health-related problems

Tips for better sleep

Having trouble sleeping is perfectly normal, especially as we age. It’s estimated that half of those older than 55 have trouble getting to sleep or staying asleep.

What to do if your sleep is poor

Let’s start with the easiest situation: you’re not getting enough sleep because you wilfully go to bed too late to achieve your needs.

This is unfortunately all too common. All I can do is point out how desperately important it is to get the sleep you need. By chronically depriving yourself of sleep, you not only are ensuring that your mental powers are under-par, but you have added significantly to the likelihood that you will develop cognitive problems in old age.

Life is a matter of priorities. To change this situation, you need to give sleep a higher priority than you’ve been doing.

Chances are, though, that your sleep deprivation is not wilful, but is caused by problems in getting to sleep, or staying asleep. If this is the case, you are probably aware of the standard advice, but let me bullet-point it first, before getting to less common solutions.

  • Have a routine
  • Have a regular schedule
  • Get some exercise during the day
  • Don’t do anything too stimulating before going too bed - this includes eating, drinking (caffeine or alcohol), smoking, working, playing games
  • Make sure your room is quiet and dark (wear earplugs and/or a sleep mask, if you can’t do anything about the environment).

Alcohol and sleep

This needs a special mention, because many people see a ‘nightcap’ as an aid to sleep. It’s true that alcohol can shorten the time it takes to fall asleep. It also increases deep sleep in the first half of the night. However, sleep is more disrupted in the second half. While increased deep sleep is generally good, there are two down-sides here: first, it’s paired with sleep disruption in the second half of the night; second, those predisposed to problems such as sleep apnea may be more vulnerable to them. Additionally, at high doses of alcohol, REM sleep is significantly reduced, and in any dose, the first REM period is significantly delayed, producing less restful sleep.

All in all, then, while alcohol may give the illusion of improving sleep, it is not in fact doing so.

Stress & anxiety

Stress and anxiety are of course major factors in chronic sleep problems, and the reason would seem to be the thoughts that plague you.

A good strategy for dealing with this is to write all your worries down, preferably with a planned action. Your planned action doesn’t have to be a solution! It simply needs to be a first step. Write it down, give it a priority rating or action date.

If your worry  is completely fruitless, with no viable action that you can (or want to) take, it’s still worth writing it down, along with its possible consequences. You probably don’t want to think about those consequences, but this is part of why the worry is plaguing you so much. Write down the possible consequences, and their likelihood, and you will get rid of much of their power over you.

Unfortunately, it seems that worriers are not simply more likely to have sleep problems, but they are more affected by them.

A study in which 18 young adults viewed images that were either disturbing or neutral, which were cued by a red minus sign (something horrible coming up!), a yellow circle (don’t worry, nothing disturbing), or a white question mark (you’ll have to wait and see), found that activity in the brain’s emotional centers, the amygdala and insula, rose dramatically when the participant was sleep deprived, with this effect being most extreme when the participant was an anxious type of person.

Sleep deprivation, it appears, has an effect on emotion that is similar to what is seen in anxiety disorders, and those who are naturally anxious are more vulnerable to these effects.

This means that sleep therapy is even more important for the naturally anxious.

How to relax

If you’re prone to stress or anxiety, you’re probably familiar with relaxation techniques. They’re a great idea, but if you haven’t found them as effective as you’d like, the problem may like in the ‘mental churn’ you can’t get rid of. Try the writing strategy first, then follow it up with a relaxation strategy.

If you’ve been unsuccessfully trying a standard relaxation exercise, you may also find a more mentally challenging relaxation strategy works better for you. T’ai chi, for example, is a form of physical meditation that demands your attention, and thus leaves less room for you to fret about your worries. It’s well worth learning for that alone (although it also has physical and mental benefits).

Another less common strategy for dealing with sleep problems is rocking. It does require some expense and effort, given that you need a bed that rocks gently, but it may be worth considering if you’re desperate.

The evidence for this is a little sketchy, unfortunately, but it seems a nice idea, and it certainly seems plausible. A small study involving 12 youngish healthy men found that when they took a 45-minute afternoon nap on a bed that rocked slowly, they went to sleep faster, moved into deep sleep faster, and showed more slow brainwaves and sleep spindles, compared to a similar nap on the same bed, held still. It is a very small sample, and a restricted one, which doesn’t include anyone with sleep problems. But it’s worth noting because apparently every one of the participants showed these effects.

Quiet time

One of the big problems for insomniacs is that typically the more you worry about not being able to get to sleep, the harder it is to fall asleep. Here’s a suggestion: redefine your goal. Why do we need sleep? Because without it we feel lousy the next day; we’re weaker, and we’re less able to think or remember. This is your real goal: giving your mind and body the opportunity to refresh itself.

You need to process the day’s material, to discard what you don’t need, to file what you do need, to wipe the sheet clean so you can start again. Try focusing on that instead.

