After years of struggling with sleep, Robert happily reported that he had found a great sleep aid available at his local drug store, a product that seemed to help him get to sleep and stay asleep quite regularly. I discovered Unisom™ on his list of medications and supplements. He hadn’t even checked off symptoms related to sleep, since he felt his problem was so nicely solved.
“For years, I would lie awake if I had the least trouble to toss about in the brain, you know… and then if I magically drifted off, it would only be for a few hours. I thought my only solution would be to either eliminate all my troubles or become an alcoholic. Only a stiff shot would knock me out. This seemed a much better option, am I wrong?”
So many times the answer to such a question is, “It depends” but not in this case. The answer is an unequivocal, “Neither the shot nor the pill is a good idea! The only variable part of the answer is just how bad it is for you!” Just because you are unconscious does NOT mean you are getting good sleep. And for Robert, good sleep really matters.
Further evaluation disclosed that Robert carries one copy of the ApoE4 gene (doubling his risk for Alzheimer’s Disease) and has high levels of fasting insulin (meaning he’s early in the course of type 2 diabetes, and has insulin resistance) as well as high blood pressure and high homocysteine.
Speaking from my heart came easily. “I am so glad you’re here! Would you rather make changes to the routines of your life all at once or one by one?” (Notice I like to leave out the last option: “… or make no changes and develop diabetes, heart disease, dementia, and an earlier death.” All of these result from the combined risk factors of anti-histamine use, sleep loss, high homocysteine and insulin resistance.) “Now is the time: everything we’re discussing is reversible with lifestyle changes, shall we start?”
What We Know
Antihistamines’ adverse health effects include:
- Impaired cognition. You know how you’re a little sleepy and dopey if you take an antihistamine? Turns out that long term use of that type of drug can increase your risk of dementia, specifically Alzheimer’s. Use them every 1-4 days and face a 20% increased risk, using 1-3 of them daily increases your risk by 50%.
- Even leaving your brain aside (!), taking antihistamines increases the risk of early death (in general) and cardiovascular disease, specifically. The anti-histamine commonly used in commercially available sleeping pills is diphenhydramine, which essentially doubles your risk of death or cardiovascular disease.
- By the way, if you were thinking you’d just ask your doctor for an Ambien™ prescription, that’s not a viable escape route, as that drug seems to increase the risk for dementia as well, though not quite doubling it.
Insulin resistance (IR) raises the risk of many chronic diseases, but especially Alzheimer’s disease (AD). We’ve suspected for almost 20 years that measured insulin resistance correlated with the development of Alzheimer’s disease but not until more recently have we fully understood the many pathways connecting the two. We know now that
- Glucose, previously the brain’s most frequent fuel, is not well-utilized by a brain accelerating its tendency to develop both IR and AD.
- The powerhouses of our cells, called mitochondria, are significantly damaged by IR and their dysfunction contributes to symptoms in AD.
- Excess insulin accumulates in the setting of IR; the “clean up” molecule, insulin degrading enzyme, would otherwise be used for cleaning up AB. AB acts like a kind of bandage in the brain, but if not cleaned up, becomes more like a scar. Much better to clean it up while it’s a bandage.
- IR contributes to the production of excess amylin and eventually amyloid beta (AB), in the brain.
- There’s more, but you get the idea….
Homocysteine is an amino acid that a properly nourished body recycles; without a good recycling process, homocysteine can accumulate and becomes a risk factor for cardiovascular disease and Alzheimer’s.
Sleep loss aggravates both IR and AD, each of which can aggravate the other!
- Sleep loss, whether it’s a medical problem or in a research setting, impairs our ability to think, shortens our lives, and can lead to IR and type 2 diabetes. Check out research here and many others.
- The connection between sleep and brain health probably runs through our “glymphatic system,” a waste clearance system that runs through our brains when we are deeply and naturally asleep. The glymphatic system clears potentially toxic substances from our brains, most notably AB.
- You know how great you feel after a good night’s sleep? Your brain is just as happy, there are clearly many cognitive gifts to enjoy from at least 7 hours of proper shut-eye.
Great, I Want to Sleep!
Getting to a good night’s sleep may be as simple as looking at the lifestyle patterns that are well known to either encourage sleep or prevent it. Marching through a sleep-enhancing day looks like this, starting with the morning:
- Get up at the same time every day! Close to sunrise would be best.
