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- The Brain’s internal system of reasoning. What is reason behind irrational behavior?
- Eliezer Sternberg is a neurologist at Yale Newhaven Hospital
- He has been researching philosophy and neurology to answer the big questions he had about human behavior
- There is a crossover between the brain and the mind
- Why are so many people so ready to accept strange behavior?
- We write people off as being irrational and crazy, which means we don’t understand why they behave the way they do
- If you take a crazy or irrational behavior and study it, you find the brain is being quite rational given the situation it’s put in
- the brain always tries to make the most rational decision
- The most important rule to remember about perception is that it is an interpretation of reality
- Our Perception can be manipulated by many different factors
- The brain takes a lot of short cuts when reading what’s out there in the environment
- Perception can be affected by diseases of the brain
- Memories can be falsified, but seem very true to the person
- This applies itself to alien-abduction stories
- Neurologists agree that people who have had abduction experiences are NOT illogical or crazy
- Instead, they are most likely affected by sleep paralysis, and their brains come up with a narrative
- Both Lucid Dreaming and Out of Body Experiences are possible.
- A Lot of fighter pilots have experienced Out of Body Experiences after rapidly making a maneuver
- The theory is that it is caused by a lack of oxygen to the brain
- This means there is a direct connection to near death and out of body
- Patience of schizophrenia have a block in their mind, which makes them unable to recognize themselves
- They usually think their thoughts are aliens, a spiritual entity, or an intelligence organization
- Given the situation, this is a logical brain response.
Interview Notes From The Show:
– Hey, welcome back to The Urban Monk, Dr. Pedram Shojai here talking about the brain today. Fascinating subject, I’m actually really excited to get into this. There’s a book called NeuroLogic, Dr. Eliezer Sternberg who wrote it, and once I saw what the book was about, I said, “Yo, yo, yo, I want this.” Because what we’re talkin’ about is the brain’s internal system of reasoning and basically looking at the hidden rationale behind irrational behavior, there’s plenty of that goin’ around right now. And so I called in the author of the book, an expert on the subject, to talk about it, and we’ve got some fun stuff to talk about. So Doc, welcome to the show.
– Thanks for havin’ me.
– Yeah this is great. So you’re a neurologist, you’re at Yale New Haven hospital, and you’ve been lookin’ at this neuroscience bit for awhile obviously, but there’s also this crossover into philosophy. What got you interested in the neurology-philosophy blend?
– Well I think that philosophy was actually my starting point in all of this, because philosophy is the art of asking big sweeping questions, and growing up I had a lot of those and I wondered about things like free will and determinism, and I wondered about who we are and our purpose and all those sorts of questions. Philosophy asks a lot of these questions, but it doesn’t necessarily answer them in a definitive way. And every time I tried to look into the answers to these questions, it led me back to neuroscience and neurology every single time. And that’s what got things started.
– Interesting, so there’s always been this chasm between the brain and the mind. The Buddhists talk about the mind, neurologists are looking at the brain, and now there’s a lotta crossover, we’re starting to find parts of the brain that could be attributed to things that would kinda classically be associated with mind, and things that may not be in body and people had religious implications to certain elements of this. And now it’s an interesting time, let’s just say that. So you’ve been looking at this spectrum of strange behaviors as they come from the brain, and what have you found?
– Well I think the first thing that caught my attention in this area is just strange behavior itself, and how so many people are willing to just accept it at face value and not dig deeper. So I work in neurology, and we see people with diseases of the brain all the time. And then there are some people for whom there are no diagnoses, you run testing, and nothing turns up. And in a lotta places, those people for whom you don’t have a diagnosis, well, they’re just irrational, they’re crazy, there’s a lotta names for them, but they’re all just covering up the fact that we just don’t know what’s going on. And those are the sorts of things that interest me ’cause a lotta times in the history of medicine there have been strange behaviors, and they have been called a lotta things, for example, hysteria was a name to describe someone who just seems crazy and for whom there’s no explanation. But nowadays we know that there’s a lot of real disease that explains those things, for example, decades ago we didn’t know about the existence of something called anti-NMDA receptor encephalitis, which is an inflammatory condition in the nervous system that makes people, quote unquote, go crazy. And since discovering that, now we’re looking for it, and those people back in the day would’ve just been called crazy. So I gotta say that what I’ve noticed in this whole area is if you take what appears to be crazy or irrational behavior, and you really do an in-depth study and look at what’s going on in the brain of that person, you often find that the brain is actually being quite rational given the situation that it’s put in, whether it’s compromised by disease or some other stay, that it’s actually using it’s own compromised situation and making the best judgement at its disposal.
