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Dr. Mehrdad Ayati from Stanford University discusses how exposure to natural light improves the mood of persons battling dementia, reducing depression and psychoactive symptoms, which are common side effects of the neurodegenerative diseases.
Dr. Ayati, well known nationally and internationally in the field of geriatric medicine, is a physician, speaker, author, and an educator. Dr. Ayati is the medical advisor to the United States Senate Special Committee on Aging providing medical advice on Aging and Challenges Faced by the Aging Population in the US. He is an Adjunct Assistant Professor of Medicine at Stanford University School of Medicine where he teaches Geriatric and Internal Medicine.
Speaker 0 00:00:05 My name is Keith . I'm a regional director of sales and strategic alliances with Silverado, uh, the world leader in providing care for those, with memory impairing diseases. Now, whether it's through our innovative clinical models of care, uh, for our residents, our world acclaimed evidence-based nexus program for early stage dementia that combined science and social engagement, or the many partnerships with global leaders in medical and scientific research Silverado is not only committed to changing the lives of those with memory impairment, uh, but through education and by example, eradicating the stigma surrounding all dementias, uh, we're currently changing lives in 22 communities across six States. Our speaker today is Dr. Merdod. Ayati a well-known nationally and internationally in the field of geriatric medicine. Uh, he is a physician, a speaker, an author, and an educator. Dr. IOT is the medical advisor to the United States Senate special committee on aging providing medical advice on aging and challenges faced by the aging population in the U S Dr.
Speaker 0 00:01:02 Ayati is an adjunct assistant professor of medicine at Stanford university school of medicine, where he teaches geriatric and internal medicine. Uh, he joined Stanford university school of medicine in 2011, his faculty, where he taught in practice internal medicine and geriatrics at the Stanford internal medicine clinic, the Stanford senior care clinic, Stanford concierge medicine and Stanford Stanford executive medicine. Dr. Ayati is a member of the ethno geriatrics committee of the American geriatric society and serves as a faculty advisor for the center on longevity at Stanford university. He is a member of the healthcare advisory committee of Northern California and Nevada chapter of the Alzheimer's association, and is a geriatric consultant on aging research projects at Sri the Stanford research Institute international, Dr. Ayati is the editor in chief of the journal of general medicine open access and is the co-author of paths to healthy aging. He is the founder of the Bay area, senior care society. Dr. ADI, I want to say thank you so much for joining us today and that we're all excited to hear, uh, your presentation. So thank you so much.
Speaker 1 00:02:04 Thank you so much. I appreciate it. Uh, gave for the warm introduction. I'm so pleased to be here and, uh, again, um, it's, uh, wonderful that we can actually connect this stays through the visual and, uh, we can see many peoples, uh, as well, and they can actually get their education through this new platform. Let's talk about, um, natural daylight and the main thing we wanted to talk is about sleep. Um, and the reason I want to talk about is sleep because the daylight is part of the sleep pattern, and we need to learn a little bit about the sleep of physiology, uh, till we are able to understand what does it mean with, uh, uh, brain circadian rhythm and the rest, uh, before I wanted to start, I have to say that I don't have any conflict of interest, um, about the topic that I'm talking right now.
Speaker 1 00:02:53 And, um, again, I'm not getting paid by any pharmaceutical or biomedical, uh, uh, by technology company or biomedical related to the topic that I'm talking right now, sleep change. It's one of the topic that we want to talk about it. And the main topic that we're going to talk is a brain circadian rhythm. Uh, why do we need to sleep? And the change of sleep as we age, and some strategies to improve the sleep, which more effects on dementia and also cognitive impairment. The main thing that I wanted that you, we all learn is about brain circadian rhythm, exactly what we talking about daylight and why the light is important. Part of that, some of the questions that we able to answer at the end of this topic is some of the major, uh, simple things that people talk about it. Like, for example, why exercise help us to sleep better?
Speaker 1 00:03:43 This is always a question that a lot of the patient asks that what's the relationship between exercise and asleep. Why light is very essential for brain function and why is sleep necessary to, or a standard physiology for body and why? When we come older, men become older, we have more complaint about asleep and why a lot of the people they're not able to sleep in nursing, home and hospitals, and especially in facilities and the people with dementia have more problem with the sleeping, why it happened. Now, the first things we wanted to say, some opinion about the sleep. And I just want to share with you some of the opinion that people had, the famous people about the sleep. Um, the one from Ernest Hemingway's, I love sleep. My life has the tendency to fall apart when I'm awake, you know, and the other one is due to sleep.
Speaker 1 00:04:33 I know we had a problems when I was younger, but I love you now. Um, Dalai Lama says sleep is the best meditation, which is true. And there's also a very funny, uh, thing set of sleeping, um, is my drug. My bed is the dealer and my alarm clock is the police. Now w the first, before we wanted to start, I wanted to say the biggest lie that happened in the history of human was this, uh, um, a statement then early to bed, early to rise, make them and healthy, wealthy, and wise. That's not true anymore. We know that people actually are sleeping more. They have much better brain function, and it does it not necessarily the people actually sleeps less. Um, it means they're a smarter. And, um, actually the sleep is one of the major, uh, Trump pubic things for happened to the brain, which we're going to talk about it as sleep is a very important part of the life.
Speaker 1 00:05:28 And it still is a mystery. We have half of our life is spent in the, in the sleep. For example, if somebody's age, I mean, this days is very easy to everybody age, till nine years old, we almost suspend Tony three years of her life in a sleep cycle, which is a very, very important part of, or for life when it's, when we have a sleep technically or body gets paralyzed. Um, and we're eyes is still moving and, uh, we still have a feeling of flying and, um, and kind of like a front of the, they call it approach to frontiers of debt. This, these are from, um, uh, Freud, actually the centers every day, every night, or brain go to a startling, uh, metamorphosis, which is true about the sleep is amazing part that why the brain does that. And I'm going to explain to you why, because then we can have the connection between the light.
