 Good morning. I stole this phrase from Mr. Shakespeare and altered it. If you have read Hamlet, to be or not to be. So, just put it like to sleep or not to. And I have a reason for it. It is not so random, because sleep is one of the essential processes of all living beings. Everybody sleeps. Although the way they sleep, the time they sleep, the place they sleep is all different. The reptiles also sleep, birds sleep, monkey sleep, mammal sleep. Everybody sleeps. And it is such an essential part of our life. The other essential part is hunger and thirst and sex. So, these four basic human processes are the need for survival and they all control from one small organ in the head, what we call hypothalamus in the area surrounding it. But it creates a different connotation in different situation. Like for example, and it is also the commonest complaint of people when they fall sick. Whether it is a mental illness or a physical illness, sleep is the first thing to get disrupted. You have a pain, you do not sleep well. You have a pain in the form of exam next day. You still do not sleep. Mothers, when the kids are in class 9th and 10th, their commonest complaint for which they come to me is that they sleep. It is called 10th exam. And the guy sleeping 14 hours. All mothers complain. And when there is a board exam, we all sleep too much. Giving us sort of panic attack to our parents. So, it is like, it is an essential thing, but still it varies and people use sleep in various forms. So, if it is so important, we should know about it. Like, we should know our mind, whatever we know. So, what is the function of sleep? If it is so essential, why did nature create it? Why sleep at all? Because the other end is that people say, that if you sleep a lot, you will lose. There is a saying in Hindi. But there are some people who want to sleep, because lot of discoveries have been done actually in sleep. Lot of great ideas come in sleep. So, it is both ends. So, let us look at it. Why it is necessary? Because sleep is something which has evolved with nature on this planet earth. We do not know about the other planets and the living beings there. But what we know of the living beings here, they all sleep. And that is the physics regular activity. So, it must be inherent in the nickel to our life. Why sleep? So, lot of theories have come in. First was the original simplest theory was that you get tired, you sleep, you wake up fresh. So, there was a theory which was restorative. There is a restorative function of the sleep. It will restore your energy which you have depleted in the day time. Then, there was a man called Mr. Segment Freud and Carl Jung. They brought out a brilliant theory. They started looking the whole thing from the angle of dream. And they said whatever in the simplest language what I can tell you is that whatever you repress and suppress during the day time in your head, there is a phase of sleep and all that comes in the form of dreams. So, for them it was like a release mechanism. You cannot keep suppressing and repressing your brain till eternity. So, brain has to release it. So, brain converts whatever you have pushed it into the unconscious mind, converts it into dreams. And this theory actually later on again came into this is the latest understanding. Do you see this name called Crick? Have you heard of him? Francis Crick. Francis Crick after discovering DNA lost interest in DNA. He switched to electrophysiology and he started working on dreams and EG and so Francis Crick and there is a man called Hobson in Howard. They brought out his theory which is the current understanding that sleep is important for one restoration and rest obviously because you go into a deep sleep and you can repel it energy. But it is more for information processing. Whatever goes into your head throughout the day whether consciously or unconsciously, subliminally or you pay your attention, your attention mechanism wants it or lot of information going in. Even while we are sitting in this room you may be looking at me and hearing about me what I am talking. But the lot of things which are going into your head even this light is an influence in your head. It must be altering some electrochemical activity in the brain. All right. Touch is doing it. Now all this plethora of information which goes within a day it has to be processed otherwise your computer will shut down some day. So what happens is that the phases in sleep where all this information is activated. So the process is activation and synthesis. They activate in the form of dreams and in the form of other things activities that happen in the night and the brain cells eliminate what is not necessary and what is necessary or what fits into the system and the past memory that is saved. So whatever you learn in the day time you all must have experienced this. If you do not sleep just before your exams and read too much you feel a sort of burnout just one or two days before exam. It is because the brain is not getting time to process it and that is why it is always told that if you have an exam sleep well and then go. Because brain will get time to process all that and categorize the content of the information into the right slots in the head. Otherwise it will all be too much to handle. So brain activates eliminates and synthesizes that is one very important function of the sleep. So in fact whatever you mug up in the day time do not think that you have already mugged up. It has to be consolidated in the night. So if you make people not to sleep first complaint they start is that lack of attention that they cannot recall they are forgetting and there is one big sign in psychiatry also. Lot of people they say I am unable to sleep and I am not able to concentrate all that is related. You are not able to concentrate is related to your lack of sleep or disturb sleep. Metabolic obviously is one of the reason that nature has evolved. We all would not have grown up if there was no sleep because one of the important hormones called growth hormone is secreted in sleep. There is a hormone called cortisol which makes you fight all the illnesses and all that. That is also linked to the sleep and more so the temperature of your body the temperature cycle is linked to sleep. The certain phases in sleep when the temperature is the highest like when you are going off to sleep your body temperature is the highest the core body temperature and as night falls it is the lowest in the morning and that is the time when the cortisol levels are higher. So it is all very very fine tuned and it gets disrupted by our lifestyles, by our food illnesses so on so forth by our thoughts but nature has fine tuned it. So if somebody is left in a situation where there are no disturbances actually theoretically body should not fall ill. It may age and die but it will not fall ill whether nothing to fall ill the body is perfectly matched and their feedback systems which actually do it to sleep has a definite role in your survival. It is not just by the way that you have to sleep to gain your energy like I said. What is the