We know that sleepwalking and these related conditions seem to run very strongly in families. There is a genetic predisposition to being able to enter into this disconnected brain state, and we know that anything that disrupts your sleep if you have that genetic predisposition can give rise to these behaviors. So, for example, I've seen people who have had non-REM parasomnia events [such as sleepwalking] triggered by the fact that they sleep in a creaky bed and their bed partner rolled over [or]
But there are also internal manifestations, internal processes that can lead to these partial awakenings. So, for example, snoring or more severe than snoring, sleep apnea, where people stop breathing in their sleep … anything that causes a change in the depth of sleep in people who are predisposed to this phenomenon of being in multiple sleep stages
On Sleep Apnea
Sleep apnea describes the phenomenon of our airways collapsing in sleep. … Our airway is essentially a floppy tube that has some rigidity, some structure to it as a result of multiple muscles. And as we drift off to sleep, those muscles lose some of their tension, and the airway becomes a bit more floppy. Now, when it's a bit of a floppy and it reverberates as we breathe in during sleep, that will result in snoring – the reverberation of the airway walls results in the noise
But in certain individuals, the airway can become quite floppy or is enough for it to collapse down and block airflow as we're sleeping. It's normal for that to happen every once in a while for everybody, but if it happens very often then what happens is that sleep can be disrupted sometimes 10, sometimes 20, sometimes even 100 times a hour, because as we drift off to sleep , the airway collapses down, our oxygen levels drop, our heart rate rises, our brain wakes up again and our sleep is essentially disrupted. …
We are now aware that obstructive sleep apnea has a range of long-term implications on our health in terms of high blood pressure, in terms of risk of cardiovascular disease, risk of stroke, impact on cognition and mental clarity . And there is now an emerging body of evidence that suggests that actually obstructive sleep apnea may be a factor in the development of conditions such as dementia
having a positive association with your bed
If you are a good sleeper, you tend to associate being in bed with being in that place of comfort, that place where you go and you … feel cozy and you drift off to sleep and you wake up in the morning feeling awake and refreshed. But for people with insomnia, they often associate bed with great difficulty getting off to sleep, with the dread of the night ahead, with the fact that they know that when they wake up in the morning they will feel horribly unrefreshed and unrested. And so the environment that we normally associate with sleep becomes an instrument of torture for them. And so many of the advances that have been made in this area about treating insomnia are really directed towards breaking down those negative associations that people have with their sleeping environment if they have insomnia and rebuilding positive associations. (19659037) On the problem with taking benzodiazepines and and  Ambien for insomnia
There has been a bit of a sea change in the last few years away from these drugs. We know that these drugs [are] sedatives. So the first thing to know is that they do not mimic normal sleep. They're associated with some major problems. Some of these drugs are, for example, associated with an increased risk of road traffic accidents in the morning, due to a hangover effect. They are associated with an increased risk of falls in the elderly, for example. And we know that people can develop dependence on these drugs and they can also habituate, which means that they require ever-increasing dosages to get the same effect
In the long term, there are now some signals coming out of the work that is being done around the world that suggest that some of these drugs are actually associated with an increased risk of cognitive decline and dementia. And while that story is not completely understood – and it may be that people who have insomnia in themselves are predisposed to dementia or actually that insomnia may be a very early warning sign of dementia – [it] surely gives us cause for concern that maybe we should not be using these drugs quite as liberally as we have done historically. And so so switch to behavioral approaches, approaches like cognitive behavioral therapy for insomnia, has been really driven by some of these concerns.
Provided you are not reading on a tablet or laptop, [and instead an] old-style analog book, I would highly recommend. It's a good way of reducing your light exposure. Keeping your mind a little bit active so that you are not concentrating on the prospect of having to drift off to sleep until you're really tired.
Sam Briger and Mooj Zadie produced and edited the audio of this interview. Bridget Bentz and Molly Seavy-Nesper adapted it for the Web