Lie quietly in your bed. Make sure that it’s quiet and dark. If you find it helpful, you can have gentle music, but not anything that is loud or in any way exciting. Traffic noise, bright light, and temperature extremes, are all common causes of what is termed “environmental sleep disorder”. Moreover, one study found that morning performance on a psychomotor vigilance task was significantly worse if the person had been exposed to traffic noise during the night. Light interferes with circadian rhythms, which are also important for learning and memory.

So, lie there quietly in the dark, and guide your mind through the events of the day. When you come to events of particular interest, focus on them, picking out the details that are important to you. Give the event/information a descriptive label. Pay little attention to events that aren’t worth remembering (you could try mentally dumping them in a trashcan or dumpster). When you’ve run through everything, go back to your labeled sets. (My Memory Journal provides a place and structure for you to do all this.)

IMPORTANT! This is NOT about dwelling on things you need to do! Those should all be in your written list. They’re done.

This is about processing the day’s events and wiping the slate clean for tomorrow.

Let me say again: Bedtime is not, ever, for thoughts of the future.

Nor is it for dwelling on the past, in the sense of emotional wallowing or fretting. What you are doing is housekeeping. You are discarding, filing, and wiping the desk clean.

When you’ve done that, now is your time for your relaxation exercise. Fill your mind with your meditational image; progressively relax your muscles. Whether or not you fall asleep, your aim is to provide the quiet place your mind needs in order to get on with the processing at an unconscious level. You’ve done your bit, giving it the best possible start. Now let it do its job.

Providing a quiet place for your mind to process new information is also an excellent strategy during the day, and this is particularly true for those whose sleep is less than optimal. If you’re learning a new skill or wanting to remember new information, giving yourself 10-15 minutes of quiet reflection (optimally in a darkened environment) helps consolidate it.

If you’re prone to stress-related sleep disturbance, you may also find this strategy useful after any emotionally stressful event.

Sleep and health

It’s a truism that sleep gets worse with age, but a recent study suggests that age may not be the main culprit. The main problem is health - which of course also tends to get worse with age. Medications can cause daytime sleepiness; pain and discomfort can interfere with nighttime sleep.

Weight, too, can be a factor in sleep problems. A study of overweight and obese people found that weight loss improved their overall sleep score by about 20%. Interestingly, the loss of belly fat was particularly useful.

Sleep and diet

Sleep length has also been linked to diet. Data from the very large 2007-2008 National Health and Nutrition Examination Survey (NHANES) found that those who slept 5 to 6 hours a night had the largest calorie intake, followed by those who slept the ‘standard’ 7-8 hours, then those getting less than 5 hours, with those sleeping most (9 hours or more), eating least.

While there were many differences in the make-up of those diets, analysis revealed just a few nutrients that were critically linked to sleep differences. Very short sleep was associated with less intake of tap water, lycopene (found in red- and orange-colored foods, especially tomatoes), and total carbohydrates. Short sleep was associated with less vitamin C, tap water, selenium (found in nuts, meat and shellfish), and more lutein/zeaxanthin (found in green, leafy vegetables). Long sleep was linked to less intake of theobromine (found in chocolate and tea), dodecanoic acid (a saturated fat) choline (found in eggs and fatty meats), total carbohydrates, and more alcohol.

Whether you can change your sleep patterns by changing your diet is as yet unknown, but it is an intriguing speculation.

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Neglect your senses at your cognitive peril!

Impaired vision is common in old age and even more so in Alzheimer’s disease, and this results not only from damage in the association areas of the brain but also from problems in lower-level areas. A major factor in whether visual impairment impacts everyday function is contrast sensitivity.

References: 

(In order of mention)

Rogers MA, Langa KM. 2010. Untreated poor vision: a contributing factor to late-life dementia. American Journal of Epidemiology, 171(6), 728-35.

Clemons TE, Rankin MW, McBee WL, Age-Related Eye Disease Study Research Group. 2006. Cognitive impairment in the Age-Related Eye Disease Study: AREDS report no. 16. Archives of Ophthalmology, 124(4), 537-43.

Paxton JL, Peavy GM, Jenkins C, Rice VA, Heindel WC, Salmon DP. 2007. Deterioration of visual-perceptual organization ability in Alzheimer's disease. Cortex, 43(7), 967-75.

Cronin-Golomb, A., Gilmore, G. C., Neargarder, S., Morrison, S. R., & Laudate, T. M. (2007). Enhanced stimulus strength improves visual cognition in aging and Alzheimer’s disease. Cortex, 43, 952-966.

Toner, Chelsea K.;Reese, Bruce E.;Neargarder, Sandy;Riedel, Tatiana M.;Gilmore, Grover C.;Cronin-Golomb, A. 2011. Vision-fair neuropsychological assessment in normal aging, Parkinson's disease and Alzheimer's disease. Psychology and Aging, Published online December 26.

