,"body":"And when you look at, for example,"},{"startTime":85.47,"endTime":87.87,"body":"people who have sleep disorders"},{"startTime":87.87,"endTime":90.36,"body":"and their rates of mental health issues,"},{"startTime":90.36,"endTime":91.59,"body":"they're very high indeed."},{"startTime":91.59,"endTime":93.9,"body":"So in individuals with insomnia,"},{"startTime":93.9,"endTime":97.16,"body":"the concurrent diagnosis"},{"startTime":93.9,"endTime":97.16,"body":"of a mental health disorder"},{"startTime":97.16,"endTime":99.0,"body":"is about 40%."},{"startTime":99.0,"endTime":101.64,"body":"If you look at people who"},{"startTime":99.0,"endTime":101.64,"body":"are excessively sleepy,"},{"startTime":101.64,"endTime":102.84,"body":"it's probably even higher,"},{"startTime":102.84,"endTime":106.32,"body":"it's of the order of getting close to 50%"},{"startTime":106.32,"endTime":110.113,"body":"and that's compared to a rate of about 15%"},{"startTime":110.113,"endTime":113.01,"body":"in individuals who have normal sleep."},{"startTime":113.01,"endTime":116.01,"body":"So really very much out of proportion."},{"startTime":116.01,"endTime":118.44,"body":"We also know that in insomnia,"},{"startTime":118.44,"endTime":122.13,"body":"the presence of a mental health diagnosis"},{"startTime":122.13,"endTime":124.96,"body":"or indeed a past diagnosis"},{"startTime":122.13,"endTime":124.96,"body":"of a psychiatric disorder"},{"startTime":125.97,"endTime":128.28,"body":"is very high indeed."},{"startTime":128.28,"endTime":130.35,"body":"But when you look at those individuals"},{"startTime":130.35,"endTime":131.49,"body":"in a little bit more detail,"},{"startTime":131.49,"endTime":134.4,"body":"what you typically see is that"},{"startTime":131.49,"endTime":134.4,"body":"when it comes to associations"},{"startTime":134.4,"endTime":136.35,"body":"between sleep disorders and mood,"},{"startTime":136.35,"endTime":139.56,"body":"the sleep disorder is often present before"},{"startTime":139.56,"endTime":141.24,"body":"or with the onset of the mood disorder,"},{"startTime":141.24,"endTime":143.64,"body":"whereas with anxiety"},{"startTime":141.24,"endTime":143.64,"body":"it's slightly different."},{"startTime":143.64,"endTime":146.37,"body":"The sleep disorder often starts alongside"},{"startTime":146.37,"endTime":148.336,"body":"the onset of anxiety"},{"startTime":146.37,"endTime":148.336,"body":"or shortly thereafter,"},{"startTime":148.336,"endTime":150.903,"body":"and I'll come back to that shortly."},{"startTime":151.74,"endTime":154.26,"body":"So in the past,"},{"startTime":154.26,"endTime":156.39,"body":"this association between sleep issues"},{"startTime":156.39,"endTime":157.41,"body":"and mental health disorders,"},{"startTime":157.41,"endTime":161.79,"body":"particularly by the psychiatric body,"},{"startTime":161.79,"endTime":165.45,"body":"has very much been the"},{"startTime":161.79,"endTime":165.45,"body":"case that sleep disturbance"},{"startTime":165.45,"endTime":168.48,"body":"is a secondary phenomenon"},{"startTime":165.45,"endTime":168.48,"body":"of mental health issues"},{"startTime":168.48,"endTime":170.27,"body":"that essentially sleep disturbance"},{"startTime":170.27,"endTime":174.09,"body":"is a symptom or is a consequence"},{"startTime":170.27,"endTime":174.09,"body":"of mental health issues,"},{"startTime":174.09,"endTime":177.15,"body":"i.e, it's the depression"},{"startTime":174.09,"endTime":177.15,"body":"that's causing the sleep issue,"},{"startTime":177.15,"endTime":179.73,"body":"it's the anxiety that's"},{"startTime":177.15,"endTime":179.73,"body":"causing the sleep issue."},{"startTime":179.73,"endTime":183.06,"body":"And the commonly held"},{"startTime":179.73,"endTime":183.06,"body":"belief until recently"},{"startTime":183.06,"endTime":184.62,"body":"has been very much that if you address"},{"startTime":184.62,"endTime":188.04,"body":"the psychiatric disorder,"},{"startTime":184.62,"endTime":188.04,"body":"you will improve sleep."},{"startTime":188.04,"endTime":189.6,"body":"So this kind of picture"},{"startTime":189.6,"endTime":191.64,"body":"whereby it's the psychiatric disorder"},{"startTime":191.64,"endTime":193.59,"body":"that results in the sleep disorder"},{"startTime":193.59,"endTime":195.249,"body":"and it's this psychiatric disorder"},{"startTime":195.249,"endTime":198.51,"body":"that you need to deal with in"},{"startTime":195.249,"endTime":198.51,"body":"order to address the sleep."},{"startTime":198.51,"endTime":201.54,"body":"But actually what we are"},{"startTime":198.51,"endTime":201.54,"body":"beginning to understand"},{"startTime":201.54,"endTime":205.8,"body":"is that this is a gross"},{"startTime":201.54,"endTime":205.8,"body":"over oversimplification"},{"startTime":205.8,"endTime":209.13,"body":"of the relationship between"},{"startTime":205.8,"endTime":209.13,"body":"psychiatry and sleep medicine."},{"startTime":209.13,"endTime":212.58,"body":"And that actually this is a"},{"startTime":209.13,"endTime":212.58,"body":"bidirectional relationship"},{"startTime":212.58,"endTime":215.189,"body":"so that psychiatric disorders"},{"startTime":212.58,"endTime":215.189,"body":"give rise to sleep disorders"},{"startTime":215.189,"endTime":217.86,"body":"and also vice versa."},{"startTime":217.86,"endTime":219.63,"body":"And what I'm going to be discussing today"},{"startTime":219.63,"endTime":222.09,"body":"is some of the evidence that shows"},{"startTime":222.09,"endTime":223.77,"body":"this bidirectional relationship,"},{"startTime":223.77,"endTime":226.56,"body":"that shows the links between the two."},{"startTime":226.56,"endTime":231.51,"body":"So why should sleep"},{"startTime":226.56,"endTime":231.51,"body":"disturbance be causative"},{"startTime":231.51,"endTime":232.71,"body":"of mental health issues?"},{"startTime":232.71,"endTime":236.88,"body":"Well, if you look at"},{"startTime":232.71,"endTime":236.88,"body":"acute sleep deprivation,"},{"startTime":236.88,"endTime":239.4,"body":"so this is only sleep deprivation"},{"startTime":239.4,"endTime":242.79,"body":"over the course of a single"},{"startTime":239.4,"endTime":242.79,"body":"night or over a few nights,"},{"startTime":242.79,"endTime":246.073,"body":"then we know that even"},{"startTime":242.79,"endTime":246.073,"body":"short-term sleep disruption"},{"startTime":246.073,"endTime":247.98,"body":"or sleep deprivation can result"},{"startTime":247.98,"endTime":250.47,"body":"in a number of different psychological"},{"startTime":250.47,"endTime":252.06,"body":"and physiological effects"},{"startTime":252.06,"endTime":254.67,"body":"that might have some"},{"startTime":252.06,"endTime":254.67,"body":"bearing on mental health."},{"startTime":254.67,"endTime":257.79,"body":"So we know that as soon as"},{"startTime":254.67,"endTime":257.79,"body":"you sleep deprive somebody,"},{"startTime":257.79,"endTime":260.94,"body":"their ability to regulate"},{"startTime":257.79,"endTime":260.94,"body":"their emotions lessens,"},{"startTime":260.94,"endTime":264.486,"body":"they begin to interpret"},{"startTime":260.94,"endTime":264.486,"body":"relatively neutral stimuli"},{"startTime":264.486,"endTime":268.969,"body":"in very negative terms, their"},{"startTime":264.486,"endTime":268.969,"body":"perception of pain increases."},{"startTime":268.969,"endTime":270.87,"body":"So there have been a variety of studies"},{"startTime":270.87,"endTime":273.819,"body":"that are usually done on German"},{"startTime":270.87,"endTime":273.819,"body":"or Canadian medical students"},{"startTime":273.819,"endTime":275.46,"body":"whereby they sleep deprive them"},{"startTime":275.46,"endTime":277.22,"body":"and give them electric shocks"},{"startTime":277.22,"endTime":280.2,"body":"and see what threshold they yell at."},{"startTime":280.2,"endTime":282.0,"body":"And it's very clear that a single night"},{"startTime":282.0,"endTime":283.5,"body":"of sleep deprivation dramatically"},{"startTime":283.5,"endTime":285.33,"body":"alters your pain threshold,"},{"startTime":285.33,"endTime":287.956,"body":"that sleep deprivation, acute"},{"startTime":285.33,"endTime":287.956,"body":"sleep deprivation again,"},{"startTime":287.956,"endTime":292.56,"body":"results in significant problems"},{"startTime":287.956,"endTime":292.56,"body":"in inhibiting responses,"},{"startTime":292.56,"endTime":295.38,"body":"so essentially frontal lobe dysfunction."},{"startTime":295.38,"endTime":299.01,"body":"And in fact there are a wide"},{"startTime":295.38,"endTime":299.01,"body":"array of cognitive functions"},{"startTime":299.01,"endTime":301.35,"body":"that suffer as a result of a single night"},{"startTime":301.35,"endTime":302.76,"body":"of sleep deprivation."},{"startTime":302.76,"endTime":305.25,"body":"There was a famous study"},{"startTime":302.76,"endTime":305.25,"body":"done about 20 years ago"},{"startTime":305.25,"endTime":308.07,"body":"where they looked at the"},{"startTime":305.25,"endTime":308.07,"body":"effects of sleep deprivation"},{"startTime":308.07,"endTime":310.937,"body":"and compared those effects both"},{"startTime":308.07,"endTime":310.937,"body":"from a cognitive perspective"},{"startTime":310.937,"endTime":313.5,"body":"and also from a sleepiness perspective"},{"startTime":313.5,"endTime":315.09,"body":"in relation to alcohol."},{"startTime":315.09,"endTime":317.25,"body":"And what they found was that even"},{"startTime":317.25,"endTime":320.4,"body":"two hours of sleep"},{"startTime":317.25,"endTime":320.4,"body":"deprivation is the equivalent"},{"startTime":320.4,"endTime":324.66,"body":"in terms of cognitive dysfunction"},{"startTime":320.4,"endTime":324.66,"body":"or in terms of sleepiness"},{"startTime":324.66,"endTime":327.09,"body":"of two to three units of alcohol,"},{"startTime":327.09,"endTime":330.06,"body":"so really quite significant indeed."},{"startTime":330.06,"endTime":332.04,"body":"And then there are a range"},{"startTime":330.06,"endTime":332.04,"body":"of physiological effects."},{"startTime":332.04,"endTime":333.87,"body":"We know that acute sleep deprivation"},{"startTime":333.87,"endTime":336.69,"body":"results in abnormalities"},{"startTime":333.87,"endTime":336.69,"body":"of endocrine function."},{"startTime":336.69,"endTime":340.41,"body":"So your hormones with"},{"startTime":336.69,"endTime":340.41,"body":"increases in cortisol"},{"startTime":340.41,"endTime":342.12,"body":"increases in adrenaline,"},{"startTime":342.12,"endTime":344.94,"body":"and these all have some"},{"startTime":342.12,"endTime":344.94,"body":"knock on consequences"},{"startTime":344.94,"endTime":347.7,"body":"on neurological or"},{"startTime":344.94,"endTime":347.7,"body":"psychiatric functioning,"},{"startTime":347.7,"endTime":349.38,"body":"it affects your immune system"},{"startTime":349.38,"endTime":351.93,"body":"and it also affects an"},{"startTime":349.38,"endTime":351.93,"body":"aspect of your nervous system"},{"startTime":351.93,"endTime":353.76,"body":"called the autonomic nervous system,"},{"startTime":353.76,"endTime":355.53,"body":"which is the part of the nervous system"},{"startTime":355.53,"endTime":359.52,"body":"that's responsible for unconscious"},{"startTime":355.53,"endTime":359.52,"body":"physiological processes"},{"startTime":359.52,"endTime":360.81,"body":"within the body"},{"startTime":360.81,"endTime":363.243,"body":"For example, your gut, sweating,"},{"startTime":365.25,"endTime":367.98,"body":"regulation of blood"},{"startTime":365.25,"endTime":367.98,"body":"pressure or heart rate."},{"startTime":367.98,"endTime":369.979,"body":"And these can actually"},{"startTime":367.98,"endTime":369.979,"body":"have knock-on consequences"},{"startTime":369.979,"endTime":374.19,"body":"on psychological factors."},{"startTime":374.19,"endTime":378.09,"body":"So for example, if you increase"},{"startTime":374.19,"endTime":378.09,"body":"heart rate using a drug,"},{"startTime":378.09,"endTime":380.67,"body":"then that can increase people's anxiety."},{"startTime":380.67,"endTime":383.16,"body":"And there have been some very"},{"startTime":380.67,"endTime":383.16,"body":"elegant models done in mice,"},{"startTime":383.16,"endTime":384.18,"body":"for example,"},{"startTime":384.18,"endTime":385.56,"body":"where they've increased heart rate"},{"startTime":385.56,"endTime":388.68,"body":"using a variety of very"},{"startTime":385.56,"endTime":388.68,"body":"fancy genetic techniques"},{"startTime":388.68,"endTime":390.21,"body":"called optogenetics,"},{"startTime":390.21,"endTime":393.33,"body":"where they switch genes"},{"startTime":390.21,"endTime":393.33,"body":"on and off using light."},{"startTime":393.33,"endTime":394.59,"body":"And what they can demonstrate"},{"startTime":394.59,"endTime":398.46,"body":"is that if you solely increase"},{"startTime":394.59,"endTime":398.46,"body":"heart rate in a mouse,"},{"startTime":398.46,"endTime":401.04,"body":"you see changes within their brain"},{"startTime":401.04,"endTime":404.76,"body":"that are very strongly paralleling changes"},{"startTime":404.76,"endTime":407.7,"body":"that are indicative of"},{"startTime":404.76,"endTime":407.7,"body":"anxiety, for example."},{"startTime":407.7,"endTime":410.22,"body":"So we have this constant feedback loop"},{"startTime":410.22,"endTime":413.64,"body":"whereby physiological"},{"startTime":410.22,"endTime":413.64,"body":"signals are integrated"},{"startTime":413.64,"endTime":417.183,"body":"into our brain and regulate our emotions."},{"startTime":418.59,"endTime":420.15,"body":"So I'm going to start off"},{"startTime":420.15,"endTime":423.87,"body":"by talking about anxiety first off."},{"startTime":423.87,"endTime":426.36,"body":"So for many people in this room,"},{"startTime":426.36,"endTime":429.18,"body":"the relationship between anxiety and sleep"},{"startTime":429.18,"endTime":430.56,"body":"is very self-evident."},{"startTime":430.56,"endTime":432.69,"body":"You know, when you are"},{"startTime":430.56,"endTime":432.69,"body":"anxious about something,"},{"startTime":432.69,"endTime":434.37,"body":"you are going to sleep more poorly."},{"startTime":434.37,"endTime":436.98,"body":"And I think that that is a"},{"startTime":434.37,"endTime":436.98,"body":"very common human experience."},{"startTime":436.98,"endTime":438.12,"body":"It doesn't necessarily mean"},{"startTime":438.12,"endTime":440.13,"body":"that you have a clinical disorder,"},{"startTime":440.13,"endTime":443.7,"body":"but that is part and parcel of anxiety"},{"startTime":443.7,"endTime":446.4,"body":"and of course, anxiety is"},{"startTime":443.7,"endTime":446.4,"body":"about perceived threats."},{"startTime":446.4,"endTime":450.725,"body":"It's about being on high alert for threat"},{"startTime":450.725,"endTime":452.91,"body":"within your environment,"},{"startTime":452.91,"endTime":454.86,"body":"it's about something"},{"startTime":452.91,"endTime":454.86,"body":"called hypervigilance."},{"startTime":454.86,"endTime":457.362,"body":"So being on alert for those dangers"},{"startTime":457.362,"endTime":462.362,"body":"and being in a constant state"},{"startTime":457.362,"endTime":462.362,"body":"of flight, fright or fight."},{"startTime":462.9,"endTime":465.96,"body":"So this high alert"},{"startTime":462.9,"endTime":465.96,"body":"whereby you are monitoring"},{"startTime":465.96,"endTime":468.596,"body":"your environment and that in itself"},{"startTime":468.596,"endTime":472.35,"body":"is quite an alerting phenomenon"},{"startTime":468.596,"endTime":472.35,"body":"when it comes to sleep"},{"startTime":472.35,"endTime":474.58,"body":"because of course, insomnia"},{"startTime":472.35,"endTime":474.58,"body":"is also a hyper-arousal state."},{"startTime":474.58,"endTime":478.2,"body":"Many of the experiences"},{"startTime":474.58,"endTime":478.2,"body":"of insomnia are such that"},{"startTime":478.2,"endTime":479.033,"body":"people will say,"},{"startTime":479.033,"endTime":482.28,"body":"well I feel on very high alert,"},{"startTime":479.033,"endTime":482.28,"body":"I can't switch my mind off."},{"startTime":482.28,"endTime":484.29,"body":"I'm finding it difficult to go to sleep."},{"startTime":484.29,"endTime":486.915,"body":"And indeed many people within"},{"startTime":484.29,"endTime":486.915,"body":"insomnia will experience"},{"startTime":486.915,"endTime":490.92,"body":"this phenomenon of hyperarousal"},{"startTime":486.915,"endTime":490.92,"body":"even during the day."},{"startTime":490.92,"endTime":494.52,"body":"So many people who will say"},{"startTime":490.92,"endTime":494.52,"body":"that they sleep very badly"},{"startTime":494.52,"endTime":497.22,"body":"will feel very tired during the day,"},{"startTime":497.22,"endTime":499.38,"body":"but they will say that"},{"startTime":497.22,"endTime":499.38,"body":"they feel on high alert,"},{"startTime":499.38,"endTime":502.62,"body":"they feel jittery, they feel"},{"startTime":499.38,"endTime":502.62,"body":"within that constant state"},{"startTime":502.62,"endTime":505.59,"body":"of flight, fright or fight."},{"startTime":505.59,"endTime":508.83,"body":"And in fact, when you look"},{"startTime":505.59,"endTime":508.83,"body":"at the genetic contributions"},{"startTime":508.83,"endTime":511.08,"body":"to anxiety and insomnia,"},{"startTime":511.08,"endTime":514.29,"body":"there is almost in an entire overlap"},{"startTime":514.29,"endTime":516.72,"body":"in the genes that have been implicated"},{"startTime":516.72,"endTime":518.52,"body":"in anxiety and insomnia."},{"startTime":518.52,"endTime":522.27,"body":"So both in terms of a physiological"},{"startTime":518.52,"endTime":522.27,"body":"and psychological state,"},{"startTime":522.27,"endTime":525.42,"body":"there are huge parallels"},{"startTime":522.27,"endTime":525.42,"body":"but in genetic terms,"},{"startTime":525.42,"endTime":527.52,"body":"these are very similar as well."},{"startTime":527.52,"endTime":528.93,"body":"And it's perhaps not surprising"},{"startTime":528.93,"endTime":531.93,"body":"that about 75% of people with anxiety"},{"startTime":531.93,"endTime":534.873,"body":"also report significant sleep disturbance."},{"startTime":536.22,"endTime":540.48,"body":"So what do we know about the"},{"startTime":536.22,"endTime":540.48,"body":"role of sleep in anxiety?"},{"startTime":540.48,"endTime":543.45,"body":"Well this is a rather interesting study,"},{"startTime":543.45,"endTime":547.29,"body":"goes back to giving medical"},{"startTime":543.45,"endTime":547.29,"body":"students electric shocks."},{"startTime":547.29,"endTime":549.84,"body":"So this study was done"},{"startTime":547.29,"endTime":549.84,"body":"whereby they presented"},{"startTime":549.84,"endTime":552.57,"body":"a number of normal individuals"},{"startTime":549.84,"endTime":552.57,"body":"with these different faces."},{"startTime":552.57,"endTime":555.084,"body":"So these are all computer generated faces"},{"startTime":555.084,"endTime":559.29,"body":"that have been altered very slightly."},{"startTime":559.29,"endTime":563.73,"body":"And what they did was they"},{"startTime":559.29,"endTime":563.73,"body":"gave these individuals"},{"startTime":563.73,"endTime":566.28,"body":"a learning task, whereby"},{"startTime":563.73,"endTime":566.28,"body":"every time they saw"},{"startTime":566.28,"endTime":567.93,"body":"one of these three faces,"},{"startTime":567.93,"endTime":569.58,"body":"they gave them an electric shock,"},{"startTime":570.51,"endTime":572.73,"body":"in order to generate a"},{"startTime":570.51,"endTime":572.73,"body":"conditioned response."},{"startTime":572.73,"endTime":575.25,"body":"So when they saw that face,"},{"startTime":575.25,"endTime":577.967,"body":"then it induced a perception of threat"},{"startTime":577.967,"endTime":580.32,"body":"or an expectation of harm."},{"startTime":580.32,"endTime":582.96,"body":"And after that learning task,"},{"startTime":582.96,"endTime":587.7,"body":"they then randomized them to"},{"startTime":582.96,"endTime":587.7,"body":"sleeping a good night's sleep"},{"startTime":587.7,"endTime":589.14,"body":"or not sleeping at all."