Sleep, Memory, and the Brain

Dan commented on the contraindications of Namenda plus Aricept. Since many of us are on the both of these agents, would you mind giving all of us more information which you obtained during the study in which you participated. We’d all appreciate it, I’m sure.   Thanks, Dan.

If you read my post the other day about my sleep deprivation for several and how it affected my brain, the following article explains in detail the reasoning behind this.

Sleep, Memory, and the Brain

When you’re sleep deprived, cognition is one of the first functions to decline. Shortchange yourself on sleep by staying up late, continue this night after night, and you ultimately shortchange your memory. And if the problem is not resolved, your memory — and your brain — will not be functioning in the best way possible.

In this excerpt from our Johns Hopkins Memory Bulletin, neurologists Marilyn Albert, Ph.D. and Guy McKann, M.D. answer questions about sleep and how it affects the brain and memory.

Q.  How much sleep does an adult need each night?

A.  As people get older, a decrease begins in both the total time sleeping and the amount of time spent in the stage of sleep associated with dreaming. A newborn sleeps 16 hours per day. In contrast, the baby’s 30-year-old mother sleeps six hours per day (if she’s lucky), and only one quarter of this time, or two hours, is occupied by the deepest stage of sleep.

Starting in middle age (between 45 and 60), not only does the amount of sleep per night start to decrease, but also the character of sleep changes. People at these ages spend less time in the stage of sleep associated with dreaming and more time in the lighter stages.

As people get older, they are more likely to shift the time when they sleep, some going to bed and to sleep earlier and waking up earlier. Others are the opposite, staying up late into the night and sleeping much of the day. When people are in their 80s, these changes are even more pronounced. Their total time asleep per day may be only six or seven hours, including time spent in daytime naps. Even though a person may take several naps a day, the total time sleeping in naps is rarely over an hour. The idea that older individuals should sleep soundly for eight to 10 hours is clearly wrong.

As a rule of thumb, one hour of sleep is required for two hours of being awake. As we get older, that ratio becomes closer to 45 minutes of sleep to each two hours awake. In other words, throughout the day you gradually accumulate a “sleep debt.” By the end of a 16-hour day, a younger person owes the “sleep bank” eight hours. In contrast, an older person has a sleep debt of only about six hours. By the end of a week, you may have accumulated a sleep debt of eight to 10 hours.

Q.  What are the effects of sleep deprivation?

A.  If you don’t allot enough time for sleep, you become sleep deprived. Besides being sleepy during the daytime, sleep-deprived people often have problems with their thinking. They are slower to learn new things, they may have problems with memory, and their ability to make judgments may be faulty, enough so that they may think they are really starting to “lose it” when the problem is really not enough sleep.

Elderly people do not recover from sleep deprivation as quickly as younger people. In experimental situations where people are kept awake for 24 hours, those in their 70s take at least a day longer to recover from their subsequent daytime sleepiness than younger people. Gender may also make a difference in the time it takes to recover from sleep deprivation; women seem to be able to recover faster than men.

True or False

Spring onions and shallots are exactly the same.

False. Shallots, or scallions, differ from other onions in that instead of having a single bulb, it divides into a cluster of smaller bulbs.

Sweet “16” Rolls Around Again!

sweet-16pa-drivers-licenseAnd they say Sweet 16 never comes around again! Well, someone is wrong. Today marks the beginning of a wonderful Happy New Year for me!

Just returned from Pittsburgh after seeing my neurologist for a regular checkup. He said, “You’re doing very well. It goes to show just how well the Aricept and Namenda works for people.” He was very pleased. And, surprise, surprise. I get to drive again but only with an “autopilot” on board. That’s fine with me. Just to feel 16, independent and to be able to get behind that wheel again. How do I describe it??!!

Other than sleeping difficulties, he sees a marked improvement since adding the Namenda to Aricept. I’ll continue the Klonopin for the REM sleep behavior disorder. For sleep he’s adding a small dose of trazodone. Thank gosh I don’t have to take Seroquel at this point. Will start the trazodone at 50-mg at bedtime and can increase it to 150-mg if necessary.

I’m not surprised with the trazodone. It’s a standard non-habit  agent for sleep. It is actually an antidepressant but the doses need to achieve an antidepressant effect are so high that the patient would be sleepy all the time. So, in essence, it is pretty much used now as an adjunct sleeper when trying to avoid drugs which produce tolerance. I feel comfortable with this since it’s something which I’ve prescribed over the years to hundreds of patients.

Oh, by the way. He truly thinks the Lewy Body Dementia Association is phenomenal!

Fact or Fiction?

In the 1960s, dung beetles were imported into Australia to reduce the number of cow dung pads.

