The Whitworths of Arizona, bringing science to you in everyday language.

Friday, February 16, 2018

Sleep Part 5: Depression and More

For the last month and more, we've been talking about sleep, how important it is and the many ways it gets disrupted. Today, we finish up and next week we talk about ways to help your loved one get to sleep and stay asleep--which is probably what you've been wanting all along! After all, it doesn't help a lot to know why a person isn't sleeping if you can't do anything about it. Well, actually, it does help to know why a person isn't sleeping because the answer to how to get them to sleep rests on the why. That's why we've spent so much time talking about it. But first, let's talk about it for one more blog.
Depression, fatigue and anxiety are all common with dementia. (3/22/13) They all can lead to lack of sleep and they all can feed each other.

Depression can be situational and temporary or a chronic dementia symptom--or both. Situational depression becomes chronic when Lewy bodies attack dopamine, a chemical involved with both mobility and mood. It can also become long-lasting, as with care partners who continually feel overwhelmed. Depression can cause either insomnia or excessive sleep. In either case, one's Circadian clock will be disrupted, (Sleep Part 2) the brain will have difficulty with clean up (Sleep Part 3) and dementia is likely to become worse.

There are some fairly safe antidepressants available. In addition, consider exercise to add oxygen and openness about the dementia to decrease negative feelings. Yes, talking about sad things takes away the sting a lot more than burying them does! (4/1/16)

Fatigue is the extreme lack of sleep. (9/25/14) It can follow depression or cause it. The best treatment for fatigue is a good, calm bedtime routine and a bedroom conducive to sleep. (to be discussed in a future blog).

Anxiety is a negative emotion very common with dementia, where a person is continually being presented with unwanted changes and limitations. Negative emotions are motivators and thus sleep-disrupting almost by definition. (4/7/17) Lack of sleep can also cause anxiety as one's defenses lower. There are anti-anxiety drugs but for many, they can cause more problems than they fix. If you use them at all, insist on the smallest dose possible, monitor carefully and quit at any sign of discomfort.

The best answer to anxiety is a two step process where you first validate it. "Yes, feeling so down isn't fun." or "This whole thing is scary, isn't it?" This allows the PlwD to feel heard and their negative feelings decrease, allowing your next step to work. That's when you say and do things that cause the PlwD to feel positive. Bribes work well here, by the way! (Blogs coming up with more about anxiety and dealing with it.)

Depression, fatigue and anxiety can cause each other or all three, and so treatment probably needs to be for all three together. This is especially true for the non-drug remedies. Besides, anyone can use more positive reinforcement, everyone needs a good sleep routine and exercise and openness is also good for everyone. Doing all of it together should improve not only one's sleep but one's general quality of life.

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

We love and welcome comments but we will not publish any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.

* Acronyms:
AD: Alzheimer's disease
BPSD: Behavioral and psychological symptoms of dementia
DLB: Dementia with Lewy bodies, where cognitive/behavioral issues occur first
LBD: Lewy body dementia, an umbrella term for both DLB and PDD
MCI: Mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
PD: Parkinson's disease
PDD: Parkinson's disease with dementia, where mobility issues occur first
PlwD: person/people living with dementia
PlwPD, LBD, PDD, AD, etc.: person/people living with PD, LBD, etc.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Friday, February 9, 2018