proof? What is the proof that you should have proof when we say all this you should have proof. One is evolutionary evidence dolphin sleeps with one half of the brain sleeping the other half is awake and then it switches the other half sleeps one half keeps awake. Cats when they sleep the eyes are roving the proof is neurochemistry when we record the some chemicals in the blood they keep altering throughout the night and these are essentially brain chemicals who they degrade and get metabolized if you do not allow people to sleep how long they can survive? Four days five days six months but it has been shown that people who sleep more than 10 hours and people who sleep less than 4 hours are more prone to having illnesses bodily illnesses the diabetes hypertension heart attacks there is a link with heart attack the most of the heart attacks happen in the morning some of a big chunk of them has sleep disturbance in the night. So all this stuff is a proof that sleep is essential animal experiments obviously you keep a rat alive and not allow the rat to sleep after few days it starts running a wire without any logic circadian rhythm you know what circadian rhythm is no you all have studied physics is there time is there something called time where Julian Barber says there is no time you know Julian Barber read Julian Barber Julian Barber says that there is no evidence of time time is the clock the clock is the contraption made by human wings everything is going on in the nature could there be time sleep says there is a time actually time is not the time which we use seconds and minutes and all that but sleep we have to measure it through this because we do not have any other tool to measure. So, we wanted to find out whether there is a rhythm in the nature we know one year revolution 24 hours rotation we know all this. So, there is there a rhythm in the human body is there or no when there was no electricity what was happening it was all linked to sunlight right there is sunrise again sun there is no sunrise. So, when we rotate and come in front of the sun we get up work through the day there is a sunset you sleep whole body was linked to that, but in a free flowing experiment it was done a man was put with food and everything in a room which was built of lead and sound proofing and everything and lowered down says about 20 feet or something and all air conditioned and everything and the sound proofing was such that there would be no peak fluctuation of electricity there would be no traffic vibrations reaching that room right. So, this man was isolated in that chamber no clock nothing there was a uniform light uniform sound and he was left there. So, the natural rhythm of body came out to be 25 hours actually the natural rhythm of waking up and sleeping and all that is runs to 25 hours. So, but we have 24 hours. So, anyway so nobody tried to change it to 25 hours because that would have meant a lot of problems in the world. So, it is all right to be 24 hours your free rhythm is 25 hours and your worldly rhythm is 24 hours. The other proof is that normally 8 hours after getting up from the bed we feel a pressure of sleep which is for 20 minutes or 30 minutes which is natural. All our sleep and waking is queued to light what we call environmental queues, zedgibers. So, people want to sleep in the afternoon which is fine, but lifestyle we live we do not sleep slightly anti-nature. This is how sleep develops in us and newborn sleeps newborn sleeps for how many hours IT in 20 whatever they wake up just for milk and all that and cry in. But when you record I will tell you just read this word called REM. New borns 50 percent of the sleep is dream sleep and we do not know what they dream because we do not have any way of recording it by the time they start speaking a dream sleep has decreased and they have forgotten everything. So, record knowing the dream of the first year of life is still a big challenge which we face we really do not know how to some some day we would want to listen to that. You never know you never know that like people at least Hindu mythology believe that you are born with your past what they call prarabd. So, you know your past life we do not know even if they tell us their past life we are cannot go and check back unless that theory of retrocausality in quantum physics comes true. Retrocausality is possible you can go back. Day time napping persist till 4 to 6. Stage 3 to 4 is a deep sleep which increases till pre-pervertal but teenagers have this specific problem. Actually when mothers get angry what they do not realize that a teenager right from 12, 13 to roughly around 17, 18 they require more sleep than adults. If adult requires 8 hours a teenager requires at least 11 hours but 11 hours sleep can take away the happiness of family because that will be board exams or your school and all and no parents can tolerate this but they do not know the biology. So, they use them. So, normally this is how sleep develops this is what I told you this you see this place thalamus. These are all chemicals GABA, histamine, 5-HT, serotonin, norepinephrine acetylcholine. These 4, 5, 6 chemicals the interplay of these chemicals makes you sleep. There is a certain chemical like 5-HT it is called serotonin in plain simple language. Serotonin it is a very high level when you are going off to sleep and as you sleep serotonin levels falls alright. The other chemical GABA increases. So, this complex interplay I will just I will come back to this slide once I show you what is the normal sleep cycle. This is like what is the function of brain basic function. Have you heard this word called homeostatis? What is it gaining balance? Brain has to gain balance if it is going too up too much up it will bring it down whatever a process if it is going down it will bring up. So, all these signals like you see this circadian rhythm is the free flowing cycle in 24 hours and brain controls this and this is how it controls 9 a.m. 3 p.m. Day light all these things information about light information about your hormones information about temperature information about your food status information about your glucose level your natural running rhythm brain balances into creating a cycle of wake and sleep right. This all can be overridden by your thought this all can be overridden by your emotion. If there is no problem you may actually sleep well and all there is a problem you may lose your sleep. So, thought can again overwrite the whole thing we all know as you grow old what happens? You can lose sleep at every small thing you lose sleep in love you lose sleep in exams you lose sleep in death you lose sleep in when you are too happy when you are too sad and you grow old you sleep hours decrease what I call is the quota decreases. So, if you have a quota of 5 hours and you nap off for 2 hours in the day then you will only get 3 hours what to do? Young people sleep more these are the stages of sleep let me see this in the slide just see this previous slide and then I will tell you you read this words RAM SWS stage 2 stage 1 all right. I am just telling you