– Interesting, so people running around frantically triaging something during an earthquake could seem crazy without the context of earthquake for people to judge that behavior, so this irrational behavior that we’re perceiving is really not looking at the underlying condition that’s driving their brains to make those decisions.
– Exactly, so in the earthquake example, the context becomes obvious because you know the earthquake is happening. But when someone’s acting equally irrationally because of a brain problem, all that is hidden, and all we see is the behavior on the outside, and it’s just so easy to leave it at that.
– How easy is it to detect some of this, I know we’re gettin’ way better with PET scans and SPECT and QEEEGs and all the different things, functional MRIs. Although there’s a study that just came out saying a lot of the software for functional MRI might be throwing it into question now, some of the data there, but we’ve got a lot of really interesting new tech showing us things that we couldn’t otherwise see previously with the brain. How good are we at detecting abnormalities now compared to five years ago even?
– So we’re a lot better than we used to be I would say, and the techniques are improving but you have to really know what to look for and know what questions you’re asking. You can put people through a dozen different scans but if the radiologist, who’s ever reading the scan, or the neurologist, doesn’t precisely know what questions to ask and what we’re really looking for, those tests are not gonna turn up with anything. So I think the first step is to really ask the questions and have investigations that are targeted. And when you do that, and you ask questions the right way, you are much more likely to turn up with answers.
– Right, now, one of the things that you talk about in your book is perception and the reliability of perception. Let’s get into that, because to me that’s fascinating, perception is something that we explore a lot in meditation, we explore a lot in esoteric realms, where, as a neurologist, does that fall in your world view?
– Well I think the most important rule to remember about all perception is that it is an interpretation, it’s not a simple window onto the world, as it were. And with that in mind, that perception can be affected by a lot of different factors. So for example, perception can trick us all the time. When you’re looking at optical illusion for example, which is the simplest example, you are seeing a trick of perception based on environmental cues. The brain takes a lotta short cuts in reading what’s out there in the environment, and an optical illusion takes advantage of the brain’s perceptual mechanisms to trick our senses. So that being a simple example, perception can also be affected by a lot of diseases of the brain, and when you really understand that architecture and how the mechanisms of perception are built, you can begin to see where perception comes from and how it applies to things like witness testimony, why it could be unreliable, how memories can be falsified but seem very true to the person.
– Interesting, so based on the data coming in at the time and the gates that are controlling perception, you can have memories that are absolutely inaccurate that don’t really represent what happened then, but your perception of the moment dictated a memory that is actually erroneous?
– Absolutely, there’s a pretty famous study on this about being lost at the mall. It turns out that people’s memories are suggestable, especially by people we feel close to, and in the study that I’m talking about they had subjects come and try to recall an episode where they were lost in the mall, which never really happened. But what they would do is have a family member, say the subject’s brother, say, “Hey, remember that time “that you were lost at the mall?” And people would be convinced by this. And then they would interview them on the subsequent days, and the people in the study would begin to invent details about it. They’d say, “You know, now that I’m thinking about this, “I remember the guy in the striped sweater “who led me to the microphone that helped me “give a call to my parents that eventually found me.” And they would start inventing more and more details as they were creating a false memory.
– Interesting, so the brother who created this impetus for the memory, so basically forced the memory on him, and said listen, you must not remember. So now they’re creating a narrative so that they’re not wrong, or they haven’t, like it some sort of shame issue of not remembering that then puts them into creating false memories?
– I think that’s actually an insightful way to put it. I think that the brain is a remarkably talented storyteller. And whenever we are faced with inconsistencies in our lives, the brain has this ability to place it into a narrative to make sense of it. So in this example, you’re being told by someone you trust that something happened to you, but you don’t remember. So the brain basically creates a narrative to make sense of that fact and to incorporate it, so does it overcome shame, sure. And this is just one of dozens and dozens of examples of where the brain does this.
– Unbelievable. You mentioned an example that I think is great, is you talk about alien abduction stories. How are these filled in with the context of what we’re talking about?