Warmly………….David Thomas

(True. Their digging activity aerates the soil, sumultaneously releasing the nutrients in the dung to the soil).

Taking Namenda? Should I take Robitussin or Robitussin DM?

Well, today is the day I raise my dose of Namenda from 15-mg up to 20-mg. I’m supposed to take 10-mg twice daily. Since I’ve had a robust response to this drug overall, I’ll be very curious to see how the increased dose will work.

 

Are you taking Namenda? The prescribing information and package insert for Namenda contains this statement: The combined use of Namenda with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been systematically evaluated and such use should be approached with caution.

DM stands for dextromethorphan. DXM is another abbreviation for it. It is a cough suppressant which is chemically related to codeine. It isn’t addictive and it doesn’t work for pain though. It’s an active ingredient in over 120 nonprescription cough and cold medications. When used in normal doses it is usually OK. It’s a good over the counter agent for coughing, etc. Most people don’t have any problems so I’m not intending for the average person to stop using it or to scare anyone. It is usually safe in the 15- to 30-milligram dosages recommended for treating cough or colds. It is a very good agent when used safely!

This is the drug that teenagers are now abusing and getting “high” from. In high doses (100-milligrams or more), it can cause a mildly euphoric and stimulating effect similar to that of ecstasy. At even higher doses, the drug’s “stoning” effect increases and hallucinations may occur. The highest plateaus are characterized by ELABORATE HALLUCINATIONS AND OUT-OF-BODY EXPERIENCES. During such out-of-body experiences, users perceive a complete disconnection from their body and surroundings, WITH NO AWARENESS OF WHAT THEY ARE DOING (OR HAVING DONE TO THEM).

Even in normal individuals, especially the elderly and those with dementia, it can also cause confusion, impaired judgment, loss of coordination, paranoia, excessive sweating, psychosis, brain damage, rigid muscle tone or involuntary muscle movement and decreased ability to regulate body temperature, which can lead to heat stroke. Other side effects can be severe dizziness, anxiety, restless feeling, or nervousness, slow, shallow breathing, dizziness, nausea, seizures, panic attacks, and addiction, coma and death, blurred vision and/or slurred speech, numb fingers or toes, dry mouth, itchy skin, irregular heartbeat and high blood pressure.

The take home message is this. Individuals with dementia already have a lot of the above symptoms. And they are more sensitive and susceptible to them when taking the DM form of Robitussin. If you are not sure whether to take this or not, please check with your physician.

DXM products are known in the street as Skittles, Red Devils, Robo (from Robitussin) or Triple C’s. The high that dextromethorphan produces is called “robotripping” or “skittling.”

Robitussin is one of the brand names for guaiphenesin. It is usually the main ingredient in many of the “tussin” drugs. It is a common over the counter  drug which dissolves thick mucus sold over the counter and usually taken by mouth to assist the bringing up (“expectoration”) of phlegm from the airways in acute respiratory tract infections. The active ingredient in Mucinex and Robitussin is guaiphenesin. So, Robitussin becomes Robitussin DM when dextromethorphan is added to it.

Guaiphenesin also comes in tablets which are easier to take. I try to avoid the thick liquid cough syrups. Bitter tasting medicine!

By the way, when it comes to these old fashioned medications, I personally prefer the generics. They are much cheaper and just as effective as the brand names. Only my opinion.

Now, that I am on Namenda, I’ll have to be cautious this winter. I’ve always relied on the long-acting form of dextromethorphan for my coughs such as Delsym. Never had much luck with the regular dose of dextromethorphan which is in the Robitussin DM form. Guess I just try a small dose of it when I need it in order to make sure all is well.

(I have no financial interest in any of the above mentioned medical products).

David

Swallow This! Bittersweet Memory Pills

 

pill-bottleThis week I had three very good days in a row. So good that I overblogged on those days. Pam even said, “You’re spending a lot of time on the computer. Why don’t you take a break?” I felt well. So well that on this past Wednesday evening I began to ponder whether I really needed to take all these ‘memory pills.’ ‘Dementia pills.’ Nothing wrong with me. I don’t think I need to take them. I could go to work again. On those days you feel poorly, kick yourself a good one and get going. It’s all in your head (oops, excuse the pun).

So I mentioned it to Pam. A good mistake, I guess. Talking about tough love! The earth shook. The dogs barked. And the wind blew. I ended up stammering, “Yes, yes. I’ll take them and no, I didn’t stop taking them. I swear to God with both hands on the Bible.” Caregivers……..tough love does work!  My red face grin.  icon_redface

Later that evening, Chad said goodnight to which I responded, “I hope you don’t die tonight.” In my heart, I was trying and meaning to say, “OK. You have a good night and sleep well.” I walked into the bedroom. Again the earth shook. Pam told me how inappropriate my comment to Chad was. I wasn’t sure what she was talking about.