the normal sleep cycle. So, there are people who come to me and tell me that I dream a lot is it normal yes or no dreaming is normal it is like a movie watching every night watch your own cinema the only trick is that you cannot remember most of it sometimes. In fact, lot of great discoveries have come out during sleep only like there was this there was this guy who discovered a chemical called a style colon in the brain right. He was trying to find out how and how the nerves the brain cells communicate with each other. Electrically they had seen they had seen a frog's nerve they used to induct electricity the leg used to jump. That means electrically we know what happens they are different neurons how are they connected to each other because there is a gap between two last time we saw it they are 100 million neurons with 100 million connections and all that. This guy was so tired and he was sleeping in the night he saw like the two tubes and at the end of the one tube there was a drop which came from nowhere and it went into the other tube and he woke up that is what happens in the nerves electrical signal comes till the end of this neuron the electrical signal converts into a chemical signal one chemical is secreted which goes to the top of the other neuron and this chemical signal turns into electrical signal in that simple very intelligent. So, you can create a space and between these two chemicals work rest of it is electricity now this chemical disturbance chemical fall the level of chemical in the brain level of chemical between the two neurons determines whether you are healthy whether you are ill whether you want to sleep whether you want to eat. So, we are just robots are we controlled by electrical and chemical signals. In fact, we are because however hard you may think and however strong you may think unless you train your mind really to control these chemicals which we do not know right now. So, if a certain chemical like serotonin I am just giving you a very very basic example like suppose in a certain area of brain between this set of neurons and this set of neurons should be say x number of serotonin molecules right and it decreases to say x minus 10 x minus 10 can create anger x minus 10 can make you angry x minus 100 can make you feel suicidal really that this happens in a certain area suppose you make it x plus 100 you may suddenly without eating you may start feeling very full all this drama is continuously going on in the brain this is how it happens serotonin falls there is a acetylcholine increases and you switch from one phase of sleep to another all mathematically done very well controlled very well controlled nature I think is the biggest mathematician nature knows where to play the trick how much to control. So, what you happen when you going up to sleep you go into stage one which is the lighter stage of sleep then you go to stage two even further lighter then you go to stage three and four stage three and four is deep sleep. So, people actually complained that I have not slept well for very long are the people who have not gone into stage three and four for very long that is a real restorative your relax your body is relaxed your respiration is working at a slow process your mind is silent your mind is not into lot of activities your brain waves slow down you can and then after 90 minutes the first dream period triggers off what we call a dream period is REM rapid eye movement you see this word called REM this is rapid eye movement. So, we got this rapid eye movement and then we called the rest of the stages as non rapid eye movement and then you dream for 20 minutes then again you go back to stage two three four then again you dream for 25 minutes then again you go into stage two three four then again you dream for 30 minutes as the night increases the dreaming period increases and the deep sleep of stage three four comes down that is why most people when they get up in the morning are actually dreaming the longest dream periods happen towards the morning deep sleep happens in the first half of the night and dreams happen later on and as you grow in the night then dreams become more elaborate and more lively. So, do people dream in the deep sleep and why is it called rapid eye movement it is a evolutionary process I told you about the cat when the cat is sleeping the eyes are. So, when you are dreaming can you act on your dreams yeah any other ideas why nature can you when you are dreaming can you act on your dreams what you are seeing can you do it the action no no when you are sleeping every night and you watching a dream can you act on those dreams regulate you can with lot of training what I am saying that suppose I am dreaming that I am dancing with whatever Karina Kapoor Karina is not there any ways can I dance at that time now if you act on your dreams it is a disorder it is a disorder this is what I love is this see it is a beauty you should be mystified by the whole thing if you start acting out in your dreams you will hurt yourself and others. So, what the mind does it paralyzes your body your hands legs everything is paralyzed the only muscles which are working one is this breathing apparatus. So, that you breathe and do not die and second is a eye movement which we call rapid eye movement both eyes are moving your eye your eyelids are closed what your eyes are moving and your breathing you do not act out in your dreams if you start acting out in your dreams that becomes a illness there are certain medicines which we give for other things those medicines can disrupt this serotonin level in those people some people act out on their dreams and they actually hurt, but why has nature done this what is the point if eyes are not moving rest of the sleep this also should stop what do you do when you watch a movie your eyes move and the movie is going on in your head at that time your eyes are moving you are dreaming this is a visual dream going on in your head right, but this again is a evolutionary thing when people used to sleep in jungles there were lot of predators and you had to save yourself from them. So, all this scanning and the lighter stage used to help them scan the environment that evolutionary trait has come down to us we are still scanning the deep in security of getting predated is still there in us whether we have built houses or castles or whatever nature knows that it is not going to work actually does not work when it happens when it happens it does not work. So, that scanning may be someday it will be very useful for us this is one evolutionary thing the second dream as I told you are important for information processing we also dream in the deep sleep have you heard of something called thought dreams is a difference between the dream of deep sleep and the sleep of REM period REM period is visual dreams how many of you see colored dreams or dreams black and white colored full colors it was always so we do not know because the plethora of colors which we see these days the bright and the artificial colors which are being created maybe they are altering the whole gray scale