Category Archives: SLEEP

Brain Study: REM Sleep Behavior Disorder Linked To Neurodegeneration

REM sleep behavior disorder is linked to Parkinson’s disease, a movement disorder; dementia with Lewy bodies, which causes cognitive decline; and multiple system atrophy, in which the ability to regulate involuntary functions, such as blood pressure, breathing, and bladder and bowel function, deteriorates.

ROCHESTER, Minn. — People with rapid eye movement (REM) sleep behavior disorder act out their dreams. While sleeping safely in bed, for example, they might throw up their arms to catch an imaginary ball or try to run from an illusory assailant. Such actions are more than just a nuisance. People with the disorder have a 50% to 80% chance of developing a serious neurodegenerative disease within a decade of diagnosis.

Read more at Mayo Clinic

DR. C’S JOURNAL: A WORD ABOUT DREAM THEORIES

Dreams are very egalitarian. I really believe that one person knows just about as much about dreams as another person, since almost all of us do a lot of it, and no two theories about dreaming are the same. However, I would like to give you some of what I have learned from my own dreams and readings about them. In addition, I have included a reference that discusses Scientific dreams studies in some detail.

When I was about 14 years of age, and burning up with a desire to learn more about medicine, I bought the only “medical” book I could find in Grass Valley, California: The interpretation of dreams, by Sigmund Freud. I vividly remember being amazed at how Freud could  figure out the symbolisms in the dream case studies he published. The interpretations were not at all clear to me, even after I was told the answer, and chewed on them a bit. I subsequently read the opinion that a lot of them were made up. The essence of Freuds theory of dreams is that they were wish fulfillments, which is patently not always true.

REM sleep was linked to dreams in 1953, a couple of years before I graduated from medical school. For years, dreams were studied in a unitary context of REM sleep, and in the opinion of some, this has slowed down progress on the knowledge of dreams immeasurably. We now know that dreams are not always linked to REM sleep. Dreaming can be neurologically interrupted, while REM sleep goes on. REM sleep can be eliminated while dreaming goes on.

So we go back to the starting block; what are dreams?

The Ancients put a lot of stock in dreams, such as Joseph’s dreams predicting a seven-year drought, which earned him a place on the pharaohs Staff. Martin Luther thought they were the work of the devil. My son Michael thinks they are a good thing, since when you dream you are sleeping, and sleep is a wonderful restorative.

My own theory is that they are random fragments of experience which are ordered and supplemented to form a story. These random fragments can either be from recent experiences, perhaps being consolidated in memory, or old experiences that are being pruned as unnecessary. These snippets are then aggregated under the influence of mood neurochemicals, and flow out in the dream narrative.

Sensations coming in from the environment can play a role. I will always remember the story of a sleep study patient, who was slapped on the back of his neck by a wet towel. He awakened immediately, and vividly remembered a dream about the French Revolution, in which he was guillotined. I read that dreams take 5 or10 minutes of time to develop, however.

I dream almost every night, and most are  forgotten rapidly. Some have enough detail and meaning for me too mull over before I get up. Some of my more common dreams are of flying, or getting lost. The pleasant dreams are definitely in the majority. Only rarely, a sinister one will wake me up.

The following reference details about 50 of the most common dreams that people experience. Much other pertinent information is contained. What is your theory on the causes and meaning of dreams? You probably have as good an idea as anybody else.

—Dr. C

Read more

DR. C’S JOURNAL: CAUSES & SYMTPOMS OF INSOMNIA

Sleep has many functions, among which are clearing the body of toxins and consolidating memory. The exact amount we need is determined by age, and genetics among another things. From what I’ve read, eight hours is required, plus or minus an hour.

That being said, there are a few  among us who are super sleepers. Going back in history this probably included Mozart and Thomas Edison: They could live healthy, productive lives with as few as three or four hours of sleep. Genetic mutations, including changes to the Orexin Gene receptor account for true super-sleepers.

Familial fatal insomnia is a genetic disease operating through prion proteins, and does not illuminate the problem of insomnia. In most people  there are two major forces which determine the onset of sleep, the circadian rhythm, and sleep pressure.

The TIMING of the sleep varies from morning larks to night owls. These shifts in the circadian rhythm is also genetic, involving many genes, including PER and CRY. Diurnal rhythm can apparently be changed, But with difficulty.

The sleep pressure is caused by the gradual daily accumulation of adenosine in the system, apparently resulting from the stripping away of the phosphate groups from the energy currency, ATP.  This can be assuaged by caffeine containing drinks, such as tea or coffee. Caffeine temporally blocks the effect of adenosine, but when it wears off, you usually go right back to your fatigue state.

INSOMNIA occurs when you do not get as much sleep as you need, and are tired in the daytime. This is a major problem for a lot of people.

Insomnia has many causes. Stress will cause an increase in Cortisone in the bloodstream which interferes with sleep. Caffeinated drinks nicotine and other stimulants can cause you to have difficulty falling asleep, and alcohol will help you fall asleep but will often result in awakening in the middle of the night when the alcohol is metabolized.

