Tag Archive | sleep apnea

Will Poor Sleep and Sleep Deprivation Now Lead to a Lifestyle-Related Dementia Later?

restorative sleep dementias going gentle into that good nightThe answer is “probably.”

There have been several studies in the last two years on the effects – positive and negative – of sleep on the brain. They all agree on one point: to function optimally, the brain requires quality sleep and enough of it.

They also agree on another point: the way our modern society is structured, the majority of us are not getting enough sleep, and the little sleep we are getting is not quality sleep.

The fact that poor sleep and future dementia are linked is not new.

A sleep disorder known as REM sleep behavior disorder is a key characteristic of Lewy Body dementia, but the sleep disorder is often present decades before symptoms of Lewy Body dementia emerge.

In a study published in the The Journal of the American Medical Association in 2011, researchers showed a strong link between sleep apnea (sleep-disordered breathing) and dementia.

However, new research is now showing that even those of us without these two sleep disorders are getting less sleep and the sleep we do get is not quality sleep. New neurological research is showing us how important enough sleep and good sleep is for our present and future neurological help.

circadian-rhythm-sleepThe body has a natural circadian rhythm designed to promote and facilitate sleep as daylight turns into evening and then night and to promote and facilitate wakefulness as night turns into day.

Until the Industrial Revolution, which actually consists of two iterations (one in the late 18th century and the second, which was the more profound of the two, in the mid-19th century, the human race generally slept and awakened based on the body’s natural circadian rhythm.

After the second iteration of the Industrial Revolution, when crude ways to keep the lights on 24 hours a day, 7 days a week emerged, all that changed. Initially, the only segment of the population that it affected were those who were employed in factories, mines, and foundries.

factory work shift work sleep deprivation going gentle into that good nightAs textile factories, ore and mineral mines, and metal foundries remade the work day into two 11-hour shifts – generally, 7 am – 6 pm and 7 pm – 6 am – the second shift of workers were forced to ignore and work against their natural circadian rhythms to fuel the manufacturing boom, which was bolstered by a greater demand for manufactured goods throughout all strata of the population.

Although there was less concern about the workers – health, quality of life, and even death – then, there is still a significant amount of data from that period that shows most of horrific accidents (the majority of which were attributable to human error and resulted in both permanent disabilities and death) occurred during the later hours of the 2nd shift.

In the early 20th century, as manufacturing expanded into transportation, work days were again revised into three shifts – 7 am – 3 pm, 3 pm – 11 pm, and 11 pm to 7 am – with similar higher accident rates in the 2nd and 3rd shifts.

medical professionals shift work going gentle into that good nightMedical professionals in hospitals, nursing facilities, and emergency services work were the next group of people to be required to work in shifts. Additionally, of all the careers in which shift workers were employed, it was not unusual for many medical professionals to work double shifts (back-to-back shifts) to provide necessary services.

During World War II, almost all manufacturing facilities in the U.S. transitioned to 24/7 production and a 1st, 2nd, and 3rd shift to support the Allies’ efforts in the war. After World War II, as those factories transitioned back to civilian manufacturing, they kept 24/7 production and three shifts in place. 

As the Technological Revolution replaced the Industrial Revolution (also in two iterations, with the first one beginning after World War II, and the second one, which now affects every human on the planet, beginning in the late 1960’s) and the world became instantaneously and simultaneously intricately connected, the 24/7 workday began to affect almost everyone on the planet, white-color workers working late nights going gentle into that good nightincluding white-collar workers who saw their workdays – and nights – lengthened beginning in the late 1980’s.

As more and more people have been, by necessity, forced into living and working in a 24/7 environment, researchers have kept a close eye on how successful our efforts to work against our natural circadian rhythms have been.

The answer is we’re all pretty much failures at it and the results are poor quality sleep and sleep deprivation.

And like our ancestors in the Industrial Revolution, working late into the night or all night, whether in a medical facility, an emergency services department, a manufacturing facility, an office, or at home (because half the world’s awake when it’s time for people in the U.S. to go to bed), shows the same elevated risks of accidents and injuries (both work-related and non-work-related) when compared to working during daylight hours.