},{"startTime":589.14,"endTime":591.75,"body":"And what they very clearly demonstrated"},{"startTime":591.75,"endTime":595.53,"body":"is that in those individuals"},{"startTime":591.75,"endTime":595.53,"body":"who had not slept at all,"},{"startTime":595.53,"endTime":599.52,"body":"they generated physiological"},{"startTime":595.53,"endTime":599.52,"body":"changes consistent with threat,"},{"startTime":599.52,"endTime":601.65,"body":"consistent with anxiety,"},{"startTime":601.65,"endTime":603.6,"body":"even when they were shown the other faces,"},{"startTime":603.6,"endTime":605.46,"body":"not just the face that"},{"startTime":603.6,"endTime":605.46,"body":"they'd learned the task to."},{"startTime":605.46,"endTime":607.95,"body":"So demonstrating that"},{"startTime":605.46,"endTime":607.95,"body":"actually a single night"},{"startTime":607.95,"endTime":611.04,"body":"of sleep deprivation"},{"startTime":607.95,"endTime":611.04,"body":"really does fundamentally"},{"startTime":611.04,"endTime":614.76,"body":"alter your level of alertness for threat,"},{"startTime":614.76,"endTime":616.35,"body":"your level of monitoring for threat,"},{"startTime":616.35,"endTime":619.023,"body":"and your perception of threat as well."},{"startTime":620.55,"endTime":623.49,"body":"And indeed when you"},{"startTime":620.55,"endTime":623.49,"body":"sleep deprive individuals"},{"startTime":623.49,"endTime":625.35,"body":"and you look at their brains,"},{"startTime":625.35,"endTime":628.53,"body":"what you see is you see very"},{"startTime":625.35,"endTime":628.53,"body":"similar patterns of changes"},{"startTime":628.53,"endTime":632.04,"body":"in activity to those seen"},{"startTime":628.53,"endTime":632.04,"body":"in individuals with anxiety."},{"startTime":632.04,"endTime":637.04,"body":"So we see a dramatic increase"},{"startTime":632.04,"endTime":637.04,"body":"in areas of the brain"},{"startTime":637.452,"endTime":640.89,"body":"that are involved in a system"},{"startTime":637.452,"endTime":640.89,"body":"called the limbic system,"},{"startTime":640.89,"endTime":643.949,"body":"which is very important"},{"startTime":640.89,"endTime":643.949,"body":"for emotional processing"},{"startTime":643.949,"endTime":645.54,"body":"and emotional memory."},{"startTime":645.54,"endTime":648.33,"body":"In particular an area of the"},{"startTime":645.54,"endTime":648.33,"body":"brain called the amygdala,"},{"startTime":648.33,"endTime":651.48,"body":"which is essentially the fear"},{"startTime":648.33,"endTime":651.48,"body":"processing center of the brain"},{"startTime":651.48,"endTime":653.46,"body":"and also another part of the limbic system"},{"startTime":653.46,"endTime":654.99,"body":"called the cingulate gyrus."},{"startTime":654.99,"endTime":657.0,"body":"And you see impaired frontal activity"},{"startTime":657.0,"endTime":658.684,"body":"and these are patterns"},{"startTime":657.0,"endTime":658.684,"body":"that you see in individuals"},{"startTime":658.684,"endTime":660.513,"body":"with anxiety as well."},{"startTime":662.61,"endTime":665.31,"body":"So what do we know about the role of sleep"},{"startTime":665.31,"endTime":666.81,"body":"in generating anxiety?"},{"startTime":666.81,"endTime":669.807,"body":"Well this is a really interesting"},{"startTime":666.81,"endTime":669.807,"body":"study from about 2005,"},{"startTime":669.807,"endTime":673.53,"body":"where they looked at individuals"},{"startTime":673.53,"endTime":677.67,"body":"who had persisting sleep"},{"startTime":673.53,"endTime":677.67,"body":"issues in childhood"},{"startTime":677.67,"endTime":680.25,"body":"and what they demonstrated"},{"startTime":677.67,"endTime":680.25,"body":"was that those children"},{"startTime":680.25,"endTime":683.13,"body":"who had those persistent sleep issues"},{"startTime":683.13,"endTime":686.04,"body":"had an increase of about"},{"startTime":683.13,"endTime":686.04,"body":"60% in the likelihood"},{"startTime":686.04,"endTime":689.28,"body":"of developing anxiety in adulthood."},{"startTime":689.28,"endTime":692.43,"body":"So really suggesting that"},{"startTime":689.28,"endTime":692.43,"body":"there is some sort of"},{"startTime":692.43,"endTime":695.85,"body":"causative relationship"},{"startTime":692.43,"endTime":695.85,"body":"between the presence of sleep"},{"startTime":695.85,"endTime":698.37,"body":"and subsequent development of anxiety."},{"startTime":698.37,"endTime":701.13,"body":"Now that of course is"},{"startTime":698.37,"endTime":701.13,"body":"not the only explanation"},{"startTime":701.13,"endTime":703.26,"body":"because it could be"},{"startTime":701.13,"endTime":703.26,"body":"argued that if you have"},{"startTime":703.26,"endTime":705.18,"body":"an underlying genetic predisposition"},{"startTime":705.18,"endTime":706.89,"body":"and as I've already said,"},{"startTime":706.89,"endTime":708.9,"body":"there is a shared genetic predisposition"},{"startTime":708.9,"endTime":710.52,"body":"to both insomnia and anxiety,"},{"startTime":710.52,"endTime":713.7,"body":"it may be that that anxiety"},{"startTime":710.52,"endTime":713.7,"body":"comes to the fore in later life"},{"startTime":713.7,"endTime":716.1,"body":"but certainly is a little hint"},{"startTime":716.1,"endTime":720.54,"body":"that actually sleep disturbance"},{"startTime":716.1,"endTime":720.54,"body":"may give rise to anxiety"},{"startTime":720.54,"endTime":721.373,"body":"later on."},{"startTime":723.33,"endTime":726.435,"body":"I'm going to talk about a"},{"startTime":723.33,"endTime":726.435,"body":"very specific type of anxiety,"},{"startTime":726.435,"endTime":729.12,"body":"so post-traumatic stress disorder."},{"startTime":729.12,"endTime":731.52,"body":"It's a very specific anxiety state"},{"startTime":731.52,"endTime":733.624,"body":"that results in marked hyperarousal,"},{"startTime":733.624,"endTime":736.35,"body":"so that fright, flight or fight response,"},{"startTime":736.35,"endTime":739.29,"body":"that in contrast to generalized"},{"startTime":736.35,"endTime":739.29,"body":"anxiety is often triggered"},{"startTime":739.29,"endTime":742.62,"body":"by particular triggers that are a reminder"},{"startTime":742.62,"endTime":747.62,"body":"of a particular psychological"},{"startTime":742.62,"endTime":747.62,"body":"or physically traumatic event."},{"startTime":748.59,"endTime":752.357,"body":"And hallmarks of PTSD include"},{"startTime":748.59,"endTime":752.357,"body":"this hyperarousal state,"},{"startTime":752.357,"endTime":757.35,"body":"but also flashbacks that are"},{"startTime":752.357,"endTime":757.35,"body":"often precipitated by triggers,"},{"startTime":757.35,"endTime":759.72,"body":"sleep disturbance is incredibly common."},{"startTime":759.72,"endTime":762.84,"body":"So about 90% of individuals with PTSD"},{"startTime":762.84,"endTime":766.74,"body":"experience sleep issues and"},{"startTime":762.84,"endTime":766.74,"body":"also trauma related nightmares."},{"startTime":766.74,"endTime":771.21,"body":"So often very vivid"},{"startTime":766.74,"endTime":771.21,"body":"emotionally charged nightmares"},{"startTime":771.21,"endTime":773.82,"body":"that are often either linked"},{"startTime":773.82,"endTime":778.82,"body":"or directly the traumatic experience"},{"startTime":779.1,"endTime":780.993,"body":"that has triggered the PTSD."},{"startTime":782.31,"endTime":785.055,"body":"So when we look at individuals"},{"startTime":785.055,"endTime":786.87,"body":"with post traumatic stress disorder,"},{"startTime":786.87,"endTime":789.06,"body":"we know that one of the strongest factors"},{"startTime":789.06,"endTime":792.39,"body":"for predicting whether or not"},{"startTime":789.06,"endTime":792.39,"body":"somebody is going to develop"},{"startTime":792.39,"endTime":797.39,"body":"PTSD after a traumatic"},{"startTime":792.39,"endTime":797.39,"body":"event is poor sleep prior to"},{"startTime":798.0,"endTime":800.73,"body":"or indeed after that trauma."},{"startTime":800.73,"endTime":804.6,"body":"So certainly there is something"},{"startTime":800.73,"endTime":804.6,"body":"about sleep deprivation"},{"startTime":804.6,"endTime":809.04,"body":"that seems to put people"},{"startTime":804.6,"endTime":809.04,"body":"at risk of developing PTSD."},{"startTime":809.04,"endTime":810.9,"body":"Now why should that be the case?"},{"startTime":810.9,"endTime":812.7,"body":"Well there is increasing evidence"},{"startTime":812.7,"endTime":816.66,"body":"from other areas of research"},{"startTime":812.7,"endTime":816.66,"body":"that suggest that REM sleep,"},{"startTime":816.66,"endTime":817.493,"body":"in particular,"},{"startTime":817.493,"endTime":820.56,"body":"rapid eye movement sleep, so"},{"startTime":817.493,"endTime":820.56,"body":"this is the stage of sleep"},{"startTime":820.56,"endTime":822.69,"body":"that we most associate with dreams,"},{"startTime":822.69,"endTime":825.003,"body":"particularly dreams of"},{"startTime":822.69,"endTime":825.003,"body":"a narrative structure,"},{"startTime":825.84,"endTime":829.8,"body":"it has a very important"},{"startTime":825.84,"endTime":829.8,"body":"role in cleansing emotions"},{"startTime":829.8,"endTime":830.82,"body":"from memories."},{"startTime":830.82,"endTime":833.13,"body":"Now obviously from an"},{"startTime":830.82,"endTime":833.13,"body":"evolutionary perspective,"},{"startTime":833.13,"endTime":836.61,"body":"it's really important that if an episode"},{"startTime":836.61,"endTime":839.13,"body":"is linked to very strong emotion,"},{"startTime":839.13,"endTime":841.35,"body":"for us to remember that"},{"startTime":839.13,"endTime":841.35,"body":"from an evolutionary"},{"startTime":841.35,"endTime":843.0,"body":"and a survival perspective."},{"startTime":843.0,"endTime":846.96,"body":"But what's not very useful is to maintain"},{"startTime":846.96,"endTime":850.68,"body":"that degree of emotional"},{"startTime":846.96,"endTime":850.68,"body":"involvement with that memory."},{"startTime":850.68,"endTime":853.26,"body":"You need to try and reduce"},{"startTime":850.68,"endTime":853.26,"body":"the emotional component"},{"startTime":853.26,"endTime":855.9,"body":"of that memory over time."},{"startTime":855.9,"endTime":859.83,"body":"And so one of the observations"},{"startTime":855.9,"endTime":859.83,"body":"has been that REM sleep"},{"startTime":859.83,"endTime":861.44,"body":"seems to be particularly associated"},{"startTime":861.44,"endTime":865.209,"body":"in taking the emotion that's associated"},{"startTime":865.209,"endTime":867.03,"body":"with the particular memory,"},{"startTime":867.03,"endTime":870.3,"body":"and REM sleep is part"},{"startTime":867.03,"endTime":870.3,"body":"of that desensitization,"},{"startTime":870.3,"endTime":872.31,"body":"that reduction in the emotional component"},{"startTime":872.31,"endTime":874.32,"body":"to that memory over time."},{"startTime":874.32,"endTime":875.91,"body":"And this has really led to the view"},{"startTime":875.91,"endTime":879.06,"body":"that actually REM sleep"},{"startTime":875.91,"endTime":879.06,"body":"may have a function"},{"startTime":879.06,"endTime":882.3,"body":"as what has been termed overnight therapy,"},{"startTime":882.3,"endTime":885.48,"body":"that actually it helps"},{"startTime":882.3,"endTime":885.48,"body":"the emotional processing"},{"startTime":885.48,"endTime":887.79,"body":"of a particularly traumatic event."},{"startTime":887.79,"endTime":891.99,"body":"And if you imagine that"},{"startTime":887.79,"endTime":891.99,"body":"individuals in PTSD have the same"},{"startTime":891.99,"endTime":894.66,"body":"nightmare but that nightmare is associated"},{"startTime":894.66,"endTime":897.03,"body":"with a very strong emotional charge,"},{"startTime":897.03,"endTime":899.85,"body":"an emotional charge that's"},{"startTime":897.03,"endTime":899.85,"body":"strong enough to wake you up,"},{"startTime":899.85,"endTime":901.65,"body":"then that process is never completed."},{"startTime":901.65,"endTime":906.51,"body":"And that perhaps is one of"},{"startTime":901.65,"endTime":906.51,"body":"the theories as to why PTSD"},{"startTime":906.51,"endTime":908.34,"body":"and those symptoms associated with it"},{"startTime":908.34,"endTime":911.67,"body":"can continue for as long as they do."},{"startTime":911.67,"endTime":915.027,"body":"And in fact often those"},{"startTime":911.67,"endTime":915.027,"body":"nightmares associated with PTSD"},{"startTime":915.027,"endTime":918.873,"body":"are the last features of"},{"startTime":915.027,"endTime":918.873,"body":"PTSD to go as it resolves."},{"startTime":919.83,"endTime":921.36,"body":"So we know that actually"},{"startTime":921.36,"endTime":924.06,"body":"there are some standard"},{"startTime":921.36,"endTime":924.06,"body":"psychological therapies"},{"startTime":924.06,"endTime":925.86,"body":"and actually this treatment"},{"startTime":925.86,"endTime":928.47,"body":"called cognitive behavioral"},{"startTime":925.86,"endTime":928.47,"body":"therapy for insomnia"},{"startTime":928.47,"endTime":931.5,"body":"is really the gold standard"},{"startTime":928.47,"endTime":931.5,"body":"psychological treatment"},{"startTime":931.5,"endTime":932.333,"body":"for insomnia."},{"startTime":932.333,"endTime":934.23,"body":"And I'm going to go on and describe that"},{"startTime":934.23,"endTime":936.15,"body":"in a bit more detail later,"},{"startTime":936.15,"endTime":938.882,"body":"can very clearly treat PTSD symptoms."},{"startTime":938.882,"endTime":942.6,"body":"So simply by treating sleep"},{"startTime":942.6,"endTime":944.73,"body":"using a non-drug based technique,"},{"startTime":944.73,"endTime":948.57,"body":"you can directly address PTSD."},{"startTime":948.57,"endTime":951.78,"body":"And indeed when one looks"},{"startTime":948.57,"endTime":951.78,"body":"at anxiety in general,"},{"startTime":951.78,"endTime":955.578,"body":"CBT for anxiety also causes"},{"startTime":951.78,"endTime":955.578,"body":"a moderate improvement"},{"startTime":955.578,"endTime":956.411,"body":"of sleep."},{"startTime":956.411,"endTime":959.13,"body":"So once again, very clear evidence"},{"startTime":959.13,"endTime":963.39,"body":"of this bidirectional relationship"},{"startTime":959.13,"endTime":963.39,"body":"between anxiety and PTSD"},{"startTime":963.39,"endTime":966.573,"body":"and sleep disturbance,"},{"startTime":963.39,"endTime":966.573,"body":"that one begets the other."},{"startTime":969.6,"endTime":970.8,"body":"Well what about depression?"},{"startTime":970.8,"endTime":974.94,"body":"Well, sleep disturbance in"},{"startTime":970.8,"endTime":974.94,"body":"depression is extremely common."},{"startTime":974.94,"endTime":977.58,"body":"About 85% of people with depression"},{"startTime":977.58,"endTime":979.23,"body":"have significant insomnia."},{"startTime":979.23,"endTime":981.81,"body":"About 50% are excessively sleepy"},{"startTime":981.81,"endTime":984.63,"body":"and about 30% of people"},{"startTime":981.81,"endTime":984.63,"body":"with depression have both."},{"startTime":984.63,"endTime":987.09,"body":"And in fact, sleep"},{"startTime":984.63,"endTime":987.09,"body":"disturbance is so common"},{"startTime":987.09,"endTime":987.99,"body":"that it forms part"},{"startTime":987.99,"endTime":990.99,"body":"of the standard diagnostic"},{"startTime":987.99,"endTime":990.99,"body":"criteria for depression,"},{"startTime":990.99,"endTime":995.04,"body":"particularly patterns of sleep"},{"startTime":990.99,"endTime":995.04,"body":"like early morning waking"},{"startTime":995.04,"endTime":999.3,"body":"is very much seen as a"},{"startTime":995.04,"endTime":999.3,"body":"biological symptom of depression."},{"startTime":999.3,"endTime":1002.33,"body":"And the reason why understanding"},{"startTime":1002.33,"endTime":1004.97,"body":"the relationship between"},{"startTime":1002.33,"endTime":1004.97,"body":"depression and sleep,"},{"startTime":1004.97,"endTime":1009.97,"body":"why it's so important is we're"},{"startTime":1004.97,"endTime":1009.97,"body":"actually quite poor generally"},{"startTime":1010.643,"endTime":1012.5,"body":"at treating depression."},{"startTime":1012.5,"endTime":1017.11,"body":"And actually if we are"},{"startTime":1012.5,"endTime":1017.11,"body":"to find treating sleep"},{"startTime":1017.11,"endTime":1019.4,"body":"is as important as treating"},{"startTime":1017.11,"endTime":1019.4,"body":"the mood disturbance"},{"startTime":1019.4,"endTime":1022.07,"body":"in order to result in"},{"startTime":1019.4,"endTime":1022.07,"body":"an overall improvement,"},{"startTime":1022.07,"endTime":1025.28,"body":"then this might dramatically"},{"startTime":1022.07,"endTime":1025.28,"body":"also improve our success"},{"startTime":1025.28,"endTime":1028.043,"body":"of treating these kinds of"},{"startTime":1025.28,"endTime":1028.043,"body":"mental health disorders."},{"startTime":1032.06,"endTime":1035.51,"body":"So what do we know about this link?"},{"startTime":1035.51,"endTime":1038.6,"body":"Well we know that if you have insomnia,"},{"startTime":1038.6,"endTime":1041.84,"body":"it doubles or even triples"},{"startTime":1038.6,"endTime":1041.84,"body":"the risk of developing"},{"startTime":1041.84,"endTime":1043.34,"body":"depression later on."},{"startTime":1043.34,"endTime":1045.35,"body":"So there is something about insomnia"},{"startTime":1045.35,"endTime":1048.89,"body":"that seems to predispose to depression."},{"startTime":1048.89,"endTime":1051.23,"body":"We know that in children in particular"},{"startTime":1051.23,"endTime":1054.14,"body":"actually there are changes"},{"startTime":1051.23,"endTime":1054.14,"body":"in our biological clock"},{"startTime":1054.14,"endTime":1056.03,"body":"that put us at risk of depression."},{"startTime":1056.03,"endTime":1059.39,"body":"So if you have something"},{"startTime":1056.03,"endTime":1059.39,"body":"called delayed sleep phase,"},{"startTime":1059.39,"endTime":1061.25,"body":"so this is if you are a night owl,"},{"startTime":1061.25,"endTime":1065.772,"body":"if your biological clock is"},{"startTime":1061.25,"endTime":1065.772,"body":"linked to going to sleep late"},{"startTime":1065.772,"endTime":1067.22,"body":"and waking up late,"},{"startTime":1067.22,"endTime":1070.7,"body":"that increases your risk"},{"startTime":1067.22,"endTime":1070.7,"body":"of depression in childhood."},{"startTime":1070.7,"endTime":1075.5,"body":"And insomnia is a really"},{"startTime":1070.7,"endTime":1075.5,"body":"important and consistent"},{"startTime":1075.5,"endTime":1079.97,"body":"risk factor for suicidal"},{"startTime":1075.5,"endTime":1079.97,"body":"ideation and suicide attempts."},{"startTime":1079.97,"endTime":1084.05,"body":"So if you in clinic see"},{"startTime":1079.97,"endTime":1084.05,"body":"somebody who is depressed"},{"startTime":1084.05,"endTime":1087.05,"body":"and has insomnia as well,"},{"startTime":1084.05,"endTime":1087.05,"body":"that sets off alarm bells"},{"startTime":1087.05,"endTime":1090.893,"body":"because they're at much"},{"startTime":1087.05,"endTime":1090.893,"body":"higher risk than average."},{"startTime":1091.76,"endTime":1093.652,"body":"And one of the other"},{"startTime":1091.76,"endTime":1093.652,"body":"interesting observations"},{"startTime":1093.652,"endTime":1097.49,"body":"is that when people have"},{"startTime":1093.652,"endTime":1097.49,"body":"depression and they remit,"},{"startTime":1097.49,"endTime":1099.83,"body":"so they are successfully treated,"},{"startTime":1099.83,"endTime":1102.17,"body":"their insomnia frequently disappears,"},{"startTime":1102.17,"endTime":1104.24,"body":"it frequently continues as well,"},{"startTime":1104.24,"endTime":1108.26,"body":"but it's much more likely"},{"startTime":1104.24,"endTime":1108.26,"body":"for insomnia to continue"},{"startTime":1108.26,"endTime":1111.26,"body":"even in depression that is ongoing,"},{"startTime":1111.26,"endTime":1114.53,"body":"suggesting that they are"},{"startTime":1111.26,"endTime":1114.53,"body":"two separate entities"},{"startTime":1114.53,"endTime":1118.88,"body":"but that clearly insomnia"},{"startTime":1114.53,"endTime":1118.88,"body":"increases the risk"},{"startTime":1118.88,"endTime":1121.073,"body":"of not getting better"},{"startTime":1118.88,"endTime":1121.073,"body":"from your depression."