Depression, Parkinson’s, chronic pain, gastroesophageal reflux and any other medical conditions can interfere with sleep. Sleep apnea, often associated with overweight and heavy snoring, is a special problem that sometimes needs the help of a sleep specialist.

Some poor habits such as reading in bed, doing work in bed, eating at bedtime, and heavy exercise just before bed can also be a problem.
A regular routine of Preparing for sleep, such as brushing and flossing and taking a warm shower are also helpful; you can get more details by looking up “sleep hygiene”.

A lot of people take a nap, but this can cause some difficulty in going to sleep. Among things you can do to prevent insomnia include living an active life, making your bedroom comfortable for sleep, and using your bedroom ONLY for sex and sleep.

Please refer to the accompanying Mayo clinic article for more organized information.

—Dr. C.

Mayo Clinic articlehttps://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167


MEDICINE: ADEQUATE SLEEP & CARDIOVASCULAR HEALTH

Mayo Clinic Division of Preventive Cardiology will be preparing a series of recordings focusing on Cardiovascular Disease states. This is the Sleep Series and this particular one focuses on what is adequate sleep and does it benefit Cardiovascular Health.

HEALTH: “6 TIPS FOR BETTER AND LONGER SLEEP” (VIDEO)

Want to not only fall asleep quickly but also stay asleep longer? Sleep scientist Matt Walker explains how your room temperature, lighting and other easy-to-fix factors can set the stage for a better night’s rest.

Sleeping with Science, a TED series, uncovers the facts and secrets behind our nightly slumber. (Made possible with the support of Beautyrest)

Check out more: https://go.ted.com/sleepingwithscience

HEALTH VIDEOS: “HOW MUCH SLEEP DO YOU REALLY NEED?”

You know you need to get enough sleep, but the question remains: How much is enough? Sleep scientist Matt Walker tells us the recommended amount for adults and explains why it’s necessary for your long-term health. Sleeping with Science, a TED original series, uncovers the facts and secrets behind our nightly slumber. (Made possible with the support of Beautyrest)

Check out more: https://go.ted.com/sleepingwithscience

Dr. C’s Journal: A Little Bit About “Energy & Fatigue”

Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.

I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.

Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.

The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.

You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.

GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.

The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.

External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.

INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.

Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.

Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.

Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?

Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.

And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.

Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!

–Dr. C

STUDY: “FRAGMENTED SLEEP” INCREASES INFLAMMATION & HARDENING OF THE ARTERIES

From UC Berkeley (June 4, 2020):

UC Berkeley Logo

“We’ve discovered that fragmented sleep is associated with a unique pathway — chronic circulating inflammation throughout the blood stream — which, in turn, is linked to higher amounts of plaques in coronary arteries,” said study senior author Matthew Walker, a UC Berkeley professor of psychology and neuroscience.

Disrupted nightly sleep and clogged arteries tend to sneak up on us as we age. And while both disorders may seem unrelated, a new UC Berkeley study helps explain why they are, in fact, pathologically intertwined.

Some tips to improve sleep quality

  • Maintain a regular sleep routine, going to bed and waking up at the same time each day.
  • As part of a nightly wind-down routine, avoid viewing computer, smartphone and TV screens in the last hour before bedtime, and keep phones and other digital devices out of the bedroom.
  • Engage in some form of physical exercise during the day.
  • Get exposure to natural daylight, especially in the first half of the day.
  • Avoid stimulants, like caffeine, and sedatives, like alcohol, later in the day.

UC Berkeley sleep scientists have begun to reveal what it is about fragmented nightly sleep that leads to the fatty arterial plaque buildup known as atherosclerosis that can result in fatal heart disease.

Read full article

COMMENTARY

“How much sleep do we need”, and “Sleep Hygine” were past topics on this site, and my own sleep fragmentation was mentioned. This study correlates sleep fragmentation in the elderly with increased blood vessel disease compared to elderly people who have no interruptions in their sleep.

The elderly have several obstacles to a good, full night’s sleep, although a fair number of my friends claim the blessings of sleeping soundly. As we get older, we lose the deepest sleep we enjoyed as children, and there is some loss of REM sleep as well. The elderly sleep more lightly.

Diseases begin to accumulate as we get older, and These DISORDERS and their TREATMENT can disrupt sleep. I mentioned My BPH with it’s blockage of flow, leading to incomplete emptying of my bladder. This led to FREQUENT URINATION and frequent arousal at night.

With aging, the tissues in the throat become more flabby, and if you SLEEP on your BACK, your inhalation may be blocked. This may result in OBSTRUCTIVE SLEEP APNEA, where your breathing  and sleep are interrupted repeatedly. The associated SNORING may interrupt the sleep of your partner, or even the sleep of those in the next room.

GERD, where you choke on regurgitated stomach contents, is more common in the elderly.

Chronic Heart, lung and Kidney disease can interfere with sleep.
SLEEP DEPRIVATION leads to a variety of problems, such as the inflammation and Arterial blockage highlighted in the above article.

Sleep is intimately connected with DIET and EXERCISE. As one of the PILLARS of HEALTH,  It s well worth discussing with your Doctor and following her instructions.

—Dr. C.