Compliments: Gifts of Love

Right around Valentine's Day we start thinking about giving gifts to show our love. That's why we've interrupted our blogs on sleep to talk about compliments. Compliments are wonderful dementia tools. Actually they are just plain wonderful with anyone. A compliment, used properly, provides motivation and makes a person want to try harder, do more, be better. They make us sit up straighter, think better, and go on to succeed more. However, they are especially great with our loved ones who are in need of positive reinforcement as they lose so much of who they used to be.
A compliment is:
  • A voluntarily given piece of positive reinforcement. It tells a person that their effort is something special and worthy of notice. This encourages the person to keep doing that something special even if the effort is difficult or frustrating.
  • A little gift of love. It tells a person that they personally are valued, interesting, appreciated and cared about.
  • A return gift to the donor. Giving a gift makes the giver feel good and compliments are no different. It just plain feels good to give a compliment to someone.
Compliments work better if:
  • if they are sincere. This is especially important with PlwD. Because they are so perceptive of feelings, their BS meter is sensitive. You have to really mean what you say. Otherwise, you lose trust. Be creative. Look for things you can honestly compliment and do it often.
  • if they are specific. Don't tell the person how wonderful they are--this is too general and doesn't offer enough information. Tell them how much you liked the colors in the picture they painted or how lovely that blouse looks on them or what a beautiful smile they have.
  • if they are related to the task at hand. Compliments about appearance are uplifting but not when the person is more concerned about how well they are doing with their new walker or getting food from their plate to their mouth.
  • when they describe how the person made your life better. "Thank you for doing the vacuuming. The room looks wonderful and I love it that I didn't have push that vacuum around!"
One great thing about giving compliments to a PlwD is that you can't give too many. If you overdo the compliments with most people, they will consider it flattery and you'll lose their trust. But PlwD process compliments a little differently. Compliment processing goes like this:
  • The compliment is accepted first at face value and causes a release of the "feel good" hormone, serotonin. Yes, even bad compliments make any person feel good at first!
  • Then sincerity is evaluated. This involves checking out the emotions of the giver. The compliment is not believed if their sincerity is doubted.
  • If the compliment is rejected, negative feelings related to distrust, belittlement, and such override any positive feelings. Up to here, the processing is the same for everyone, except that the PlwD is much more sensitive to insincerity.
The next step involves abstract thinking, where a person evaluates content and motivation. This requires tasks such as doing comparisons and considering past events. The PlwD can seldom do much of this. And so:
  • If the compliment passes the sincerity test, the PlwD accepts it. With concrete thinking, the brain accepts first information it receives about the compliment--the initial good feeling, which stays and actually improves the PlwD's ability to communicate.
And so, the bottom line is,
  • be continually on the lookout for things to compliment 
  • compliment often and 
  • always mean it.
Oh, one more thing. People, women especially, often have difficulty accepting them. When you receive a compliment and you say something like "Oh, this old thing. I picked it up at Goodwill." you not only put yourself down, you invalidate that person's judgment as well as your own and take the joy out of the whole interaction.

Instead, accept all compliments with at the least a smile and a "Thank you." If it is appropriate, I like to say, "Thank you, I like it too." or even "Thank you. I felt so lucky to find it while shopping at Goodwill." Just as a compliment is a gift to you, your response can be gift to the donor, making every compliment a mini-celebration complete with a gift exchange.

Next week, back to the series on sleep, with a blog on how it's related to depression and more.

* Acronyms:
AD: Alzheimer's disease
BPSD: Behavioral and psychological symptoms of dementia
DLB: Dementia with Lewy bodies, where cognitive/behavioral issues occur first
LBD: Lewy body dementia, an umbrella term for both DLB and PDD
MCI: Mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
PD: Parkinson's disease
PDD: Parkinson's disease with dementia, where mobility issues occur first
PlwD: person/people living with dementia
PlwPD, LBD, PDD, AD, etc.: person/people living with PD, LBD, etc.

We love and welcome comments but we will not publish any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Friday, February 2, 2018

Sleep Part 4: Apnea

Recent blogs have been about how the brain uses sleep to keep us healthy. This blog is about how apnea disrupts a person's sleep. It is not the only disruption, of course. Previous blogs have discussed how one's internal clock and age-related issues like repeated bathroom trips can interrupt sleep.