to colored possible, but the they are dreams in the deep sleep they are non visual dreams they are non visual they are verbal dreams actually the people who write scripts in their dream and sometimes they are just words though, but they are it is rare it all depends on what is your orientation of pressure on your head. So, you can have your thought dream verbal dream in deep sleep and so as I said it keeps going up and down slow wave sleep is characterized by 0.5 to 2 hertz synchronized EEG EEG is the recording of the brain electroencephalography like you have electrocardiography you have electroencephalography brain normally as I said muscle atonia eye movements desynchronized EEG if you do a EEG of the brain normal in a wake stage will you find synchrony or desynchronized brain will you find one type of activity throughout the brain no yeah brain normally has a desynchronized EEG if you have record from various parts have been to go into deep or come up you will find different activities all together brain only gets synchronized in electrical activity only in two or three situations one is what you know as epilepsy when people have epileptic fit the brain synchronizes when you are in coma or when the body is in deep sleep that is the only time when brain synchronized otherwise brain is running it alters and you find different electrical activity normal activity of a awake is what you call a alpha wave 8 to 13 hertz yeah the maximum in the back here is are we visual animals we are animals that is certain no argument about that are we visual animal or are we oral animals see how the nature evolved we bank more on eyes or more on ears we survive through eyes what is more problem if you do stop hearing or you stop seeing if you stop hearing there will be more problem or you stop seeing there will be more yeah but our brain is still geared to visual cues see hearing what evolved first seeing or language so evolutionary thing is older brain starts developing from visual cortex the part of the brain and the it is here right not in your eyes and the thicker layer is here so these are 8 to 13 hertz wave which comes from here call alpha wave in awake state I in a resting stage that is good for your mind I give you some activity the activity increases from 13 to 20 hertz alright and you sleep it comes down to 4 to 7 and deeper 0 to 2 hertz so brain can alter all that there is a clock or generator or whatever is fitted in the head but it keeps regulating why I am saying we have visual animals because if you close your eyes this electrical activity will change if you open your eyes it will change if you close it will alpha alpha waves will increase if you open they will decrease as you give stimulus to the brain the brain keeps changing it is still q 2 eyes now what happens is that because the language and all these things sound and everything came later although in the mythology says that the word came first and then rest came oh we started everything but anyway that the oral system is also very powerful it is again q 2 lot of it once suppose somebody does not see then the mind cues to all this so it was always easy to hit arrow while seeing or to shoot when you see it is always very difficult to hear the sound and shoot try that do not try driving with your eyes closed you want to cue to the horns and then drive done actually Kanpur you can do it Kanpur you should only drive with your eyes closed only respond to oral cues oh yeah this is very important this is how we record the brain you put electrodes here here here and what we see I will just show you but see this what is this owler lark how many of you study better in the morning none of you how many of you study better in the night right for law I am 48 years last 43 years I have been trying to get up in the morning and study and I gave up I gave up 20 years back since then I have never tried right and I have no shame for that people ask me to get up in the morning go for a walk I have never done it in fact once I went and I got shocked actually went few steps and then I sat down and I watched people walking I was wondering what is the problem here why do not they go and sleep why the running in the morning 10 kilometer what is the point and then I stumbled when I started doing my sleep research in 93 in in the man's and then I realized that what we defined in last 17 years in sleep is people have their own rhythms in the body some people are night owls some are morning larks so we are either night owls or morning larks it is about identifying your rhythm but again as I said this is not a very very clean categorized boxes of behavior they are just variations but people can vary according to need but largely your core rhythm remains the same if you are a morning type person you will remain a morning type person come what may and you will disturb others if you get up and if you are a night person you will keep away given if you want to sleep at 10 o clock you will not get sleep so it is best to identify your own systems and work according to that this is what we do when we record a signal from chin also because we want to identify whether it is a dream sleep or it is a non dream sleep muscle activity tells us if the muscles are relaxed this is the type of pattern when you do a recording of the brain while sleeping is all like let me explain it to you this is the chin it tells you the muscle activity this is occipital here brain waves from here these are brain waves from center so when you put the whole electrical activity in a pattern then you know which phase of sleep you are initially it used to be very difficult what we do what we call this is something called polysomnography polysomnography poly is multiple somnose sleep graph is record initially when we used to do this we used to get records like this and now if I tell people who are doing sleep research now they look at it like a awe or maybe they hate us but what we used to do in the initial years from 1960s to 95 60 live was doing we used to do this whole reams of papers of paper recording and analyze sit and analyze each frame like we divided the whole thing into 30 seconds frame epochs frame by frame 30 second epochs we were recording whether it is stage 1 stage 2 and then sit back go back again and calculate how much was stage 1 stage as a very painful process but anyway 98 around 98 and 2000 all these things started coming in so I have personally done all this paper epoch reading and so you do a recording for 8 hours then give another 3 hours to score the data for 1 night now it is easy now you just put in all this wires and you can measure respiration by putting a small transducer here and you can measure hand movements and all that putting some wires here and then you get just press the button and computer will record and press the button will give you report also and you can charge your money happily. So, this is the type of stuff which we see I mean you do not have to go into detail once you are done then you have this type of record it will exactly give you computer will give you how much of deep sleep you have how