},{"startTime":1122.93,"endTime":1125.06,"body":"So when we look in the general population,"},{"startTime":1125.06,"endTime":1126.513,"body":"and this is looking"},{"startTime":1125.06,"endTime":1126.513,"body":"for depressive symptoms"},{"startTime":1126.513,"endTime":1128.69,"body":"in the general population,"},{"startTime":1128.69,"endTime":1131.45,"body":"what we see is that in"},{"startTime":1128.69,"endTime":1131.45,"body":"individuals who've got insomnia,"},{"startTime":1131.45,"endTime":1134.72,"body":"if we treat insomnia"},{"startTime":1131.45,"endTime":1134.72,"body":"usually with this treatment"},{"startTime":1134.72,"endTime":1138.23,"body":"called CBTi, cognitive"},{"startTime":1134.72,"endTime":1138.23,"body":"behavioral therapy for insomnia,"},{"startTime":1138.23,"endTime":1140.78,"body":"that causes quite a significant reduction"},{"startTime":1140.78,"endTime":1142.76,"body":"in depressive symptoms."},{"startTime":1142.76,"endTime":1147.32,"body":"And in one randomized control"},{"startTime":1142.76,"endTime":1147.32,"body":"trial that was done relatively"},{"startTime":1147.32,"endTime":1152.0,"body":"recently where they gave"},{"startTime":1147.32,"endTime":1152.0,"body":"people, some groups CBTi,"},{"startTime":1152.0,"endTime":1154.91,"body":"the other group they gave"},{"startTime":1152.0,"endTime":1154.91,"body":"sleep hygiene education."},{"startTime":1154.91,"endTime":1157.13,"body":"Sleep hygiene is this terrible term"},{"startTime":1157.13,"endTime":1158.9,"body":"that we use all the time."},{"startTime":1158.9,"endTime":1163.46,"body":"Essentially what it describes"},{"startTime":1158.9,"endTime":1163.46,"body":"is advice regarding behaviors"},{"startTime":1163.46,"endTime":1165.05,"body":"that improve your sleep,"},{"startTime":1165.05,"endTime":1168.29,"body":"simple things like"},{"startTime":1165.05,"endTime":1168.29,"body":"avoiding caffeine at night,"},{"startTime":1168.29,"endTime":1169.862,"body":"like not exercising late at night,"},{"startTime":1169.862,"endTime":1173.18,"body":"like making sure that your"},{"startTime":1169.862,"endTime":1173.18,"body":"bedroom is dark and quiet,"},{"startTime":1173.18,"endTime":1174.74,"body":"really rather common sense,"},{"startTime":1174.74,"endTime":1178.76,"body":"but it's often used as a"},{"startTime":1174.74,"endTime":1178.76,"body":"treatment for sleep disturbance,"},{"startTime":1178.76,"endTime":1180.818,"body":"that is not really a treatment."},{"startTime":1180.818,"endTime":1183.055,"body":"What they demonstrated is that actually"},{"startTime":1183.055,"endTime":1185.57,"body":"if you give people CBTi,"},{"startTime":1185.57,"endTime":1188.18,"body":"as opposed to sleep hygiene education,"},{"startTime":1188.18,"endTime":1191.78,"body":"there is a clear benefit"},{"startTime":1188.18,"endTime":1191.78,"body":"in terms of treating"},{"startTime":1191.78,"endTime":1194.87,"body":"depressive symptoms"},{"startTime":1191.78,"endTime":1194.87,"body":"associated with insomnia."},{"startTime":1194.87,"endTime":1197.42,"body":"And the other really"},{"startTime":1194.87,"endTime":1197.42,"body":"quite striking feature"},{"startTime":1197.42,"endTime":1200.51,"body":"is that if you treat"},{"startTime":1197.42,"endTime":1200.51,"body":"insomnia successfully,"},{"startTime":1200.51,"endTime":1204.53,"body":"then you reduce the likelihood"},{"startTime":1200.51,"endTime":1204.53,"body":"of a depressive episode"},{"startTime":1204.53,"endTime":1206.78,"body":"over the next year."},{"startTime":1206.78,"endTime":1211.01,"body":"So that's really suggesting"},{"startTime":1206.78,"endTime":1211.01,"body":"that actually improving insomnia"},{"startTime":1211.01,"endTime":1213.92,"body":"reduces the risk of developing depression."},{"startTime":1213.92,"endTime":1215.78,"body":"Now the reason why it's up to a year is"},{"startTime":1215.78,"endTime":1218.78,"body":"because that's the longest"},{"startTime":1215.78,"endTime":1218.78,"body":"study that's been done so far,"},{"startTime":1218.78,"endTime":1221.42,"body":"but it may be that"},{"startTime":1218.78,"endTime":1221.42,"body":"actually treating insomnia"},{"startTime":1221.42,"endTime":1222.742,"body":"may have a dramatic improvement"},{"startTime":1222.742,"endTime":1226.22,"body":"in the likelihood of developing"},{"startTime":1222.742,"endTime":1226.22,"body":"insomnia later on in life"},{"startTime":1226.22,"endTime":1227.723,"body":"for many years to come."},{"startTime":1230.51,"endTime":1235.34,"body":"So what about in people who"},{"startTime":1230.51,"endTime":1235.34,"body":"are clinically depressed?"},{"startTime":1235.34,"endTime":1237.83,"body":"Actually, very similar findings."},{"startTime":1237.83,"endTime":1241.766,"body":"When you give people CBTi"},{"startTime":1237.83,"endTime":1241.766,"body":"versus standard sleep advice,"},{"startTime":1241.766,"endTime":1244.52,"body":"this concept of sleep hygiene,"},{"startTime":1244.52,"endTime":1247.22,"body":"on top of standard"},{"startTime":1244.52,"endTime":1247.22,"body":"treatment for depression"},{"startTime":1247.22,"endTime":1249.14,"body":"like antidepressant drugs"},{"startTime":1249.14,"endTime":1252.38,"body":"or psychological"},{"startTime":1249.14,"endTime":1252.38,"body":"interventions for depression,"},{"startTime":1252.38,"endTime":1254.87,"body":"you increase the likelihood of remission."},{"startTime":1254.87,"endTime":1258.98,"body":"So it's worth saying that CBTi"},{"startTime":1254.87,"endTime":1258.98,"body":"is a very simple treatment"},{"startTime":1258.98,"endTime":1261.14,"body":"that doesn't involve"},{"startTime":1258.98,"endTime":1261.14,"body":"giving people any drugs,"},{"startTime":1261.14,"endTime":1263.51,"body":"it doesn't involve"},{"startTime":1261.14,"endTime":1263.51,"body":"giving people medications"},{"startTime":1263.51,"endTime":1265.97,"body":"that are potentially side effect causing"},{"startTime":1265.97,"endTime":1268.76,"body":"and that might result"},{"startTime":1265.97,"endTime":1268.76,"body":"in withdrawal effects."},{"startTime":1268.76,"endTime":1271.16,"body":"So this is a really simple intervention"},{"startTime":1271.16,"endTime":1274.61,"body":"that can dramatically increase"},{"startTime":1271.16,"endTime":1274.61,"body":"the likelihood of recovery"},{"startTime":1274.61,"endTime":1277.16,"body":"from conditions like depression."},{"startTime":1277.16,"endTime":1281.03,"body":"And if you look at other comparators,"},{"startTime":1281.03,"endTime":1283.88,"body":"so another study looked at the combination"},{"startTime":1283.88,"endTime":1287.36,"body":"of antidepressant drugs"},{"startTime":1283.88,"endTime":1287.36,"body":"and sleep hygiene advice"},{"startTime":1287.36,"endTime":1290.774,"body":"versus this CBTi plus a placebo"},{"startTime":1290.774,"endTime":1292.94,"body":"instead of an antidepressant,"},{"startTime":1292.94,"endTime":1296.09,"body":"these had very similar"},{"startTime":1292.94,"endTime":1296.09,"body":"impacts on depression."},{"startTime":1296.09,"endTime":1299.3,"body":"So really suggesting that"},{"startTime":1296.09,"endTime":1299.3,"body":"actually a sleep intervention"},{"startTime":1299.3,"endTime":1302.999,"body":"may be as good as starting"},{"startTime":1299.3,"endTime":1302.999,"body":"people on antidepressants"},{"startTime":1302.999,"endTime":1305.6,"body":"or at least some people"},{"startTime":1302.999,"endTime":1305.6,"body":"on antidepressants."},{"startTime":1305.6,"endTime":1307.16,"body":"And actually when you look at"},{"startTime":1307.16,"endTime":1311.51,"body":"psychologically-based"},{"startTime":1307.16,"endTime":1311.51,"body":"interventions directed at insomnia"},{"startTime":1311.51,"endTime":1314.39,"body":"versus psychological interventions"},{"startTime":1311.51,"endTime":1314.39,"body":"directed at depression,"},{"startTime":1314.39,"endTime":1318.95,"body":"they seem to have similar"},{"startTime":1314.39,"endTime":1318.95,"body":"reductions in depressive symptoms."},{"startTime":1318.95,"endTime":1322.939,"body":"So once again highlighting"},{"startTime":1318.95,"endTime":1322.939,"body":"the fact that ignoring sleep"},{"startTime":1322.939,"endTime":1325.01,"body":"in individuals who are depressed"},{"startTime":1325.01,"endTime":1327.683,"body":"is potentially not doing them any favors."},{"startTime":1330.41,"endTime":1333.623,"body":"And there are yet more studies that show"},{"startTime":1333.623,"endTime":1338.0,"body":"that if you improve sleep"},{"startTime":1333.623,"endTime":1338.0,"body":"early on in the treatment"},{"startTime":1338.0,"endTime":1339.05,"body":"of somebody with depression,"},{"startTime":1339.05,"endTime":1343.97,"body":"you are likely to increase"},{"startTime":1339.05,"endTime":1343.97,"body":"remission of that depression,"},{"startTime":1343.97,"endTime":1347.15,"body":"that poorer sleep at"},{"startTime":1343.97,"endTime":1347.15,"body":"baseline really does predict"},{"startTime":1347.15,"endTime":1349.1,"body":"a more difficult course,"},{"startTime":1349.1,"endTime":1352.64,"body":"people being more refractory"},{"startTime":1349.1,"endTime":1352.64,"body":"to standard treatments."},{"startTime":1352.64,"endTime":1356.57,"body":"And going back to this issue of children"},{"startTime":1356.57,"endTime":1357.95,"body":"who have a delayed phase"},{"startTime":1357.95,"endTime":1360.17,"body":"at being at increased risk of depression,"},{"startTime":1360.17,"endTime":1363.86,"body":"in adults, we also see that"},{"startTime":1360.17,"endTime":1363.86,"body":"this is a very important factor"},{"startTime":1363.86,"endTime":1367.22,"body":"that a delayed sleep phase,"},{"startTime":1363.86,"endTime":1367.22,"body":"so being a night owl,"},{"startTime":1367.22,"endTime":1370.58,"body":"tends to put you at risk of a"},{"startTime":1367.22,"endTime":1370.58,"body":"higher severity of depression,"},{"startTime":1370.58,"endTime":1372.5,"body":"more suicidal ideation."},{"startTime":1372.5,"endTime":1374.03,"body":"And the reason why this is important"},{"startTime":1374.03,"endTime":1376.64,"body":"is because there are some"},{"startTime":1374.03,"endTime":1376.64,"body":"very simple treatments"},{"startTime":1376.64,"endTime":1379.46,"body":"like light therapy or melatonin"},{"startTime":1379.46,"endTime":1382.882,"body":"that can be very useful in"},{"startTime":1379.46,"endTime":1382.882,"body":"driving people's body clocks"},{"startTime":1382.882,"endTime":1384.29,"body":"forward or back."},{"startTime":1384.29,"endTime":1386.79,"body":"And I'm going to come back"},{"startTime":1384.29,"endTime":1386.79,"body":"to that in a little while."},{"startTime":1388.46,"endTime":1390.77,"body":"This is the the final"},{"startTime":1388.46,"endTime":1390.77,"body":"mental health condition"},{"startTime":1390.77,"endTime":1392.66,"body":"that I'm going to be discussing,"},{"startTime":1392.66,"endTime":1394.67,"body":"the most serious of the"},{"startTime":1392.66,"endTime":1394.67,"body":"mental health conditions"},{"startTime":1394.67,"endTime":1396.47,"body":"that we see, schizophrenia,"},{"startTime":1396.47,"endTime":1400.34,"body":"and the view that sleep"},{"startTime":1396.47,"endTime":1400.34,"body":"may have an important role"},{"startTime":1400.34,"endTime":1403.07,"body":"in schizophrenia has come"},{"startTime":1400.34,"endTime":1403.07,"body":"from a number of observations."},{"startTime":1403.07,"endTime":1405.86,"body":"The first is that many people"},{"startTime":1403.07,"endTime":1405.86,"body":"with schizophrenia, in fact,"},{"startTime":1405.86,"endTime":1407.57,"body":"the vast majority of"},{"startTime":1405.86,"endTime":1407.57,"body":"people with schizophrenia"},{"startTime":1407.57,"endTime":1410.39,"body":"will complain of sleep disturbance."},{"startTime":1410.39,"endTime":1411.855,"body":"The second observation is that actually"},{"startTime":1411.855,"endTime":1415.43,"body":"if you improve sleep, it"},{"startTime":1411.855,"endTime":1415.43,"body":"tends to improve delusions"},{"startTime":1415.43,"endTime":1418.55,"body":"that are associated"},{"startTime":1415.43,"endTime":1418.55,"body":"with psychotic episodes."},{"startTime":1418.55,"endTime":1422.09,"body":"And the other feature is"},{"startTime":1418.55,"endTime":1422.09,"body":"that actually schizophrenia"},{"startTime":1422.09,"endTime":1424.913,"body":"often results in marked sleep disturbance"},{"startTime":1424.913,"endTime":1428.57,"body":"that is rather peculiar"},{"startTime":1424.913,"endTime":1428.57,"body":"in other walks of life."},{"startTime":1428.57,"endTime":1431.513,"body":"So this is a plot of an actograph,"},{"startTime":1432.53,"endTime":1435.92,"body":"so this is a little watch like"},{"startTime":1432.53,"endTime":1435.92,"body":"device that monitors movement"},{"startTime":1435.92,"endTime":1439.13,"body":"and it uses movement as"},{"startTime":1435.92,"endTime":1439.13,"body":"a proxy marker of sleep."},{"startTime":1439.13,"endTime":1441.71,"body":"And what you can see here is that"},{"startTime":1441.71,"endTime":1444.74,"body":"midnight is on the far left"},{"startTime":1444.74,"endTime":1449.36,"body":"and you can see there are"},{"startTime":1444.74,"endTime":1449.36,"body":"two days in each line."},{"startTime":1449.36,"endTime":1453.2,"body":"And what you can see is that"},{"startTime":1449.36,"endTime":1453.2,"body":"whilst the majority of movement"},{"startTime":1453.2,"endTime":1456.41,"body":"does happen during the"},{"startTime":1453.2,"endTime":1456.41,"body":"day, the circadian rhythm,"},{"startTime":1456.41,"endTime":1458.69,"body":"that standard pattern of going to sleep"},{"startTime":1458.69,"endTime":1463.31,"body":"at 10 or midnight and waking"},{"startTime":1458.69,"endTime":1463.31,"body":"up between six and eight"},{"startTime":1463.31,"endTime":1467.78,"body":"has largely gone and sleep"},{"startTime":1463.31,"endTime":1467.78,"body":"periods occur during the day,"},{"startTime":1467.78,"endTime":1469.43,"body":"they occur during the night,"},{"startTime":1469.43,"endTime":1472.16,"body":"there is a breakdown of the"},{"startTime":1469.43,"endTime":1472.16,"body":"natural circadian rhythm."},{"startTime":1472.16,"endTime":1476.073,"body":"And this is something"},{"startTime":1472.16,"endTime":1476.073,"body":"called non-24 hour, sorry,"},{"startTime":1476.073,"endTime":1478.97,"body":"irregular sleep-wake disorder."},{"startTime":1478.97,"endTime":1481.88,"body":"And this is something that"},{"startTime":1478.97,"endTime":1481.88,"body":"is really very peculiar"},{"startTime":1481.88,"endTime":1482.72,"body":"to schizophrenia,"},{"startTime":1482.72,"endTime":1485.07,"body":"we don't see it very"},{"startTime":1482.72,"endTime":1485.07,"body":"often in other conditions."},{"startTime":1487.07,"endTime":1490.803,"body":"So we know that there are"},{"startTime":1487.07,"endTime":1490.803,"body":"very clear associations"},{"startTime":1490.803,"endTime":1493.43,"body":"between sleep issues and psychosis"},{"startTime":1493.43,"endTime":1498.43,"body":"in that if you have sleep issues,"},{"startTime":1493.43,"endTime":1498.43,"body":"again, as with depression,"},{"startTime":1498.83,"endTime":1503.54,"body":"it seems to double the odds of"},{"startTime":1498.83,"endTime":1503.54,"body":"having a psychotic experience"},{"startTime":1503.54,"endTime":1506.51,"body":"and that the severity of the insomnia"},{"startTime":1506.51,"endTime":1509.244,"body":"that these individuals have"},{"startTime":1506.51,"endTime":1509.244,"body":"correlates very closely"},{"startTime":1509.244,"endTime":1511.569,"body":"with psychotic symptoms like paranoia"},{"startTime":1511.569,"endTime":1514.34,"body":"or thought disorganization."},{"startTime":1514.34,"endTime":1516.873,"body":"And in fact one of the really"},{"startTime":1514.34,"endTime":1516.873,"body":"interesting observations"},{"startTime":1516.873,"endTime":1520.01,"body":"which is generating a lot"},{"startTime":1516.873,"endTime":1520.01,"body":"of research at the moment"},{"startTime":1520.01,"endTime":1522.742,"body":"is that about 75% of"},{"startTime":1520.01,"endTime":1522.742,"body":"people with schizophrenia"},{"startTime":1522.742,"endTime":1526.19,"body":"will complain of significant"},{"startTime":1522.742,"endTime":1526.19,"body":"sleep disturbance"},{"startTime":1526.19,"endTime":1529.461,"body":"many days or even weeks"},{"startTime":1526.19,"endTime":1529.461,"body":"before they begin to develop"},{"startTime":1529.461,"endTime":1531.02,"body":"psychotic symptoms."},{"startTime":1531.02,"endTime":1534.56,"body":"Now this is from a therapeutic perspective"},{"startTime":1534.56,"endTime":1537.65,"body":"really interesting because if"},{"startTime":1534.56,"endTime":1537.65,"body":"we can track people's sleep"},{"startTime":1537.65,"endTime":1540.38,"body":"and we can identify a"},{"startTime":1537.65,"endTime":1540.38,"body":"deterioration in their sleep,"},{"startTime":1540.38,"endTime":1543.5,"body":"then we can actually predict"},{"startTime":1540.38,"endTime":1543.5,"body":"that they might be going on"},{"startTime":1543.5,"endTime":1545.12,"body":"to have psychotic episodes"},{"startTime":1545.12,"endTime":1547.52,"body":"and may actually be able to pre-treat them"},{"startTime":1547.52,"endTime":1551.78,"body":"to stop their psychosis"},{"startTime":1547.52,"endTime":1551.78,"body":"getting as bad as it is."},{"startTime":1551.78,"endTime":1553.73,"body":"And in fact, if you look at individuals"},{"startTime":1553.73,"endTime":1556.34,"body":"who have their first episode of psychosis,"},{"startTime":1556.34,"endTime":1560.03,"body":"about 80% have a"},{"startTime":1556.34,"endTime":1560.03,"body":"diagnosable sleep disorder."},{"startTime":1560.03,"endTime":1562.22,"body":"In fact, the average"},{"startTime":1560.03,"endTime":1562.22,"body":"number of different types"},{"startTime":1562.22,"endTime":1564.05,"body":"of sleep disorder in individuals"},{"startTime":1564.05,"endTime":1566.24,"body":"who develop their first"},{"startTime":1564.05,"endTime":1566.24,"body":"psychotic experience"},{"startTime":1566.24,"endTime":1568.46,"body":"is three different types"},{"startTime":1566.24,"endTime":1568.46,"body":"of sleep disorders."},{"startTime":1568.46,"endTime":1570.951,"body":"So it is really very"},{"startTime":1568.46,"endTime":1570.951,"body":"suggestive of the fact"},{"startTime":1570.951,"endTime":1575.39,"body":"that actually sleep and psychosis"},{"startTime":1570.951,"endTime":1575.39,"body":"are very closely linked."},{"startTime":1575.39,"endTime":1577.31,"body":"And again, as with the depression,"},{"startTime":1577.31,"endTime":1580.07,"body":"sleep and circadian"},{"startTime":1577.31,"endTime":1580.07,"body":"problems really do predict"},{"startTime":1580.07,"endTime":1583.193,"body":"a poor prognosis in these individuals."},{"startTime":1585.05,"endTime":1586.94,"body":"So does sleep intervention help?"},{"startTime":1586.94,"endTime":1588.488,"body":"Well actually this is one"},{"startTime":1586.94,"endTime":1588.488,"body":"of the areas of research"},{"startTime":1588.488,"endTime":1590.9,"body":"that really does need"},{"startTime":1588.488,"endTime":1590.9,"body":"quite a lot more work"},{"startTime":1590.9,"endTime":1594.38,"body":"because in patients with psychosis"},{"startTime":1594.38,"endTime":1596.27,"body":"we have very limited data."},{"startTime":1596.27,"endTime":1599.81,"body":"We know that actually CBTi"},{"startTime":1596.27,"endTime":1599.81,"body":"does help these individuals"},{"startTime":1599.81,"endTime":1602.33,"body":"and it causes large improvements in sleep"},{"startTime":1602.33,"endTime":1605.27,"body":"and there's some preliminary"},{"startTime":1602.33,"endTime":1605.27,"body":"data that it also improves"},{"startTime":1605.27,"endTime":1607.13,"body":"their psychotic experiences."