– Well alien abduction stories have been formally studied because they’re just shockingly common. And a lotta people who don’t believe in them would be pretty quick to say that anyone who believes in alien abductions is crazy or illogical. But they study the people who espouse these beliefs. It turns out that they’re absolutely not, they’re of excellent mental health, they’re really no different from anybody else. And what’s also interesting about alien abduction stories is they’re very consistent from person to person. So the typical story is somebody wakes up in a dark room and they have a vision of ghastly figures, and have weird sensations throughout their body and feel manipulated by these alien figures, usually they’re ghastly, white, or have sort of rounded shapes. So the question is, why are people having this experience so consistently even though they don’t have any trace of psychosis or any medical evidence that they should be having this quote, irrational experience? And what’s interesting is there’s a problem in sleep medicine, known as sleep paralysis, that’s a remarkably close experience to this. So every time we wake up in the morning there are two things that happen in the brain. One is we regain consciousness, we wake up, and see and smell and hear. And on the other hand our muscle control returns because we’re paralyzed during sleep, which is why we don’t act out our dreams and so forth. So for some people there can be a delay between those two features of awakening. So some people might have their consciousness wake up and they can hear and smell and see, but their muscle control has not returned, so they’re paralyzed. And this is often associated with hallucinations of ghastly figures, can be associated with weird noises, and even sensations of poking or prodding of the body. So the brain, again, has to come up with a narrative. So you’re paralyzed, it’s dark, you’re unable to move, you’re confused, and you’re seeing hallucinations of these figures over you. And the brain has to reconcile that, it has to come up with a narrative to make sense of it. And if you live in America where alien abduction stories are common, and maybe you even have wondered about other beings, that is actually a pretty logical explanation for what’s happened to you, it’s something that makes sense, it explains all the symptoms, and you are now part of a large group of people who’ve had this experience and believe in the alien source of it.
– So going back to the brother mall example, if you are in a culture that doesn’t really have the alien narrative in its ethos, and so that you have this experience but there is no underlying history, you don’t know what an alien looks like, you’ve never seen a picture of those little guys, are you likely to have the same experience, or are you going to have some other shamanic experience or something that fits in with the narrative that you’re familiar with?
– That’s a great question, and the answer is, sleep paralysis is a medical problem of sleep that happens worldwide. So people in all cultures have the experience. But the explanation for it, the story or narrative that they come out with is completely different. If you go to other cultures they don’t talk about aliens, but they talk about being visited by spirits, or they talk about, one unfortunate explanation is they think it’s a village rapist who’s come in and has a ghastly face, who comes in. Some think it’s the spirits of the dead or ancestors who come and visit you and haunt you upon waking. So depending on your culture and what ideas are being passed from person to person, people have a different narrative to explain the same experience.
– Very interesting. Now is there a correlation with say, people who have these experiences and a diagnosis, like is there a diagnosis of sleep paralysis where someone who has sleep paralysis is more likely to have it? Can we find that the people that are having these dreams tend to also have sleep paralysis?
– Yes, we can. Those people do tend to have more problems with sleep, and sleep paralysis, like anything in medicine, has a spectrum of severity, so it’s remarkably common to have some degree of sleep paralysis. When I talk to classrooms about this, usually there’s a couple of hands raised of people who have had this experience in every class. But usually it’s only for a few seconds. Some people with severe sleep disorders can have this experience for minutes, and rarely, even hours. But it’s definitely a more prevalent finding in people who have alien abduction experiences.
– That’s phenomenal, and do we know where sleep paralysis comes from, for your average person, is it something that is a nutrient deficiency, is it some physiological issue that could be cured, or we’re still trying to figure that out?
– So the actual mechanism of that disorder is unknown, we know it’s associated with a lot of different sleep disorders, so it’s not a diagnosis as much as it is a symptom of poor sleep architecture.
– Interesting, okay, so if you have apnea, whether it’s obstructive or central or any of these things, the brain’s not gettin’ what it needs and this is some sort of side effect of the architecture of the brain. So if you don’t go into stage four sleep and get what you need out of there, then you can pop out and end up in this sleep paralysis area?
– Right, so sleep has different phases, there’s a rhythm of sleep, a cycle of sleep, and if that cycle is interrupted, then things go haywire. And that’s sort of the vague explanation for why it happens, it’s a problem with the architecture and the rhythm of sleep.
