AWAKENING FROM ALZHEIMER'S - THE AWAKENING BEGINS.

[ihope]

Day 3
Dr Michael Breus
Sleep

very good interview. More directed towards management sleep disorders in AD and lots of very interesting information. Useful for everyone as it is generally applicable for improving sleep quality. He said if there is only one take home message it is that sleep needs to be consistent

Just one night of bad sleep results in defects of reaction time, emotionally irritable/over emotional, cognition decreased

Functions of sleep
every one has different sleep needs. just one hour less one night is not too bad, 2 hrs less starts having effects. What happens in sleep? probably multiple purposes. Not sure of mechanisms. Studies in the 1940s only started exploring sleep architecture so its a new field.

1.Sleep deprivation compounded over time : affects every organs system.
2. Immune function decreases dramatically. Flu shots given to sleep deprived people - less sero-convert. Cancer cells multiply faster.
3. Deep sleep: Growth hormone and bodily repair.
4. REM: information moves short term to long term memory.
5. Chronically poor sleep and the brain: If you have a genetic propensity, AD genes can be affected.

Sleep cycles
Sleep is a dance - stages cycling. Different things happen in each cycle - 80 to 120 min, average 90 mins. Average person has 5 cycles - 7 1/2 hours. 8 hours is a myth. (lol mine is exactly 7 1/2 hours). (Different during adolescence - another purpose of sleep is development and growth.)

All the cycles aren't the same - first part of night is deep sleep - growth hormone, cellular repair. In the last third of the night is REM sleep and mental restoration occurs. So if you wake early you cut off the REM sleep and its cognitive effects. So if you go to bed too late, you shift forward and miss the last sleep cycle and miss the last REM cycle. REM sleep deprivation results in poor memory eg cant find keys, walk into a room and forget why you are there etc.

Sundowning
People with cognitive decline - their amount of sleep shortens as a result of the cognitive decline. Almost as if they become a shift worker, also napping during the day. Sundowning is an interesting condition, melatonin production in the early evening in those with AD has a paradoxical reaction of agitation - they get sleepy as their melatonin accumulates and they are tired but they get cranky and disinhibited and more confused. . Here light therapy is of help. Commercially available on Amazon, 460 nanometers, not very expensive. Switches off melanopsin and melatonin in the early evening. Used in sundowning from 5pm to about 7 to 8 pm and reduces the agitation.

Medications and sleep
Some meds for AD (eg Donepezil/Aricept) or Parkinson's cause insomnia which or changes circadian rhythm and aggravates agitation and memory issues.

Melatonin in AD
Data equiviocal. Melatonin is a hormone. Beware of purity standards. Some are pharamecutical grade, others not. 95% are sold in overdosage format. Adult dose normally half to 1 mg. When one ages, about 58 to 60 years, melatonin production decreases. Start low dose, takes 90 mins before want to fall asleep. Check there are no drug interactions eg beta-blockers, cardiac drugs.

Magnesium
He likes magnesium. Bananas. Peel of magnesium 3x magnesium than fruit. Boil sliced banana with skin. Use water as tea with cinnamon or honey. (ugh)

Two drivers of sleep
1. Sleep drive: like hunger. Adenosine builds up during the brain. Same structure as caffeine, which blocks adenosine receptors.
2. Circadian rhythm - body temperature drop at night drives melatonin release. Routine critical. napping not good for circadian rhythm - try to keep active during the day. Light in the morning. Light boxes or sunlight. Exercise in the morning - improves quality of sleep.

Hydration
breathe out a litre of water when breathing thru the mouth while sleeping.

Daytime naps
Try and keep to normal bedtime or waking time even if one has had a disturbed night as a caretaker. Sleep needs to be consistent

sleep apnoea
Weight gain an important factor causation wise. Results in refractory hypertension. Difficult to use CPAP in AD. Can use oxygen cannula. Can use mouthguards that advance the mandible.

Restless leg syndrome and periodic limb movements.
1. Caused by lack of dopamine sometimes.
2. Iron deficiency often associated - ferritin should be more than 50 and this fixes the restless legs.
3. There are some meds available.