Speaker 1 00:06:19 And we are always, I mean, this is, this is based on a history that why we are doing all of these things in, during the sleep and why. And there's just should be reason. Now, the reason that we know it's about probably one of the things that I want to say this gentle man you may hear about. And he just recently passed away Dr. Damon. He was the father of his sleep medicine and, and he was actually working at Stanford. Many things we know about the sleep brain, circadian rhythm is actually because of his work. Um, after he became semi-retired, he started to writing newspaper and the books, one of the books that actually made was asleep. Walk with me that it was a very nice movie that actually based on what, what, what is the experience about his sleep? I encourage you, if you wanted to look at it's kind of like a comedy, but, um, it's, it's kind of like given an idea of what does it mean to the sleep cycle?
Speaker 1 00:07:11 I just want to quickly talk about it, cause this is not a topic that we're going to talk about it today, but I wanted to tell you about this topic because, um, this is the sleep cycle. It is important to understand the sleep cycle. We have two sleep cycle. Overall. One, one is sleep cycle that we have it's non-REM, which is we call non rapid eye movement sleep. And the other one is rapid eye movement sleep, which is we call REM. Now every time when we go to sleep, like, for example, if you're sleeping at 10 o'clock at night, we go to the non REM and one REM cycle, which usually takes around 90 to 110 minutes. Like, for example, if you start a journey and 10:00 PM, we're going to go around like almost around 12, 12, 1230, or maybe 1132, this cycle, what happened is we go for stage one, two entry, which this three stages are non REM sleep.
Speaker 1 00:08:04 I'm just circling here. Now during the, the stages we get first lightest sleep or muscle brain activity decreased, we go to stage two and then our I've movement and muscle activities stop. And the brain has a very, very slow wave at that point, technically in non REM sleep, especially a stage one, two and three, we are in a very, very deep sleep. Then we go to this cycle, which we call rapid odd moments suddenly are hard to start to increase the rate. The rate to breathing is start to going up. Blood pressure is going to go up and body is paralyzed, but what we see or all is move so fast. And we started to have dream. Every cycle is around 90 to 110 minutes. Now we may wake up between cycle. Some of us, we would go to the bathroom. Some of us, we may come back again and we, if you're, we move from one cycle to other cycles so fast.
Speaker 1 00:08:59 And then during the denied, we have like a three or four of these cycles, which is going to be six hours or seven hours of sleep. The more we go toward the morning, we have more I'm asleep means that technically Remy sleep is the time that we wake up in the morning. And sometime we have some anxiety because it's still, our heart rate is elevated or, or, or, um, or respiratory rate is increase, slow wave, which is the stage one and two entry. It's a very, very deepest sleep. Whenever you don't asleep for a long time, like 24 hours, the first thing happened. You find a bed even don't want to change your clothes, or you just go and jump to the bed. It is a very, very important because it's very, very restful and what we see that or vegetative body function and peripheral vascular tone, significantly decrease.
Speaker 1 00:09:50 This is a very, very important part because our blood pressure drops at this point or respond to rates is going to be, we'll be breeds less, more slower. And we have a very, very basic mature, uh, metabolic rate at that point. And that's really, really important and very close to coma. I mean, even if the external is, um, noises may not waking us up when we are in a non REM sleep, it's a very, very important to maintain our immune system, to regulate our body temperature or regulate or blood pressure or moods and, and many other things. The cycle of his sleep is more important than food. And technically we can die by, um, uh, sleep deprivation, but it's still even, we are a star of the food. We still can make it four weeks, but as sleep deprivation can kill us. If we don't get non-REM asleep for period of time, because our body technically entire physiology depends on this cycle.
Speaker 1 00:10:49 When we have remedy, which is a paradoxical sleep, which I S I told you that, um, when we have like an average, every minutes, we go to this REM sleep, which is five to 30 minutes. And then the person is going to be, um, when the person is extremely sleepy, we have less REM asleep, more non REM sleep, non rapid eye movement, which is more deepest sleep. But when we are having more naps, for example, or we're really not very tired, then we have more REM sleep. And this is very interesting. No REM sleep is a very interesting time because it's exactly the time that we have all our dreams happen. We have active bodily movement, which is very interesting, but what happened is, as I explained to you, that we wake up in the morning with Remy sleep. What is very important that we need to understand in REM sleep, we need to have our muscle tone to be decreased and depress.
Speaker 1 00:11:45 If it's not happened, then we are going acting out every single day teams that we have, um, during the sleep time. And this is why some people, you probably hear, they have like sleepwalking the reason they're asleep walking, because they don't get this paralyzed after muscles. And then they start to acting off the dreams. If you don't get this depression of the muscles, then we are going to be extremely moving during that time, as I said, or as far as you rate is increased heart rate, and this is all reaction to the dream. No, it is so important. I said, why our muscles needs to be paralyzed because otherwise we're going to act up every single dreams that we have. And one of the problem that we see in elderly and some of the geriatric, uh, complex situation like people have Parkinson's disease or Lewy body, or the people have Alzheimer, they have REM sleep behavioral disorder.
Speaker 1 00:12:37 Does it mean that during the REM sleep, they're acting out their dreams. And most of the time there's a partner in the bed and one partner is kind of heating the other one and that's exactly happened. Um, and, and, and again, the same thing we have is, is all about the dreams that we have, um, during the, the remise sleep. Well, the most important question, which I'm actually going to go through that, that why the light is also going to be important, why we are, or brain is active or shut down. The answer is bore. Brain is extremely active, especially during the sleep. When we do the pet CT scan of the brain, as you see the red area here, um, in the, in the brain pet CT scan, you can see easily that we have, we are very active brain. Actually, when we talking about REM sleep, right?
