This article has been adapted from Jackie Pool’s new book, Reducing the Symptoms of Alzheimer’s Disease and Other Dementias.
It highlights the importance of good sleep as a restorative cognitive rehabilitation technique and offers tips on how to sleep longer and deeper.
Sleep ranks with diet and regular exercise as an essential component of a healthy life.
The function of sleep has mystified scientists for thousands of years, but modern research is providing new clues about what it does for both the mind and body. Sleep serves to re-energise the body’s cells, clear waste from the brain, and support learning and memory. It even plays a vital role in regulating mood, appetite and libido.
Sleeping is an integral part of our life, and as research shows, it is incredibly complex.
The brain generates two distinct types of sleep – slow-wave sleep (SWS), known as deep sleep, and rapid eye movement (REM), also called dreaming sleep. Most of the sleeping we do is of the SWS variety, characterised by large, slow brain waves, relaxed muscles and slow, deep breathing, which may help the brain and body to recuperate after a long day. Deep sleep is one of the most fundamental ways our body heals itself. Without sleep you can’t form or maintain the pathways in your brain that let you learn and create new memories, and it is harder to concentrate and respond quickly. The National Institute of Neurological Diseases and Stroke (NINDS 2017) states that sleep is important to a number of brain functions, including how nerve cells (neurons) communicate with each other. In fact, your brain and body stay remarkably active while you sleep. Recent findings suggest that sleep plays a housekeeping role by removing toxins in your brain that build up while you are awake.
Ideally while you sleep your body should be busy repairing itself, so I’d like to offer you some insight that I think will help you or the person you support to obtain much-needed sleep without the negative side effects of drugs or even supplements like melatonin.
The hormone cortisol can play a major role in robbing someone of a good night’s sleep.
Cortisol is the necessary ‘stress hormone’ that is designed to help you wake up in the morning and in emergencies, to cope with danger. However, too much cortisol is a problem and the average 50-year-old has night time cortisol levels more than 30 times higher than those of the average 30-year-old.
Circulating cortisol normally rises and falls throughout the 24-hour daily cycle, and is typically highest at around 8 am and lowest between midnight and 4 am.
Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increase alertness, making it more difficult to relax into sound sleep. Frequent or constant stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state incompatible with restful sleep.
If this is the reason for poor sleep, anything that reduces stress may improve sleep. This can include relaxation, breathing and/or meditation techniques, certain yoga postures, healthy diet and lifestyle changes.
Melatonin is a natural hormone produced at night that helps regulate sleep/wake cycles. The right level of melatonin can help you sleep more deeply and lengthen your sleep cycle. If you get sleepy during the day even though you had plenty of rest, it’s a sign that you have too much melatonin production. When the sun goes down and darkness occurs, the pineal gland, located just above the middle of the brain, is ‘turned on’ and begins to actively produce melatonin, which is released into the blood. Usually, this occurs around 9 pm. As a result, melatonin levels in the blood rise sharply and you begin to feel less alert as your body starts to prepare to sleep. Melatonin levels in the blood stay elevated for about 12 hours – all through the night – before the light of a new day when they fall back to low, barely detectable, daytime levels by about 9 am.
The natural production of melatonin to aid sleep patterns needs a person to be in a dimly lit setting. In addition to sunlight, artificial indoor lighting can be bright enough to prevent the release of melatonin. Several studies have showed that melatonin levels are diminished in people with Alzheimer’s disease when compared with age-matched control subjects. Whether low melatonin is related to the cause or to the effect of Alzheimer’s disease is still being researched but the severity of the symptoms of dementia has been proven to directly link to the decrease in nighttime melatonin levels.
So, in order to sleep well, we need to lower our stress level and to also achieve the right level of melatonin.
Bredesen (2014) recommends optimum sleep of eight hours per night and Perlmutter (2014) goes further, recommending that sleep patterns should be combined with eating patterns too. The last meal of the day should be eaten at least three hours before sleep, with eight hours of sleep and the next meal not to be eaten until 12 hours after the last meal. So, for example, if an evening meal is eaten at seven o’clock and sleep starts at ten thirty, you would wake up no earlier than six thirty in the morning and eat breakfast at seven o’clock.
The Sleep Foundation suggests a sleep hygiene programme that will help us to achieve this. Sleep hygiene is a range of practices that are necessary to quality nighttime sleep and daytime alertness.
A study in 2015 by P. Strøm-Tejsen and colleagues objectively measured the effects of bedroom air quality on sleep and next-day performance. The study highlights how it is often possible to select bedroom air temperature at will, but in bedrooms with the window closed for energy conservation and the internal door closed for privacy, the effective ventilation rate is often so poor that CO2 levels routinely exceed 2500 ppm. This occurs in cold or temperate regions and certainly also in air-conditioned bedrooms in hot-humid regions. The study found that sleep quality improved significantly when the CO2 level was lower, as did next-day reported sleepiness and ability to concentrate and the subjects’ performance of a test of logical thinking. The simple and effective solution was to increase the clean outdoor air supply into the bedroom by opening the window.
Good practice for a good night’s sleep
- Avoid napping during the day because it disturbs the normal pattern of sleep and wakefulness.
- Exercise regularly to build muscle mass and increase brain output of serotonin and dopamine, brain chemicals that reduce anxiety and depression.
- Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside often. Light exposure helps maintain a healthy sleep–wake cycle.
- Keep your blood sugar stable. Avoid sugar in the diet and refined carbohydrates to keep from spiking your insulin production. Keep well hydrated – dehydration puts the body in stress and raises cortisol levels. Keep pure water by your bed and drink it when you first wake up and before you go to sleep.
- Establish a regular relaxing bedtime routine. For example, set a habit of a warm bath, a warm drink, listening to relaxing music. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don’t dwell on or bring your problems to bed.
- Make sure the bedroom air quality is high and that the bedroom is pleasant and relaxing. Open the window a small way, if the outside air is of high quality. Check the comfort of the bed and the pillow. Check that the room temperature is comfortable and that the light level is relaxing.
- Consider anti-stress supplements but always check with your GP before you start any supplements.
For an individual who is experiencing cognitive difficulties, abilities to connect with others, control behaviour in response to emotions and even to get a good night’s sleep can be impaired. The downward spiral into worsening symptoms of dementia then begins as distressed feelings lead to distressed behaviour, which is misunderstood and negatively responded to by others. This undermining interaction leads to yet more distress, distressed behaviour and further symptoms of dementia. That spiral can only end up as a devastating self‑fulfilling negative experience for all. But the good news is that all of these factors are within our own control. The important and exciting message is that we can do something to improve our brain function by addressing those emotional states and use a framework to help the person exercise and to get a good night’s sleep. So, it is possible to reduce the symptoms of dementia in those who are living with the disability.