Here are a few statistics directly tied to shift work (if you’re an office jockey reading this, remember that this applies equally to you and all those late nights and overnights you’re working wherever you’re working them):

  • Work-related injuries increased to a little over 15% on the 2nd shift and almost 28% on the 3rd shift.
  • The longer the shift, the higher the risk of injuries: 13% higher on a 10-hour shift and almost 30% higher on a 12-hour shift. 
  • The more consecutive night shifts worked, the greater the risk of sustaining an injury (37% higher by the fourth consecutive night shift as opposed to 17% higher by the fourth consecutive day shift).
  • Almost 50% of the late-night (10 pm – 1 am) and early-morning (5 am – 8 am) car accidents – fatal and non-fatal – involve drivers who are driving to or from work.

Pretty scary, huh? And, yet, despite all the evidence that it’s a really bad idea, a dangerous idea, and a dumb idea, we, as a society, keep doing it. I won’t get in-depth into the reasons for that here, except to say that they are tied to greed and competitiveness, which are soul issues.

What is the biology behind the statistics above?

That we can answer. And I’ve had more jobs than not where I worked 10-12 hours on a Sunday-Thursday night schedule, where I’ve worked many late, late nights only to be back at my office first thing the next morning, and where I’ve pulled many all-nighters, so I’ve got a lot of firsthand experience to bring to the table.

The reality is that unless you’re physically exhausted – mental exhaustion actually keeps the brain in gear and is totally counterproductive – you can’t get any real quality sleep during the day. Melatonin production is off and all the hormones to keep you awake are in action, so trying to sleep well is a losing battle.

So while you may be able to get a few hours of restless sleep, you do not go through the normal sleep cycles associated with nighttime restorative sleep.

As a result, because your brain is “foggy” when you’re awake, your response times are sluggish, and, combined with the normal circadian rhythm of sleep kicking in at night – even if you’re awake – all of these are directly tied to the increased risks of accidents and injuries during work hours at night.

The later you work at night the more likely you will have an injury and/or accident because these are the normal hours when sleep is deepest and during which you’ll be fighting sleep the most.

But the long-term effects of poor sleep and sleep deprivation are just as serious with regard to neurological health.

In a series of studies on sleep published in late 2013, researchers discovered that good sleep and normal sleep (7-8 hours at night) enables the brain to clean out the toxins – including beta amyloid proteins, which are involved in the development and progression of Alzheimer’s Disease – that have accumulated in it during the day’s mental activities. This process is so energy-intensive that it can be done only during sleep, when the brain doesn’t have anything else to do.

And here’s the thing. Perpetually skimping on sleep, for a lot of us who don’t do shift work and don’t have careers that demand a lot of late, late nights and early, early mornings on a consistent basis, is a lifestyle choice.

Technically, however, all of these types of careers, except for manufacturing work, which puts food on the table and pays the bills for people who might not be able to do so otherwise, are lifestyle choices because anyone going into these careers know the demands before they choose the education and jobs that lead to them.

And that substantially increases your risk of developing a lifestyle dementia.

digital and electronic connectivity sleep deprivedWe, as a society, are very sleep-deprived. And that includes a lot of people who are not earning their living during the night.

Much of that, in my opinion, is because we are digitally and electronically connected all the time and that crowds out the time we allocate for sleep.

A few questions should help you know if this applies to you personally.

  1. Do you watch TV for several hours in bed or do you play video games before you go to sleep?
  2. Is your smart phone or tablet beside your bed so you can check email or keep up with social media? Do you check them during the night?
  3. Are you digitally and electronically connected last thing before you close your eyes at night and first then when you awaken in the morning?
  4. Do you remember what you did at night before you got digitally and electronically connected?

If the answer to the first three questions is “yes” and the answer to the last question is “no,” then you’re making a lifestyle choice, probably sacrificing sleep (it’s important to remember that all these digital and electronic things stimulate the brain, so their after-effects stay with you for quite some time after you turn them off, and that means it takes you longer to fall asleep), to stay connected all the time to a world, that quite frankly, isn’t all that important or real anyway.