},{"startTime":1607.13,"endTime":1608.57,"body":"But when you take normal individuals,,"},{"startTime":1608.57,"endTime":1610.79,"body":"and it's worth saying"},{"startTime":1608.57,"endTime":1610.79,"body":"that normal individuals"},{"startTime":1610.79,"endTime":1614.66,"body":"will often experience"},{"startTime":1610.79,"endTime":1614.66,"body":"psychotic like symptoms,"},{"startTime":1614.66,"endTime":1617.178,"body":"then if you improve sleep"},{"startTime":1614.66,"endTime":1617.178,"body":"in normal individuals,"},{"startTime":1617.178,"endTime":1619.768,"body":"you reduce the frequency of"},{"startTime":1617.178,"endTime":1619.768,"body":"reporting of psychotic like"},{"startTime":1619.768,"endTime":1622.034,"body":"experiences and vice versa."},{"startTime":1622.034,"endTime":1625.52,"body":"If you reduce sleep to about four hours,"},{"startTime":1625.52,"endTime":1628.43,"body":"there is a significant"},{"startTime":1625.52,"endTime":1628.43,"body":"increase in these symptoms."},{"startTime":1628.43,"endTime":1632.402,"body":"So once again showing a direct correlation"},{"startTime":1632.402,"endTime":1636.263,"body":"between sleep and psychotic illness."},{"startTime":1637.16,"endTime":1638.39,"body":"So what about other settings?"},{"startTime":1638.39,"endTime":1641.99,"body":"Well, this is more in my world,"},{"startTime":1638.39,"endTime":1641.99,"body":"in the neurological world."},{"startTime":1641.99,"endTime":1646.99,"body":"So we know that actually sleep disturbance"},{"startTime":1647.18,"endTime":1650.6,"body":"or sleep disturbance as"},{"startTime":1647.18,"endTime":1650.6,"body":"a result of psychiatric"},{"startTime":1650.6,"endTime":1653.66,"body":"or psychological factors"},{"startTime":1650.6,"endTime":1653.66,"body":"can actually affect"},{"startTime":1653.66,"endTime":1655.55,"body":"a range of other conditions."},{"startTime":1655.55,"endTime":1658.64,"body":"So this is to illustrate sleep walking."},{"startTime":1658.64,"endTime":1660.59,"body":"We know that actually stress and anxiety"},{"startTime":1660.59,"endTime":1663.86,"body":"are very common triggers for sleepwalking"},{"startTime":1663.86,"endTime":1666.38,"body":"because essentially what"},{"startTime":1663.86,"endTime":1666.38,"body":"happens when you are stressed,"},{"startTime":1666.38,"endTime":1669.89,"body":"when you're anxious, your"},{"startTime":1666.38,"endTime":1669.89,"body":"sleep is rather fragmented,"},{"startTime":1669.89,"endTime":1671.21,"body":"it's disrupted."},{"startTime":1671.21,"endTime":1674.12,"body":"And actually in sleepwalking"},{"startTime":1671.21,"endTime":1674.12,"body":"what we know is happening"},{"startTime":1674.12,"endTime":1676.85,"body":"is that any factor that"},{"startTime":1674.12,"endTime":1676.85,"body":"disrupts your sleep,"},{"startTime":1676.85,"endTime":1679.43,"body":"particularly the deeper"},{"startTime":1676.85,"endTime":1679.43,"body":"stages of your sleep,"},{"startTime":1679.43,"endTime":1682.79,"body":"can result in part of the brain"},{"startTime":1679.43,"endTime":1682.79,"body":"waking up parts of the brain"},{"startTime":1682.79,"endTime":1685.64,"body":"that are responsible for"},{"startTime":1682.79,"endTime":1685.64,"body":"movement, for emotion,"},{"startTime":1685.64,"endTime":1687.77,"body":"whereas the rest of the"},{"startTime":1685.64,"endTime":1687.77,"body":"brain remains asleep."},{"startTime":1687.77,"endTime":1689.547,"body":"And if you have stress or anxiety"},{"startTime":1689.547,"endTime":1691.16,"body":"that is fragmenting your sleep,"},{"startTime":1691.16,"endTime":1693.41,"body":"it puts you much more at risk of having"},{"startTime":1693.41,"endTime":1695.183,"body":"these kinds of episodes."},{"startTime":1696.38,"endTime":1698.872,"body":"This is a picture by Henry Fuseli,"},{"startTime":1698.872,"endTime":1703.01,"body":"who's an Anglo Swiss painter,"},{"startTime":1698.872,"endTime":1703.01,"body":"it's called the Nightmare."},{"startTime":1703.01,"endTime":1704.96,"body":"Actually from my perspective,"},{"startTime":1704.96,"endTime":1706.61,"body":"rather than illustrating a nightmare,"},{"startTime":1706.61,"endTime":1710.0,"body":"it illustrates two sleep disorders,"},{"startTime":1710.0,"endTime":1712.4,"body":"the first being of sleep paralysis,"},{"startTime":1712.4,"endTime":1716.24,"body":"which is commonly reported"},{"startTime":1712.4,"endTime":1716.24,"body":"in the normal population."},{"startTime":1716.24,"endTime":1718.7,"body":"It's also commonly reported in students"},{"startTime":1718.7,"endTime":1721.22,"body":"because students tend to be"},{"startTime":1718.7,"endTime":1721.22,"body":"burning the candle at both ends"},{"startTime":1721.22,"endTime":1724.58,"body":"and tend to have slightly more"},{"startTime":1721.22,"endTime":1724.58,"body":"disrupted sleep than average."},{"startTime":1724.58,"endTime":1726.725,"body":"And the other thing that"},{"startTime":1724.58,"endTime":1726.725,"body":"it illustrates is something"},{"startTime":1726.725,"endTime":1730.43,"body":"that often goes hand in"},{"startTime":1726.725,"endTime":1730.43,"body":"hand with sleep paralysis,"},{"startTime":1730.43,"endTime":1732.89,"body":"which is something called"},{"startTime":1730.43,"endTime":1732.89,"body":"hypnogogic hallucinations."},{"startTime":1732.89,"endTime":1734.382,"body":"So what we think this represents"},{"startTime":1734.382,"endTime":1737.57,"body":"is that during dreaming"},{"startTime":1734.382,"endTime":1737.57,"body":"sleep, during REM sleep,"},{"startTime":1737.57,"endTime":1739.01,"body":"we're completely paralyzed."},{"startTime":1739.01,"endTime":1741.29,"body":"The only muscles that work are the muscles"},{"startTime":1741.29,"endTime":1743.93,"body":"that allow us to breathe,"},{"startTime":1741.29,"endTime":1743.93,"body":"for obvious reasons,"},{"startTime":1743.93,"endTime":1746.33,"body":"and also the muscles that move"},{"startTime":1743.93,"endTime":1746.33,"body":"our eyes from left to right,"},{"startTime":1746.33,"endTime":1749.63,"body":"which is where the term rapid"},{"startTime":1746.33,"endTime":1749.63,"body":"eye movement comes from."},{"startTime":1749.63,"endTime":1751.345,"body":"But actually the rest of our musculature"},{"startTime":1751.345,"endTime":1753.41,"body":"is completely paralyzed."},{"startTime":1753.41,"endTime":1755.39,"body":"In individuals with sleep paralysis,"},{"startTime":1755.39,"endTime":1757.94,"body":"it seems that that mechanism of paralysis"},{"startTime":1757.94,"endTime":1761.93,"body":"that arises in REM sleep is"},{"startTime":1757.94,"endTime":1761.93,"body":"not switched off quickly enough"},{"startTime":1761.93,"endTime":1763.64,"body":"when we wake up."},{"startTime":1763.64,"endTime":1767.78,"body":"And if that happens and there"},{"startTime":1763.64,"endTime":1767.78,"body":"remain fragments of REM sleep"},{"startTime":1767.78,"endTime":1769.58,"body":"that intrude into wakefulness,"},{"startTime":1769.58,"endTime":1772.19,"body":"that can also be associated"},{"startTime":1769.58,"endTime":1772.19,"body":"with hallucinations,"},{"startTime":1772.19,"endTime":1775.37,"body":"which we think probably"},{"startTime":1772.19,"endTime":1775.37,"body":"represents dream mentation"},{"startTime":1775.37,"endTime":1777.8,"body":"spilling over into consciousness."},{"startTime":1777.8,"endTime":1779.84,"body":"Now if you can imagine"},{"startTime":1777.8,"endTime":1779.84,"body":"that you're lying in bed"},{"startTime":1779.84,"endTime":1782.63,"body":"and you're paralyzed and you can't move,"},{"startTime":1782.63,"endTime":1784.828,"body":"it's perhaps not unsurprising"},{"startTime":1784.828,"endTime":1786.83,"body":"that some of those hallucinations"},{"startTime":1786.83,"endTime":1787.88,"body":"that you might experience"},{"startTime":1787.88,"endTime":1790.01,"body":"of somebody sitting on your chest,"},{"startTime":1790.01,"endTime":1792.17,"body":"of somebody pinning you down."},{"startTime":1792.17,"endTime":1794.09,"body":"The other types of"},{"startTime":1792.17,"endTime":1794.09,"body":"hallucinations that people"},{"startTime":1794.09,"endTime":1796.46,"body":"with sleep paralysis often experience"},{"startTime":1796.46,"endTime":1799.58,"body":"are out of body experiences"},{"startTime":1796.46,"endTime":1799.58,"body":"or an intruder in the room"},{"startTime":1799.58,"endTime":1801.95,"body":"or standing over the edge of the bed."},{"startTime":1801.95,"endTime":1804.74,"body":"And we know that sleep"},{"startTime":1801.95,"endTime":1804.74,"body":"paralysis and hallucinations,"},{"startTime":1804.74,"endTime":1806.18,"body":"as well as being a feature of a range"},{"startTime":1806.18,"endTime":1807.38,"body":"of neurological disorders,"},{"startTime":1807.38,"endTime":1809.81,"body":"conditions like narcolepsy for example,"},{"startTime":1809.81,"endTime":1812.5,"body":"are often much more likely to"},{"startTime":1809.81,"endTime":1812.5,"body":"occur in anxious individuals"},{"startTime":1812.5,"endTime":1816.38,"body":"because their REM sleep is much"},{"startTime":1812.5,"endTime":1816.38,"body":"more likely to be disrupted"},{"startTime":1816.38,"endTime":1819.08,"body":"and they're much more likely"},{"startTime":1816.38,"endTime":1819.08,"body":"to wake up from REM sleep"},{"startTime":1819.08,"endTime":1821.183,"body":"and experience these kinds of phenomena."},{"startTime":1823.34,"endTime":1827.48,"body":"This is something that might"},{"startTime":1823.34,"endTime":1827.48,"body":"be familiar to to many people,"},{"startTime":1827.48,"endTime":1830.36,"body":"which is what we term"},{"startTime":1827.48,"endTime":1830.36,"body":"night eating syndrome."},{"startTime":1830.36,"endTime":1834.228,"body":"So night eating syndrome is one facet"},{"startTime":1834.228,"endTime":1838.76,"body":"of eating out of sleep or at night."},{"startTime":1838.76,"endTime":1841.373,"body":"So the typical thing that we see"},{"startTime":1841.373,"endTime":1843.68,"body":"in the neurological sleep services"},{"startTime":1843.68,"endTime":1848.68,"body":"is something called sleep eating,"},{"startTime":1848.87,"endTime":1852.95,"body":"which is a version of non-REM parasomnias,"},{"startTime":1852.95,"endTime":1855.41,"body":"a version of of sleepwalking."},{"startTime":1855.41,"endTime":1856.79,"body":"These are individuals who will get up"},{"startTime":1856.79,"endTime":1857.9,"body":"in the middle of the night,"},{"startTime":1857.9,"endTime":1861.23,"body":"who will still be in"},{"startTime":1857.9,"endTime":1861.23,"body":"all, in the truest sense,"},{"startTime":1861.23,"endTime":1864.65,"body":"still be asleep and they will"},{"startTime":1861.23,"endTime":1864.65,"body":"go down and seek out food."},{"startTime":1864.65,"endTime":1866.87,"body":"Now the key issue is that"},{"startTime":1864.65,"endTime":1866.87,"body":"they will often eat things"},{"startTime":1866.87,"endTime":1869.93,"body":"that are completely either toxic"},{"startTime":1869.93,"endTime":1872.63,"body":"or something that they would"},{"startTime":1869.93,"endTime":1872.63,"body":"not eat during the day."},{"startTime":1872.63,"endTime":1874.28,"body":"So the kinds of things that we see"},{"startTime":1874.28,"endTime":1877.1,"body":"are vegetarians eating raw meat"},{"startTime":1877.1,"endTime":1879.98,"body":"or occasionally"},{"startTime":1877.1,"endTime":1879.98,"body":"individuals drinking things"},{"startTime":1879.98,"endTime":1884.39,"body":"like washing up liquid or even"},{"startTime":1879.98,"endTime":1884.39,"body":"toxic substances like bleach."},{"startTime":1884.39,"endTime":1887.227,"body":"But night eating syndrome is"},{"startTime":1884.39,"endTime":1887.227,"body":"something slightly different."},{"startTime":1887.227,"endTime":1888.983,"body":"So these are individuals who will wake up"},{"startTime":1888.983,"endTime":1890.51,"body":"in the middle of the night"},{"startTime":1890.51,"endTime":1894.89,"body":"and will have this absolutely"},{"startTime":1890.51,"endTime":1894.89,"body":"irrepressible urge to eat."},{"startTime":1894.89,"endTime":1897.98,"body":"They won't be able to go back"},{"startTime":1894.89,"endTime":1897.98,"body":"to sleep until they've eaten."},{"startTime":1897.98,"endTime":1901.58,"body":"And it is thought that in"},{"startTime":1897.98,"endTime":1901.58,"body":"some of these individuals"},{"startTime":1901.58,"endTime":1906.2,"body":"there is a clear disruption"},{"startTime":1901.58,"endTime":1906.2,"body":"of the circadian clock"},{"startTime":1906.2,"endTime":1909.2,"body":"because the circadian"},{"startTime":1906.2,"endTime":1909.2,"body":"clock as well as regulating"},{"startTime":1909.2,"endTime":1912.342,"body":"when we sleep also regulates"},{"startTime":1909.2,"endTime":1912.342,"body":"every other biological function"},{"startTime":1912.342,"endTime":1914.57,"body":"and it regulates when we eat."},{"startTime":1914.57,"endTime":1916.64,"body":"And so disruption of the circadian clock"},{"startTime":1916.64,"endTime":1919.46,"body":"can result in this kind of thing,"},{"startTime":1919.46,"endTime":1922.64,"body":"whereby essentially"},{"startTime":1919.46,"endTime":1922.64,"body":"your gut is telling you"},{"startTime":1922.64,"endTime":1924.14,"body":"that it's time to eat."},{"startTime":1924.14,"endTime":1926.99,"body":"But actually what we see is"},{"startTime":1924.14,"endTime":1926.99,"body":"that this kind of condition"},{"startTime":1926.99,"endTime":1929.96,"body":"is seen at much higher"},{"startTime":1926.99,"endTime":1929.96,"body":"frequency, unsurprisingly,"},{"startTime":1929.96,"endTime":1931.88,"body":"in individuals with eating disorders,"},{"startTime":1931.88,"endTime":1935.06,"body":"so bulimia and anorexia nervosa."},{"startTime":1935.06,"endTime":1940.06,"body":"And so actually sometimes"},{"startTime":1935.06,"endTime":1940.06,"body":"treating any eating disorder"},{"startTime":1940.13,"endTime":1942.14,"body":"with a psychological technique"},{"startTime":1942.14,"endTime":1945.923,"body":"can dramatically improve"},{"startTime":1942.14,"endTime":1945.923,"body":"night eating syndrome as well."},{"startTime":1946.88,"endTime":1949.52,"body":"And the final other setting"},{"startTime":1946.88,"endTime":1949.52,"body":"that I want to mention"},{"startTime":1949.52,"endTime":1952.52,"body":"is a group of conditions that are termed"},{"startTime":1952.52,"endTime":1954.35,"body":"functional neurological disorders."},{"startTime":1954.35,"endTime":1957.68,"body":"So these are disorders"},{"startTime":1954.35,"endTime":1957.68,"body":"that are not as a result"},{"startTime":1957.68,"endTime":1959.66,"body":"of structural changes to the brain,"},{"startTime":1959.66,"endTime":1963.08,"body":"they're not as a result of"},{"startTime":1959.66,"endTime":1963.08,"body":"trauma or damage that we can see"},{"startTime":1963.08,"endTime":1966.474,"body":"on scans or on electrical"},{"startTime":1963.08,"endTime":1966.474,"body":"tests that we think"},{"startTime":1966.474,"endTime":1970.4,"body":"have a basis in the function"},{"startTime":1966.474,"endTime":1970.4,"body":"of the nervous system"},{"startTime":1970.4,"endTime":1972.89,"body":"rather than the structure"},{"startTime":1970.4,"endTime":1972.89,"body":"of the nervous system"},{"startTime":1972.89,"endTime":1976.34,"body":"and result in things like"},{"startTime":1972.89,"endTime":1976.34,"body":"paralysis or numbness,"},{"startTime":1976.34,"endTime":1978.26,"body":"tremor, occasionally seizures"},{"startTime":1978.26,"endTime":1980.72,"body":"that are termed non-epileptic seizures."},{"startTime":1980.72,"endTime":1983.51,"body":"And what we see anecdotally"},{"startTime":1980.72,"endTime":1983.51,"body":"is that individuals"},{"startTime":1983.51,"endTime":1985.79,"body":"with functional neurological disorders"},{"startTime":1985.79,"endTime":1988.76,"body":"often experience very poor sleep indeed."},{"startTime":1988.76,"endTime":1990.23,"body":"And that improving their sleep"},{"startTime":1990.23,"endTime":1992.753,"body":"also treats their functional symptoms."},{"startTime":1994.55,"endTime":1999.55,"body":"So I'm going to talk a little"},{"startTime":1994.55,"endTime":1999.55,"body":"bit more about insomnia."},{"startTime":1999.71,"endTime":2002.11,"body":"What is the basis of insomnia?"},{"startTime":2002.11,"endTime":2004.81,"body":"And I think that many"},{"startTime":2002.11,"endTime":2004.81,"body":"of you will recognize"},{"startTime":2004.81,"endTime":2007.12,"body":"the association between a dog and a bell."},{"startTime":2007.12,"endTime":2011.5,"body":"So this is really to"},{"startTime":2007.12,"endTime":2011.5,"body":"illustrate Pavlov's dogs."},{"startTime":2011.5,"endTime":2012.94,"body":"Pavlov was the neuroscientist"},{"startTime":2012.94,"endTime":2015.91,"body":"who really described the"},{"startTime":2012.94,"endTime":2015.91,"body":"classic conditioning response."},{"startTime":2015.91,"endTime":2018.04,"body":"So he was a Russian neuroscientist"},{"startTime":2018.04,"endTime":2019.48,"body":"at the turn of the century"},{"startTime":2019.48,"endTime":2022.99,"body":"who was experimenting on"},{"startTime":2019.48,"endTime":2022.99,"body":"the salivary glands of dogs."},{"startTime":2022.99,"endTime":2026.103,"body":"And he noted that when he"},{"startTime":2022.99,"endTime":2026.103,"body":"entered into his laboratory,"},{"startTime":2026.103,"endTime":2028.66,"body":"they would start salivating."},{"startTime":2028.66,"endTime":2032.5,"body":"He then started experimenting"},{"startTime":2028.66,"endTime":2032.5,"body":"by ringing a bell"},{"startTime":2032.5,"endTime":2034.6,"body":"every time he presented them with food."},{"startTime":2034.6,"endTime":2036.28,"body":"And within two or three days,"},{"startTime":2036.28,"endTime":2039.22,"body":"every time he rang the bell,"},{"startTime":2036.28,"endTime":2039.22,"body":"they started salivating."},{"startTime":2039.22,"endTime":2041.29,"body":"So really demonstrating this concept"},{"startTime":2041.29,"endTime":2043.933,"body":"that all around us we"},{"startTime":2041.29,"endTime":2043.933,"body":"have environmental stimuli"},{"startTime":2043.933,"endTime":2046.127,"body":"that we associate with"},{"startTime":2043.933,"endTime":2046.127,"body":"particular behaviors"},{"startTime":2046.127,"endTime":2048.37,"body":"and those environmental stimuli"},{"startTime":2048.37,"endTime":2051.28,"body":"may not necessarily be directly correlated"},{"startTime":2051.28,"endTime":2053.74,"body":"to the behavior that we're exhibiting."},{"startTime":2053.74,"endTime":2055.72,"body":"So the reason why this is important"},{"startTime":2055.72,"endTime":2057.818,"body":"is because it tells us a"},{"startTime":2055.72,"endTime":2057.818,"body":"lot about what we understand"},{"startTime":2057.818,"endTime":2059.71,"body":"insomnia to be."},{"startTime":2059.71,"endTime":2064.54,"body":"So insomnia used to be termed"},{"startTime":2059.71,"endTime":2064.54,"body":"psychophysiological insomnia,"},{"startTime":2064.54,"endTime":2066.223,"body":"which really illustrates the fact"},{"startTime":2066.223,"endTime":2068.56,"body":"that there are psychological"},{"startTime":2066.223,"endTime":2068.56,"body":"factors at play,"},{"startTime":2068.56,"endTime":2071.32,"body":"but there are also"},{"startTime":2068.56,"endTime":2071.32,"body":"physiological factors at play."},{"startTime":2071.32,"endTime":2074.11,"body":"Those psychological"},{"startTime":2071.32,"endTime":2074.11,"body":"factors can be conscious"},{"startTime":2074.11,"endTime":2075.67,"body":"or they can be unconscious."},{"startTime":2075.67,"endTime":2078.34,"body":"So when I talk about conscious"},{"startTime":2075.67,"endTime":2078.34,"body":"psychological factors,"},{"startTime":2078.34,"endTime":2080.65,"body":"many individuals with insomnia"},{"startTime":2080.65,"endTime":2083.41,"body":"will experience an anxiety about sleep,"},{"startTime":2083.41,"endTime":2086.11,"body":"they will experience an"},{"startTime":2083.41,"endTime":2086.11,"body":"anxiety about the night ahead,"},{"startTime":2086.11,"endTime":2088.51,"body":"the fact that their"},{"startTime":2086.11,"endTime":2088.51,"body":"partner is snoring away"},{"startTime":2088.51,"endTime":2091.45,"body":"while they're being tortured"},{"startTime":2088.51,"endTime":2091.45,"body":"by wakefulness overnight,"},{"startTime":2091.45,"endTime":2092.86,"body":"they'll experience frustration"},{"startTime":2092.86,"endTime":2095.41,"body":"that they're not able to sleep,"},{"startTime":2095.41,"endTime":2097.3,"body":"they'll experience anxiety"},{"startTime":2095.41,"endTime":2097.3,"body":"about whether or not"},{"startTime":2097.3,"endTime":2098.83,"body":"they can function the following day"},{"startTime":2098.83,"endTime":2101.75,"body":"and participate in all the"},{"startTime":2098.83,"endTime":2101.75,"body":"things that they want to."