Speaker 1 00:13:29 The reason is that we have increased optimism capitalism of the body. Yes, it's so important. We have lots of things that happen. Like Freud says about the Ram is the time that we all go mad. We can have psychosis, Hollister nation. We can talk during this time. A lot of people says the time to connection to the gods. Um, and, um, it is exactly the time that we have chaotic firing of all neurons and, uh, many of, uh, and for entire, again, the human is the time to sexually. We actually going to be activated. Um, and, and even for women or men, they're both the same and it's starting from limbic system, this is going to happen. Now it comes to the very important question. When our brain is very active during the sleep, then why do we need a sleep? Should we just be awake and why the brain needs that the time of activity?
Speaker 1 00:14:22 Because what happened to them brain? Exactly. The sleeping tub. Cause we for retired brains getting rest during the sleep, but we know that's not true. Brain is very, very active during the sleeping time, why we need to do that. And what's the benefit of asleep. Yeah. And that's the question is going to come here. This is the guy, I don't know if you knew him, but this is Randy Gardner. He was a very famous guy that actually it was who was able to be awake for 264, four hours, which is 11 days and 24 minutes. That was part of the study. Dr. Devin was part of this study. The study was done in San Diego and they technically, they didn't use any assimilate, no coffee, anything in 1964. And they're continuously doing the electrons follow gram of his brain, checking the blood pressure, do EKG and see what happened to Randy.
Speaker 1 00:15:14 After that amount of time after Randy, some of their people, they able to broke the record. I think somebody made it till 12 days in South Africa. But again, what happened is a very important things of what happened to him on the second day is Randy, his eyes are stopped to focusing his stop, identify the object by touch. He was not able to say, this is hard. This is rough anymore. He'd become very moody on coordinated. And he becomes half Holocene nation. After that, he has short-term memory loss. I wanted to really pay attention to this part because that's very, very important to understand it later. And then he started to have very paranoid psychosis who complete, he recovered completely. He's still alive. And, um, um, it doesn't have a longer and damage, but we were able to learn why many of psychosis feature memory loss, even so sorry, touch eyes.
Speaker 1 00:16:10 Everything has been complete, completely gone while he was asleep. No. Now back to physiology, when we talk about the sleep, there's two, there are many, many neurotransmitter in the brain is important, but there's a two signals are very, very important in our body to understand about the sleep cycle. One of them is atrazine. One of them is melatonin, which you heard about that. These are signals from our body, the signals from our environment to tell our body is tired and ezine is the production of the muscles is built up during the day in the brain. And is technically what we call is internal energy store. If you do exercise, if you use your muscles, you build up the animals in and add it as in is the reason that people get a snip pressure. As you see in the picture. If I, when the front of monitor, when I'm talking to you, if I have my eyes are getting closed and I just keep sleeping, that means I have a lot of animals in my brain.
Speaker 1 00:17:09 Okay. Adam is in coffee, coffee and caffeine, which we all taking in the morning is technically, as you see here, right? This is the admin cuisine, and this is going to be your, your, your, your caffeine caffeine, technically, uh, block the adenosine receptor. And doesn't let the ad and Rozene to sit on that, but it's going to be limitation. Now, the first question that I said in my topic, why exercise make you sleep better? Because when you use your muscles, you produce more ad nauseum. As a consequence of that, your brain is going to be more sleepy at night, and then you're able to sleep better. But what happened during the sleep time, there is a system in the brain called glymphatic system is produced by a spinal fluid, goes to a brain and a start to clearing and cleaning your brain. As a consequence of that, then you're technically able to get rid of ad nauseum.
Speaker 1 00:18:03 And then when you wake up in the morning, next morning, your brain is free of Adam cuisine and you are fresh. If you don't asleep, you still have some residual Adams in from the day before that's, while you feel very groggy, you feel incoordinated next day, you are not able to concentrate very well because you still have residual ad nauseum in your brain. It is so important. The brain during that cycle, that we talk about it, the start to cleaning through the spinal fluid. This adamancy. The second thing is, which is a subject of our talk today is about melatonin. Melatonin is approaching is technically as a brain. Circadian rhythm is the which technically help us to understand the master clock in the brain. This is the master clock. This is the time when we look at, okay, this is the daytime in California. And this is the nighttime responding to the light was not only for us animal plants and microbes that all have some brain, the master clock in their system.
Speaker 1 00:19:00 Even pious has it microbes, have they have it. But again, for us is a melatonin is the one is telling us what happened. I want it to bring their attention here to this picture is a very busy picture, but I want to tell you, what's going on here is the light. As you see here comes through your eyes. When it comes to your eyes, it goes from the lens and then go all the way to retina, which is here in the red. Now you're processing the lights and the lights goes to the place here, which we call super nucleus. Um, again, SCN or super Christ, Marik, nucleus. This is the place in the brain that has started to processing all the lights that happen. And as a consequence from that place, it goes to a place in the brain called pineal gland. And from pineal gland, we produce natural melatonin here in the blood stream.
Speaker 1 00:19:50 Then light go to eyes, go to this place, go to the pineal gland. And we have natural melatonin in the body that is telling us that this is the day. This is the night. This is the time to sleep. This is the time to be active. No, I'm honored to answer some questions here that you may have here. When we getting older, what happened to us? Many of us, we have cataract or lens are not going to be very clear. That's why we have a problem with getting lights or retina. Many people they're starting to have degeneration in the retinal area. That's why they're not able to process light very well. This is one of the reason as we're getting older is sleeping is going to be much difficult for us. When it comes here, we get calcification of this places, Supercross, Marik, new clothes, get calcified as we're getting older.
