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.
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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.