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.

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.

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.

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.