Speaker 1 00:20:38 And this is why we have a hard time to processing, to sleeping cycle. And I wanted to tell you something, the people getting dementia, especially like for example, Alzheimer's dementia. What happened in people with Alzheimer's dementia, they get a lot of protein that they come and cut displaces. This connection's going to be cut, like from here to here going to be caught. What else can cause that a stroke that people have a stroke, they have cutting of the system. There's not able to light process very well all the way to the pineal gland, Supercross, MarTech new clues. And that's what we're not able to produce natural melatonin. That's why we're not able to understand circadian brain rhythm wearing wow. Melatonin. Technically is a time. Messenger is telling us, this is the day. This is the life is producing. Technically during the day we get the light and evening melatonin comes to the bloodstream and then it start to getting to the system and telling us that this is the day.
Speaker 1 00:21:38 This is the night. Now it's so important because I wanted to tell you this cycle, which is you can understand what does it mean now? Let's just, just start from here. Let me just back again. My pen here, let's just start from nine. O'clock imagine that you are in California. I mean, we're now I'm talking from California. It's like in like nine o'clock is dark and melatonin. Start to comes to my system. What happened is melatonin as a time is going to go tell to my bladder and my intestine area that please stop functioning. If they don't do it, we're going to be all night in the bathroom. This you can see here, the bowel movement is stop. We're going to go to deepest sleep and a two o'clock in the morning. We're doing very deep sleep. I will tell you, melatonin has the converse effect with the body temperature at four 30 o'clock in the morning, we feel extremely cold, but melatonin is high or body temperatures go.
Speaker 1 00:22:33 Usually when we start the night with the blanket, uh, we put the blanket on the bedside, but in the morning we need the blanket. We have to put it on. Cause we feel extremely cold. And in the morning when we have a sunrise or blood pressures, start to rise, melatonin is start to stop at seven 30 in the morning between six 45 to seven 30 is still, we have some residual melatonin in the system. This is why people are very, um, drowsy is still in early morning. One of the reasons we have the highest amount of accident in the highway is actually early morning because people are still very, very sleepy. Um, and again, eight 30 in the morning when the melatonin completely stopped, we going to have a ball movement. The start we have, um, high alertness at 10 o'clock. If you want to do any examination, this is the best time tanks to key, to, to coordinate this time for conference because 11 o'clock is the best time that you can learn everything.
Speaker 1 00:23:26 And then afternoon, we have the best coordination, fastest reaction time. If you want to make any financial decision, this is the best time. And you have a very high cardiovascular effectiveness in the afternoon. This is why a lot of people talk about it is the best time to do or cardio exercise in the early afternoon, like before, like around like 5:00 PM, 4:00 PM, because our heart is in the maximum function, not very early in the morning, and that's kind of things that it can help us to understand or body. Um, uh, this is us. This is 24 hours. What we call it, natural daylight brain circadian rhythm, that we are going to talk more about it in the next slide. As we said, that melatonin is going to up at nighttime and then it's going to have a drop in there. And then based on that, we have different kinds of people.
Speaker 1 00:24:14 Some people are advanced sleep phase disorder. Now what happened in this people, as you see here in the picture, um, their melatonin is actually instead of going up much later at the night, it goes up much earlier in the evening, like for example, 6:00 PM, 7:00 PM. They feel extremely sleepy much earlier. And their body temperature is kind of like dropping much earlier at that trauma. Two o'clock two o'clock in the morning. This is why we call it morning type people. The people wake up between two o'clock and five o'clock and they usually go to sleep between six to 9:00 PM. As we getting to middle age to our elderly, we are this type of people, melatonin res much earlier in our body's system. I have a point about this for you, which I'm going to share with you the other, uh, as you probably say, the core body temperature drops, we feel as sleepy.
Speaker 1 00:25:06 And again, we are have a gradual progress through the age, and this is why many of people, when they get to middle age toward older adult, they actually wake up much early in the morning. And they're always complaining about that. They have the problem to fall back in sleep. On the other side, the people have delayed the sleep phase disorder, delayed sleep phase disorder are the people that are two hours. Usually late. There are evening type people. And most of these people are teenagers, teenagers, and young people. As you see here, the young people, the melatonin is not going to go up after midnight. And the core body temperature is going to drop much later. This is why they wake up around like 11:00 AM or 12:00 PM. And this is the complainant, always the parents about younger teenager, but this is a very normal sleep phase disorder and family history is going to be one of the tanks that it's very strongly contribute to that.
Speaker 1 00:26:01 Now, based on that people have a different cycle. If feed imagined that normal people or the people there, like, for example, I don't call it normal anymore because this is not true. But if somebody like, for example, asleep at 9:00 PM, wake up at 8:00 AM we call it normal? No delayed is the phase disorder or the young people and teenager, they wake up 2:00 AM they sleep at 3:00 AM. They wake up 12:00 PM. And as we're getting older, we sleep much earlier at the evening time. And we wake up at two or three o'clock in the morning and we're not able to fall asleep. We talk about this tree. Well, who are these people? They're sleeping tonight. They wake up sleep two hours. They wake up people with dementia. These are exactly the, what we talk about it because of the blockage on the nervous system in the brain, they have a very sporadic sleep cycle.
Speaker 1 00:26:53 This is what we call it. Irregular asleep, waking with rhythm. The other one is non 24 hours of sleep, wake and rhythm. This is exactly going to be some people with cognitive impairment neurodegenerative, but this is going to be a very, very good example. The wife physiology CLI people with a stroke, people with dementia, they have very sporadic cycle of his sleep. And this is a very common mistake that I see a lot of time that people trying to give them medication to make them asleep eight hours straight at night. The people with dementia, that's absolutely a wrong practice because the brain is not at the situation that they are able to sleep for a six to eight hours. They are going to have a sporadic the sleep cycle, and they're going to be awake. They're going to wander. They get their Walker. If they're able to walk walking around the house or facility and they come back to the bed, they sleep for a couple hours.