Evidence of lacking good judgment twice within hours of each other. Before going to bed, she said, “You really did stop your medicine, didn’t you?” I had to convince her that I didn’t. Whether it was poor judgment, word or phrase finding difficulty or just plain not thinking, it wasn’t the read David. Pam reminded me of my past couple of years and the symptoms I’ve shown. She reminded me of my abnormal SPECT scan.

And then the next morning — Thursday. I awakened having slept poorly. I was in a fog and feeling fuzzy. My gait was a little stiff and slow. Good morning, Lewy Body Dementia. I see you’re back. Reality smacked me in the face! With no sarcasm at all, Pam said, “Do you still want to go off the Namenda and Aricept?” I had no retort……..

David

Tuesday October 28, 2008

 

I started on a higher dose of Namenda today. 15-mg. Will do this for 1 month then go up to 20-mg daily. So far I like this med and am very impressed with it. After hearing so many people talking about the side-effects their loved ones have, I am indeed fortunate. Thank you, Dear Lord!

Am feeling well but want to remind myself when I read this down the road about yesterday. The National News last night mentioned ‘Groundhog Day‘ as a metaphor to the economy on Wall Street. Very seriously, I immediately said to Pam, “That anchorman just made a mistake. Ground Hog Day is in February and it isn’t on Wall Street. It originated right here in PA not far from us in Punxsutawney. I can’t believe that the news has the season and place all mixed up.” She was kind and gentle stating, “Honey, he was talking about Wall Street….” and proceeded to explain it to me. For the life of me, I just didn’t get it.

Actually, I kinda have to laugh but it’s also scary. I’ve also been witty and have loved parables and metaphors. When I taught in high school, in college and in medical schools, one of my top methods of teaching was using parables. What has my brain come to? But I’m still happy with what I have and I’ll keep plugging along.

“I was dying. Somewhere. Confused and disoriented. Nurses and doctors rushing me to somewhere. Oh, I was in a hospital somewhere. Somewhere. On a gurney. Lucidity and Lewy Body land engulfed me while I was trying to sit up. And then I heard it. The metallic reverberation of a jail cell opening and closing. Looking behind me, I see prisoners in shackles. All males. Adults, adolescents and young boys. All in handcuffs. All in a single line slowly walking through the jail door. The younger boys not even knowing what was happening…snickering and grinning with cocky attitudes. Those poor kids, I thought. “Hurry, she said.” The sound of the nurse hollering while charging through with the gurney. “I’m so confused.” That thought echoed through my mind over and over. And I’m dying.”

I awakened in a state of befuddlement. Dazed. Feeling like I was fading away. All at the same time that I realized I had been dreaming. I tried to get out of bed so I wouldn’t go back to sleep and continue the dream. But I could hardly move. I really did feel confused and disoriented and yet the normal part of my brain was trying to figure out what the dream meant –all at the same time. I walked to the bathroom and thought I was in a hospital room. I couldn’t shake that awful feeling this morning. I couldn’t wait for that cup of java as I shuffled out to the kitchen. That’s when Pam reminded me that we were both going for blood work this morning and that I was fasting. Bummer. I was slowly coming alive. I couldn’t shake it though. It lingered for hours. I don’t even remember that needle going into my vein. Oh, yea. It was just a test for triglycerides. The Niaspan is working. Let’s hope those numbers have dropped even more. When we arrived home, I felt absolutely fine. Go figure because I can’t figure it out. Won’t even try tonight. But it’s OK. I’m greatful for the day and for what I do have.

Pam, I feel sorry for you sometimes. Having to deal with my changing states of confusion yet being so loving and kind. Thank you.

And now off to bed……………………..David

Sunday October 26, 2008

 

 

Now you can understand my email address!

Check out the new category at the top of the page. It describes another side of me other than just being a physician — The Knitting Doctor.

I think knitting is one of those things I’ve always done which may have helped me more than I’ll ever know. Maybe it actually prevented me from developing Lewy Body Disease early on! It’s one of those visuospatial crafts which stimulates a certain part of the brain. And each and every craft works on a different part of the brain! So, get out the needles, the hooks, some thread, some yarn or some rope! Yes, rope. Making knots for all those boats and ships……..yes, they help to keep the brain active!

The little picture here is from Beth Brown-Reinsel’s book calledKnitting Ganseysshown on her Knittingtraditions website. I made this about 3 years ago for my nephew in New Hampshire. Ironically, his looks are very similar. I remember well having tremors at the time but I kept plugging along with the sweater just thinking that I needed to relax more. Little did I know Lewy was snaking his way in and I didn’t even know it. That is the time that I was the moderator for the Gansey List on Yahoo. 