Apnea, is a condition where sleepers stop breathing hundreds of times during the night. The autonomic nervous system (ANS) automates a person's life supporting activities such as breathing or heartbeats. We don't generally have to think about these actions. Our body just does them. Apnea can happen without dementia, but dementia, and especially LBD* weaken the ANS* so that a sleeping person "forgets" to breath. The resulting lack of oxygen in the brain wakes up the person. They start breathing again but they don't really catch up. With each waking event, the brain gets a little more behind. It needs lots of oxygen to fuel that janitorial service that works while you sleep to clear out dementia-causing debris. (Sleep, Part 3) With the brain still clogged, dementia symptoms can increase. (Think about how foggy you feel after a sleepless night!) Thus, it is a vicious circle. Dementia may cause apnea and then apnea makes the dementia worse!

Apnea is treatable but a PlwD* may not be able to tolerate or accept the treatment, which usually involves wearing a CPAP* mask while sleeping. Without an understanding of why it is needed, the PlwD will seldom leave this strange and annoying device on long enough to get used to it and find out how much better they sleep.

Doctors sometimes prescribe sedatives to help a person get to sleep initially while wearing the mask, but that is seldom an option for anyone with dementia, and especially anyone with LBD. A milder anti-psychotic like Seroquel or a mild anti-depressant like Welbutrin might help, but they are not always an option either. Some people tolerate these drugs and some don't. Besides, waking up and going back to sleep--with the mask on--is the real hurdle. It can't be fixed over and over with drugs.

In an online forum, a care partner told of how her loved one becoming very disoriented when he woke up with this strange contraption on his face. Another group member responded, "At this point (and condition) of that good man's life, I just wouldn't try to get him to use it. There will be enough things to cause him panic, distress, and discomfort in how he will be spending his life now, without adding a CPAP mask to what he will be going through." The group member has a point. Besides being a confusing irritation to the PlwD, trying to do something so difficult is also distressing, and often sleep-depriving, to the care partner as well. Is the high cost in peace and sleep worth a benefit that is limited because the mask comes off over and over?

Perhaps, this is an example of when a care partner must stop and re-evaluate their goals. There comes a time in the care of a PlwD when care goals must change from improving function to choosing comfort. A CPAP mask is actually very good for improving function--it can greatly improve clarity if used properly. But if the PlwD's dementia is so advanced that they can't use it properly, it is probably more of a burden than help. The changing of a goal from function to comfort is not easy because it signals the beginning of the end. However, it doesn't have to happen all at once. With each treatment and each activity, a care partner gets to make a separate decision. Some efforts at maintaining function can last much longer than others. Using or not using a CPAP may simply be the first decision of this sort that comes along.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.

* Acronyms:
ANS: Autonomic nervous system
CPAP mask: Continuous positive airway pressure mask
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia
Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Friday, January 26, 2018

Sleep Part 3: The Brain's Janitor

There's been a lot of talk about nutrients that will improve clarity by flushing things like free radicals out of your brain. But one of the best ways to do this is to sleep. That's right. Simply sleep. Well, for many PlwD*, sleep isn't so simple--see last week's blog. But it is very important for mental clarity as anyone who wakes up groggy after a poor night's sleep can attest.

Sleep is the time when the brain cleans house. The lymphatic system, which works as the body's janitor 24 hours a day can't cross the blood brain barrier (BBB). But don't worry, the brain has its own janitor, the glymphatic system. The problem is that the brain doesn't have enough power to operate it AND do other brain functions well. And it is designed to shut down many of these functions for several hours a day--a process we call "sleep." Sleep isn't the quiet, inactive time we grew up thinking it was however. A whole different set of brain functions come into play and one of them is the brain's janitoring service.

Researchers now believe that while a person sleeps, brain cells shrink. The resulting space is then filled with cerebral fluid that circulates throughout the brain and flushes out waste proteins, dead cells and other debris that builds up in the spaces between brain cells. It's like a busy building, where the janitors come in and do their work after the office workers have gone home and the halls are empty. Then when the person wakes up, the brain cells return to normal, which slows the flow of cerebral fluid to almost nothing. And so when sleep doesn't happen, the debris can't get flushed out and a person gets groggy, inefficient and can have many dementia symptoms. If a person is already living with dementia, of course this just makes it worse.