},{"startTime":2101.75,"endTime":2105.01,"body":"And importantly, especially nowadays,"},{"startTime":2105.01,"endTime":2106.69,"body":"they will experience significant anxiety"},{"startTime":2106.69,"endTime":2110.02,"body":"about the health issues"},{"startTime":2106.69,"endTime":2110.02,"body":"that their insomnia"},{"startTime":2110.02,"endTime":2113.5,"body":"may predispose them"},{"startTime":2110.02,"endTime":2113.5,"body":"to, rightly or wrongly."},{"startTime":2113.5,"endTime":2116.2,"body":"And we can chat about"},{"startTime":2113.5,"endTime":2116.2,"body":"that a little bit later."},{"startTime":2116.2,"endTime":2118.75,"body":"So those are the conscious factors,"},{"startTime":2118.75,"endTime":2122.11,"body":"but it's likely that unconscious factors"},{"startTime":2122.11,"endTime":2124.57,"body":"are as important as"},{"startTime":2122.11,"endTime":2124.57,"body":"those conscious factors,"},{"startTime":2124.57,"endTime":2128.05,"body":"because we all learn how to sleep."},{"startTime":2128.05,"endTime":2132.04,"body":"As children, we learn the"},{"startTime":2128.05,"endTime":2132.04,"body":"fact that bed is a place"},{"startTime":2132.04,"endTime":2134.14,"body":"where we sleep and we stay awake"},{"startTime":2134.14,"endTime":2137.41,"body":"until our parents wake us"},{"startTime":2134.14,"endTime":2137.41,"body":"up or until dawn wakes us up"},{"startTime":2137.41,"endTime":2139.09,"body":"and then we're awake."},{"startTime":2139.09,"endTime":2141.4,"body":"But in individuals who"},{"startTime":2139.09,"endTime":2141.4,"body":"have had significant"},{"startTime":2141.4,"endTime":2143.92,"body":"sleep disturbance for a"},{"startTime":2141.4,"endTime":2143.92,"body":"prolonged period of time,"},{"startTime":2143.92,"endTime":2145.75,"body":"that conditioned response,"},{"startTime":2145.75,"endTime":2148.0,"body":"that association between bed and sleep"},{"startTime":2148.0,"endTime":2150.43,"body":"is replaced with a negative"},{"startTime":2148.0,"endTime":2150.43,"body":"conditioned response,"},{"startTime":2150.43,"endTime":2152.89,"body":"which is that bed is a"},{"startTime":2150.43,"endTime":2152.89,"body":"place where we're awake,"},{"startTime":2152.89,"endTime":2155.11,"body":"where we're having difficulty sleeping,"},{"startTime":2155.11,"endTime":2157.48,"body":"where we're struggling"},{"startTime":2155.11,"endTime":2157.48,"body":"to get off to sleep."},{"startTime":2157.48,"endTime":2160.6,"body":"And so what a lot of"},{"startTime":2157.48,"endTime":2160.6,"body":"people do with insomnia is,"},{"startTime":2160.6,"endTime":2163.42,"body":"and this is quite intuitive,"},{"startTime":2163.42,"endTime":2166.18,"body":"is if you think you are going"},{"startTime":2163.42,"endTime":2166.18,"body":"to get a bad night's sleep,"},{"startTime":2166.18,"endTime":2167.89,"body":"you will stay in bed"},{"startTime":2166.18,"endTime":2167.89,"body":"for a little bit longer,"},{"startTime":2167.89,"endTime":2169.84,"body":"you'll try and catch up on your sleep."},{"startTime":2169.84,"endTime":2172.24,"body":"Whereas actually what"},{"startTime":2169.84,"endTime":2172.24,"body":"that is successfully doing"},{"startTime":2172.24,"endTime":2175.12,"body":"is strengthening that conditioned response"},{"startTime":2175.12,"endTime":2176.29,"body":"between bed and being awake"},{"startTime":2176.29,"endTime":2179.008,"body":"because you are extending"},{"startTime":2176.29,"endTime":2179.008,"body":"the period of time in bed"},{"startTime":2179.008,"endTime":2181.78,"body":"that you are awake rather than asleep."},{"startTime":2181.78,"endTime":2183.1,"body":"So that's what I mean"},{"startTime":2183.1,"endTime":2186.22,"body":"by these unconscious"},{"startTime":2183.1,"endTime":2186.22,"body":"psychological factors."},{"startTime":2186.22,"endTime":2188.68,"body":"And then finally there are"},{"startTime":2186.22,"endTime":2188.68,"body":"the physiological factors."},{"startTime":2188.68,"endTime":2190.6,"body":"So we know that poor quality sleep"},{"startTime":2190.6,"endTime":2194.059,"body":"causes endocrine changes"},{"startTime":2190.6,"endTime":2194.059,"body":"that I've already mentioned."},{"startTime":2194.059,"endTime":2197.26,"body":"It results in an increase"},{"startTime":2194.059,"endTime":2197.26,"body":"in cortisol levels"},{"startTime":2197.26,"endTime":2200.71,"body":"and steroids are a very good"},{"startTime":2197.26,"endTime":2200.71,"body":"way of inducing insomnia."},{"startTime":2200.71,"endTime":2204.64,"body":"And so those changes can"},{"startTime":2200.71,"endTime":2204.64,"body":"then reinforce the insomnia"},{"startTime":2204.64,"endTime":2206.331,"body":"and adrenaline is also increased"},{"startTime":2206.331,"endTime":2208.39,"body":"and adrenaline is a very good way"},{"startTime":2208.39,"endTime":2210.82,"body":"of inducing insomnia as well."},{"startTime":2210.82,"endTime":2212.62,"body":"So why do I tell you all of this?"},{"startTime":2212.62,"endTime":2216.25,"body":"Well, because I think it"},{"startTime":2212.62,"endTime":2216.25,"body":"gives a very good illustration"},{"startTime":2216.25,"endTime":2219.13,"body":"of why we think that"},{"startTime":2216.25,"endTime":2219.13,"body":"cognitive behavioral therapy"},{"startTime":2219.13,"endTime":2220.69,"body":"for insomnia works."},{"startTime":2220.69,"endTime":2223.99,"body":"So there is the standard"},{"startTime":2220.69,"endTime":2223.99,"body":"sleep hygiene advice"},{"startTime":2223.99,"endTime":2226.03,"body":"that we've already discussed."},{"startTime":2226.03,"endTime":2228.16,"body":"Sleep hygiene is not going"},{"startTime":2226.03,"endTime":2228.16,"body":"to make the difference"},{"startTime":2228.16,"endTime":2229.99,"body":"between somebody who is a good sleeper"},{"startTime":2229.99,"endTime":2232.15,"body":"and somebody who has chronic insomnia,"},{"startTime":2232.15,"endTime":2234.04,"body":"it's not really going to help."},{"startTime":2234.04,"endTime":2236.89,"body":"If you have intermittent,"},{"startTime":2234.04,"endTime":2236.89,"body":"poor quality sleep,"},{"startTime":2236.89,"endTime":2240.133,"body":"then certainly paying"},{"startTime":2236.89,"endTime":2240.133,"body":"attention to caffeine,"},{"startTime":2241.03,"endTime":2243.91,"body":"paying attention to what"},{"startTime":2241.03,"endTime":2243.91,"body":"you are doing during the day"},{"startTime":2243.91,"endTime":2245.86,"body":"will help improve the"},{"startTime":2243.91,"endTime":2245.86,"body":"quality of your sleep,"},{"startTime":2245.86,"endTime":2248.11,"body":"but it's not, if you've"},{"startTime":2245.86,"endTime":2248.11,"body":"got chronic insomnia"},{"startTime":2248.11,"endTime":2251.68,"body":"going to miraculously resolve"},{"startTime":2248.11,"endTime":2251.68,"body":"your chronic insomnia."},{"startTime":2251.68,"endTime":2254.293,"body":"And so over the last 20 years or so,"},{"startTime":2255.43,"endTime":2257.8,"body":"this treatment called"},{"startTime":2255.43,"endTime":2257.8,"body":"cognitive behavioral therapy"},{"startTime":2257.8,"endTime":2259.6,"body":"for insomnia has been developed"},{"startTime":2259.6,"endTime":2262.21,"body":"and this has been extensively researched."},{"startTime":2262.21,"endTime":2263.23,"body":"We now know it to be"},{"startTime":2263.23,"endTime":2265.579,"body":"one of the most effective"},{"startTime":2263.23,"endTime":2265.579,"body":"treatments for insomnia."},{"startTime":2265.579,"endTime":2269.048,"body":"It's probably as effective"},{"startTime":2265.579,"endTime":2269.048,"body":"in the medium term"},{"startTime":2269.048,"endTime":2272.08,"body":"as any drug we can give"},{"startTime":2269.048,"endTime":2272.08,"body":"and in the long term"},{"startTime":2272.08,"endTime":2274.03,"body":"it's probably more effective."},{"startTime":2274.03,"endTime":2275.62,"body":"So what is CBTi?"},{"startTime":2275.62,"endTime":2280.06,"body":"Well CBTi is a multifaceted"},{"startTime":2275.62,"endTime":2280.06,"body":"psychological intervention"},{"startTime":2280.06,"endTime":2283.006,"body":"that involves attacking various aspects"},{"startTime":2283.006,"endTime":2286.09,"body":"of the psychological"},{"startTime":2283.006,"endTime":2286.09,"body":"factors that drive insomnia."},{"startTime":2286.09,"endTime":2289.42,"body":"So part of it is about"},{"startTime":2286.09,"endTime":2289.42,"body":"stress management therapy,"},{"startTime":2289.42,"endTime":2291.1,"body":"part of it is about relaxation"},{"startTime":2291.1,"endTime":2292.66,"body":"and mindfulness-based therapy."},{"startTime":2292.66,"endTime":2294.55,"body":"But perhaps the most important part"},{"startTime":2294.55,"endTime":2296.35,"body":"of cognitive behavioral therapy"},{"startTime":2296.35,"endTime":2298.78,"body":"is essentially a form of brain retraining,"},{"startTime":2298.78,"endTime":2301.48,"body":"where we try and reestablish"},{"startTime":2301.48,"endTime":2305.23,"body":"that positive conditioned"},{"startTime":2301.48,"endTime":2305.23,"body":"response between bed and sleep"},{"startTime":2305.23,"endTime":2306.4,"body":"rather than bed and wake."},{"startTime":2306.4,"endTime":2310.93,"body":"And one of the ways we do that"},{"startTime":2306.4,"endTime":2310.93,"body":"is with a module within CBTi,"},{"startTime":2310.93,"endTime":2313.33,"body":"which is called sleep compression."},{"startTime":2313.33,"endTime":2316.03,"body":"So imagine that you"},{"startTime":2313.33,"endTime":2316.03,"body":"are somebody who spends"},{"startTime":2316.03,"endTime":2318.73,"body":"nine hours a night in bed"},{"startTime":2318.73,"endTime":2321.43,"body":"and you're doing that because"},{"startTime":2318.73,"endTime":2321.43,"body":"you know you are only sleeping"},{"startTime":2321.43,"endTime":2323.59,"body":"for five or six hours a night"},{"startTime":2323.59,"endTime":2326.26,"body":"and you're trying to"},{"startTime":2323.59,"endTime":2326.26,"body":"maximize the amount of sleep"},{"startTime":2326.26,"endTime":2328.78,"body":"that you are getting over"},{"startTime":2326.26,"endTime":2328.78,"body":"the course of the night."},{"startTime":2328.78,"endTime":2332.35,"body":"That means you're spending"},{"startTime":2328.78,"endTime":2332.35,"body":"two or three hours a night"},{"startTime":2332.35,"endTime":2334.18,"body":"in bed, awake."},{"startTime":2334.18,"endTime":2337.3,"body":"So as part of this sleep"},{"startTime":2334.18,"endTime":2337.3,"body":"compression protocol,"},{"startTime":2337.3,"endTime":2338.38,"body":"what we would do is say,"},{"startTime":2338.38,"endTime":2341.92,"body":"well, if you are only spending"},{"startTime":2338.38,"endTime":2341.92,"body":"five and a half hours a night"},{"startTime":2341.92,"endTime":2343.27,"body":"in bed asleep,"},{"startTime":2343.27,"endTime":2345.97,"body":"then we want you, for a period of time,"},{"startTime":2345.97,"endTime":2349.42,"body":"to restrict yourself to five"},{"startTime":2345.97,"endTime":2349.42,"body":"and a half hours a night."},{"startTime":2349.42,"endTime":2353.53,"body":"So go to bed at five, go to bed"},{"startTime":2349.42,"endTime":2353.53,"body":"at one and wait, sorry five,"},{"startTime":2353.53,"endTime":2354.88,"body":"that would be quite hardcore,"},{"startTime":2354.88,"endTime":2358.75,"body":"go to bed at one and wake up"},{"startTime":2354.88,"endTime":2358.75,"body":"at 6:30 and get out of bed"},{"speaker":"when you wake up at 6","startTime":2358.75,"endTime":2360.85,"body":"30."},{"speaker":"when you wake up at 6","startTime":2360.85,"endTime":2363.4,"body":"Now in the first instance,"},{"speaker":"when you wake up at 6","startTime":2360.85,"endTime":2363.4,"body":"in the first few days,"},{"speaker":"when you wake up at 6","startTime":2363.4,"endTime":2364.57,"body":"that's going to be like torture."},{"speaker":"when you wake up at 6","startTime":2364.57,"endTime":2366.67,"body":"There's nothing worse"},{"speaker":"when you wake up at 6","startTime":2364.57,"endTime":2366.67,"body":"than telling somebody"},{"speaker":"when you wake up at 6","startTime":2366.67,"endTime":2369.25,"body":"who's got insomnia to"},{"speaker":"when you wake up at 6","startTime":2366.67,"endTime":2369.25,"body":"spend less time in bed."},{"speaker":"when you wake up at 6","startTime":2369.25,"endTime":2373.51,"body":"But what that does is it drives"},{"speaker":"when you wake up at 6","startTime":2369.25,"endTime":2373.51,"body":"mechanisms within the brain"},{"speaker":"when you wake up at 6","startTime":2373.51,"endTime":2375.31,"body":"that are termed homeostatic mechanisms,"},{"speaker":"when you wake up at 6","startTime":2375.31,"endTime":2378.49,"body":"essentially it's sleep"},{"speaker":"when you wake up at 6","startTime":2375.31,"endTime":2378.49,"body":"depriving you a little bit more."},{"speaker":"when you wake up at 6","startTime":2378.49,"endTime":2382.66,"body":"And over time what that does"},{"speaker":"when you wake up at 6","startTime":2378.49,"endTime":2382.66,"body":"is it encourages the brain"},{"speaker":"when you wake up at 6","startTime":2382.66,"endTime":2386.38,"body":"to take advantage of the"},{"speaker":"when you wake up at 6","startTime":2382.66,"endTime":2386.38,"body":"time that you are in bed"},{"speaker":"when you wake up at 6","startTime":2386.38,"endTime":2388.12,"body":"and to go to sleep."},{"speaker":"when you wake up at 6","startTime":2388.12,"endTime":2389.881,"body":"And over time what we see"},{"speaker":"when you wake up at 6","startTime":2389.881,"endTime":2392.63,"body":"is that sleep tends to be consolidated,"},{"speaker":"when you wake up at 6","startTime":2392.63,"endTime":2396.46,"body":"that the sleep that people are"},{"speaker":"when you wake up at 6","startTime":2392.63,"endTime":2396.46,"body":"getting is less fragmented,"},{"speaker":"when you wake up at 6","startTime":2396.46,"endTime":2400.48,"body":"it's less broken, and"},{"speaker":"when you wake up at 6","startTime":2396.46,"endTime":2400.48,"body":"is of better quality."},{"speaker":"when you wake up at 6","startTime":2400.48,"endTime":2404.08,"body":"And then with time that period"},{"speaker":"when you wake up at 6","startTime":2400.48,"endTime":2404.08,"body":"of compression is eased."},{"speaker":"when you wake up at 6","startTime":2404.08,"endTime":2406.39,"body":"As you get better quality sleep,"},{"speaker":"when you wake up at 6","startTime":2406.39,"endTime":2409.54,"body":"the amount of time you get"},{"speaker":"when you wake up at 6","startTime":2406.39,"endTime":2409.54,"body":"to spend in bed is extended."},{"speaker":"when you wake up at 6","startTime":2409.54,"endTime":2412.12,"body":"Essentially what that is"},{"speaker":"when you wake up at 6","startTime":2409.54,"endTime":2412.12,"body":"doing is it's re-driving"},{"speaker":"when you wake up at 6","startTime":2412.12,"endTime":2415.3,"body":"the brain's association with"},{"speaker":"when you wake up at 6","startTime":2412.12,"endTime":2415.3,"body":"the head hitting the pillow"},{"speaker":"when you wake up at 6","startTime":2415.3,"endTime":2417.94,"body":"and going to sleep rather"},{"speaker":"when you wake up at 6","startTime":2415.3,"endTime":2417.94,"body":"than staying awake."},{"speaker":"when you wake up at 6","startTime":2417.94,"endTime":2422.83,"body":"Now there is a rather more"},{"speaker":"when you wake up at 6","startTime":2417.94,"endTime":2422.83,"body":"dramatic Guantanamo Bay style"},{"speaker":"when you wake up at 6","startTime":2422.83,"endTime":2424.63,"body":"treatment that is out there,"},{"speaker":"when you wake up at 6","startTime":2424.63,"endTime":2427.84,"body":"which is called intensive"},{"speaker":"when you wake up at 6","startTime":2424.63,"endTime":2427.84,"body":"sleep retraining."},{"speaker":"when you wake up at 6","startTime":2427.84,"endTime":2429.79,"body":"Now for reasons that will become obvious,"},{"speaker":"when you wake up at 6","startTime":2429.79,"endTime":2431.92,"body":"this is not really hit the mainstream,"},{"speaker":"when you wake up at 6","startTime":2431.92,"endTime":2434.11,"body":"but it is being used in"},{"speaker":"when you wake up at 6","startTime":2431.92,"endTime":2434.11,"body":"places like Australia"},{"speaker":"when you wake up at 6","startTime":2434.11,"endTime":2436.27,"body":"largely on a research basis."},{"speaker":"when you wake up at 6","startTime":2436.27,"endTime":2439.0,"body":"So imagine you've got very bad insomnia,"},{"speaker":"when you wake up at 6","startTime":2439.0,"endTime":2442.42,"body":"you are really not sleeping well at all."},{"speaker":"when you wake up at 6","startTime":2442.42,"endTime":2444.46,"body":"I'm going to ask you the night before"},{"speaker":"when you wake up at 6","startTime":2444.46,"endTime":2448.09,"body":"you come into my sleep"},{"speaker":"when you wake up at 6","startTime":2444.46,"endTime":2448.09,"body":"lab, not to sleep at all,"},{"speaker":"when you wake up at 6","startTime":2448.09,"endTime":2450.73,"body":"to be completely sleep"},{"speaker":"when you wake up at 6","startTime":2448.09,"endTime":2450.73,"body":"deprived when you come in,"},{"speaker":"when you wake up at 6","startTime":2450.73,"endTime":2454.39,"body":"you'll be invited into my"},{"speaker":"when you wake up at 6","startTime":2450.73,"endTime":2454.39,"body":"sleep lab at about nine o'clock"},{"speaker":"when you wake up at 6","startTime":2454.39,"endTime":2457.93,"body":"in the evening having not"},{"speaker":"when you wake up at 6","startTime":2454.39,"endTime":2457.93,"body":"slept at the night before."},{"speaker":"when you wake up at 6","startTime":2457.93,"endTime":2460.28,"body":"And I'm going to put some"},{"speaker":"when you wake up at 6","startTime":2457.93,"endTime":2460.28,"body":"electrodes on your scalp"},{"speaker":"when you wake up at 6","startTime":2461.59,"endTime":2463.96,"body":"and then at midnight I'm going to say,"},{"speaker":"when you wake up at 6","startTime":2463.96,"endTime":2465.97,"body":"okay, I'm going to"},{"speaker":"when you wake up at 6","startTime":2463.96,"endTime":2465.97,"body":"switch the lights off now"},{"speaker":"when you wake up at 6","startTime":2465.97,"endTime":2467.323,"body":"and try and go to sleep."},{"speaker":"when you wake up at 6","startTime":2468.4,"endTime":2470.59,"body":"And if you manage to go to sleep,"},{"speaker":"when you wake up at 6","startTime":2470.59,"endTime":2473.26,"body":"which I think is very"},{"speaker":"when you wake up at 6","startTime":2470.59,"endTime":2473.26,"body":"unlikely being in a sleep lab"},{"speaker":"when you wake up at 6","startTime":2473.26,"endTime":2476.29,"body":"in a strange environment"},{"speaker":"when you wake up at 6","startTime":2473.26,"endTime":2476.29,"body":"with sensors stuck on you,"},{"speaker":"when you wake up at 6","startTime":2476.29,"endTime":2478.45,"body":"then even if you do fall asleep,"},{"speaker":"when you wake up at 6","startTime":2478.45,"endTime":2479.98,"body":"then after three minutes of sleep"},{"speaker":"when you wake up at 6","startTime":2479.98,"endTime":2481.6,"body":"as verified by your brainwaves,"},{"speaker":"when you wake up at 6","startTime":2481.6,"endTime":2483.55,"body":"I'm going to wake you up again"},{"speaker":"when you wake up at 6","startTime":2483.55,"endTime":2488.23,"body":"and I'm going to do that every"},{"speaker":"when you wake up at 6","startTime":2483.55,"endTime":2488.23,"body":"half hour for the next 25 hours."},{"speaker":"when you wake up at 6","startTime":2488.23,"endTime":2493.12,"body":"So you will have 50 opportunities"},{"speaker":"when you wake up at 6","startTime":2488.23,"endTime":2493.12,"body":"to fall off to sleep"},{"speaker":"when you wake up at 6","startTime":2493.12,"endTime":2495.88,"body":"over the next 25 hour period."