much of REM sleep you have and I will escape all this because this may not be of interest so what do you do when people come with sleep problems as doctors we have to take all this history you have to look at complaint you have to look at sleep schedules we have to check the medical history you have to check about substance abuse because all this substance abuse but this is the most important person when you are taking a sleep history bed partner and I do not say it is spouse wife husband whatever it can be a bed partner whoever it is the sleep pattern has to be checked from the bed partner because this person who is having a problem may not actually realize what is happening the other person gets disturbed by the snoring by the repeated jerking of hands and legs by when people a lot of people who talk too much in the sleep and they always afraid that they may leak a secret but it has never happened in fact I know so many people they would talk a lot and in the daytime they are anxious but I have never seen somebody some spouse or bed partner coming up that our marriages or relationships breaking on this issue that this word came out and now who is this why it is important but but partner is at least for one in one type of illness which is a very very common illness 30 percent of Americans have it in the 30 percent of Indians are going to have it the lot of road accidents which happen because of it there is a lot of morbidity which is happening with something called a sleep apnea. So, you have we have to check whether there is a episodes of snoring 40 percent of we I will just come to that illness because there is something which everybody should know for jerking for gasping whether there is a episode when the breath stops in the night and another mood changes and all that. So, let me just briefly tell you about the type of problems which we see and any any of us can suffer from all this it is a medical thing. So, it may not be of direct consequence except for doctors but it is very important for people to recognize that there is something called sleep disorder like any other illnesses like we are identified depression like we are identified diabetes cancer like we are identified people growing thin and fat. So, similarly the type of problems which people face is in very simple language either this do not sleep which is called insomnia or the sleep too much which is called hypersomnia right. And the third is disomnia as you do not have a comfortable sleep because of various reasons and the fourth is what you call as circadian rhythm disturbance. This is also very common for people who travel too much or work in shifts for students a lot of students suffer from circadian rhythm they have to study at night get up in the morning go to lecture. Similarly, shift workers have one week you are working in the night the next week you are working in the day time when you travel across time zones from west to east. Pilots time zone travelling is one of the major cause for it and parasomnias you are sleeping but still you are doing lot of things which you do in the which you should not be doing in sleep like talking in the sleep walking in the sleep acting out on your dreams. So, I will just try to briefly tell you what all disturb can disturb insomnia let us look at when people do not this is a common complaint not getting proper sleep. So, there could be a problem in quality that you cannot get sleep or you sleep and you get up early in the morning or the whole night you are not very comfortable. Most people will get up the commonest complaint right now is that people say when you get up in the morning we feel that we have not slept the mind has been working all the night their environmental causes for it non refreshing this is the commonest complaint non refreshing is a subjective perception that I have not slept in the night. Now, duration wise this can be very very transient may be for two three days when you are stressed you do not get sleep or a short term from two three days to say six months or it can be a chronic thing it is ongoing thing where you are not getting proper sleep. The cause can be either because of it can be a primary thing like a sleep disorder in itself everything else is fine but you are still getting a sleep disorder that is very rare the sleep disorder in itself is very rare. So, it has to be secondary you are either medically ill or you are having a psychiatric problem or it could be environmental like for some cities in India it is hugely environmental the noise of generators the noise of electricity going up and down fan going up and down ACs all this noise apart from this noise level in the society has generally gone up during the day time with automobile television lot of people who keep watching television it is a noise after all. So, it can take off your quality one third of population in one year suffers one sixth has serious problem one twelfth has chronic women have more than men elderly more than young. So, we will just Indian India is a standard thing one good thing is that whatever epidemiology has shown is more or less standard across the continents and all that that is probably I do not know it is because of globalization or what similar lifestyles evolving and similar type of you would not find much difference between somebody living in New York and Bombay may be there is a difference in nobody honks on the road, but largely structure is the same I have cut down this the complaints as I said daytime drowsiness daytime drowsiness is directly related to not sleeping fatigue lack of concentration anxiety depressive symptoms feeling of mind working during sleep this is a very common thing your stress in your mind keeps working lot of patients are depressive patients otherwise normal people when they stress they think a lot and impaired quality of life. So, poor sleep what we find is temperature dysregulation the temperature should be lowest in the morning, but when we measure it is very high no delta waves delta waves as I said 0 to 2 which is the deepest sleep the deepest sleep we do not find oxygen consumption changes there is no peak in growth hormone. In fact, there let me give an example there was a kid who was all was not growing up and all other investigations were normal, but the the doctor who was seeing obviously did not know all this final details of sleep. So, finally, they send it to a psychiatrist and it may be something else is wrong psychiatrist had some know of know how of sleep. So, he checked out whether the sleep is ok or not and wonderfully some medicine was given to correct the sleep and within one year the whole growth had resumed just by simple manipulation of sleep because growth hormone is cigarette in the deep sleep. So, if there is no deep sleep growth hormone is less and that is one reason why kids who are having problems who are restless who are not sleeping well or very fidgety angry the emotionally disorder lot of parents insist that do not give medicines, but why medicines should be given is this because that is the growing phase you can keep doing behavioral