Normal sleep occurs in cycles of 75% deep sleep, which is when cleaning and restoring happens and 25% of lighter, REM* sleep, which is when dreams occur. That's why short naps may not work well. They may not allow a person to go through a whole cycle and the flushing may not start, or if started may not be complete. Ideally, you need about 7 hours of uninterrupted sleep. Now we know that few elderly folks can last a whole night without getting up to go to the bathroom a time or three! However, the good news is that this doesn't have to be problematic since people usually wake up between cycles. If the person can go right back to sleep, they can start another cycle.

You, as care partner, may have more difficulty getting back to sleep. Because you are waking up on the PlwD's schedule instead of your own, it may not be between cycles for you. In addition, you probably have to think about what you are doing more than they do. For these reasons, you may be wide awake by the time you get back to bed. Now is the time when a sleep ritual can help. Here is a simple one:
  • Release all thoughts of frustration. You can't do anything about it now anyway.
  • Then think a few moments about something positive, something you feel grateful about. This gets the soothing, calming chemicals flowing in your body.
  • Start deep breathing. Put your hand on your abdomen and feel it rise as you breathe in and lower as you breathe out.
  • With your eyes closed, focus on a point in the dark and on nothing else but your breathing. If you find your thoughts gliding off into other things, gently pull them back.
You may be able to guide your PlwD through this by saying what your are doing and encouraging them to mirror you.

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.

* Acronyms:
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia
BBB: Blood brain barrier
REM: Rapid eye movement

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Friday, January 19, 2018

Ringing in the New Year with a New You

We are interrupting our series on sleep for a blog entry from our alternative therapies consultant, Regina Hucks, that should really wake you up. Actually, only the very first section is here. You have to go to her blog, Alternative Therapies for Dementia Care, to read the rest. I'm sure you'll want to read on once you get to the end of this segment. Or, if you want to get right into it, click here and go now! 

Happy New Year to each and every one of you. 2018 shows promise as truly a NEW Year but as is everything in life, to make it NEW will require YOUR participation.

This month’s blog post isn’t about any therapies. It’s about going into a New Year, a year of possibilities and YOUR ability to make it everything you desire . If you were a Numerologist, you’d say it was the Year of Angels filled with excitement, love, relationships, peace and success. Astrologers would say we are headed into a Universal Fresh Start!

Well, I believe it’s the Year of YOU, that everything predicted by numerologists and Astrologers is about YOU. But what does that really mean?

It means, this is the year of change in YOUR life…through positive change IN you. The laws of the Universe are pretty well convincing when it comes to change. The ONLY thing in this world that you have ANY control over changing is…YOU. When you change the way you think, let go of old thoughts that truly do not serve a positive purpose in your life, YOU change and like dominoes falling, everything around you changes for the better.

That kind of goes against the grain of everything you are and believe as a caregiver right? Well…give this some thought…

If you were on an airplane and suddenly the masks fell from the ceiling… would you try to help the people around you first or would you put your mask on first and then help those around you?

I was 13 when my Mother, the Quantum Physicist, first asked me that question and with my chest puffed out and my heart filled with compassion, my answer was, “I’d help everyone I could.” Her response was, “Well, my darling girl, that’s a very noble gesture but also a very stupid thing to do and I would miss you terribly.” “Miss me?” I asked. “Well of course,” she said with that you’re about to get that 2 by 4 across the head kind of lesson look on her face. “You have so much compassion in your heart for people. You are truly fulfilled when serving others but, my dearest daughter, if you do not take care of yourself first, you will be dead and unable to help anyone and that would be such a waste.” Wow … lesson received.

Taking care of YOU … FIRST. That is a very hard concept for caregivers to get their head around but trust this, YOU matter. YOU have value and worth not only to yourself but to so many others but unless you are mentally, physically, emotionally and spiritually healthy, you can do little to help anyone.

Achieving YOUR desires. Finding JOY and Peace in YOUR life. Being the VERY BEST of YOU. Creating the life YOU want and deserve. Yes, YOU can have it all!