},{"speaker":"when you wake up at 6","startTime":2495.88,"endTime":2497.62,"body":"Now imagine what that does."},{"speaker":"when you wake up at 6","startTime":2497.62,"endTime":2500.59,"body":"So you are already sleep deprived,"},{"speaker":"when you wake up at 6","startTime":2500.59,"endTime":2504.7,"body":"you may not fall asleep at"},{"speaker":"when you wake up at 6","startTime":2500.59,"endTime":2504.7,"body":"all in the first few naps,"},{"speaker":"when you wake up at 6","startTime":2504.7,"endTime":2507.58,"body":"but within a short period of time"},{"speaker":"when you wake up at 6","startTime":2507.58,"endTime":2508.96,"body":"you're going to be so sleep deprived"},{"speaker":"when you wake up at 6","startTime":2508.96,"endTime":2510.25,"body":"because even if you fall asleep,"},{"speaker":"when you wake up at 6","startTime":2510.25,"endTime":2512.89,"body":"you're only going to be allowed"},{"speaker":"when you wake up at 6","startTime":2510.25,"endTime":2512.89,"body":"to sleep for three minutes."},{"speaker":"when you wake up at 6","startTime":2512.89,"endTime":2515.86,"body":"And that is going to"},{"speaker":"when you wake up at 6","startTime":2512.89,"endTime":2515.86,"body":"happen every half an hour."},{"speaker":"when you wake up at 6","startTime":2515.86,"endTime":2519.28,"body":"Believe you me, by the end"},{"speaker":"when you wake up at 6","startTime":2515.86,"endTime":2519.28,"body":"of that 25 hour period,"},{"speaker":"when you wake up at 6","startTime":2519.28,"endTime":2521.8,"body":"every time the lights go out"},{"speaker":"when you wake up at 6","startTime":2519.28,"endTime":2521.8,"body":"and you're told to go to sleep,"},{"speaker":"when you wake up at 6","startTime":2521.8,"endTime":2523.093,"body":"you will go to sleep."},{"speaker":"when you wake up at 6","startTime":2524.23,"endTime":2528.01,"body":"Now you can imagine how unpleasant"},{"speaker":"when you wake up at 6","startTime":2524.23,"endTime":2528.01,"body":"that is as an experience,"},{"speaker":"when you wake up at 6","startTime":2528.01,"endTime":2530.607,"body":"but actually even that 25 hour period"},{"speaker":"when you wake up at 6","startTime":2530.607,"endTime":2532.87,"body":"of intensive sleep re-training"},{"speaker":"when you wake up at 6","startTime":2532.87,"endTime":2534.927,"body":"can significantly improve"},{"speaker":"when you wake up at 6","startTime":2532.87,"endTime":2534.927,"body":"the sleep of people"},{"speaker":"when you wake up at 6","startTime":2534.927,"endTime":2536.86,"body":"within insomnia."},{"speaker":"when you wake up at 6","startTime":2536.86,"endTime":2540.07,"body":"So I think it's a really good illustration"},{"speaker":"when you wake up at 6","startTime":2540.07,"endTime":2543.16,"body":"of the role of that conditioned response,"},{"speaker":"when you wake up at 6","startTime":2543.16,"endTime":2546.76,"body":"associating going to"},{"speaker":"when you wake up at 6","startTime":2543.16,"endTime":2546.76,"body":"bed, lights going out,"},{"speaker":"when you wake up at 6","startTime":2546.76,"endTime":2547.99,"body":"and drifting off to sleep"},{"speaker":"when you wake up at 6","startTime":2547.99,"endTime":2550.48,"body":"in terms of addressing"},{"speaker":"when you wake up at 6","startTime":2547.99,"endTime":2550.48,"body":"people within insomnia."},{"speaker":"when you wake up at 6","startTime":2550.48,"endTime":2554.17,"body":"Now this is very intensive,"},{"speaker":"when you wake up at 6","startTime":2550.48,"endTime":2554.17,"body":"it's very torturous."},{"speaker":"when you wake up at 6","startTime":2554.17,"endTime":2555.46,"body":"I can imagine that a lot of people"},{"speaker":"when you wake up at 6","startTime":2555.46,"endTime":2558.49,"body":"run screaming out of the"},{"speaker":"when you wake up at 6","startTime":2555.46,"endTime":2558.49,"body":"sleep lab when you try this,"},{"speaker":"when you wake up at 6","startTime":2558.49,"endTime":2560.95,"body":"but it is an effective treatment."},{"speaker":"when you wake up at 6","startTime":2560.95,"endTime":2563.992,"body":"There are of course other"},{"speaker":"when you wake up at 6","startTime":2560.95,"endTime":2563.992,"body":"non-drug based options,"},{"speaker":"when you wake up at 6","startTime":2563.992,"endTime":2567.34,"body":"treatments that are"},{"speaker":"when you wake up at 6","startTime":2563.992,"endTime":2567.34,"body":"perhaps less mainstream."},{"speaker":"when you wake up at 6","startTime":2567.34,"endTime":2568.66,"body":"I just wanted to talk about"},{"speaker":"when you wake up at 6","startTime":2568.66,"endTime":2571.3,"body":"one particular treatment strategy,"},{"speaker":"when you wake up at 6","startTime":2571.3,"endTime":2574.03,"body":"which is called lucid dreaming therapy."},{"speaker":"when you wake up at 6","startTime":2574.03,"endTime":2576.718,"body":"So some of you in this"},{"speaker":"when you wake up at 6","startTime":2574.03,"endTime":2576.718,"body":"room will be familiar"},{"speaker":"when you wake up at 6","startTime":2576.718,"endTime":2578.62,"body":"with this concept of lucid dreaming."},{"speaker":"when you wake up at 6","startTime":2578.62,"endTime":2583.62,"body":"So this is the experience"},{"speaker":"when you wake up at 6","startTime":2578.62,"endTime":2583.62,"body":"that when you are dreaming,"},{"speaker":"when you wake up at 6","startTime":2583.78,"endTime":2585.4,"body":"you are aware that you are asleep"},{"speaker":"when you wake up at 6","startTime":2585.4,"endTime":2586.6,"body":"and you are aware of dreaming."},{"speaker":"when you wake up at 6","startTime":2586.6,"endTime":2589.12,"body":"And sometimes individuals who lucid dream"},{"speaker":"when you wake up at 6","startTime":2589.12,"endTime":2592.96,"body":"will also be able to control"},{"speaker":"when you wake up at 6","startTime":2589.12,"endTime":2592.96,"body":"the content of their dreams,"},{"speaker":"when you wake up at 6","startTime":2592.96,"endTime":2595.9,"body":"which has always struck me as"},{"speaker":"when you wake up at 6","startTime":2592.96,"endTime":2595.9,"body":"a bit of a magical experience."},{"speaker":"when you wake up at 6","startTime":2595.9,"endTime":2597.91,"body":"It would be lovely to be able to control"},{"speaker":"when you wake up at 6","startTime":2597.91,"endTime":2601.21,"body":"your dream mentation,"},{"speaker":"when you wake up at 6","startTime":2597.91,"endTime":2601.21,"body":"your experiences at night."},{"speaker":"when you wake up at 6","startTime":2601.21,"endTime":2602.47,"body":"Now unfortunately,"},{"speaker":"when you wake up at 6","startTime":2602.47,"endTime":2605.71,"body":"lucid dreaming has had"},{"speaker":"when you wake up at 6","startTime":2602.47,"endTime":2605.71,"body":"a bit of a pseudoscience"},{"speaker":"when you wake up at 6","startTime":2605.71,"endTime":2606.88,"body":"connotation to it"},{"speaker":"when you wake up at 6","startTime":2606.88,"endTime":2611.02,"body":"and for many years it was"},{"speaker":"when you wake up at 6","startTime":2606.88,"endTime":2611.02,"body":"really disbelieved as an entity."},{"speaker":"when you wake up at 6","startTime":2611.02,"endTime":2615.31,"body":"But actually one really"},{"speaker":"when you wake up at 6","startTime":2611.02,"endTime":2615.31,"body":"fascinating study done in Germany"},{"speaker":"when you wake up at 6","startTime":2615.31,"endTime":2618.767,"body":"a few years ago really"},{"speaker":"when you wake up at 6","startTime":2615.31,"endTime":2618.767,"body":"illustrated that lucid dreaming"},{"speaker":"when you wake up at 6","startTime":2618.767,"endTime":2622.75,"body":"has an underlying neurobiological basis."},{"speaker":"when you wake up at 6","startTime":2622.75,"endTime":2624.97,"body":"And in this study they got six people"},{"speaker":"when you wake up at 6","startTime":2624.97,"endTime":2627.22,"body":"who said that they could lucid dream"},{"speaker":"when you wake up at 6","startTime":2627.22,"endTime":2630.55,"body":"and they got them into a"},{"speaker":"when you wake up at 6","startTime":2627.22,"endTime":2630.55,"body":"functional MRI scanner."},{"speaker":"when you wake up at 6","startTime":2630.55,"endTime":2634.69,"body":"Functional MRI essentially"},{"speaker":"when you wake up at 6","startTime":2630.55,"endTime":2634.69,"body":"measures brain activity."},{"speaker":"when you wake up at 6","startTime":2634.69,"endTime":2638.77,"body":"And they got them to clench"},{"speaker":"when you wake up at 6","startTime":2634.69,"endTime":2638.77,"body":"their left hand for 10 seconds,"},{"speaker":"when you wake up at 6","startTime":2638.77,"endTime":2640.18,"body":"then signal with their eyes,"},{"speaker":"when you wake up at 6","startTime":2640.18,"endTime":2642.82,"body":"so do a pre-agreed"},{"speaker":"when you wake up at 6","startTime":2640.18,"endTime":2642.82,"body":"sequence of eye movement"},{"speaker":"when you wake up at 6","startTime":2642.82,"endTime":2644.38,"body":"and then clench their right hand."},{"speaker":"when you wake up at 6","startTime":2644.38,"endTime":2646.96,"body":"And to do that in alternating ways."},{"speaker":"when you wake up at 6","startTime":2646.96,"endTime":2649.72,"body":"And what they demonstrated"},{"speaker":"when you wake up at 6","startTime":2646.96,"endTime":2649.72,"body":"is that when they got them"},{"speaker":"when you wake up at 6","startTime":2649.72,"endTime":2651.25,"body":"in the scanner to do that while awake,"},{"speaker":"when you wake up at 6","startTime":2651.25,"endTime":2654.22,"body":"unsurprisingly when they"},{"speaker":"when you wake up at 6","startTime":2651.25,"endTime":2654.22,"body":"clenched their left hand,"},{"speaker":"when you wake up at 6","startTime":2654.22,"endTime":2657.64,"body":"their right motor area"},{"speaker":"when you wake up at 6","startTime":2654.22,"endTime":2657.64,"body":"lit up and vice versa."},{"speaker":"when you wake up at 6","startTime":2657.64,"endTime":2659.11,"body":"And you can see that here,"},{"speaker":"when you wake up at 6","startTime":2659.11,"endTime":2663.19,"body":"these are the areas that are"},{"speaker":"when you wake up at 6","startTime":2659.11,"endTime":2663.19,"body":"corresponding to motor activity"},{"speaker":"when you wake up at 6","startTime":2663.19,"endTime":2664.99,"body":"within the hand."},{"speaker":"when you wake up at 6","startTime":2664.99,"endTime":2668.08,"body":"So, so far, not very surprising."},{"speaker":"when you wake up at 6","startTime":2668.08,"endTime":2671.41,"body":"They then got these same"},{"speaker":"when you wake up at 6","startTime":2668.08,"endTime":2671.41,"body":"individuals to get into the scanner"},{"speaker":"when you wake up at 6","startTime":2671.41,"endTime":2672.94,"body":"and not to actually clench their hands,"},{"speaker":"when you wake up at 6","startTime":2672.94,"endTime":2674.92,"body":"but imagine they were"},{"speaker":"when you wake up at 6","startTime":2672.94,"endTime":2674.92,"body":"clenching their hands."},{"speaker":"when you wake up at 6","startTime":2674.92,"endTime":2676.33,"body":"So there was no physical movement,"},{"speaker":"when you wake up at 6","startTime":2676.33,"endTime":2679.3,"body":"it was just the imagination"},{"speaker":"when you wake up at 6","startTime":2676.33,"endTime":2679.3,"body":"of clenching their hands."},{"speaker":"when you wake up at 6","startTime":2679.3,"endTime":2680.133,"body":"And sure enough,"},{"speaker":"when you wake up at 6","startTime":2680.133,"endTime":2684.07,"body":"what they demonstrated is"},{"speaker":"when you wake up at 6","startTime":2680.133,"endTime":2684.07,"body":"that there was activity"},{"speaker":"when you wake up at 6","startTime":2684.07,"endTime":2685.45,"body":"in the motor areas of the brain"},{"speaker":"when you wake up at 6","startTime":2685.45,"endTime":2689.17,"body":"that corresponded to which"},{"speaker":"when you wake up at 6","startTime":2685.45,"endTime":2689.17,"body":"side they imagined clenching,"},{"speaker":"when you wake up at 6","startTime":2689.17,"endTime":2692.05,"body":"perhaps less marked, which"},{"speaker":"when you wake up at 6","startTime":2689.17,"endTime":2692.05,"body":"is also unsurprising,"},{"speaker":"when you wake up at 6","startTime":2692.05,"endTime":2692.89,"body":"but nevertheless,"},{"speaker":"when you wake up at 6","startTime":2692.89,"endTime":2695.41,"body":"they showed similar"},{"speaker":"when you wake up at 6","startTime":2692.89,"endTime":2695.41,"body":"patterns of activation."},{"speaker":"when you wake up at 6","startTime":2695.41,"endTime":2697.84,"body":"They then got these"},{"speaker":"when you wake up at 6","startTime":2695.41,"endTime":2697.84,"body":"people into the scanner"},{"speaker":"when you wake up at 6","startTime":2697.84,"endTime":2700.03,"body":"and asked them to fall asleep"},{"speaker":"when you wake up at 6","startTime":2700.03,"endTime":2702.97,"body":"and to signal to the researchers"},{"speaker":"when you wake up at 6","startTime":2702.97,"endTime":2704.5,"body":"when they were lucid dreaming"},{"speaker":"when you wake up at 6","startTime":2704.5,"endTime":2707.5,"body":"with a pre-agreed"},{"speaker":"when you wake up at 6","startTime":2704.5,"endTime":2707.5,"body":"sequence of eye movements."},{"speaker":"when you wake up at 6","startTime":2707.5,"endTime":2710.56,"body":"And in their dream they"},{"speaker":"when you wake up at 6","startTime":2707.5,"endTime":2710.56,"body":"asked them to dream"},{"speaker":"when you wake up at 6","startTime":2710.56,"endTime":2712.87,"body":"that they were clenching their left hand ,"},{"speaker":"when you wake up at 6","startTime":2712.87,"endTime":2714.43,"body":"then to signal with their eyes"},{"speaker":"when you wake up at 6","startTime":2714.43,"endTime":2715.87,"body":"that they were switching hands,"},{"speaker":"when you wake up at 6","startTime":2715.87,"endTime":2719.08,"body":"and then to dream that they"},{"speaker":"when you wake up at 6","startTime":2715.87,"endTime":2719.08,"body":"were clenching their right hand."},{"speaker":"when you wake up at 6","startTime":2719.08,"endTime":2720.845,"body":"And what they showed was"},{"speaker":"when you wake up at 6","startTime":2719.08,"endTime":2720.845,"body":"exactly the same pattern"},{"speaker":"when you wake up at 6","startTime":2720.845,"endTime":2722.56,"body":"of motor activity."},{"speaker":"when you wake up at 6","startTime":2722.56,"endTime":2725.23,"body":"So very clearly demonstrating"},{"speaker":"when you wake up at 6","startTime":2725.23,"endTime":2727.9,"body":"that this concept of lucid dreaming,"},{"speaker":"when you wake up at 6","startTime":2727.9,"endTime":2729.31,"body":"which as I said was a bit of"},{"speaker":"when you wake up at 6","startTime":2729.31,"endTime":2734.31,"body":"a scientific pseudo babble entity,"},{"speaker":"when you wake up at 6","startTime":2734.59,"endTime":2738.52,"body":"very much had a basis in our brains."},{"speaker":"when you wake up at 6","startTime":2738.52,"endTime":2740.2,"body":"Now the reason why this is important"},{"speaker":"when you wake up at 6","startTime":2740.2,"endTime":2743.246,"body":"is because there has been a real interest"},{"speaker":"when you wake up at 6","startTime":2743.246,"endTime":2747.34,"body":"in the use of training"},{"speaker":"when you wake up at 6","startTime":2743.246,"endTime":2747.34,"body":"people to lucid dream"},{"speaker":"when you wake up at 6","startTime":2747.34,"endTime":2750.31,"body":"in order to seek control"},{"speaker":"when you wake up at 6","startTime":2747.34,"endTime":2750.31,"body":"over the nightmares"},{"speaker":"when you wake up at 6","startTime":2750.31,"endTime":2753.28,"body":"that they have in the context of PTSD."},{"speaker":"when you wake up at 6","startTime":2753.28,"endTime":2755.83,"body":"And actually there is quite good evidence"},{"speaker":"when you wake up at 6","startTime":2755.83,"endTime":2757.75,"body":"that if you teach people to lucid dream"},{"speaker":"when you wake up at 6","startTime":2757.75,"endTime":2760.15,"body":"and establish control"},{"speaker":"when you wake up at 6","startTime":2757.75,"endTime":2760.15,"body":"over your nightmares,"},{"speaker":"when you wake up at 6","startTime":2760.15,"endTime":2762.754,"body":"that's a very good way of"},{"speaker":"when you wake up at 6","startTime":2760.15,"endTime":2762.754,"body":"treating nightmare disorder"},{"speaker":"when you wake up at 6","startTime":2762.754,"endTime":2765.28,"body":"and treating PTSD as well."},{"speaker":"when you wake up at 6","startTime":2765.28,"endTime":2768.73,"body":"So this is a really"},{"speaker":"when you wake up at 6","startTime":2765.28,"endTime":2768.73,"body":"fascinating area of medicine"},{"speaker":"when you wake up at 6","startTime":2768.73,"endTime":2771.91,"body":"because 20 years ago this"},{"speaker":"when you wake up at 6","startTime":2768.73,"endTime":2771.91,"body":"wasn't really even believed"},{"speaker":"when you wake up at 6","startTime":2771.91,"endTime":2772.783,"body":"as an entity."},{"speaker":"when you wake up at 6","startTime":2774.88,"endTime":2778.33,"body":"So when it comes to treating people"},{"speaker":"when you wake up at 6","startTime":2778.33,"endTime":2780.19,"body":"with psychiatric disorders,"},{"speaker":"when you wake up at 6","startTime":2780.19,"endTime":2783.37,"body":"it's really worth making sure"},{"speaker":"when you wake up at 6","startTime":2783.37,"endTime":2786.91,"body":"that you are addressing"},{"speaker":"when you wake up at 6","startTime":2783.37,"endTime":2786.91,"body":"their sleep disturbance"},{"speaker":"when you wake up at 6","startTime":2786.91,"endTime":2789.01,"body":"and considering whether"},{"speaker":"when you wake up at 6","startTime":2786.91,"endTime":2789.01,"body":"or not they may have"},{"speaker":"when you wake up at 6","startTime":2789.01,"endTime":2790.96,"body":"other sleep disorders at play."},{"speaker":"when you wake up at 6","startTime":2790.96,"endTime":2794.408,"body":"So many of the drugs used"},{"speaker":"when you wake up at 6","startTime":2790.96,"endTime":2794.408,"body":"in psychiatric disorders"},{"speaker":"when you wake up at 6","startTime":2794.408,"endTime":2796.66,"body":"cause people to gain weight."},{"speaker":"when you wake up at 6","startTime":2796.66,"endTime":2797.95,"body":"And when you gain weight you are"},{"speaker":"when you wake up at 6","startTime":2797.95,"endTime":2800.8,"body":"at increased risk of"},{"speaker":"when you wake up at 6","startTime":2797.95,"endTime":2800.8,"body":"obstructive sleep apnea,"},{"speaker":"when you wake up at 6","startTime":2800.8,"endTime":2802.33,"body":"obstructive sleep apnea,"},{"speaker":"when you wake up at 6","startTime":2802.33,"endTime":2805.87,"body":"which requires this mask in"},{"speaker":"when you wake up at 6","startTime":2802.33,"endTime":2805.87,"body":"order to prevent the airway"},{"speaker":"when you wake up at 6","startTime":2805.87,"endTime":2806.77,"body":"from collapsing."},{"speaker":"when you wake up at 6","startTime":2806.77,"endTime":2809.35,"body":"And we know that obstructive"},{"speaker":"when you wake up at 6","startTime":2806.77,"endTime":2809.35,"body":"sleep apnea in and of itself"},{"speaker":"when you wake up at 6","startTime":2809.35,"endTime":2811.99,"body":"can result in significant"},{"speaker":"when you wake up at 6","startTime":2809.35,"endTime":2811.99,"body":"mood disturbance."},{"speaker":"when you wake up at 6","startTime":2811.99,"endTime":2816.04,"body":"We know that many of the drugs"},{"speaker":"when you wake up at 6","startTime":2811.99,"endTime":2816.04,"body":"that are used in depression,"},{"speaker":"when you wake up at 6","startTime":2816.04,"endTime":2819.7,"body":"schizophrenia and anxiety"},{"speaker":"when you wake up at 6","startTime":2816.04,"endTime":2819.7,"body":"also put people at risk"},{"speaker":"when you wake up at 6","startTime":2819.7,"endTime":2821.74,"body":"of a condition called"},{"speaker":"when you wake up at 6","startTime":2819.7,"endTime":2821.74,"body":"restless leg syndrome."