Laudate, T. M., Neargarder S., Dunne T. E., Sullivan K. D., Joshi P., Gilmore G. C., et al. (2011). Bingo! Externally supported performance intervention for deficient visual search in normal aging, Parkinson's disease, and Alzheimer's disease. Aging, Neuropsychology, and Cognition. 19(1-2), 102 - 121.

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Eating right for your brain

Although I’m a cognitive psychologist and consequently think that memory and cognition is mostly about your mastery of effective strategies, when it comes to age-related cognitive decline, I’m a big believer in the importance of diet and exercise. But while we know these things can play an important role in why some people develop cognitive impairment and even dementia as they age, and others don’t, we don’t yet know with any great certainty exactly what exercise programs would be the best use of our time, and what diet would have the most benefit.

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Even mild head injuries can seriously affect the brain

Traumatic brain injury is the biggest killer of young adults and children in the U.S., and in a year more Americans suffer a TBI than are diagnosed with breast, lung, prostate, brain and colon cancer combined. There are many causes of TBI, but one of the more preventable is that of sports concussion.

References: 

References (and more details) for the studies I have mentioned can be found in my topic collection on TBI.

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Diabetes - its role in cognitive impairment and dementia

There was an alarming article recently in the Guardian newspaper. It said that in the UK, diabetes is now nearly four times as common as all forms of cancer combined. Some 3.6 million people in the UK are thought to have type 2 diabetes (2.8 are diagnosed, but there’s thought to be a large number undiagnosed) and nearly twice as many people are at high risk of developing it. The bit that really stunned me? Diabetes costs the health service roughly 10% of its entire budget.

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Mild Cognitive Impairment

Except in the cases of stroke or traumatic brain injury, loss of cognitive function is not something that happens all at once. Cognitive impairment that comes with age may be thought of as belonging on a continuum, with one end being no cognitive impairment and the other end being dementia, of which Alzheimer's is the most common type.

Most older adults are actually at the "no impairment" end of the continuum. A further 30-40% of adults over 65 will have what is called "age-related memory impairment", which is the type of cognitive loss we regard as a normal consequence of age -- a measurable (but slight) decline on memory tests; a feeling that you're not quite as sharp or as good at remembering, as you used to be.

Only about 1% of these people will develop Alzheimer's.

But around 10% of adults over 65 develop "mild cognitive impairment", and this is a precursor of Alzheimer's. This doesn't mean someone with MCI will inevitably get Alzheimer's in their lifetime, but their likelihood of doing so is substantially increased.

Whether you are one of those 10% depends in part on your age and your level of education. A study2 of nearly 4000 people from the general population of a Minnesota county, run by the Mayo Clinic, indicates 9% of those aged 70 to 79 and nearly 18% of those 80 to 89 have MCI. The prevalence decreased with years of education: it was 25% in those with up to eight years of education, 14% in those with nine to 12 years, 9% in those with 13 to 16 years, and 8.5% in those with greater than 16 years.

Whether or not this will develop into Alzheimer’s can be predicted with a reasonably high level of accuracy (75%) by the rate at which brain tissue is being lost, and in particular the rate at which it is being lost in the hippocampus (arguably the most important region for memory in the brain). Whether actions known to build brain tissue (physical exercise, mental stimulation) can counteract that in this population is not yet known — but it certainly can’t hurt!

Mild cognitive impairment doesn’t necessarily mean memory problems. There are two types of MCI: those with the amnesic subtype (MCI-A) have memory impairments only, while those with the multiple cognitive domain subtype (MCI-MCD) have other types of mild impairments, such as in judgment or language, and mild or no memory loss. Both sub-types progress to Alzheimer's disease at the same rate, but they do have different pathologies in the brain.

Mild cognitive impairment is not necessarily obvious to outside observers. A person with it can function perfectly well, and although they may feel their impairment is obvious to all around them, it's not likely to be obvious to anyone not living with them.

A person suffering from mild cognitive impairment may find that they have problems with:

  • finding the right words
  • making decisions
  • remembering recent events
  • placing things in space (for example, getting the proportions right when drawing a simple object such as a box).

Essentially, age-related cognitive impairment might be thought of as slight, non-important, cognitive impairment, while mild cognitive impairment is a condition where significant cognitive impairment exists which nevertheless doesn't affect daily functioning. Dementia is significant cognitive impairment that does interfere with daily life.

 

See more research at my companion website About Memory

References: 

  1. Becker, J.T. et al. 2006. Three-dimensional Patterns of Hippocampal Atrophy in Mild Cognitive Impairment. Archives of Neurology, 63, 97-101.
  2. Petersen, R. et al. 2006. Study presented April 4 at the American Academy of Neurology meeting in San Diego. Press release
  3. Quinn, J.F. & Kaye, J.A. 2004. Study presented at the 56th annual meeting of the American Academy of Neurology in San Francisco. Press release
  4. Small, G.W. 2002.What we need to know about age related memory loss. British Medical Journal, 324, 1502-1505.

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