Review of The Nocturnal Brain by Dr Guy Leschziner

Dr Guy Leschziner is a busy man. He is a consultant neurologist at several London Hospitals, clinical lead for the Sleep Disorders Centre, Guy's Hospital[1], one of Europe's largest sleep units and Reader in Neurology at the Institute of Psychiatry, Psychology and Neuroscience, King's College London [2]. He has also written a beautiful and interesting book, deserving a place on the bookshelves, not only of insomniacs, but also those who like stories, science, and want a greater understanding of the human psyche. I read it straight through, on a train from Cornwall, and was sorry when it ended. That’s a treatment I usually reserve for novels.

There’s another thing about Guy Leschziner, and it almost feels as though I am breaking a taboo to say it. He’s a nice man. I am fed up with authors whose works knock others, who use “humour” to belittle, whose grandiosity interferes with their ability to appreciate others.   Our world needs more kindness, compassion and tolerance, and it seems to me that Guy Leshziner has this, that he listens, and uses his considerable intelligence to seek understanding and explain.  To me, this ability has greater benefits than just making us feel better: it engenders trust, so that information flows faster and more easily, diagnosis is more accurate and patient satisfaction improves.  Not surprising that it was he, rather the many doctors who had gone before, who discovered that the client referred to the clinic when his girlfriend reported him saying frightening and abusive things in his sleep was actually the victim of a lying partner.


If I had a sleeping problem I’d consider myself lucky to end up at the clinic at Guy’s Hospital. 

So what about the book? From the beginning I was conscious of my own pleasure in reading it.  I am a sucker for hardbacks anyway, but this is particularly nice example. I liked the author’s use of language, its layout, the paper quality, and its authenticity. Perhaps the unusual care spent on a book in this price range is a result of the bidding war for the rights, won by Simon and Schuster.  Sleep is big business. Matthew Walker’s “Why we Sleep”[3] has shown publishers the size of the potential market.


Martha Kearney, quoted on the cover, describes the book as “in the tradition of Oliver Sacks”, and indeed it is. Subtitled “tales of nightmares and neuroscience” it is made up of stories intertwined with teaching and insights, which seem to hark back to an earlier age. I can almost smell the bees waxed oak furniture of the early 20th century consulting room. I remember the impact of Oliver Sacks 1985 book[4]. Everyone I knew had a well-read copy, and yet those reading were unlikely to mistake their wife for a hat: we were curious, voyeurs, largely untouched by the phenomena described by Dr Sacks. In contrast, Dr Leschziner is writing about poor sleep, an issue experienced by most of us at some time in our lives. One in ten adults is a chronic insomniac. He describes extreme examples: a 79 year old woman togging up, unlocking her motorbike, and driving off in the middle of the night, waking in the morning without any recall of a trip undertaken when her conscious brain was still asleep; a middle aged man with such a pattern of sleep eating that locking his fridge results in him eating his parrot’s birdseed. (I was glad that he didn’t eat the parrot).  At the same time, there is plenty of content with which the average insomniac will identify. Some solace, in that some of the problems encountered are overcome, but this is not a “how to” book. It does not offer solutions, other than as understandings that may arise from the case histories (stories) presented. 


As for the “stories”, I hate most popular self-help/health books. I loathe   the case studies written in the same false voice, the packaged people put in boxes. It is a pleasure to hear individual voices in these stories.  This book is a page-turner, and that is because the people described have their own individual character, and as readers, we care about them.  As for the nature of the problems they experience, these include narcolepsy, epilepsy, sleepwalking, Kleine-Levin syndrome, REM parasomnias, REM sleep behaviour disorder and restless legs. This book should end any notion that sleep is the brain switching off. Rather it is a series of powerful brain states that are disassociated from consciousness, and when things go wrong repercussions can be dramatic. Sleep involves different parts of the brain and occasionally some parts of the brain (e.g. those that regulate movement) can be awake, whilst others (rational thinking and memory) are asleep. 


Whilst we know much more about sleep and the brain than we did a few decades ago, I am most struck by how much we still don’t know, and how inadequate our tools to detect the operations of the sleeping brain. EEG equipment was first developed in 1926, and the first functional MRI scanner was built in the 1970s. EEG data, collected via electrodes glued to the scalp, is awkward and time consuming to generate and provides only gross information of the electrical activity between points measured.  MRI scanners are expensive, noisy and confined spaces, not conducive to sleep. Accelerometer data, as collected by our Fitbit, can provide some insights, but is not a very good guide as to non-REM sleep states. . We need more detail, easily collected, for a better picture of the brain aberrations that cause unusual sleep behaviour. Until then the human skills of Dr Leschzinger and his colleagues are vital in diagnosing causes and determining potential treatments for the sleep problems a that are prevalent, disturbing and expensive in today’s world. I wish Dr Laschzinger many more stories, preferably with happy endings.


Anna McKay copyright 2019

The Nocturnal Brain: Tales of Nightmares and Neuroscience by Dr Guy Leschziner