},{"speaker":"when you wake up at 6","startTime":2821.74,"endTime":2823.155,"body":"So this is a neurological disorder"},{"speaker":"when you wake up at 6","startTime":2823.155,"endTime":2826.191,"body":"that results in uncomfortable sensations"},{"speaker":"when you wake up at 6","startTime":2826.191,"endTime":2829.48,"body":"usually in the legs, but it"},{"speaker":"when you wake up at 6","startTime":2826.191,"endTime":2829.48,"body":"can affect other body parts,"},{"speaker":"when you wake up at 6","startTime":2829.48,"endTime":2831.52,"body":"that typically come on in the evening"},{"speaker":"when you wake up at 6","startTime":2831.52,"endTime":2833.68,"body":"that result in a sense of agitation"},{"speaker":"when you wake up at 6","startTime":2833.68,"endTime":2836.56,"body":"and can cause quite"},{"speaker":"when you wake up at 6","startTime":2833.68,"endTime":2836.56,"body":"marked sleep disturbance."},{"speaker":"when you wake up at 6","startTime":2836.56,"endTime":2839.53,"body":"So the kinds of individuals"},{"speaker":"when you wake up at 6","startTime":2836.56,"endTime":2839.53,"body":"that I often see are individuals"},{"speaker":"when you wake up at 6","startTime":2839.53,"endTime":2842.68,"body":"who are being treated"},{"speaker":"when you wake up at 6","startTime":2839.53,"endTime":2842.68,"body":"for depression or anxiety"},{"speaker":"when you wake up at 6","startTime":2842.68,"endTime":2845.62,"body":"and actually their sleep"},{"speaker":"when you wake up at 6","startTime":2842.68,"endTime":2845.62,"body":"worsened with their treatment"},{"speaker":"when you wake up at 6","startTime":2845.62,"endTime":2847.153,"body":"because it goes unrecognized"},{"speaker":"when you wake up at 6","startTime":2847.153,"endTime":2849.55,"body":"that actually, what it's doing doing,"},{"speaker":"when you wake up at 6","startTime":2849.55,"endTime":2851.56,"body":"the treatment itself is generating"},{"speaker":"when you wake up at 6","startTime":2851.56,"endTime":2853.33,"body":"the sleep disorder primarily."},{"speaker":"when you wake up at 6","startTime":2853.33,"endTime":2856.42,"body":"So it is really important"},{"speaker":"when you wake up at 6","startTime":2853.33,"endTime":2856.42,"body":"that psychiatrists"},{"speaker":"when you wake up at 6","startTime":2856.42,"endTime":2859.318,"body":"and indeed GPs who are"},{"speaker":"when you wake up at 6","startTime":2856.42,"endTime":2859.318,"body":"treating psychiatric disorders"},{"speaker":"when you wake up at 6","startTime":2859.318,"endTime":2861.01,"body":"on a regular basis,"},{"speaker":"when you wake up at 6","startTime":2861.01,"endTime":2863.65,"body":"know what it is their drugs are doing"},{"speaker":"when you wake up at 6","startTime":2863.65,"endTime":2865.75,"body":"or potentially doing to the patients"},{"speaker":"when you wake up at 6","startTime":2865.75,"endTime":2867.79,"body":"they're prescribing it to."},{"speaker":"when you wake up at 6","startTime":2867.79,"endTime":2870.76,"body":"And then finally, I know I"},{"speaker":"when you wake up at 6","startTime":2867.79,"endTime":2870.76,"body":"already mentioned this issue"},{"speaker":"when you wake up at 6","startTime":2870.76,"endTime":2871.9,"body":"of the circadian rhythm,"},{"speaker":"when you wake up at 6","startTime":2871.9,"endTime":2873.85,"body":"the association between"},{"speaker":"when you wake up at 6","startTime":2871.9,"endTime":2873.85,"body":"the circadian rhythm"},{"speaker":"when you wake up at 6","startTime":2873.85,"endTime":2877.483,"body":"and depression in children and in adults,"},{"speaker":"when you wake up at 6","startTime":2879.25,"endTime":2881.23,"body":"the circadian rhythm can be adjusted."},{"speaker":"when you wake up at 6","startTime":2881.23,"endTime":2883.42,"body":"So we know that there are a number of"},{"speaker":"when you wake up at 6","startTime":2883.42,"endTime":2885.97,"body":"extrinsic environmental factors"},{"speaker":"when you wake up at 6","startTime":2885.97,"endTime":2889.72,"body":"that define what are"},{"speaker":"when you wake up at 6","startTime":2885.97,"endTime":2889.72,"body":"circadian clock is set at."},{"speaker":"when you wake up at 6","startTime":2889.72,"endTime":2891.37,"body":"And these are termed zeitgebers,"},{"speaker":"when you wake up at 6","startTime":2891.37,"endTime":2892.993,"body":"from the German for time givers."},{"speaker":"when you wake up at 6","startTime":2893.86,"endTime":2897.73,"body":"The most powerful of which"},{"speaker":"when you wake up at 6","startTime":2893.86,"endTime":2897.73,"body":"are exposure to light"},{"speaker":"when you wake up at 6","startTime":2897.73,"endTime":2898.87,"body":"and melatonin."},{"speaker":"when you wake up at 6","startTime":2898.87,"endTime":2902.08,"body":"Melatonin is a hormone that's"},{"speaker":"when you wake up at 6","startTime":2898.87,"endTime":2902.08,"body":"secreted by our brains."},{"speaker":"when you wake up at 6","startTime":2902.08,"endTime":2904.78,"body":"It is a chemical signal to the brain"},{"speaker":"when you wake up at 6","startTime":2904.78,"endTime":2906.64,"body":"that it is time to go to sleep."},{"speaker":"when you wake up at 6","startTime":2906.64,"endTime":2908.2,"body":"We tend to see in normal sleep"},{"speaker":"when you wake up at 6","startTime":2908.2,"endTime":2909.97,"body":"as that melatonin levels tend to rise"},{"speaker":"from about 6","startTime":2909.97,"endTime":2911.92,"body":"00 PM onwards,"},{"speaker":"from about 6","startTime":2911.92,"endTime":2915.13,"body":"peak at the time at which"},{"speaker":"from about 6","startTime":2911.92,"endTime":2915.13,"body":"we want to go to sleep"},{"speaker":"from about 6","startTime":2915.13,"endTime":2918.49,"body":"and then start dropping"},{"speaker":"from about 6","startTime":2915.13,"endTime":2918.49,"body":"down shortly before waking."},{"speaker":"from about 6","startTime":2918.49,"endTime":2922.48,"body":"But in addition to it being"},{"speaker":"from about 6","startTime":2918.49,"endTime":2922.48,"body":"a chemical signal for sleep,"},{"speaker":"from about 6","startTime":2922.48,"endTime":2925.54,"body":"it is also an adjuster"},{"speaker":"from about 6","startTime":2922.48,"endTime":2925.54,"body":"of the circadian clock."},{"speaker":"from about 6","startTime":2925.54,"endTime":2929.08,"body":"But it's really important"},{"speaker":"from about 6","startTime":2925.54,"endTime":2929.08,"body":"to note one thing,"},{"speaker":"from about 6","startTime":2929.08,"endTime":2933.19,"body":"is that depending on what"},{"speaker":"from about 6","startTime":2929.08,"endTime":2933.19,"body":"time you give melatonin"},{"speaker":"from about 6","startTime":2933.19,"endTime":2935.44,"body":"in relation to somebody's circadian clock,"},{"speaker":"from about 6","startTime":2935.44,"endTime":2938.68,"body":"you can have really"},{"speaker":"from about 6","startTime":2935.44,"endTime":2938.68,"body":"dramatically different effects."},{"speaker":"from about 6","startTime":2938.68,"endTime":2942.068,"body":"So if you give somebody"},{"speaker":"from about 6","startTime":2938.68,"endTime":2942.068,"body":"a dose of melatonin"},{"speaker":"from about 6","startTime":2942.068,"endTime":2944.86,"body":"significantly before their normal bedtime,"},{"speaker":"from about 6","startTime":2944.86,"endTime":2947.56,"body":"you will shift their"},{"speaker":"from about 6","startTime":2944.86,"endTime":2947.56,"body":"circadian clock forward."},{"speaker":"from about 6","startTime":2947.56,"endTime":2949.21,"body":"If you give it a little bit too late,"},{"speaker":"from about 6","startTime":2949.21,"endTime":2950.95,"body":"you'll actually shift it back."},{"speaker":"from about 6","startTime":2950.95,"endTime":2953.23,"body":"And this is something term"},{"speaker":"from about 6","startTime":2950.95,"endTime":2953.23,"body":"the phase response curve,"},{"speaker":"from about 6","startTime":2953.23,"endTime":2957.28,"body":"it's the adjustment that melatonin makes"},{"speaker":"from about 6","startTime":2957.28,"endTime":2958.21,"body":"on the circadian rhythm"},{"speaker":"from about 6","startTime":2958.21,"endTime":2961.66,"body":"according to when it's given"},{"speaker":"from about 6","startTime":2958.21,"endTime":2961.66,"body":"from a time perspective."},{"speaker":"from about 6","startTime":2961.66,"endTime":2964.6,"body":"And it's related to the"},{"speaker":"from about 6","startTime":2961.66,"endTime":2964.6,"body":"individual's own body clock"},{"speaker":"from about 6","startTime":2964.6,"endTime":2966.49,"body":"rather than the external clock."},{"speaker":"from about 6","startTime":2966.49,"endTime":2968.227,"body":"Which is one of the reasons"},{"speaker":"from about 6","startTime":2966.49,"endTime":2968.227,"body":"I think why melatonin,"},{"speaker":"from about 6","startTime":2968.227,"endTime":2970.48,"body":"at least in this country,"},{"speaker":"from about 6","startTime":2970.48,"endTime":2972.61,"body":"is a prescription only medicine"},{"speaker":"from about 6","startTime":2972.61,"endTime":2974.32,"body":"because you need to know"},{"speaker":"from about 6","startTime":2972.61,"endTime":2974.32,"body":"what you are doing with it"},{"speaker":"from about 6","startTime":2974.32,"endTime":2976.273,"body":"rather than doling it out willy-nilly."},{"speaker":"from about 6","startTime":2978.13,"endTime":2979.81,"body":"So I'm going to stop there."},{"speaker":"from about 6","startTime":2979.81,"endTime":2982.456,"body":"So I'm just going to stop with"},{"speaker":"from about 6","startTime":2979.81,"endTime":2982.456,"body":"my conclusions and I think,"},{"speaker":"from about 6","startTime":2982.456,"endTime":2986.89,"body":"I hope, I've shown you"},{"speaker":"from about 6","startTime":2982.456,"endTime":2986.89,"body":"that sleep is fundamental"},{"speaker":"from about 6","startTime":2986.89,"endTime":2989.65,"body":"to good mental health as"},{"speaker":"from about 6","startTime":2986.89,"endTime":2989.65,"body":"well as good physical health,"},{"speaker":"from about 6","startTime":2989.65,"endTime":2992.65,"body":"that sleep issues are not simply secondary"},{"speaker":"from about 6","startTime":2992.65,"endTime":2995.23,"body":"to mental health issues"},{"speaker":"from about 6","startTime":2995.23,"endTime":2997.99,"body":"and may actually be driving"},{"speaker":"from about 6","startTime":2995.23,"endTime":2997.99,"body":"mental health issues,"},{"speaker":"from about 6","startTime":2997.99,"endTime":2999.4,"body":"and that really sleep medicine"},{"speaker":"from about 6","startTime":2999.4,"endTime":3003.15,"body":"should be a part of"},{"speaker":"from about 6","startTime":2999.4,"endTime":3003.15,"body":"standard psychiatric care."},{"speaker":"from about 6","startTime":3003.15,"endTime":3005.82,"body":"One of the things that we're"},{"speaker":"from about 6","startTime":3003.15,"endTime":3005.82,"body":"very bad at in this country"},{"speaker":"from about 6","startTime":3005.82,"endTime":3007.83,"body":"and actually in other countries as well,"},{"speaker":"from about 6","startTime":3007.83,"endTime":3010.23,"body":"is that we don't really train doctors"},{"speaker":"from about 6","startTime":3010.23,"endTime":3012.57,"body":"about sleep particularly well."},{"speaker":"from about 6","startTime":3012.57,"endTime":3015.6,"body":"And hopefully that is gradually changing,"},{"speaker":"from about 6","startTime":3015.6,"endTime":3017.19,"body":"but very gradually."},{"speaker":"from about 6","startTime":3017.19,"endTime":3018.023,"body":"Thank you."},{"speaker":"from about 6","startTime":3018.023,"endTime":3020.942,"body":"(audience applauds)"},{"speaker":"from about 6","startTime":3026.13,"endTime":3026.963,"body":"- Thank you, Guy."},{"speaker":"from about 6","startTime":3026.963,"endTime":3029.94,"body":"As usual, I've got a whole stack"},{"speaker":"from about 6","startTime":3026.963,"endTime":3029.94,"body":"full of questions coming in"},{"speaker":"from about 6","startTime":3029.94,"endTime":3032.1,"body":"from wherever people are out there,"},{"speaker":"from about 6","startTime":3032.1,"endTime":3035.241,"body":"which we'll start with before"},{"speaker":"from about 6","startTime":3032.1,"endTime":3035.241,"body":"I open it up to the floor"},{"speaker":"from about 6","startTime":3035.241,"endTime":3038.25,"body":"and I'm going to try and"},{"speaker":"from about 6","startTime":3035.241,"endTime":3038.25,"body":"group some of them together."},{"speaker":"from about 6","startTime":3038.25,"endTime":3041.55,"body":"So there's a common"},{"speaker":"from about 6","startTime":3038.25,"endTime":3041.55,"body":"question coming through"},{"speaker":"from about 6","startTime":3041.55,"endTime":3045.57,"body":"is what's the difference"},{"speaker":"from about 6","startTime":3041.55,"endTime":3045.57,"body":"in mental health terms"},{"speaker":"from about 6","startTime":3045.57,"endTime":3047.28,"body":"between sleep deprivation,"},{"speaker":"from about 6","startTime":3047.28,"endTime":3049.86,"body":"particularly say for shift"},{"speaker":"from about 6","startTime":3047.28,"endTime":3049.86,"body":"workers or people like me,"},{"speaker":"from about 6","startTime":3049.86,"endTime":3052.293,"body":"and insomnia?"},{"speaker":"from about 6","startTime":3053.43,"endTime":3055.83,"body":"They're not necessarily the"},{"speaker":"from about 6","startTime":3053.43,"endTime":3055.83,"body":"same thing as I understand"},{"speaker":"from about 6","startTime":3055.83,"endTime":3056.663,"body":"what you're saying."},{"speaker":"from about 6","startTime":3056.663,"endTime":3057.69,"body":"- So you know, that's absolutely true."},{"speaker":"from about 6","startTime":3057.69,"endTime":3062.659,"body":"So I think that there is a"},{"speaker":"from about 6","startTime":3057.69,"endTime":3062.659,"body":"wealth of evidence out there"},{"speaker":"from about 6","startTime":3062.659,"endTime":3065.22,"body":"that chronic sleep deprivation"},{"speaker":"from about 6","startTime":3065.22,"endTime":3068.82,"body":"has a number of very"},{"speaker":"from about 6","startTime":3065.22,"endTime":3068.82,"body":"significant health consequences."},{"speaker":"from about 6","startTime":3068.82,"endTime":3071.4,"body":"So it has impact on blood pressure,"},{"speaker":"from about 6","startTime":3071.4,"endTime":3074.94,"body":"cardiovascular disease, kidney disease,"},{"speaker":"from about 6","startTime":3074.94,"endTime":3078.0,"body":"it increases cognitive deficits"},{"speaker":"from about 6","startTime":3078.0,"endTime":3083.0,"body":"and can drive, we think,"},{"speaker":"from about 6","startTime":3078.0,"endTime":3083.0,"body":"can drive dementia."},{"speaker":"from about 6","startTime":3083.399,"endTime":3085.74,"body":"And that's just a very, very small list,"},{"speaker":"from about 6","startTime":3085.74,"endTime":3089.34,"body":"actually sleep deprivation is listed"},{"speaker":"from about 6","startTime":3089.34,"endTime":3092.31,"body":"by the World Health Organization"},{"speaker":"from about 6","startTime":3089.34,"endTime":3092.31,"body":"as a possible carcinogen."},{"speaker":"from about 6","startTime":3092.31,"endTime":3093.93,"body":"So there is very good evidence"},{"speaker":"from about 6","startTime":3093.93,"endTime":3096.33,"body":"that actually chronic"},{"speaker":"from about 6","startTime":3093.93,"endTime":3096.33,"body":"shift work, for example,"},{"speaker":"from about 6","startTime":3096.33,"endTime":3100.023,"body":"increases your risk of breast"},{"speaker":"from about 6","startTime":3096.33,"endTime":3100.023,"body":"cancer or prostate cancer."},{"speaker":"from about 6","startTime":3101.1,"endTime":3103.11,"body":"Insomnia is rather different"},{"speaker":"from about 6","startTime":3103.11,"endTime":3106.661,"body":"because if you actually record"},{"speaker":"from about 6","startTime":3103.11,"endTime":3106.661,"body":"the sleep of individuals"},{"speaker":"from about 6","startTime":3106.661,"endTime":3111.12,"body":"who have insomnia using their brain waves,"},{"speaker":"from about 6","startTime":3111.12,"endTime":3115.86,"body":"so we get a very clear physiological"},{"speaker":"from about 6","startTime":3111.12,"endTime":3115.86,"body":"measure of their sleep."},{"speaker":"from about 6","startTime":3115.86,"endTime":3118.17,"body":"For most people with insomnia,"},{"speaker":"from about 6","startTime":3118.17,"endTime":3121.92,"body":"their total sleep time is"},{"speaker":"from about 6","startTime":3118.17,"endTime":3121.92,"body":"not that much different"},{"speaker":"from about 6","startTime":3121.92,"endTime":3123.99,"body":"from normal individuals."},{"speaker":"from about 6","startTime":3123.99,"endTime":3127.05,"body":"And so one of the real distinctions,"},{"speaker":"from about 6","startTime":3127.05,"endTime":3130.68,"body":"and I think that this drives"},{"speaker":"from about 6","startTime":3127.05,"endTime":3130.68,"body":"insomnia in many cases,"},{"speaker":"from about 6","startTime":3130.68,"endTime":3132.66,"body":"is that what has not been explained"},{"speaker":"from about 6","startTime":3132.66,"endTime":3134.19,"body":"by the medical profession in general,"},{"speaker":"from about 6","startTime":3134.19,"endTime":3135.744,"body":"and I think it to some extent"},{"speaker":"from about 6","startTime":3135.744,"endTime":3139.59,"body":"it's confounded by a lot of"},{"speaker":"from about 6","startTime":3135.744,"endTime":3139.59,"body":"the stuff that's in the media,"},{"speaker":"from about 6","startTime":3139.59,"endTime":3141.38,"body":"is that for the vast majority"},{"speaker":"from about 6","startTime":3139.59,"endTime":3141.38,"body":"of people with insomnia,"},{"speaker":"from about 6","startTime":3141.38,"endTime":3146.38,"body":"those health concerns that"},{"speaker":"from about 6","startTime":3141.38,"endTime":3146.38,"body":"they have about their insomnia"},{"speaker":"from about 6","startTime":3146.73,"endTime":3148.38,"body":"are not applicable to them."},{"speaker":"from about 6","startTime":3148.38,"endTime":3150.09,"body":"There are a few individuals"},{"speaker":"from about 6","startTime":3150.09,"endTime":3152.22,"body":"who have very, very short sleep times"},{"speaker":"from about 6","startTime":3152.22,"endTime":3154.14,"body":"when measured on their brain waves,"},{"speaker":"from about 6","startTime":3154.14,"endTime":3156.69,"body":"and we know that they are"},{"speaker":"from about 6","startTime":3154.14,"endTime":3156.69,"body":"at increased risk of things"},{"speaker":"from about 6","startTime":3156.69,"endTime":3158.31,"body":"like cardiovascular disease,"},{"speaker":"from about 6","startTime":3158.31,"endTime":3160.26,"body":"but for the vast majority"},{"speaker":"from about 6","startTime":3158.31,"endTime":3160.26,"body":"of people within insomnia,"},{"speaker":"from about 6","startTime":3160.26,"endTime":3161.7,"body":"that's not the case."},{"speaker":"from about 6","startTime":3161.7,"endTime":3165.15,"body":"It's also worth saying that"},{"speaker":"from about 6","startTime":3161.7,"endTime":3165.15,"body":"on an experiential basis,"},{"speaker":"from about 6","startTime":3165.15,"endTime":3167.58,"body":"sleep deprivation and"},{"speaker":"from about 6","startTime":3165.15,"endTime":3167.58,"body":"insomnia are not the same."},{"speaker":"from about 6","startTime":3167.58,"endTime":3170.61,"body":"If you take somebody who"},{"speaker":"from about 6","startTime":3167.58,"endTime":3170.61,"body":"has got sleep deprivation"},{"speaker":"from about 6","startTime":3170.61,"endTime":3173.01,"body":"and you say to them, get into"},{"speaker":"from about 6","startTime":3170.61,"endTime":3173.01,"body":"bed and drop off to sleep,"},{"speaker":"from about 6","startTime":3173.01,"endTime":3175.26,"body":"they'll fall asleep very, very quickly."},{"speaker":"from about 6","startTime":3175.26,"endTime":3177.1,"body":"If you put somebody"},{"speaker":"from about 6","startTime":3175.26,"endTime":3177.1,"body":"with insomnia into a bed"},{"speaker":"from about 6","startTime":3177.1,"endTime":3180.3,"body":"and say go to sleep, they'll"},{"speaker":"from about 6","startTime":3177.1,"endTime":3180.3,"body":"lie there wide awake,"},{"speaker":"from about 6","startTime":3180.3,"endTime":3181.56,"body":"completely wired."