– Wonder if anyone’s looked at alien abduction stories increasing with new parents because I haven’t had normal sleep in two and a half years. So I should start seein’ some crazy shit soon. So in different cultures, it’s funny man, I had a crazy dream last night where I was with some people and we met some shaman and they gave us this little blue mushroom and it was like a, this was in my dream, I don’t really have dreams like this, and so we take this little blue mushroom and then I wake up from that experience and I’m like hallucinating. And I’m like, no, but I’m in my bed, make it stop, and so I reach over and touch my wife’s hand and I’m like, okay I’m here, but I’m still having this state of hallucination from a dream that I had that I thought I had come out of. So I called up my buddy, my shaman buddy, this morning actually, and I’m telling him about this thing and he’s like, “Oh my God, I’ve had one of those.” And so he wouldn’t have remembered had I not remembered, and I wouldn’t have remembered if I hadn’t have called him for something else. And so maybe it is more common than we think, we just don’t remember it as much, ’cause I don’t have sleep paralysis, it’s not as disruptive.
– Yeah, and what that sounds like to me is there is a, it’s not a sort of snap your fingers and you’re awake, there is a little bit of process, and you woke up in the middle of a dream which often we don’t. And it seems like you were sort of halfway in between sleeping and wakefulness and your dream carried over. That’s pretty crazy.
– Yeah, it was really interesting, I typically don’t have dreams of that sort. I have messed with lucid dreaming a little bit, I’ve messed with some out of body things. What’s your impression of that? We’ve had a couple guests on the show, very logical, rational people who have been in emergency rooms and watched people hovering over their bodies and things of the sort. I don’t know if you’ve looked at any of that research.
– I have, so both of those things are real, true experiences that people have and can actually be induced. So lucid dreaming is a phenomenon which people are able to control their dreams, as opposed to the dreams just happening to them, so they have an active decision-making role in what happens. Never happened to me but apparently it’s pretty cool.
– [Padram] It is cool, it is really cool.
– So the explanation is, generally the frontal lobe, which is the source of decision-making in the brain, is shut down during sleep. So that’s why things are very passive, but for some people the frontal lobe is actually active. And they’ve actually done FMRI imaging on lucid dreamers and found increased activity in the frontal lobe during their dreams. And apparently lucid dreaming is something that you can be trained to do. I don’t know if you ever tried to get training, it’s actually being experimented with as a treatment for nightmares. Which is great, because people who have debilitating nightmares, like people with PTSD for example. If you can train yourself to exit the terrifying part of a dream, that’s actually highly therapeutic. The interesting thing on out of body experiences is, they have been reported for years. But they were formally studied when it was noticed in the Air Force that a lot of fighter pilots were having these after making really tight maneuvers. And they would describe in great detail the feeling of being outside the cockpit, sort of on the back on the plane, looking down, seeing themselves piloting the plane. So it seems to happen after making maneuvers that rapidly change the direction of the plane. One thought is that a quick drop in oxygen in the brain can cause this out of body experience. The other situation where people have these are cardiac arrest, or people with heart attacks, which, if the heart stops, the blood’s not getting to the brain, and people have the same neurological oxygen deprivation. So that is actually a situation where true, near-death experience leads to the out of body connection, which is something that, the connection we’ve always had throughout the literature on death and mortality. But the fact that you can induce it by imitating that lack of oxygen to the brain, like by flying a plane, is pretty cool.
– You know it’s fascinating, it’s pretty consistent with the whole near-death thing, right, so lack of oxygen to the brain is sending some certain signals saying, hey, this isn’t good. You said something there that’s really gotten me thinking, is, I’ve done training on lucid dreaming, I’ve done some training on astral travel, had some very profound experiences, there’s something there. And what you mentioned with the frontal lobe and the prefrontal cortex, is it the prefrontal cortex in particular that you’re seeing lit up?
– It is, yeah.
– So that’s also the part that we’re working during meditation, right, so as you become more and more seasoned as a meditator, we see more activity there. And so I’ve looked at a lotta studies on this, like density of the prefrontal cortex with meditators and things of the sort. There’s some connection there because in all of that literature what is spoken of is really activating this center, which is dead smack center of that, and that allows us to then have control of our dream state. So these guys maybe figured out how to control the dream state that way very early on, and there’s something really interesting in that that I’d like to keep exploring. I don’t know if you have any colleagues that are looking at that literature in particular, but to me that’s fascinating.