For years, I knit on a daily basis. It was good for me. But………knowing what I know now………..I should have also been doing other hobbies and crafts along the way. Since each activity stimulates a unique portion of the brain, I had only been working on one of them. But this part of my brain is probably over developed since knitting is second nature to me. For the past 1-2 years, though, I lost some interest in knitting. Guess what? Yes, I just thought it was stress since I didn’t feel any depression. Looking back, I blamed every one of my symptoms of LBD to ‘stress.’ How pathetic that I didn’t know any better. But then no one around me did either. I now realize that I was suffering from apathy, a common symptom of dementia.

Since I’ve been on the Aricept and the Namenda, the apathetic days are fewer and fewer. I’ve been able to resume knitting but not as intensely as in the past. I am currently working on a pastel green reversible cable baby blanket. Big deal! Well, actually it is. I’m very happy that I can now knit again and look forward to continuing to do it for many years to come.

However, David, don’t get to complacent. There are other crafts and 120 other ways to increase my brain power. Let me think now. I’m able to resume the computer again…..another ingrained activity. I should probably review my Spanish which I learned during the 4 years living in Guadalajara, Mexico. But there isn’t anyone around here who speaks Spanish. I could review it on the web but it just isn’t the same as speaking another language in real life. Think now. You’ve added various puzzles to your list of new activities, thinking out loud with this blog. Guess I’ll take a look at that 120 list and see what might interest me. But, be careful. Don’t bite off more than you can chew. You have a tendency to want to do so much but then you get tired and feel guilty whenever you don’t immediately follow through with your own expectations.

Margo and Stein………….you guys were a breath of fresh air yesterday! Thanks for visiting us. We love you guys. You and your family have been a Rock of Gibraltar to me over the years. Margo, I remember so clearly the first time we met. I wanted to interview you to be my administrative assistant when I opened up my private practice right out of residency training. It seems like this past week but it really was in 1982. That’s why you still seem so young to me. Happy Birthday this week. You are still in your 40s to me. You hold your age of 70 uncommonly well!! You’re so energetic, vibrant and full of life! I used to think that 70 was ‘old.’ Now I know better.

It’s been a quiet low key day today. atching football, knitting and playing with the dogs. Pam is tired. We just found out that both her potassium and iron are both low. I’m worried about her. I remember when the joke was just to give someone some “Geritol.” I don’t know if they even sell that stuff anymore. Those were the days~~

Enough for today.

David

Friday October 24, 2008

Bizarre. Yes, dreams can be. Last night I dreamed that I was ‘somewhere’ with a bunch of people. During the gathering, I had a moment of severe confusion and disorientation. It lasted for a long long time in the dream. Now that’s a new type of dream I’ve never experienced before. Go figure.

I’m getting weary of all the political ads. Can’t wait until Election Day is over. Seems like it’s been a long drawn out affair. I’m sure most people have already decided so let’s get it over with. Have been watching MSNBC, CNN, etc. The anchor folks so to have run out of things to say. They’re now down to what kind of clothes people are wearing and how much they cost! Aren’t there more important things in life?

We’re having friends (Margo and Stein) visit us from Pittsburgh tomorrow. They are dear and closer to us than some family members. Funny how ya can choose your friends but not your family! It’ll be a very nice day in spite of the rainy forecast for the weekend. Stein is so witty I don’t know if I’ll be able to keep up with him. Margo’s brother-in-law is suffering from Alzheimer’s disease. I think he’s also on Namenda and Aricept.

Speaking of that. I’m really noticing a positive difference since adding the Namenda to the Aricept. My sleeping pattern had been terrible for the past 3-4 years. I noticed an improvement after taking the Namenda for about 4-5 weeks. Am sleeping better than ever right now. And the Vivimind. That’ll take awhile. Am taking 10-mg daily for 1 month and then I’ll increase it to 2 tabs/day. My understanding of it is that it’ll take much longer to notice any results. Fortunately, I haven’t had any side-effects from any of the 3 of them.

I spoke with Angela Taylor this week. She’s the Chair of the Science Committee and on the Board of Directors of the Lewy Body Dementia Association (LBDA).  What a lovely, caring and smart lady! How lucky we all are with her running the ship. Thank you, Angela, for your interest. You perked me up and encouraged me and you didn’t even know it.

Am looking forward to reading Dr. Tom Grayboys’ book – Life in the Balance. I put in a request to the birthday fairy. She’s coming soon.

I just discovered a new game called KenKen. Never heard of it before. Haven’t tried it yet but it sounds like it’ll be another way of working the brain.

OK, David. Give the computer a rest and do something else today. It’ll stimulate your brain.

David

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