Speaker 1 00:27:43 They wake up. This is totally normal physiology for the brain and any, um, a sleeping medication for them is really not going to be helpful. But the life of human has been changed because we have a lot of the artificial lights in our system, TV monitor computer. When we look at the history, we're been technically living here, cave into darkness. And then when we have the agricultural, um, life, then we start to do ag agriculture during the day. And then nighttime, we, it goes to the tour houses and the darkness, and then we sleep. I wanted to, but because of this gentleman, Thomas Edison, uh, he waited the darkness and we have a much brighter, um, environment. That's makes the brain to become confused as well. And that's something that we have to pay attention. I can tell you before I actually went to Stanford, I was just practicing in the central Valley.
Speaker 1 00:28:39 And most of the people have been farmers there. Uh, personally, I have to say that I've never seen any farmers have a complaint of a sleep problem in my life because they leave with the natural daylight cycle. They wake up exactly at the sunrise day work during the sun, they get the exposure to the sun and light and they go and asleep at the evening time. And they actually work very well. Um, the brain cycle is really adjusted to melatonin and natural, but because we are in the city life, we have tons of lights right now, as you probably hear. And I just reading an, uh, a year ago, uh, there was a very interesting article in national geography that when they look at the, from the space shuttle, the planet is very bright right now because of the lots of artificial lights in the cities.
Speaker 1 00:29:28 And that's definitely is a toxic for brain because brain doesn't like to be under the light. And that's one of the things we talk about circadian rhythm, it's so important or body function or temperature, hormonal effect, obesity, depression, bipolar, everything is related to our circadian rhythm. We know it. We know that people may get more metabolism problem or diabetes, even in the study of Donna in rats and mice, that are the mice that the eating later off the night, or they have the habit of eating any time. Instead of like the mice that they have, the specific time of the day, day eating, and a specific time to stop eating, they are less likely to get diabetes, but the one, they have a sporadic pattern of eating the actually get more. It definitely affects off the vascular system. We know that, um, this, so Kenyan, brutalism, and not as sleeping, it affects of high blood pressure diabetes.
Speaker 1 00:30:22 We know the story that a gentlemen in the 2014 world cup soccer for world cup, he died of the sleep deprivation after 24 hours of night slipping. But again, some people have totally a sporadic pattern, right? Um, this gentleman has the 10 hours of each night to sleep and he he's getting more hours of asleep. And he was a very smart man, but the, um, Tesla had a very interesting pattern of his sleeping, sleeping, couple hours. You wake up a steep couple of us, but when we average is asleep, it was sleeping for 14 hours a day, but it was very sporadic, but he gets what his brain needed at that time. But it's so important to understand the why the snip is important for memory, because we talk about asleep and in the Randy experience that he actually had a very short time, as we know here, the steep is the most important it's in part of reconstructing of a memory.
Speaker 1 00:31:15 And it's a time that anything we get into short term memory goes to the long-term memory. And this is so important because hypo Campbell area, this is the place that you see here in the blue collar. This is the place that is responsible for short-term and also, or learning short-term memory and also learn, no, this is the important part that talk about declarative and procedural memory. Okay. Now, when so many has like Alzheimer's dementia, what we see here, MRI that this hypo Campbell area gets shrink, gets actual thick. And this is why it's so important to understand it. When we talk about declarative memory and procedural memory, this is exactly what we talk about. Declarative memory is technically on the temporal lobe is about facts and is about events. Like for example, you remember the anniversary, remember the birthday procedural memory is a skills and habit and need for this to part, the sleep is so important because this is the time that you moving from your short-term to long-term like, for example, today, anything I telling you, it's a, it goes to a short-term memory, but if you sleep tonight, then tomorrow morning, you wake up and say, Oh, there was a speaker, Dr.
Speaker 1 00:32:27 Yachty. He came on board. He talk about the sleep and he's, he told us many times if you don't sleep very well tonight, you may not able to remember the details that I, we talk about it. And these are the memories that we definitely need the sleep for, for the cycle. As you see here, uh, which is very well explained when we are awake, everything's come to hypo capital area. As you see here, sitting there, but what happened during the sleep everything's get organized and move to the deep layer of the brain. And when you wake up in the morning, your hypo Campo, area's completely empty. You're ready for the new information. And what happened to your deep side of the brain is everything is very, very well organized. You see the colors, blue are together purple and the pink saw together. And this is exactly the reason that we have this.
Speaker 1 00:33:15 Um, it is so important. We all was saying that it's a common experience of the problem. Difficult at night is resolving the morning after the comedy of his sleep has worked on it. That's absolutely true. Um, I just want to say that it is so important to understand that your immune system is really related to the sleep cycle. We see on this study, the people that have poor sleep, the influence of vaccine is not effective in them, and they are having more potential to get cold as well. But if one of the things is about light therapy, because light, if we cannot get the sunlight, which again, we are in California, we were lucky, but in many people that they don't have a light. They brought the bright light therapy. First started from people in UK and a Scandinavian country because they really didn't. They don't have the light and most of the, or most of the year, but what happened is that the, they developed the sunlight or light box.
Speaker 1 00:34:08 And then what happened is during the sunlight and light box, they're starting to give them the light at that time for people like the teenagers, they better to give them in the two hours early morning for people older adults, they better to give them advanced, which we call advanced asleep phase two hours at the same dose in the evening. But then they have to do routine eye exam as well. But it has a lot of effect bright by terribly. We see in people with dementia has effectiveness on depression and anxiety and in depth in many, a study that we have so far, the best time for a sleep, uh, for, for bright light therapy. It depends on what the problem that you have for teenagers. We need to make the melatonin to be secreted earlier time. That's why early morning light therapy. It's going to be the best time for people or most of the older adult people.