– Yeah, I don’t know anyone who’s directly working on that, I know it’s an active area. There is a lotta work also on meditation and neuroimaging, looking at that relationship, but I think there’s still a lotta work to be done, it’s still a pretty mysterious area, but very interesting and open for research.
– Yeah, yeah, no, that’s great. So what about schizophrenia, there’s so many areas based on this. Is schizophrenia a place where’s there some sort of syntax error where there’s no logical explanation, so that then they have to create a whole new persona to then be able to metabolize this narrative in a way that can be rational for them?
– Yeah, so schizophrenia I think represents one of the classic examples of the quote unquote, crazy person, that nobody understands. Everyone has walked across a busy street corner and saw someone ranting on a street corner and saying things that don’t make sense, and just so easy to pass that person off as, oh that guy’s just crazy. But one thing that I came upon really early working on this book is research on why schizophrenic, patients with schizophrenia hear voices. And one of the most remarkable findings that I stumbled upon is that they’re actually hearing their own voices. So during an auditory hallucination, if you were to place a microphone on the throat, you can actually hear the hallucinations themselves, you can hear the voices in people’s heads. So then the question becomes if it’s their own voices, and it turns out it’s more than their own voices, it’s also their own thoughts, but if it’s their own mind creating this voice, why don’t they recognize it? And the answer is that patients with schizophrenia have basically a block in the circuit of self-recognition, and they have trouble recognizing products of their own thought. So for example, a patient with schizophrenia may write a song and not be able to recognize having written that one, or have trouble recognizing their own handwriting. And what I’ve also noticed is that when you ask people with schizophrenia who’s in your head, who’s talkin’ to you? They come up with actually a pretty consistent set of explanations, and it’s usually one of three categories. It’s either a religious entity, so it’s God, or angels, something like that, or prophets, it’s either aliens, or something supernatural, or it’s something like an organization with a lot of technological savvy, like the CIA, or the FBI is in my head. And when you think about it, imagine you’re the brain of this patient and you’re hearing voices in your head, the voice knows you, it knows your weaknesses, it knows everything about you and it has access to your mind, and the means to spy on you. Those three explanations are actually the most logical ones that you could come up with. The CIA could do it, God or angels could do it, some religious power could do it, or some supernatural or alien force. And that’s just the brain, again, creating a narrative to explain a really, really crazy experience.
– That’s fascinating, and we can’t leave out the Scientologists ’cause they’re always in the head. So I just wanna get this part down, you’re saying that when they’re vocalizing these voices, we’re able to detect it because there’s some sort of muscular activity around the voice box that they’re actually trying to internally vocalize it? How are we hearing the fact that there’s these voices?
– Yeah, so it turns out that there’s an entity called subvocal speech, which means basically mumbling. So everybody mumbles, and mumbling is when you’re trying to think about something and you think about it so hard that you accidentally give subtle activation to the vocal musculature. And it’s basically creating very, very quite sound, and if you were to amplify it, you could actually hear those voices.
– Interesting, interesting. Wow, man there is just so much cool stuff comin’ outta neurology now. I remember back in what, 2001 or so, when I first started practicing, I no longer practice. I was workin’ with a number of neurologists and it was all just TMJ and headaches, and there wasn’t the practical application of neurology was basically elaborate diagnosis of stuff that we didn’t know how to fix. And it seems that now it’s gotten way more interesting, and guys like you are out there just asking big questions and finding ways to find answers in the brain. How much, do you see patients on a weekly basis, are you still in clinical practice?
– On a daily basis, yeah.
– On a daily basis, yeah, wow. And so what kind of patients come your way?
– All sorts, and to your point, back in the day, neurology had this terrible reputation of diagnose and adios. We wouldn’t have anything to offer, which,
– [Pedram] I didn’t wanna say it.
– Yeah, which is unfair, but also very old. But now we see people of all sorts, so my specialty is epilepsy. And there’s so many drugs now for epilepsy, and we’re able to treat people with seizures remarkably better than ever before. We treat people with stroke, with migraines, we treat people with sleep disorders, with movement disorders like Parkinson’s disease, so really all over the spectrum. One of the classic parts of neurology that has been difficult to treat and we had little to offer was in behavioral neurology, which focuses on the dementias, like Alzheimer’s disease. And I think even in that area we’re now on the forefront of new medications that are very, very promising, so I think it’s an exciting time for neurology and for patients who have neurological conditions.