techniques for rest of your life beyond 18 you have all the time. Behavioral techniques should be done but behavioral techniques in itself are not going to do anything. So, medicine actually that is the growing and learning period. So, if you can treat by this final adjustments, but anyway I mean whoever prescribed should know why they are writing the medicine especially with children. I will skip this data as I said primary insomnia is rare early onset brain stem defects long term treatment is required. Secondary is very important psychiatric illnesses depression anxiety grief schizophrenia medical can be migraine asthma pain acidity what you call acid peptic syndrome gastrointestinal symptoms. These are stress most common you have stress all the time environmental factors as we said substance abuse is going up in the society. Alcohol use is really short up smoking and all that and everything alters if people think they can drink and it will not 6 percent it 6 percent it it provoked the desire take it away the performance about alcohol. He was talking in a sexual context it provoked the desire take it away the performance. So, alcohol does this people think they can have two drinks and then sleep one or two days five days ten days they can have it, but beyond a certain time alcohol destroys the sleep architecture. And that is one reason when people stop alcohol they get into a withdrawal syndrome insomnia is one of the first withdrawals in symptom that is because that whole sleep architecture is gone sleeping pills sleeping pills should not be taken for very long period. Psychophysiological sleeplessness phobia this is the this is what people get into nature somehow has done it in such a way at least the two activities which cannot be done while you are thinking one is sleeping the other is sex both these things cannot simultaneously go on with thought because if you think you cannot do it and that is the loop where people get into in both cases lot of you ask any psychiatrist who is treating people with sexual dysfunctions physically they are all right mentally they are it is all in the head they are watching themselves and same is with sleep try this try sleeping sometime when you are actually not sleeping tell you mind that I want to sleep you will never get sleep more you try the more awakened you will get what happens so when people get sleep disturbance they get into this phobia suppose they have to go to sleep at ten o clock the mind will start working at six o clock in the evening what if I do not get sleep I have to sleep what if I keep awake what will happen now they will keep fighting this so when they go to bed the mind is already heightened up it is worried it is attempting hard muscle stands mind stands I have to go to sleep and when your muscle stands and your mind stands sleep is a reverse process and then you try to sleep you do not get sleep again you confirm your own hypothesis see I told you I cannot sleep no see I cannot sleep is self created but then once it starts and it is done for three four five days the switch is on so anyway diagnosis is the clinical thing polysomnography finding we keep doing it every day so there is a people who have problem they sleep later there is a decreased slow wave sleep increased muscle activity subjective misperception is something which when you record these people there is a adequate sleep onset sleep architecture is normal everything is normal but they still feel that they have not slept what happens is what we call a cognitive biological discoordination biologically you are sleeping but the thought part of your mind feels that you are not sleeping so when you get up in the morning it is like I have been awake it can happen to all of us in periods of stress but these people have persistent complain so the mind does not feel that I have slept mind can feel anything you may actually sleep for ten minutes and mind can feel that fine enough again as I said it is a daytime thought which determines let me just not burden you with medication and all sleep hygiene have you heard of this term have you heard of personal hygiene we take bath every day how many of us bother about sleep taking hygiene of the mind now education is for the people who have sleep problems they have to be educated about sleep the process second is that you have to your body sleep is linked to lot of cues in the environment so these are suggested to which should be done on a daily basis by average people also but anyway once the sleep is disordered you have to do it as a treatment exercise late afternoon or evening is always better for sleep than morning exercise so if you have to sleep at ten o clock is better you do exercise at six thirty yeah no you know it is like your body gets tired at that time and the body has to relax it is already a sleep time you do it in the morning then obviously it is a we will still feel one of the yoga gurus in this country who is a successful businessman also suddenly caught the attention of this country and everybody said I said what is the benefit we are sleeping well so I said tell me what is the routine no we have to go to Babaji's camp at three thirty in the morning I said what Babaji you get up early in the three thirty in the morning you will anyway get sleep so he used to wake up people at three thirty make them walk four thirty till to their camp or whatever these are the people who happily sleeping till eight o clock in the morning so anyway sleep will improve simple technique but there is no you do not need a rocket science died limit fluid near bedtime drink less near the bedtime do not sleep empty stomach lot of people who eat food at eight o clock and sleep at twelve o clock and then they take a breakfast till say eight thirty in the morning twelve hours of empty stomach can disrupt your sleep because of the acidity so that British system is fine seven o clock dinner and whatever supper or whatever you have to take at nine thirty ten little bit light snack but anyway it may suit or may not suit but heavy meals in the night always create problem avoid stimulants alcohol and smoking evening bath with lukewarm water two point five to three hours before bedtime is a good trigger for sleep so people who are not getting proper sleep if they just two couple of these things and mattress and temperature noise obviously we cannot control all this we can I think have a good mattress at least go to bed when sleepy use bed for sex and sleep only lot of people when they do not get sleep they try to compensate in the daytime and if you check most of them would be lying down in the bed for everything reading book watching TV everything so put the light out put the light out if no sleep in twenty minutes get out of the bed this is the most difficult part we advise that if you do not get sleep get out of the bed sit read do anything do some light activity move to different room till sleepy again come back to bed again you do not get sleep for twenty minutes go back again keep doing it till you start getting sleep twenty minutes it may be seven times in a night it may be ten