Speaker 1 00:34:59 Most of my patient in geriatric, because they have a problem that they feel asleep in the evening and they wake up two or three o'clock the best time is later afternoon. And this is so important, which is one of the advice I give it to my patient. If you really want to, to adjust your asleep, you better to have the song glasses till noon and do not go outside. And then when you go outside is early afternoon. Technically when we get retired, we all getting out in the early morning, and this is the biggest mistake that we do because when we get light in during the morning time, technically where melatonin is going to be secreting earlier in the more in the evening, the best thing for this population is wait till afternoon stains side to stay indoors early afternoon, go outside and get the maximum sun and light in the afternoon that going help.
Speaker 1 00:35:50 And if they want to do early morning walk, they should use a very strong sunglasses to not getting light in the daytime. And then later afternoon walk with all sunglasses to getting the maximum white, the effects of the anxiety and light is so important to people of dementia. We see the people with vascular dementia. There's a lot of the scores that we see that even turning minutes exposure to the morning light has helped with anxiety as well. We have of goodness study from darling and colleagues that showed the people with Alzheimer's dementia. They actually have very effectiveness on aggressive behavior are fortunately many of our, uh, memory care units. And again, there, most of them is indoors. We have very limited a memory care unit that they have a very big places and they can go outside and they get a good morning light. Some of the tips is the light is important.
Speaker 1 00:36:42 If you do the light therapy for Alzheimer's dementia, we're not going to see effect right away. It takes maybe six months to see that. And, um, and again, um, a lot of people, they say windows, windows is really not important. If you are two, three meters away from the three or four meters away from the windows is really not. You really need to have a good exposure to the light. And this is exactly answering the question to why the hospital and nursing home are the worst place for sleeping because of the artificial light that we use it in a nursing home in hospital. I want to quickly just say about pharmacologic, because you may ask him, this is not a topic we've got to talk today. Maybe another time we can coordinate for have this topic about what are the sleep medication that we use, but one or two, say something that, um, um, only time when we use them, when we have, um, chronic insomnia, they are not responding to behavioral therapy or does the acute, the stressor that we need to use the sleeping medication, always the smallest dose.
Speaker 1 00:37:44 And we also have to really be careful about adverse risk effect, because what happened is that it's so important that we know, and there are different types. There are short acting to help to fall asleep. There are intermediate acting to helping you to staying asleep. This is so important. There's lots of them. I don't want to talk about them. That's not a topic for today, but there are lots of the medications are available and they're also carrying the risk. As you see here, there's lots of risk is here with them, but it's so important. I'm not saying that we do not prescribe. We should be vigilant. We should be smart. We should really find the right person. As I said, like for example, somebody with dementia, prescribing a sleeping medication is a wrong way to go because it's where are you? Where, where did this?
Speaker 1 00:38:27 Where is this medication is going to go? In which receptors it is so important that the physicians or practitioner families altogether come a good model of what medications do we need to use. And that's kind of like a needs of skills and some knowledge behind that. Um, again, uh, um, there are maybe effective compared to placebo. Um, but again, don't forget the most of this study is a pharmaceutical run by death. But again, just want to say that the side effect is there and we have a loss of mortality, cancer, many other things from this side effect of this medication and the long-term use of this medication is always caused the habit because we've developed tolerance. This is a question that we don't know there, why this has happened, and this is something we need to understand. And some of the medication, like for example, about, um, watch, we call men non benzodiazepine, receptor agonist.
Speaker 1 00:39:24 So it can be in the famous one. We know does increase with the risk of fall and, uh, the same thing as like lorazepam and the use of benzodiazepine, or even like non benzodiazepine, receptor agonists should be limited to less than six months because long-term use associated with definitely cognitive impairment and dementia melatonin that you buy, which is, uh, um, from, from outside maybe effective, doesn't have the same side effects that all non benzodiazepine, but it's very different people. People have a very different response to melatonin because we don't have really a right physiologic dose for that. And this is why we have this, which depends on the people. How much did those have this, the medication that they needed based on the seral melatonin. And this is why it's kind of like an artifice sleep. And also even geriatric when it comes to what is the right dose of melatonin, somebody needs it.
Speaker 1 00:40:20 But for example, many people, they may need a 0.1 milligram of from electronic. If you give them more, it actually makes them more groggy and more side effects. Maybe some people need 10 milligram. Maybe people need one milligram. This is why even for external the location settlement of 20 and, or, or, or over the counter, we recommend to start with the tiny dose and then gradually increase the dose to, to see the effect I wanted to just wrap up here that it is so important to understand is sleep is not a dizziness. If somebody sleeping is not Nisa, somebody is, is, is sick. It's means that the body needs to sleep, but we have to also understand about over sedating and over sleeping as well. It is important to understand change in the circadian brain rhythm. I have to say, if everybody understand his own brain, circadian rhythm, natural daylight, and how we can use the sun and the daylight as orthopedic effect, then you're able to understand your own physiology much better. And there's really no safest sleep aid medication at D.
Speaker 0 00:41:24 Wow, well, Dr. Roddy again, thank you so informative. So much information to digest. So thank you so much, uh, for this amazing, uh, presentation, uh, lots of questions here, and we're going to do our best to get through as many as we can. Uh, I'm going to start first of all, with, um, would you consider it to be unhealthy or a cause for concern, if a person is in bed for eight hours of sleep, but wakes up six to eight times each night for about three to five minutes each time, would that be something that would be cause for concern?