It’s the New Year … NEW … that’s the key word here. It’s the year of the NEW YOU and yes, you can create it all and it’s easier than you think. Read on …

That week between Christmas and New Years Day is generally a time to rest, reflect and renew the spirit with promises for change in the coming year. We create NEW resolutions (more than likely reworded repeats of old resolutions) with a twist on new resolves. At least, that seems to be the case with 99% of my friends. So what about that 1%? What their Secret?

I have a few friends that are always successful in creating and fulfilling their New Years Resolutions so about 10 years ago, I sat down with each of them to find out what their secret was. Oddly enough, what they told me, I already knew. What I wasn’t doing was applying it to my New Year Resolutions like I was to everything else in my life. What the heck was I thinking?

Change is something most people resist. Change can be intimidating…but it really depends on your perspective. Technology can be intimidating … Cooking a 6 course meal for 30 people can be intimidating … for many people, going to social functions with 300 strangers can be intimidating but simply changing the way you see things, the way you think about things is … really simple because it is about what you believe to be true and considering the possibilities of a different outcome. Feeling intimidated by change is simply fear of stepping out of the box you’ve created for yourself.

How do you feel when you get a haircut or buy a new shirt or blouse or a new pair of shoes? That feeling is being excited about the CHANGE in you! You stepped outside your box and created a NEW YOU if only for a day, a week or even a single moment.

Here’s why.
Thoughts create words, words create energy, energy transforms matter. In other words, everything you think or speak is like the energy of a prayer. That energy has the ability to change things including the DNA in your body on a cellular level.

So, HOW do you do that? Stay with me now … (Click here to continue.)

(Be sure to go see what's next! Helen)

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers and neither is Regina Hucks.  As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Friday, January 12, 2018

Sleep Part 2: Circadian Clock Issues

This blog is about how one's internal clock can get messed up and cause a person's sleep/wake times to be disrupted.

Sleep is the time when the body actively restores and strengthens its resources. During our deepest sleep, muscles are relaxed, allowing them to rest and be repaired. The blood supply to muscles is increased, bringing hormones and other chemicals to repair damage and normal wear and replacing the proteins needed to fuel movement.

A Circadian clock controls when these activities and other regular ones occur. From its control center very near the brain's visual cortex, it secretes various hormones at given times throughout the day and night. (Circadian is Latin for "about a day.") The hormones trigger a person to feel sleepy or hungry. Once asleep, they trigger the brain when to go into a heavy sleep where various cleaning, repair and other upkeep tasks happen, when to go into a lighter sleep (REM sleep) where memory sorting dreams occur, and when to wake up.

The internal clock maintains its accuracy in a variety of ways, but the most important is by using information from light sensors in the eyes sent via the visual cortex's non-visual sensory system. When the clock is damaged by dementia, its functioning can become inaccurate and garbled. Sleep and waking routines are disrupted. A person might get their days and nights turned around. More likely, they will wake up several times a night and nap often during the day. Of course, it is not only the PlwD's* sleep that is disturbed. The care partner's sleep is too.

The control centers for both visual and non-visual systems are very close together in an area that is often an early LBD target (think illusions, hallucinations and the like). Because of the closeness, the Circadian clock can be an early target as well, causing any of the above time regulation issues.

Of course, Lewy bodies are the only culprits. As people age, they tend to wake more often for a variety of reasons, from bathroom visits to apnea and more. The circadian clock functions in cycles of about 90 minutes each. Waking in the middle of a cycle can interfere and cause the clock to malfunction. This may cause a person to have difficulty sleeping at night, staying awake during the day or have repeated shorter periods of sleeping and waking throughout the day. None of these may provide for the deep sleep or for the dreaming sleep, both of which the brain needs for good functioning.