– What, and this is a can of worms but I gotta go here, are there any interventions that are on the horizon that are promising that are non-pharma? The pharmaceutical interventions seem to be gettin’ better off, but I, back in the day I studied with Barry Sterman and a lot of these EEG guys, are there any other, you know, magnetic practices over transcranial stimulation, anything else that you’re seeing that’s promising that isn’t using drugs?
– Well, I can speak for epilepsy which is my specialty, we’re doing a lot of stuff now with implanted devices in the brain that can detect when seizures are about to happen and just stop them before they get any worse or before they spread. There’s a lot now with epilepsy surgery, so if you could find out exactly where in the brain the seizure’s coming from, and you can pinpoint to the millimeter exactly where it’s coming from, a surgery just taking off a small part of the brain can be curative, which is remarkable. People who would be suffering with 10 seizures a day can be seizure free these days. And that’s where they’re at, and also, one of the hottest topics now in epilepsy and higher research is marijuana. Marijuana for seizure prevention is being actively studied and every epilepsy conference you go to now will have at least one or two talks on cannabis for epilepsy.
– And using cannabinoids, CBD, stuff like that, moreso than the THC, yeah.
– Right, and trying to figure out the best delivery mechanism and dosing, and seeing how far it can really go in helping people who have really difficult-to-control epilepsy.
– That’s fantastic, and so from Charlotte’s Web down, that whole industry is, it’s crazy what’s happening there. There’s people claiming that it cures cancer, there’s all kinds of medical claims around cannabis. Very little has been studied, but in this particular space there actually is study, like Charlotte’s Web, there is research around epilepsy and we are seeing positive results.
– Yeah, there is, and we do see some problems get resolved. I should say, on marijuana there’s a, people have sort of have what we call secondary gain, or personal reasons for wanting to claim that it’s good for lots of different things. A lotta that has not been demonstrated. But I think we’re also now in a political time where it’s becoming more acceptable to study this stuff. And listen, whatever people’s opinions are on it, if it can really help people who are sick, then, I mean, that’s great, that’s a good thing.
– Yeah, we’ve had a few guests on talking about the politicization of this thing, and just how it went down back with Nixon, and even before in the 1920’s, it’s kind of a mess. But then you start looking at what it can do for pain, fantastic. And then we just recently had Daniel Amen on the show, and he was saying they just did a big study on recreational pot users, and showed all kinds of issues with their SPEC scans, and finding big gaps in the brains, so, he’s very anti-marijuana for that. And there’s a lot of evidence that suggests that daily use recreationally might not be good for you, so yeah, look, if you sell pot, you wanna sell more pot, so you gotta look at reasonable, rational arguments comin’ from people who are lookin’ at it.
– Yeah, it’s true. There are, long term studies on marijuana are that it’s relatively safe, there are some consequences, specifically it worsens your memory, it worsens your motivation over time in ways that can be permanent. Not to get too political about it, but if you wanna compare it to universally legal drugs like cigarettes, clearly cigarettes are far more dangerous. I would say, and you could probably attest to this, that if I had to summarize medical school in one piece of advice, it’s don’t smoke cigarettes, one of the most dangerous things you can do, do for your health.
– Yeah, it’s funny, a lot of the benefits that we’ve had this century are, in the last 150 years say, in medicine, have really been around public health sanitation and gettin’ people to quit smoking. And it’s done wonders, yeah.
– Yeah, I mean, cigarette smoking makes almost everything worse, it can cause almost every disease. And in neurology one of the most common thing we see is stroke, cardiologists, one of the most common thing they see are heart attacks. And again, both cases, cigarette smoking is right up there with most important risk factors.
– That’s it, that’s it. And when you compare it to opioids and all these other pharmaceuticals that people are hooked on, marijuana is just really low on the totem pole for things we should be worried about. We had a couple questions from the audience, I’m gonna kick over to Shawn right now. We do also live questions, so here we go.
– Okay so I have one from M.K. first. She has identical twins and one had night terrors for about a year at three, and now has debilitating migraines. Is there any correlation between the two? The other twin has neither.
– Identical twins, one had night terrors at the age of three, and now has debilitating migraines. Any connection?
– Between night terrors and migraines.
– [Pedram] Migraines later in life?