Speaker 1 00:41:54 No, but what is the reason it's so important if somebody is saying, uh, it's true different situation. If somebody is staying in bed for eight hours, but has interrupted asleep. If my understanding is that person wake up for six or seven, that means the person really doesn't get enough necessary sleep very well. Number one, we have to find why that person is actually wakes up six to eight times at night or day, whatever the person's cycle is. There's definitely a reason for it. They are that person doesn't get a very good maintaining sleep. Most of the people they have to go for urination. That means that if there are using, uh, there's a medical problem, that they actually, they have to go to the bathroom or they using medication that actually makes us interrupted asleep. This is the job of the physician. This is job of geriatrician to review their medication list and make sure this is, or even the medical problem to see what's the why, the reason what's the reason the person has to wake up six or eight times at night and they'll go to the bathroom. What is there any underlying neurological diseases there? Um, but yes, it's, if you just stayed eight hours in the bed, but we have to go six to eight hours. No, that's not healthy. That means there's something wrong. But if somebody is really asleep for eight hours in this thing that I just say congratulate to that person is very lucky as a good brain able to do that.
Speaker 0 00:43:15 I'm envious of that person. For sure. The next question is, does one produce more melatonin during REM cycle versus the non Wren cycles?
Speaker 1 00:43:24 No, the melatonin produced during the daytime and then it relieves at nighttime technically. Um, we get the light during the day we get the process and nighttime be producing the melatonin. Melatonin is kind of like a steady goal. It doesn't matter what non REM REM asleep anyway. And, um, and that's, this is my understanding of question is right in middle of 20, it doesn't do anything with Rehmann non-REM is released at evening time. When the, whenever based on your local area, as far as like a sunset it's released, whenever it's going to be dark outside. And then this is the time that your brain has start to feeling that you want it to fall asleep.
Speaker 0 00:44:05 Okay. Next question is talking during the sleep, is that as, as somebody who talks during the sleep, is that something you learned about, or is that a sign of anything or is that normal?
Speaker 1 00:44:15 It's just sign as, as the, that person during the REM sleep is not able to suppress the speech muscles. And again, as we said, we all add some of our, some of us were acting out or dreams at night. The people also sleep talking is the same problem. They talking in the dreams, but they're not able to paralyze their speeching muscles. And this is very genetic. Um, a lot of people have a degree. They also get this as well. And then the, they talk during the sleep. This is nothing wrong about it. This is the way that they are. This is the way they are. And it's very interesting. Sometime they even tell all their secrets at night during the sleep, if they have the partner is someone they can learn all about their secrets at night.
Speaker 0 00:44:58 Good. The next question is what is your suggestions of family caregivers that are caring for their family members with dementia and the dementia patients or the measure family member is waking the family members up at night during their natural sleep patterns. What's your recommendation for that family caregiver? Who's in a situation
Speaker 1 00:45:15 Question. I mean, the problem is that most of the time we, we wake them up for, uh, changing, like for example, changing the pool up or something at nighttime and technically makes the interrupted asleep. Is it the question is about that family caregivers. I define my understanding is that, um, first of all, the people with dementia, they, if they are very lucky, they may, they may be asleep, is straight and they don't have this sporadic, his sleep pattern, but we always recommend to minimize any instruction at nighttime. And this is the same thing for memory care as well, to any interruption at night, as much as we can, um, to, to let them their brain again, with the dealing, with all the damage and broken system to kind of like adjusting itself with the sleep. Um, and this is why I know a lot of people are very, um, um, sensitive about it.
Speaker 1 00:46:08 But again, I completely understand because sometime when they have bowel movement and urination, it caused a urinary tract infection as well. But as far as we do, I will say the same protocol that we use for the babies. We try to not really make the lights on. It's not making a lot of noises is try to do it as much as the slowly and quiet that we can. I've observed it in many other places in memory care, they do this protocol and they try to be very calm and quiet when they're doing this ADL's as far as if he can do it and makes the situation to not make their brain to be awake, because otherwise they're going to be awakened agitated at that time.
Speaker 0 00:46:46 And, and for the, let's say for the person who's still at home, maybe their is caring for them. And now that spouse is not getting a lot of sleep themselves due the interruptions, what any recommendations or thoughts for that person and how to
Speaker 2 00:46:58 Regulate them? Exactly,
Speaker 1 00:47:00 Exactly. One of the main major problem for many, um, uh, people, um, um, that, because the loved one has dementia and doesn't have a very straight to sleep pattern and wake up multiple times at night. And, um, it's, uh, sadly I have to say, this is the time that most of the time the family, uh, decides to, uh, move the loved one to the facility. I mean, as I'm saying, cause a sadly we're not, but this is the time that really cannot do that because it's very difficult and caring of the loved one with dementia at home is very, very difficult. Especially night will be the time that they're going to have a very, as, as music, explain the sporadic, his sleep pattern, not let the other people asleep. And, um, and or maybe the time that they need to find someone to come and help them at night.
Speaker 1 00:47:49 Someone that'd be awake at any time when days start to wake up and wanders, be with them to make sure they are safe. And, um, again, some of my patients, they get asleep like, um, two to three times a night, they get a caregiver at home at nighttime and at least at what they have respite to sleep time that they have at least two to three nights a week, they can asleep. And the rest of the week that they can, they know that their loved one is going to be awake and they do that. Um, again, it's very hard because if you give a sleeping medication to family, caregiver, and the loved one has dementia, it's going to be unsafe because they're going to be in deep sleep and they're going to be wandering around. And it it's still in home. Environments can be dangerous, honestly, most of the time for my patient, if there is no any problem, I really, this is the time I recommend to take them to a place, to, to a memory care unit because, uh, at least, uh, especially when the loved one and again, the partner or family caregiver is also in the geriatric zone.