And whatever is real or important about it can wait until tomorrow. Like it did when a lot of us were little kids and there was no cable tv, there was no public internet, there were no video games, there were no personal digital/electronic devices, and there were no cell phones.

The world didn’t end then, and it won’t end now if you put all these away early in the evening and give your brain a chance to relax by playing a game with your family, listening to music that soothes your soul, getting lost in a book, or simply being quiet for a little while, using that time to meditate and reflect on your day and make plans for tomorrow.

Even though since I was born I’ve always had trouble sleeping a lot and getting good sleep when I do, I purposely shut everything down early in the evening to engage in quieter and more reflective activities and I stay away from it until I’ve had some quality time in the morning to get ready to tackle it again.

One day each week – for me, it’s the weekly Sabbath – I disconnect completely for the 24 hours between sunset Friday and sunset Saturday, and I’ve begun to move away from being connected much on Sundays as well.

I rarely have my cell phone anywhere near me and even when I do, I rarely use it. I certainly don’t want it in my bedroom with me at night.

With my sleep history, I’m already behind in this game, so I make lifestyle choices to improve my odds the best I can. It may not be enough to stave off dementias, but at least I know the choices I’m making increase the odds that, if I live long enough (I always pray I don’t…we start dying the day we’re born, so it’s pretty much all downhill from that point on), they’re either mild or short and done.

For all of us who can read this today, now is the time to start making sure we’re doing everything in our power to get enough sleep and to get good sleep when we do. That’s a lifestyle choice that only you can make for you and that only I can make for me.

It may mean some hard choices. It may mean a career change. It may mean disconnecting during nighttime from technology. It may mean looking at our lives and figuring out what’s really important in the long-term, instead of buying into the pervasive idea that now is the only important time in our lives.

But in the end, from this moment on, at least in the realm of sleep, you can do something to help yourself, but you have to decide what you’re willing to trade off now and what you’re willing to live with in the future.

 

 

“You Oughta Know: Acknowledging, Recognizing, and Responding to the Steps in the Journey Through Dementias and Alzheimer’s Disease” – Chapter 7 Excerpt

You Oughta Know: Recognizing, Acknowledging, and Responding to the Steps in the Journey Through Dementias and Alzheimer's DiseaseIn this eighth installment of brief excerpts from each chapter in the book You Oughta Know: Acknowledging, Recognizing, and Responding to the Steps in the Journey Through Dementias and Alzheimer’s Disease, we look at the seventh step in the journey through dementias and Alzheimer’s Disease.

This post includes an excerpt from chapter 7, which provides a comprehensive look at how to acknowledge, recognize, and respond to the seventh step in the journey through dementias and Alzheimer’s Disease: sleep changes and disruptions.

This chapter shows that changes to sleep patterns and sleep disturbances, which includes sundowning, are all part of the seventh step in the journey through dementias and Alzheimer’s disease.

This chapter also discusses how this step impacts our loved ones and us as caregivers and the practical, real-time, and loving ways we as caregivers should respond and help our loved ones walk through this step in the journey.

This series begins with the forward to the book and an explanation of why I wrote this book and why you should read it.

The series continues with the inclusion of excerpts from Chapter 1, Chapter 2, Chapter 3, Chapter 4, Chapter 5, Chapter 6, and, with this post, Chapter 7.

The steps in the journey through dementias and Alzheimer’s Disease are presented sequentially in the order in which they actually appear in the course of these neurological diseases.

There are no other books that literally walk through each step in sequential order as they emerge in the journey through dementias and Alzheimer’s Disease.

Additionally, there is no other book that discusses:

  1. The process we as caregivers acknowledge each new step – there is an acceptance period that we have to go through
  2. The process we use to guide ourselves and our loved ones with dementias and Alzheimer’s Disease through the recognition phase of each step
  3. The concrete, loving, and practical information on how we should respond and how we can help guide our loved ones’ responses

These are the things that make You Oughta Know: Acknowledging, Recognizing, and Responding to the Steps in the Journey Through Dementias and Alzheimer’s Disease unique and stand alone in the plethora of books about dementias and Alzheimer’s Disease.

going gentle into that good night divider

Excerpt “Chapter 7: ‘Don’t Know If It’s Day Or Night’”

“Changes and disruptions in sleep are the next step in the journey our loved ones go through with dementias and Azheimer’s Disease. Included in this step is a phenomenon called sundowning, which we’ll explain the logic and science behind.