},{"speaker":"from about 6","startTime":3181.56,"endTime":3183.39,"body":"So that in itself tells you"},{"speaker":"from about 6","startTime":3183.39,"endTime":3186.66,"body":"that these are two different"},{"speaker":"from about 6","startTime":3183.39,"endTime":3186.66,"body":"physiological states."},{"speaker":"from about 6","startTime":3186.66,"endTime":3190.08,"body":"- Thank you, and the next"},{"speaker":"from about 6","startTime":3186.66,"endTime":3190.08,"body":"question is more practical."},{"speaker":"from about 6","startTime":3190.08,"endTime":3192.63,"body":"So you've already outlined"},{"speaker":"from about 6","startTime":3190.08,"endTime":3192.63,"body":"there's a lot of people out there"},{"speaker":"from about 6","startTime":3192.63,"endTime":3194.22,"body":"with insomnia,"},{"speaker":"from about 6","startTime":3194.22,"endTime":3196.342,"body":"but I'd rather suspect that CBTi"},{"speaker":"from about 6","startTime":3196.342,"endTime":3199.47,"body":"is not available to most of them."},{"speaker":"from about 6","startTime":3199.47,"endTime":3202.23,"body":"- Yes, I mean I think huge"},{"speaker":"from about 6","startTime":3199.47,"endTime":3202.23,"body":"inroads have been made"},{"speaker":"from about 6","startTime":3202.23,"endTime":3204.36,"body":"into that over the last few years."},{"speaker":"from about 6","startTime":3204.36,"endTime":3209.36,"body":"So I think last year NICE"},{"speaker":"from about 6","startTime":3204.36,"endTime":3209.36,"body":"approved a digital form"},{"speaker":"from about 6","startTime":3210.45,"endTime":3214.403,"body":"of CBTi and indeed in a"},{"speaker":"from about 6","startTime":3210.45,"endTime":3214.403,"body":"number of different areas"},{"speaker":"from about 6","startTime":3214.403,"endTime":3216.0,"body":"of the country,"},{"speaker":"from about 6","startTime":3216.0,"endTime":3220.92,"body":"GPs can directly refer"},{"speaker":"from about 6","startTime":3216.0,"endTime":3220.92,"body":"for free to two or three"},{"speaker":"from about 6","startTime":3220.92,"endTime":3224.19,"body":"digital CBTi platforms."},{"speaker":"from about 6","startTime":3224.19,"endTime":3226.8,"body":"There are some that are free for use"},{"speaker":"from about 6","startTime":3226.8,"endTime":3228.72,"body":"even without prescription."},{"speaker":"from about 6","startTime":3228.72,"endTime":3231.99,"body":"Now obviously that's not"},{"speaker":"from about 6","startTime":3228.72,"endTime":3231.99,"body":"suitable for everyone,"},{"speaker":"from about 6","startTime":3231.99,"endTime":3235.02,"body":"but I think in terms of"},{"speaker":"from about 6","startTime":3231.99,"endTime":3235.02,"body":"improving accessibility"},{"speaker":"from about 6","startTime":3235.02,"endTime":3238.23,"body":"to this treatment, it's"},{"speaker":"from about 6","startTime":3235.02,"endTime":3238.23,"body":"a huge step forward."},{"speaker":"from about 6","startTime":3238.23,"endTime":3242.16,"body":"Getting face-to-face CBTi"},{"speaker":"from about 6","startTime":3238.23,"endTime":3242.16,"body":"remains a bit of a challenge."},{"speaker":"from about 6","startTime":3242.16,"endTime":3242.993,"body":"- [Audience Member] Yes, thank you."},{"speaker":"from about 6","startTime":3242.993,"endTime":3247.23,"body":"I wanted to ask you about"},{"speaker":"from about 6","startTime":3242.993,"endTime":3247.23,"body":"age related sleep issues"},{"speaker":"from about 6","startTime":3247.23,"endTime":3250.501,"body":"where typically, have less REM sleep"},{"speaker":"from about 6","startTime":3250.501,"endTime":3252.965,"body":"and wake up, early morning waking."},{"speaker":"from about 6","startTime":3252.965,"endTime":3256.519,"body":"Is that something to be accepted as normal"},{"speaker":"from about 6","startTime":3256.519,"endTime":3259.002,"body":"because it just happens with age"},{"speaker":"from about 6","startTime":3259.002,"endTime":3261.84,"body":"or is it something that needs treating?"},{"speaker":"from about 6","startTime":3261.84,"endTime":3263.56,"body":"- I think it's a question"},{"speaker":"from about 6","startTime":3261.84,"endTime":3263.56,"body":"of degree really."},{"speaker":"from about 6","startTime":3263.56,"endTime":3265.887,"body":"So we know that actually"},{"speaker":"from about 6","startTime":3263.56,"endTime":3265.887,"body":"our circadian rhythm"},{"speaker":"from about 6","startTime":3265.887,"endTime":3270.801,"body":"changes throughout life and"},{"speaker":"from about 6","startTime":3265.887,"endTime":3270.801,"body":"typically in teenagehood"},{"speaker":"from about 6","startTime":3270.801,"endTime":3273.93,"body":"and I'm experiencing this"},{"speaker":"from about 6","startTime":3270.801,"endTime":3273.93,"body":"now trying to pry my kids"},{"speaker":"from about 6","startTime":3273.93,"endTime":3278.04,"body":"out of bed in the morning,"},{"speaker":"from about 6","startTime":3273.93,"endTime":3278.04,"body":"our circadian rhythm delays,"},{"speaker":"from about 6","startTime":3278.04,"endTime":3279.18,"body":"it gets later."},{"speaker":"from about 6","startTime":3279.18,"endTime":3283.83,"body":"And actually as we get older,"},{"speaker":"from about 6","startTime":3279.18,"endTime":3283.83,"body":"our circadian rhythm advances,"},{"speaker":"from about 6","startTime":3283.83,"endTime":3288.12,"body":"and that's part of normal"},{"speaker":"from about 6","startTime":3283.83,"endTime":3288.12,"body":"physiological function."},{"speaker":"from about 6","startTime":3288.12,"endTime":3290.04,"body":"Now the other thing that happens we age"},{"speaker":"from about 6","startTime":3290.04,"endTime":3292.75,"body":"is those circuits that stabilize our sleep"},{"speaker":"from about 6","startTime":3293.67,"endTime":3295.44,"body":"are slightly less effective."},{"speaker":"from about 6","startTime":3295.44,"endTime":3299.422,"body":"And so insomnia tends to be a"},{"speaker":"from about 6","startTime":3295.44,"endTime":3299.422,"body":"bigger issue as we get older."},{"speaker":"from about 6","startTime":3299.422,"endTime":3303.603,"body":"In terms of incidence, in"},{"speaker":"from about 6","startTime":3299.422,"endTime":3303.603,"body":"prevalence, it's cumulative."},{"speaker":"from about 6","startTime":3304.53,"endTime":3309.53,"body":"But I guess the big question"},{"speaker":"from about 6","startTime":3304.53,"endTime":3309.53,"body":"is if you are going to sleep"},{"speaker":"from about 6","startTime":3309.9,"endTime":3312.36,"body":"and waking up at roughly the same time"},{"speaker":"from about 6","startTime":3312.36,"endTime":3314.79,"body":"and you're waking up feeling refreshed"},{"speaker":"from about 6","startTime":3314.79,"endTime":3316.41,"body":"and you're not suffering"},{"speaker":"from about 6","startTime":3316.41,"endTime":3320.16,"body":"due to cognitive effect or"},{"speaker":"from about 6","startTime":3316.41,"endTime":3320.16,"body":"sleepiness during the day,"},{"speaker":"from about 6","startTime":3320.16,"endTime":3322.01,"body":"then you're probably sleeping enough."},{"speaker":"from about 6","startTime":3323.04,"endTime":3325.74,"body":"- [Audience Member] Thank you,"},{"speaker":"from about 6","startTime":3323.04,"endTime":3325.74,"body":"you've more or less answered"},{"speaker":"from about 6","startTime":3325.74,"endTime":3326.85,"body":"the question I was going to ask."},{"speaker":"from about 6","startTime":3326.85,"endTime":3329.1,"body":"I just then wanted to"},{"speaker":"from about 6","startTime":3326.85,"endTime":3329.1,"body":"make a quick comment,"},{"speaker":"from about 6","startTime":3329.1,"endTime":3331.41,"body":"which is I was so glad you"},{"speaker":"from about 6","startTime":3329.1,"endTime":3331.41,"body":"mentioned lucid dreaming."},{"speaker":"from about 6","startTime":3331.41,"endTime":3334.02,"body":"I went to a lucid dreaming"},{"speaker":"from about 6","startTime":3331.41,"endTime":3334.02,"body":"weekend with Charlie Morley"},{"speaker":"from about 6","startTime":3334.02,"endTime":3338.64,"body":"and it was fantastic and has"},{"speaker":"from about 6","startTime":3334.02,"endTime":3338.64,"body":"really improved my sleeping,"},{"speaker":"from about 6","startTime":3338.64,"endTime":3340.89,"body":"so thank you."},{"speaker":"from about 6","startTime":3340.89,"endTime":3343.083,"body":"- Quick advert for a"},{"speaker":"from about 6","startTime":3340.89,"endTime":3343.083,"body":"lucid dreaming course."},{"speaker":"from about 6","startTime":3347.01,"endTime":3348.21,"body":"- [Audience Member] Thank you."},{"speaker":"from about 6","startTime":3348.21,"endTime":3350.79,"body":"What if an individual only lucid dreams"},{"speaker":"from about 6","startTime":3350.79,"endTime":3354.09,"body":"and these lucid dreams"},{"speaker":"from about 6","startTime":3350.79,"endTime":3354.09,"body":"end in an abrupt manner"},{"speaker":"from about 6","startTime":3354.09,"endTime":3358.32,"body":"which ends in resulting"},{"speaker":"from about 6","startTime":3354.09,"endTime":3358.32,"body":"of an incomplete sleep,"},{"speaker":"from about 6","startTime":3358.32,"endTime":3360.93,"body":"would you say there's"},{"speaker":"from about 6","startTime":3358.32,"endTime":3360.93,"body":"underlying mental health issues"},{"speaker":"from about 6","startTime":3360.93,"endTime":3362.28,"body":"to that?"},{"speaker":"from about 6","startTime":3362.28,"endTime":3363.87,"body":"- To sorry, to?"},{"speaker":"from about 6","startTime":3363.87,"endTime":3365.16,"body":"- [Audience Member] for"},{"speaker":"from about 6","startTime":3363.87,"endTime":3365.16,"body":"an individual having"},{"speaker":"from about 6","startTime":3365.16,"endTime":3366.93,"body":"only lucid dreams or only the dreams"},{"speaker":"from about 6","startTime":3366.93,"endTime":3369.69,"body":"that he or she can"},{"speaker":"from about 6","startTime":3366.93,"endTime":3369.69,"body":"remember are lucid dreams?"},{"speaker":"from about 6","startTime":3369.69,"endTime":3373.14,"body":"- Yeah, well I think there are two things."},{"speaker":"from about 6","startTime":3373.14,"endTime":3376.41,"body":"So the first thing is that if"},{"speaker":"from about 6","startTime":3373.14,"endTime":3376.41,"body":"you are not a lucid dreamer"},{"speaker":"from about 6","startTime":3376.41,"endTime":3378.69,"body":"and you're waking up from your"},{"speaker":"from about 6","startTime":3376.41,"endTime":3378.69,"body":"dreams on a regular basis,"},{"speaker":"from about 6","startTime":3378.69,"endTime":3379.86,"body":"and I think that tells you something"},{"speaker":"from about 6","startTime":3379.86,"endTime":3381.42,"body":"about your sleep quality."},{"speaker":"from about 6","startTime":3381.42,"endTime":3385.86,"body":"So the kinds of things that we see people"},{"speaker":"from about 6","startTime":3385.86,"endTime":3388.59,"body":"having very strong"},{"speaker":"from about 6","startTime":3385.86,"endTime":3388.59,"body":"recollection of their dreams"},{"speaker":"from about 6","startTime":3388.59,"endTime":3391.08,"body":"are individuals who, for"},{"speaker":"from about 6","startTime":3388.59,"endTime":3391.08,"body":"example, have got sleep apnea,"},{"speaker":"from about 6","startTime":3391.08,"endTime":3393.63,"body":"and who are having recurrent"},{"speaker":"from about 6","startTime":3391.08,"endTime":3393.63,"body":"awakenings from REM sleep"},{"speaker":"from about 6","startTime":3393.63,"endTime":3396.06,"body":"as a result of closure of their airway."},{"speaker":"from about 6","startTime":3396.06,"endTime":3398.19,"body":"But in lucid dreaming,"},{"speaker":"from about 6","startTime":3396.06,"endTime":3398.19,"body":"this is slightly different."},{"speaker":"from about 6","startTime":3398.19,"endTime":3400.797,"body":"So actually there is some"},{"speaker":"from about 6","startTime":3398.19,"endTime":3400.797,"body":"evidence that in lucid dreaming,"},{"speaker":"from about 6","startTime":3400.797,"endTime":3402.87,"body":"and this is controversial,"},{"speaker":"from about 6","startTime":3402.87,"endTime":3406.2,"body":"and it's not been replicated extensively,"},{"speaker":"from about 6","startTime":3406.2,"endTime":3410.4,"body":"is that actually lucid"},{"speaker":"from about 6","startTime":3406.2,"endTime":3410.4,"body":"dreaming illustrates"},{"speaker":"from about 6","startTime":3410.4,"endTime":3413.46,"body":"one of these examples of local sleep."},{"speaker":"from about 6","startTime":3413.46,"endTime":3417.87,"body":"So what I mean by that is"},{"speaker":"from about 6","startTime":3413.46,"endTime":3417.87,"body":"we've moved very much away from"},{"speaker":"from about 6","startTime":3417.87,"endTime":3420.63,"body":"viewing sleep as a global brain state."},{"speaker":"from about 6","startTime":3420.63,"endTime":3422.04,"body":"So different parts of the brain"},{"speaker":"from about 6","startTime":3422.04,"endTime":3423.99,"body":"can exist in different"},{"speaker":"from about 6","startTime":3422.04,"endTime":3423.99,"body":"stages of sleep and wake"},{"speaker":"from about 6","startTime":3423.99,"endTime":3424.89,"body":"at the same time."},{"speaker":"from about 6","startTime":3424.89,"endTime":3426.39,"body":"And in fact that's probably even the case"},{"speaker":"from about 6","startTime":3426.39,"endTime":3428.76,"body":"for some of you out there,"},{"speaker":"from about 6","startTime":3428.76,"endTime":3430.68,"body":"which is that actually during wakefulness,"},{"speaker":"from about 6","startTime":3430.68,"endTime":3433.5,"body":"we constantly see little"},{"speaker":"from about 6","startTime":3430.68,"endTime":3433.5,"body":"small islands of sleep"},{"speaker":"from about 6","startTime":3433.5,"endTime":3435.57,"body":"occurring within your cerebral cortex,"},{"speaker":"from about 6","startTime":3435.57,"endTime":3438.06,"body":"some of you more than others maybe."},{"speaker":"from about 6","startTime":3438.06,"endTime":3440.13,"body":"And in lucid dreaming,"},{"speaker":"from about 6","startTime":3440.13,"endTime":3441.793,"body":"this is probably another"},{"speaker":"from about 6","startTime":3440.13,"endTime":3441.793,"body":"example of local sleep"},{"speaker":"from about 6","startTime":3441.793,"endTime":3444.15,"body":"in that the majority"},{"speaker":"from about 6","startTime":3441.793,"endTime":3444.15,"body":"of the brain is asleep,"},{"speaker":"from about 6","startTime":3444.15,"endTime":3447.21,"body":"but the part of the brain that"},{"speaker":"from about 6","startTime":3444.15,"endTime":3447.21,"body":"is responsible for awareness,"},{"speaker":"from about 6","startTime":3447.21,"endTime":3449.91,"body":"and there is some"},{"speaker":"from about 6","startTime":3447.21,"endTime":3449.91,"body":"interesting work looking at"},{"speaker":"from about 6","startTime":3449.91,"endTime":3451.86,"body":"whether or not those areas of the brain"},{"speaker":"from about 6","startTime":3451.86,"endTime":3456.5,"body":"that we see exhibiting some"},{"speaker":"from about 6","startTime":3451.86,"endTime":3456.5,"body":"sort of waking like behavior"},{"speaker":"from about 6","startTime":3457.83,"endTime":3460.919,"body":"may be part of a network called"},{"speaker":"from about 6","startTime":3457.83,"endTime":3460.919,"body":"the default mode network,"},{"speaker":"from about 6","startTime":3460.919,"endTime":3463.11,"body":"which is essentially what's responsible"},{"speaker":"from about 6","startTime":3463.11,"endTime":3465.66,"body":"we think for consciousness, for awareness,"},{"speaker":"from about 6","startTime":3465.66,"endTime":3467.91,"body":"or internal experience, may be awake,"},{"speaker":"from about 6","startTime":3467.91,"endTime":3470.28,"body":"but actually the rest of"},{"speaker":"from about 6","startTime":3467.91,"endTime":3470.28,"body":"the brain remains asleep."},{"speaker":"from about 6","startTime":3470.28,"endTime":3471.9,"body":"So it may be much less of a problem"},{"speaker":"from about 6","startTime":3471.9,"endTime":3473.07,"body":"for people with lucid dreaming."},{"speaker":"from about 6","startTime":3473.07,"endTime":3475.007,"body":"I don't think we fully know though."},{"speaker":"from about 6","startTime":3476.049,"endTime":3477.3,"body":"- [Audience Member] Your reference shows"},{"speaker":"from about 6","startTime":3477.3,"endTime":3478.35,"body":"a strong correlation between poor sleep"},{"speaker":"from about 6","startTime":3478.35,"endTime":3480.12,"body":"and poor mental health,"},{"speaker":"from about 6","startTime":3480.12,"endTime":3481.77,"body":"and I was just wondering"},{"speaker":"from about 6","startTime":3480.12,"endTime":3481.77,"body":"how true that holds"},{"speaker":"from about 6","startTime":3481.77,"endTime":3483.21,"body":"across all kinds of societies"},{"speaker":"from about 6","startTime":3483.21,"endTime":3485.16,"body":"or across the historical record."},{"speaker":"from about 6","startTime":3485.16,"endTime":3488.34,"body":"I mean away from like modern"},{"speaker":"from about 6","startTime":3485.16,"endTime":3488.34,"body":"city life, electric lights,"},{"speaker":"from about 6","startTime":3488.34,"endTime":3490.17,"body":"screens, everything else."},{"speaker":"from about 6","startTime":3490.17,"endTime":3492.75,"body":"- Yeah, I mean I think the"},{"speaker":"from about 6","startTime":3490.17,"endTime":3492.75,"body":"short answer is we don't know,"},{"speaker":"from about 6","startTime":3492.75,"endTime":3496.35,"body":"because these kinds of"},{"speaker":"from about 6","startTime":3492.75,"endTime":3496.35,"body":"studies were not done in"},{"speaker":"from about 6","startTime":3496.35,"endTime":3499.563,"body":"Elizabethan England or"},{"speaker":"from about 6","startTime":3496.35,"endTime":3499.563,"body":"in hunter-gatherers."},{"speaker":"from about 6","startTime":3499.563,"endTime":3502.068,"body":"What we can say is"},{"speaker":"from about 6","startTime":3499.563,"endTime":3502.068,"body":"certainly when you look at"},{"speaker":"from about 6","startTime":3502.068,"endTime":3506.943,"body":"some of the epidemiological"},{"speaker":"from about 6","startTime":3502.068,"endTime":3506.943,"body":"work that's been done,"},{"speaker":"from about 6","startTime":3507.78,"endTime":3509.7,"body":"there is some really fascinating work"},{"speaker":"from about 6","startTime":3509.7,"endTime":3513.882,"body":"that has looked at"},{"speaker":"from about 6","startTime":3509.7,"endTime":3513.882,"body":"hunter-gatherer communities"},{"speaker":"from about 6","startTime":3513.882,"endTime":3518.882,"body":"in places like Peru, in Namibia,"},{"speaker":"from about 6","startTime":3513.882,"endTime":3518.882,"body":"and in Laos and Cambodia."},{"speaker":"from about 6","startTime":3522.24,"endTime":3524.7,"body":"And so these are"},{"speaker":"from about 6","startTime":3522.24,"endTime":3524.7,"body":"pre-industrialized societies"},{"speaker":"from about 6","startTime":3524.7,"endTime":3526.74,"body":"and what they find is"},{"speaker":"from about 6","startTime":3524.7,"endTime":3526.74,"body":"that insomnia seems to be"},{"speaker":"from about 6","startTime":3526.74,"endTime":3531.03,"body":"a much lesser problem for them than it is,"},{"speaker":"from about 6","startTime":3531.03,"endTime":3534.99,"body":"in fact, in some of these societies,"},{"speaker":"from about 6","startTime":3534.99,"endTime":3537.363,"body":"the word for insomnia"},{"speaker":"from about 6","startTime":3534.99,"endTime":3537.363,"body":"doesn't actually exist."},{"speaker":"from about 6","startTime":3538.83,"endTime":3540.33,"body":"- Well, thank you very much."},{"speaker":"from about 6","startTime":3540.33,"endTime":3543.12,"body":"Thank you much everybody"},{"speaker":"from about 6","startTime":3540.33,"endTime":3543.12,"body":"and Professor Leschziner,"},{"speaker":"from about 6","startTime":3543.12,"endTime":3545.592,"body":"thank you for a wonderful"},{"speaker":"from about 6","startTime":3543.12,"endTime":3545.592,"body":"evening and talk."},{"speaker":"from about 6","startTime":3545.592,"endTime":3548.592,"body":"(audience applauds)"}]}