Speaker 1 00:48:47 And I'm very worried about their health as well, if they're not able to sleep at all. And th these are the, exactly the discussion that we have with the family most of the time.
Speaker 0 00:48:56 Yeah, absolutely. That makes sense. And I guess, uh, the next question I've got Dr. Yachty is, uh, is there a recommended, uh, for the bright light therapy timing? So for somebody who's got, uh, Alzheimer's or dementia and they have sporadic sleep cycles, is there a recommended timing for BLT?
Speaker 1 00:49:13 It's a good, good, good question. My suggestion for the people with dementia, I put them in the category is still off the advanced sleep disorder. And I actually say early afternoon time, it's the best time that we do bright light therapy. It's not my suggestion is this same model that they do in the many of the memory care units in other countries in UK, um, in the Scandinavian countries, they do it as well in Australia. They do to Japan, they do it as well. They actually do early afternoon bright light therapy for many of their residents with dementia in their care homes. And, uh, they've, they've seen a good result. They, they even use it when they are getting admitted to the hospital in the early afternoon time. And they see that even in not helping them for three to six months to sleep, but they're more calm. And actually one of the other things that they can see sundowning sundowning behavior, which is exactly the result of the bright, uh, the lack of the lights, especially when the outsides start to become dark. This is exactly the reason a part of the circadian brain rhythm is sun sundowning, which we see in the, in the dementia people that can help significantly with sundowning as well, much better than any medication.
Speaker 0 00:50:25 Okay, wonderful. Um, if you are a morning person, uh, what's the best time to get sunlight
Speaker 1 00:50:33 Early afternoon. If you are a morning type person, wake up, then you better to not getting out of the house till early afternoon. And probably the best time I will say is going to be after 1:00 PM, try to get the maximum of light between one to 3:00 PM. If you go outside this time, do not use any sunglasses. If you can, if some of the people, because of medical problem, they have to do sunglasses, um, that just make it very limited. And, um, and that, that situation that can help, um, um, uh, a significant, but not during the data, if you have to go outside during the daytime, like from morning till noon or early afternoon, definitely use the hat or the strong sunglasses. Okay. And the other advice that I just, again, we just forgot to tell is about watching TV or computer tend to have the lights can be also confusing for brain. There is also a possibility that, uh, um, um, that they can, they can do, um, um, uh, use sunglasses when they watched a TV. You also look at an, a monitor, dirty, specific sunglasses for monitoring TV also, which can be very helpful.
Speaker 0 00:51:43 Wonderful. Okay. I think we've got time for just maybe one or two or so more questions. Um, are there any sleep disorders or patterns that are considered symptomatic or a sign of early dementia?
Speaker 1 00:51:56 Are there any specific, I'm sorry, I just lost,
Speaker 0 00:51:59 Uh, specific, uh, sleep disorders or, uh, sleep issues that might be a sign of potential onset of dementia.
Speaker 1 00:52:08 Very good question. You know, um, there's, the scientists are, um, wandering for many years that is sleep deprivation or lack of sleep is one of the risk factor for developing cognitive impairment and dementia. We haven't find them in neuroscientists. Haven't find that people like, for example, have a sleep deprivation. It's a sign of early dementia, but they know people that they don't have a good sleep pattern is much higher risk of developing cognitive impairment later. And there is, there is possibly that there is this, there are some neurodegeneration is happening to the brain that we're not aware of that. Um, and again, we can not recognize it or finding an image that at the technology at that point, maybe we will find it in the future, but it is, it is important that we understand as of now, if we have a sleep problem, we definitely need to take it seriously and discuss with our provider. And if there's any treatment needs to be done, they can do it, um, at that time.
Speaker 0 00:53:11 Wonderful. Okay. What can you say about people who haven't really active dreams like with nightmares? Are there any known treatments for that?
Speaker 1 00:53:20 If they have a very severe yes, they have. Um, there are some sort of the medication, which in the category of dopaminergic medication, which we call it, um, again, you just say medication we use for people with Parkinson's they have, but very low dose. Not that doesn't mean the person has a Parkinson, but technically we use a very tiny dose of this medication. If they're active dreams is problematic, or they have REM behavioral sleep disorder, um, um, that is causing a significant problem. Yes, these are the medication that we use. Okay.
Speaker 0 00:53:56 All right. I think we can squeeze one more in here. And, uh, for first of all, for all those who submitted questions, apologies. If we can't get to all again, uh, this has just been so informative and Dr. ADI is a wealth of information, so thank you, Dr. ADI, the last question I'm going to, uh, just, uh, throw your way is how does hydration affects sleep? Does hydration have any impact on a person's sleep?
Speaker 1 00:54:16 It is, it helps with the good blood circulation. For course, of course it helps with the brain circulation. Definitely. It helps with the clearance of Adam's cuisine, which I explained to in my presentation as well, because you have a better flow off your spinal fluid as well. It helps significantly. Um, however, there's on the other side, if you do too much hydration, you may have to, uh, pay back in the nighttime with going for more UNH. It should be very important to have a balance at what is the time of dehydration. Because on the other side, we see, especially in older people on the other side of the too much hydration also can cause some problems. It is very important, but yes, it is effective, but timing is also so important.
Speaker 0 00:54:58 I just want to say I've, I've been, uh, just overwhelmed. There's so many comments coming in. Everybody is very appreciative of the information. It's been very fascinating, very informative. So on behalf of everybody who's joined us today. I just, again, want to say, thank you so much for sharing this very important presentation and information with us today, and for all those who did join us again on behalf of, uh, all of us here at Silverado doc, I don't want to say thank you so much for taking the time to join us today and be with us today. So thank you all. And hopefully everybody has a great night's sleep tonight. Thank you. Bye