But first we need to talk about the science of sleep. All humans have a 24-hour internal clock that is known as our circadian clock (the term circadian rhythm refers to any biological process that completes a 24-hour cycle).

This clock, shown below, is a complex and coordinated system of neurology, hormones, environmental factors, and routines that are established from the time we are born.

circadian rhythm sundowning melatonin going gentle into that good night

Everyone’s circadian clock is unique, but each follows the general pattern shown above. In fact, the clock shown above is the ideal and the circadian clock that humans basically followed until the Industrial Revolution took place in the late 18th and early 19th centuries.

Since the full transition into the Industrial Revolution, human life and the adherence to this natural circadian clock has been altered and challenged because one of the side-effects of the Industrial Revolution was the development of artificial lighting (gas in the 19th century and electricity in the 20th century), which enabled lighting to be available 24 hours a day.

This was the byproduct of greed that served the captains of industry well (instead of limiting work hours to daylight hours only, artificial lighting enabled factories, foundries, mining operations, etc. to operate on a 24/7 schedule), but the human race definitely got the short end of the stick here.

Because the body is designed genetically, neurologically, hormonally, and environmentally to function in sync with the 24-hour circadian clock shown above, disrupted sleep and sleep deprivation has a chaotic effect on the body, even in otherwise-healthy people.

Time and again, science and medicine have shown a significant increase in accidents and serious injuries among shift workers who work at night. This includes not only production workers, but also professionals such as medical personnel. There is also a considerable amount of evidence that shows night shift workers are much likely to be injured or killed in driving accidents because they have a higher incidence of falling asleep behind the wheel going to and from work.

The most disruptive shift to the human body is the graveyard shift (usually 11 pm to 7 am). By the time these workers start their shift, the body is fully prepared (the hormone melatonin relaxes the body and mind for sleep beginning around 9 pm) to sleep. Forcing the body to do the complete opposite of what is it naturally designed to do is often counterproductive and very destructive to human health.”

Sundowning and the Sleep Conundrum of Dementias and Alzheimer’s Disease

Today’s post will discuss how dementias and Alzheimer’s Disease affect circadian rhythms and sleep, as well as some tips to help manage sleep disruptions effectively.

There are a lot of factors that make up our sleep behavior. I first want to discuss the biology of sleep and how, even if there are no other sleep disorders, dementias and Alzheimer’s Disease disrupt the biological sleep cycle.

Normal Circadian RhythmHumans have an internal 24-hour clock that is synchronized with daytime and nighttime (light has a profound impact on this clock). This clock is referred to as our circadian rhythm.

As people age, this clock changes so that they normally tend to go to sleep earlier and wake up earlier. Sleep disorders like insomnia and sleep apnea are more common in older people as well. But their circadian rhythms are still primarily based on light (the more light, the more wakefulness; the less light, the more sleepiness) and time of day.

However, in our loved ones suffering from dementias and Alzheimer’s Disease, circadian rhythms go out the window because the diseases impair the brain’s ability to tell time and to distinguish between light and dark as indicators of when to sleep and when to awaken. It is sometimes helpful, in the early stages, to get a 24-hour clock to help our loved ones distinguish between A.M. hours and P.M. hours, but eventually that will be a casualty of the diseases.

The most common circadian rhythm disorder associated with dementias and Alzheimer’s Disease is a phenomenon known as “sundowning.” It occurs in the late afternoon and early evening.

It is characterized by speech and behavior repetition, constant pacing , excessive restlessness, wandering, disorientation to time and place, and agitation or aggression towards others.

Wandering is especially dangerous because if our loved ones get outside, they can walk long distances with limited vision because of the sun going down, sometimes on crowded roadways, and are susceptible to being the victims of crime and vehicular death.