- Go outside and get 30 minutes of as much sun as you can find within the first hour or two.
- Eat a low-carbohydrate, protein rich breakfast within an hour or two
- Do brain-challenging activities in the morning.
- Enjoy the computer!
- Enjoy your caffeine in the morning: your genetics will determine whether you need to stop by 9 a.m., noon or shortly thereafter. Everyone needs to stop by 3 p.m. to sleep soundly at a normal bedtime!
The middle of the day and the afternoon:
- Might include some exercise: if you’re doing something quite challenging, that’s great and might help you sleep, but be finished an hour or two before dinner.
- Naps are fine, but wake from your nap by 3 p.m. at the latest.
- 15 minutes of meditation now or in the evening.
Evening should start with dinner.
- Finish dinner at least 3 hours before your bedtime.
- Eat nothing more until tomorrow morning. Herb tea and water are fine.
- Off the computer 2-3 hours before bed.
- Off the TV 1-2 hours before bed.
- Read in a dimly lit room or soak in a hot tub for a while.
Head to your bedroom by 9-10 p.m.
- Where’s it cool, dark, and has only the minimal amount of plug-in electronics, such as a reading lamp. Almost everything else can be turned off.
- Best if wi-fi isn’t available in your bedroom at night.
- Before bed, lie on the floor with your legs up the wall for 5 minutes. Add a few spinal twists if you know how to do those.
- Sweet dreams!
Instead of a Sleeping Pill
There are many supplements that can help with a good night’s sleep.
- The Basics: For folks over the age of 40, it’s reasonable to supplement with melatonin as needed. The older you get the more you might need: 0.5-10 mg at bedtime can help you drop into sleep. To stay asleep, tryptophan can be helpful, 1000 mg of L-tryptophan or 100 mg of 5-hydroxy tryptophan at bedtime.
- So many more. The practitioners at Northwest Memory Care are particularly skilled in making individualized recommendations, that will hopefully short-cut your way through the maze of herb and vitamin and amino acid sleep aids!
And Two Medications to Consider...
There are two medications that seem to allow “normal” brain wave cycling during the sleep achieved by taking them. Trazodone™ and Gabapentin™ are both primarily used for other purposes (depression and nerve pain, respectively), but both can help support a fairly normal sleep cycle. Dosing varies among individuals, and folks need to be observant and ask the question: is this medication actually helping me, without side effects, or do I need to look farther for a natural means?
It turns out for Robert that a combination of melatonin and Gabapentin are conferring on him delicious, solid sleep. Personally, I felt dopey when I tried Gabapentin, so my solution has been a bit more unusual. I call my own solution The Stork and The Cat.
Strange, Rare and Peculiar
The Stork: A very wise do-it-yourself researcher named Seth Roberts spent a lot of time finding the bare minimum of interventions he could adopt that would insure him a great night of sleep. Here are his two favorite deep sleep strategies:
- Single-leg-stand to exhaustion. Twice a day, stand on one leg until you can’t do it any longer (cramping or fatigue) and then switch to the other leg, do the same.
- At bedtime (before you brush your teeth!) , when you haven’t eaten for the last three hours, measure out two teaspoons of honey and enjoy.
Chronic sleep problems also deserve to be further evaluated. Undiagnosed sleep apnea can wreck your sleep, your metabolism, and your health in general. Get a sleep study! Also consider doing a test we use at NMC called the DUTCH test, a dried urine test that checks for levels of adrenal hormones. Having too much or too little can both disrupt sleep. Setting adrenal function back on track can restore a normal night of sleep.
The Cat. If you haven't considered this: make sure your roving cats and dogs cannot get to you during the night! Even a sweet cuddling cat can disturb you during a light phase of sleep. I can't imagine how many people I've told to kick squirming dogs out of the bedroom, but never imagined that a mostly quiet, sweet, and gentle cat could be disrupting my sleep. The proof is in the pudding, as they say, or in my case: the proof is in eight hours of uninterrupted sleep!
How’s your sleep?
After every particularly good night of sleep, give yourself a great congratulatory hug: you are doing a wonderful kindness to your brain, your self, your family and the world around you.