times next three days but eventually we will start sleeping what happens is that suppose people do not get sleep they sleep at five o clock in the morning then they sleep till ten they will compensate five hours are already over so your whole phase of sleep is already shifted in the night its phase advanced phase delayed rather your cycle is gone three days your cycle is gone permanently so what is so you do not compensate if you get up at eight o clock get up at eight o clock whether you have slept at quarter to eight does not matter then what will happen three four days later you will start falling asleep in the night in the right time suppose you do not sleep and sleep from five to ten five hours of sleep you already taken in the process what have you done is delayed the night onset of sleep lot of people who sleep in the daytime for two hours they cannot get sleep in the night because it is obviously it is a quota suppose you have a twenty percent of your quota is deep sleep you sleep in the afternoon twenty percent quota is over so what is left is all this jumping around in the night wind down before time now this is this is something which is very important keep worrying time separate I tell people the most people complain when I go to the word I am thinking I said why are you thinking at that time you finish off your work sit for half an hour take a pen and paper worry worry yourself to death and then once you are sure there is nothing more to worry nothing more to think for that day at least now if you want to worry you can worry endlessly but everybody has a quota of worry now shut down your copy relax and wind down and go to sleep this is a skill which has to be developed how many of us have worry time should be a well defined worry time no issues close your eyes sit let everything come into your head whatever remains after 10 15 minutes think about it find out a solution what you are going to do tomorrow what you are not going to do shut it off anyway you are not going to do anything in the night now all my friends there are 500 people in this country who are like me no before I advise them they do not have before and that is what I do most of the time it is about training it is all training you tell your mind anything it will start doing it see I do not ask people to not think when they are involved in creative thinking I will do not stop myself also we are writing a script you have to think you are thinking about some theory you have to think but there is a difference between worry and thinking there is a huge difference worry is a ruminative thinking you observe worry sometime worry has a very very typical quality and he can tell you more about worry the psychology of worry is that worry is very very restricted number one it is like ruminative same set of thoughts will keep worrying you and they will not lead you anywhere like you give exam and your one paper is gone but what happens why are you worried about it now why are you worried anyway it is gone anyway you are out of the classroom but you will keep worrying till the teacher calls you up and says keep finding a pass and he just tells you pass and you feel happy all your worry is gone but it is such a absurd thing it is totally absurd you had read a subject you some questions were asked you replied you knew or you did not know if you did not know you should come back and read it for your knowledge sake if you knew you have answered copy is not in your hand it is with somebody else you are bothered about that somebody whether is giving you marks or not instead of doing what is in your hand so worry has this irritating quality but half the human race is worrying all the time more than half I think 90 percent people just worry it is only 10 percent who are slightly about it try try it will work always true it is a fact most people see there is nothing to do you are restricted bodily also restricted and people do not know how to travel in mind otherwise they could be there KLM flight and still be in their village or wherever they are going that is a that is trick of human mind to focus on what you are doing right now is very difficult what you have right now is this no that that is not is it must have been at some time now people are very comfortable one reason is they board they have 18 hours flight they get bored what to do somebody tells you fly from Bombay to Sydney is 18 hours they said 18 hours you can't how much you will move how much exercise will you do so that the boredom is the real thing and it see most people also cannot read throughout even if you carry books nobody reads I have seen it most people cannot read it the movie something which is passive it keeps coming to you and so evokes reaction and all that this is the type of activity which should be done when people are not sleeping passive how which is they do not have to apply your mind keep watching but most people get into something very very active and so anyway that is see there is nothing hard and fast about sleep whatever suits you if you don't sleep and you are happy wonderful you sleep for three hours and happy wonderful if you are not sleeping in your problem it is not wonderful it is it is plain simple when you are working and do not try to sleep is the trick do not try to sleep drugs obviously is a preview of doctors but ideal medicine which should have no side effect no residual side effect it should have a rapid onset it should not have tolerance tolerances that you take one pill today then you have to take three pills three days later because one is not working and no dependence when you stop medicine you should not have withdrawal effects but that medicine we don't have actually right now these are just group of medicines I will skip these slides and tell you something very interesting I think these slides may not be very relevant is all medicines and they keep coming every now and then in the market sleeping pills are the most widely prescribed drugs all over the world by all physicians irrespective of their specialties people are more addicted to sleeping pills than to air I think so and WHO says that by 2020 every second Indian or third Indian will also take so I think we are moving fast hypersomnia as excessive sleep it has various very interesting illness called narcolepsy people suddenly they are doing something and they get into this episode where they are excessively sleepy and they have to sleep it was found in dogs first and then it is in human beings rare but but other depression and sleep related breathing disorder there is a syndrome called kumkaran syndrome we wrote a paper from Levan's Klein Leven syndrome where you don't find any cause the person goes into a episode of sleeping for days together not getting up not eating not anything sleeps and then gets up and becomes totally normal maybe kumkaran had all this really no they did not know whether this was the illness or not but kumkaran definitely had a syndrome he must he must be having what you call obstructive sleep apnea sleep related breathing disorders are very common what happens is what you call apnea