– Yes, yeah yes, actually. Migraines and most headache disorders are worsened by any kind of sleep problem. So every time I see a migraine patient, I screen them for any kind of sleep problems and try to fix those, so I send almost everybody to get a sleep study to diagnose whatever it is that may be worsening their sleep, and then in consequence, worsening their migraines. So that connection is real and important, so helping one helps the other.
– Great, how much of the sleep spectrum, I looked at sleep a lot back in the day, a lot of it was oxygen to the brain, so if you desat, then all of sudden your sleep starts to go. What percentage of say sleep problems have to do with just not getting enough oxygen to the brain?
– Well, I would say that it’s sleep apnea is the one that is sort of defined, apnea means lack of oxygen, so that’s what it’s defined by. And because sleep apnea is the most common sleep disorder, that accounts for a huge percentage. But it can be so debilitating, people with sleep apnea, they get so many problems. It increases your risk of, well it makes you tired during the day, but it also increases your risk of headaches, it increases your risk of stroke, believe it or not. So it’s just, it’s a really important thing to deal with, and a lot of people say, “Oh, I snore, it’s no big deal.” And it is a big deal, if you’re a bad snorer, that’s something that needs to be worked up by a sleep specialist.
– Yeah, Amen. Yo, you got one more question?
– Yeah, so one more. So Ling says that she has insomnia and restless legs and sleep disturbances, so are there any remedies for that?
– Insomnia, restless legs, and sleep disturbances, she’s asking for any remedies. I’m sure there’s plenty, barring a diagnosis, but do you have any kind of general advice for insomnia, restless legs and sleep issues?
– Yeah, absolutely. So a lotta people don’t know this, that there are sleep clinics that you can go to and at my hospital, Yale, the sleep clinics are some of the most popular in the whole hospital because good sleep is crucial. And insomnia is a very broad problem, it’s like saying, cough or belly pain, it could be so many different things, and that should be worked up by specialist. Restless leg syndrome actually does have a specific, very effective treatment, which is basically a dopamine-based medication which has to be prescribed by a doctor, so I would definitely recommend seeing a sleep specialist and those things can be remarkably improved.
– Excellent, excellent. The book is called NeuroLogic, it’s out in paperback, gorgeous cover by the way, it’s really good. I’ve been around a lotta books, so trust me when I say it’s pretty. Doctor Eliezer Sternberg out at Yale, still on the front lines seein’ patients every single day, and took the time to write a book. I know it takes a long time to do that, it’s a lotta work, but you’re helping a lotta people with this, it’s nice, I really appreciate when people from the ivory towers help take information and make it available to the masses, because there’s so much garbage out there in the mass media, there’s so much bad health advice out there, and part of my job here is to really pierce through that and go get real information for people and make it actionable, and help them help themselves. So I appreciate the fact that you, you don’t need to write a book but you did it because you’re helping a lot more people this way.
– I gotta say so are you, and I think as a fellow doctor I think you know that doctors are really good at talking to each other in general. And that’s great and important, but often not as well first at talking to the general public, and that, unfortunately leaves non experts and people with other agendas and people with inaccurate information being the major speakers on a lot of medical issues. And I think that doctors need to do a better job of disseminating good, useful, accurate health information to people.
– Yup, Amen, and so yeah, with your permission I would love to call you back whenever something neurological happens. I’m actually puttin’ together a dream team of people that I really enjoyed having on the show and then as trending events come up, I just wanna call my experts and be like, hey, what’s your opinion on this? Because you’re right, when I moved out of medicine into corporate wellness, all the voices were these consultants who had no experience in anything healthcare, they were just business people giving people health advice and hiring a couple health coaches to tell, telling the health coaches to say what they wanted to say. And so it’s a real dangerous space when you don’t have experts who know what they’re talkin’ about and so I’d love to have you as an expert and call you when there’s more neurological stuff to talk about here.
– Be happy to, my favorite subject.
– Love it, love it. Well thank you so much for being on the show, and if you have any questions, to the audience, let us know, bring it in, we’ll tag the good doc in there and we’ll try to get some of the questions answered. Check out the book, it’s fascinating, I was perusing through it a couple days ago, I think that this is the frontier of where science and psychology and spirituality and all these things are meeting, and this is a very interesting subject matter for us all to look at. Check me out at theurbanmonk.com, give me any comments wherever you’re seeing this, and I will see you next time.