One probable cause of sundowning is that there is damage to the part ofSleep/Wake Patterns Circadian Rhythm the brain that produces melatonin (the sleep hormone) and the reduced production causes an irregular sleep-wake rhythm

Another theory on the cause of sundowning is related to the energy levels of our loved ones with dementias and Alzheimer’s Disease . At the end of the day they are likely tired from the day’s activities.

This can aggravate the symptoms of the diseases, making them more anxious and stressed. Before the onset of these diseases, this time of day would have typically been the busiest for them. They would be getting home from work, getting ready for dinner, doing household chores, and going to bed. Now that they’re unable to do those things, they have little to do at a time that was the busiest of the day for them.

The most common sleep disorder that occurs with dementias and Alzheimer’s Disease is an irregular sleep-wake rhythm. You can see in the graph above how disruptive this rhythm is and why our loved ones with dementias and Alzheimer’s can be so tired, in general, all the time.

However, I believe the most damaging effect of this sleep pattern is that it actually prevents the restorative/repair functions that occur during a normal sleep rhythm, which exacerbates the neurological damage that dementias and Alzheimer’s Disease do to the brain. In short, this sleep pattern makes the diseases worse.

The most effective – and safe – way to try to minimize an irregular sleep-wake rhythm is to add melatonin to nighttime medications. As I’ve said before, up to 12 mg of melatonin is considered safe, but start with a low dose (3 mg or 5 mg) and give it time to see if that gives our loved ones more continuous and restful sleep. The goal is to keep them asleep at night and keep them awake during the day. Too much melatonin can have them sleeping all the time.

I would also suggest keeping our loved ones active and busy – as they are able – during the day (I will talk more about this in another post, but will briefly touch on it here). Up until the last week and a half of my mom’s life, when she’d had the major heart attack and just couldn’t do much with me, I had her help me with the household chores that she could like making the bed, folding laundry, preparing meals, and helping me with the dishes.

I didn’t care whether it was perfect or not (initially a big challenge to my normal OCD about those kinds of things), but I found that the more she did, the better she felt and the better she slept.

There is a sleep disorder that is specific to Lewy Body dementia and is one of the primary symptoms of that form of dementia. It is called R.E.M. sleep behavior disorder.

R.E.M. sleep behavior disorder is impossible to miss. Anytime a sufferer is asleep, they are in motion acting out their dreams and, at least in my mom’s case, having sometimes understandable and sometimes not in-depth conversations. It is also characterized by “picking” at clothing or bedclothes while asleep.

On the one hand, at least for me, it was quite fascinating to watch Mom dream and act out her dreams. Apparently – and I’ve seen this with other Lewy Body dementia sufferers, so it must be common for all of us to dream about – she dreamed quite often about food, because she’d often make the motion of either eating with a utensil or with her hands to her mouth. That was usually when she was napping during the day. 

Most of her conversations occurred at night, although occasionally she’d say a line or two during a daytime nap. And they’d last all night sometimes.

Her nightime dreams also included a lot of moving around and possibly a version of restless legs syndrome (not uncommon for R.E.M. sleep behavior disorder).

While I know this had a detrimental effect on her quality of sleep, it was disruptive for me too. I have always been a light sleeper and have had my own issues all my life with not sleeping much (and sometimes not sleeping at all for a day or two) and not getting quality sleep (waking up a lot or being wide awake in the early morning hours and not being able to go back to sleep for an hour or two). With Mom talking and moving around all night, it made sleep that much more difficult for me.

An increase in melatonin helped with this as well. I bumped her up to 7 mg each night (she was at 5 mg before) and it was just enough to keep most of the symptoms at bay. There were still some nights when it was noticeable, but the worst of the symptoms seemed to be alleviated. And because she slept better, she felt better and did better during the daytime.

I hope this brief overview helps. If you have any questions or any topics you would like to see discussed here, leave me a comment or email me at goinggentleintothatgoodnight.com. If I don’t know the answer, I’ll do my best to try to find it.

You’re not alone and my intent and goal is to keep reminding you of that and help you as much as I am able.