and all of us in our families will have people and it should be treated simple because I will tell you why I just keep this narcolepsy thing it we don't see it in India much although I have seen one case in the man's but largely ordinary doctors they don't come across all this ordinary means not ordinary knowledge in the general setups these are all very very specialized this is mismatch between internal oscillator and external demands like pilots like travel across time zone hypersomnia fatigue distress delay I was talking to many train drivers yeah yeah they are not sleep at night they are all they have run a train and come say check in the traffic from Delhi to come right after they come back home they are not sleep throughout the night they can't sleep go to the market and go all that no this is very interesting I was watching this television in one of the soaps Chidiagar there is this character who is a ticket collector so in his house he has he doesn't sleep in the bed he has made a birth which he folds in the day night he opens up with the chain and all and sleeps and made a window which is opening to the compound like a train window then only he can sleep so any parasomnias are physiological phenomena which appear due to activation of failure to suppress during sleep some of these are very interesting because these are common also nightmares all of us you know the English word nightmare all of us had it kids have it they wake up suddenly in the night sweating and crying and all that so it could be they must be seeing a bad dream but these are very common things of kids grow out of it versus they something called a night terror night terror is not associated with any dream so waking up from a bad dream is different from suddenly getting a situation where the child is very very restless and but nothing is to be done just consolation hold the child things will go off the talking in the night or walking in the night you will see a lot of movies on this right all the good ones was a film called Hamosh by we do you know Chopra in initial days and there was a film where Nargis used to whether Rahman Rathur then so lot of people lot of people mumble and talk and all that jokingly I tell them I suppose the wife which wife which come and say we talk slot in the night I said you allow him to talk in the daytime stop talking in the night anyway but it's a it's a not a illness it's a physiological variation unless it gets serious you don't really treat it for kids it's very very simple kids having sleep problem they should they should end their play they should not go to the bed tired what the assumption is that if they are doing it and the tired and goes off to bed that is not for kids whatever tiredness the activity they have to do they should do it and finish it at a certain point of time from that time they should wind down slowly do more sedentary activities read or comic or drawing or whatever so that when they go to bed the muscles have already relaxed it's already self limiting about fatigue fatigue should be avoided and you can't if child is having problem there is no point shouting at him you have to protect that child doesn't heard and do all that stuff but these are all lot of people when they get up they are confused really believe me these are entity like this confusional arousals when they get up they really don't know which way I think they are happy people get confused when they wake up into this world you're sleeping happy don't want to get back to all this but then these are all small tidbits here and there let's see this this is something a lot of medical illnesses which happened during sleep Bruxism like people grind their treat is a common problem with some kids who have nocturnal nervous is the past urine in the bed in the night which most kids have a control over bladder by five or six years of age but some kids during the time of stress they against again start doing it human beings this is this is the mind this frontal lobe controls everything in extreme states of fear in extreme states of insecurity people urinate even adults mind just loses it RAM behavior is what I will just end with this people who start acting out on their dreams normally body is paralyzed but some people when they are dreaming they start acting out so when people shot shout too much in the night of throwing their hands here and there always suspect that there is a possibility of because there is a risk the person can hurt himself for and this is very well treatable situation okay so we will just keep this sleep in psychiatric disorder well let me just finish it with the obstructive sleep apnea obstructive sleep apnea is a disordered breathing during sleep when people lie down this the palate falls back and already the flow of air is restricted for some people the soft palate which is a hanging thing just goes and hits the back wall so there is a you whole lot of problem in ox air coming in and out every time the air cannot the body the mind throws it and the mind gets awakened in the process in the process what happens is that one remains in a lighter stage of sleep all the time oxygen levels keep falling from 98 to 90 to 74 40 percent snorers have that and what the typical is that the partner will tell that the snoring increases in a crescendo reaches a peak and suddenly for 10 seconds it feels that the person is stopped breathing they can also shake their hand or have jerks or something like that and they are multiple opposites like this during the night hundreds and all so what happens is the people start feeling they term drowsiness they start having hypertension cardiac risk and all that so if you have if you know that somebody is having this problem it is very easy it is treatable by a simple machine called CPAP continuous positive air pressure while you are sleeping just plug the machine put the mask on your nose sleep happily it will take care of all these episodes of apnea and quality of life will change by 180 degree so we will end at this if there is anything you want to ask check anything the circadian rhythm is the rhythm see there is no clock fitted in the head they are both cute both cute see the don't don't go by the word clock which we use this is a digital clock or that is analog clock from cesium atom and all that clock which we use for our survival is different biological clock is the rhythm inside circadian rhythm is a circadian is from 24 hours so there are other rhythms in the body also they may be a rhythm for you a yearly rhythm they may be a monthly rhythm menstrual cycle so biological clock will also control menstrual cycle there is some connection that it has to have a 14 days and then so there are lot of other things like you food digestion everything I mean it is it is not about just sleep circadian has been said it is a frame of 24 hours biological clock is the real rhythm circadian is 24 hours you have you can put 48 hour rhythms will look at 6 monthly rhythm whatever so that clock keeps working obviously there is a clock because otherwise you wouldn't die you should see a film called in time watch it