Circadian clock malfunctioning can cause a person to sleep a lot in the daytime, but there are other reasons for this too. With dementia, everything from thinking to moving takes more time--and more energy. Add the tremors common with PDD*, and it gets even more energy-intensive. This means that the PlwD needs more sleep to replenish their energy. It's nature's way of allowing the body and the brain the time they need to catch up and clean up. Unless the PlwD is not sleeping much at night, this is not something to stress about. Just use the time to do something for yourself--like catching up on your own sleep!

If the PlwD isn't getting much night-time sleep, experiment with nap time and bedtime routines to find the best ones for helping a PlwD fall asleep at night and stay asleep for longer periods at night. (Suggestions in a later blog.)

Next week: Sleep, Part 3: The Brain's Janitor.

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.

* Acronyms:
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Friday, January 5, 2018

Sleep Part 1: The Value of Sleep

Sleep is as necessary to good health as exercise--maybe even more! An elderly or infirm person, including anyone with dementia, needs about 7 to 9 hours of sleep a day to function properly. The symptoms from lack of adequate sleep include: confusion, less muscle strength, decreased function of vital organs, pain sensitivity, diabetes risks, and a weakened immune system. Add the damage already done by dementia, which increases all of the above symptoms in both likelihood and severity, and you can see how important sleep is for our loved ones. However, LBD,* and dementia in general, also interrupts sleep with a variety of issues and so sleep isn't always easy to obtain.

Sleep is the time when the body actively restores and strengthens its resources. During our deepest sleep, muscles are relaxed, allowing them to rest and be repaired. The blood supply to muscles is increased, bringing hormones and other chemicals to repair damage and normal wear and replacing the proteins needed to fuel movement. The tremors common to persons living with Parkinson's disease with dementia (PlwPDD)* put a lot of wear on their muscles each day and so this restorative period is quite important.

Unlike the muscles and other body functions that slow down and relax during sleep, the brain is very busy. Think of it as a busy office, shut down for the night. Besides being the time for restoring used up chemicals and proteins and preparing for a new day, this is when the brain does its heavy cleaning. This has become a very interesting area for researchers. First, it was nutrition like antioxidants that would rid the body damaging "free radicals." Then came drugs that that clear away sticky clumps of plaque in the brain and improve function. So far, all the research has been with Alzheimers, but we of course hope that it works with other dementias too. Then came new research on how important sleep is for the brain's janitor work. Even the drugs need sleep to work properly!

Sleep is a part of the Circadian Rhythm, an internal clock that times various functions including sleeping, waking and secreting of various chemicals at appropriate times for repair, cleaning, relaxing, waking, and so on. When this cycle is thrown off, the body doesn't get the restorative care it needs. As people age, they tend to wake more often for a variety of reasons, from bathroom visits to apnea and more. All can interfere with the function of their internal clock. The visual cortex is often an early Lewy body target (Think hallucinations!) and so a PlwLBD can experience these issue earlier and more intensely.

Apnea is one of the conditions that can greatly interfere with sleep. Apnea, a condition which sleepers stop breathing hundreds of times during the night, is linked to memory decline itself. Its resulting lack of oxygen tends to make already present dementia worse. This lack of oxygen is what wakes a person up, so that they can start breathing again. Apnea is treatable but a PlwD may not be able to tolerate or accept the treatment.

Depression often interferes with sleep. Depression is a very common symptoms with LBD, because of the loss of dopamine, which is a feel good chemical as well as one that facilitates movement. The problem here is that some Parkinson's drugs may decrease depression but cause insomnia.
REM sleep behavior disorder is a common symptom of LBD, often showing up years before any other symptoms. Its active dreams can disturb sleep, or more likely disturb a partner's sleep. Past blog entries have discussed this phenomenon.

And finally, how do we combat all of this? How do we help our loved ones...and ourselves...get the sleep we need. The easiest answer is to take a sleeping pill, but that is probably the lest safe for anyone. There are many environmental and mental things to try. Mainly it is a matter of setting up a soothing routine, following it with relaxing thoughts and waiting for nature to take charge.

Look for more about each of these issues in future blogs.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.

* Acronyms:
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.