Food before bed
1. Alcohol not a good idea
2. Don't want an AD person to go to bed hungry - "hangry" makes them agitated. Insulin resistance?
3. GERD flared by spicy food will disrupt sleep
4. He admits he is not a nutritionist and doesn't know much about food and sleep

Prevention of AD
1. consistency of sleep - bed time and wake time. The latter is more important even if you go to bed late one night - always wake at the same time
2. Sunlight. Go out every morning and get 15 mins sunlight
3. If you find yourself forgetful in the day - look if you snore and get sleepy in the day- check for sleep apnoea.

thesleepdoctor.com

After listening to the interview on sleep on this summit, I purchased Dr.Mark Burhenne's Book (The 8 Hour Sleep Paradox). It has been the most helpful resource I have found on Sleep apnea . What struck me the most was his explanation about the Range of Sleep Disordered Breathing p33. It made me realize that any amount of interference in healthy oxygen levels during sleep has an impact on the body. He also mentions numerous symptoms / disorders that can be related to less than optimal sleep. I brought his book in to my recent dentist appointment and asked her to do an assessment of my mouth anatomy as was described in this book. One of the two tests indicated I may have a higher likelihood of a sleep disorder. This is info is just a piece to the puzzle to explore if it is a problem for me. Dr. Burhenne has checklists. He discusses ways to get sleep apnea assessed as well as individualized treatment options. I purchased an apple app (sleep tracker) as an initial place to start in determining if I or my husband may have some level of sleep challenges.

[KatieS]

welcome ihope. Very impressive dentist to note your anatomy likely to strangle your airway every night. After I was diagnosed with sleep apnea, my hygienist noted that my tongue seems to obstruct my airway. I'm not familiar with Dr. Burhenne's book, (I will look at now) but Dr.Bredesen discusses having sleep apnea ruled out multiple times in his book. Beyond an app, you'll need the overnight oxygen sensors, nasal and body straps worn in your own bed at home. Of any intervention that I've done for E4, treatment of sleep apnea has been my silver bullet towards improved cognition.

[floramaria]

I found this summary thanks to floramaria.... I listened to these interviews but my notes are sparse. thank you for the time you took to take notes and your comments / impressions on these sessions. Both are valuable.
Karen

Hey there, my friend! So happy to see you here. I was just reading unread posts and stumbled onto yours.

[ihope]

Thanks for your help getting there. Took a bit to find the lightening bolt for the search but I did!

[anne from california]

I have had a sleep study that indicated "mild sleep apnea, could benefit from cpap." I got this done at the behest of my dentist, who sees a low airway (IV on the Mallampati rating) and signs of clenching, and my questionnaire indicated some signs of apnea despite the fact that I'm not the "stereotypical apnea profile"--middle-aged overweight male who snores. (Middle-aged, but that's where it ends!) I noted some daytime sleepiness, which has gone away since I dumped the grains. I honestly thought my dentist was just trying to sell me an expensive mouthpiece. Maybe I should go for it. (Not interested in cpap--that sounds like an expensive facepiece that won't get used.) Seeing my dentist in two weeks and I'm SURE this will come up.

[KatieS]

I have had a sleep study that indicated "mild sleep apnea, could benefit from cpap." I got this done at the behest of my dentist, who sees a low airway (IV on the Mallampati rating) and signs of clenching, and my questionnaire indicated some signs of apnea despite the fact that I'm not the "stereotypical apnea profile"--middle-aged overweight male who snores. (Middle-aged, but that's where it ends!) I noted some daytime sleepiness, which has gone away since I dumped the grains. I honestly thought my dentist was just trying to sell me an expensive mouthpiece. Maybe I should go for it. (Not interested in cpap--that sounds like an expensive facepiece that won't get used.) Seeing my dentist in two weeks and I'm SURE this will come up.

Annie, I would review the results of your sleep study. I have seen significant oxygen desaturations (resulting in permanent brain neuronal white matter deficits) almost apneas (evidence of upper airway resistance syndrome) and lack of deep sleep stages and/or REM sleep (only seen with the lab sleep study with the EEG), all disregarded in the summary recommendations. The oral mouth pieces do lower the apneas, but the CPAP can fully eliminate apneas. In my opinion, the new CPAP pillow or no mask equipment is much more comfortable than the mouthpiece forcing your jaw forward based on having my husband experiencing both devises. Feel free to PM me if you have any sleep apnea questions.

[Jan]

Thanks for your help getting there.

Welcome, ihope, Flora makes a wonderful friend. So glad she led you here.

[Jan]

I have had a sleep study that indicated "mild sleep apnea, could benefit from cpap." I got this done at the behest of my dentist, who sees a low airway (IV on the Mallampati rating) and signs of clenching, and my questionnaire indicated some signs of apnea despite the fact that I'm not the "stereotypical apnea profile"-...

Anne, glad you have had improvement since removing grains from your diet. I'm always glad to see nutrition carefully assessed for health. And I concur with KatieS, the importance of addressing sleep disturbances, especially the possibility of sleep apnea, cannot be overstated.

Let us know how your next dental visit goes - and kudos for finding a dentist who seems very attentive to your whole health.