Sleep your way to a sharper mind wth Dr. Jennifer Brinckerhoff and Jodi Bornstein

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Larry (00:01):

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You are connected and you are listening to specifically for seniors, the podcast for those in the remember when Generation. Today's podcast is available everywhere you listen to podcasts and with video at specifically for seniors YouTube channel. Now here's your host, Dr. Larry Barsch,

Larry (01:13):

And in our contest news, we have a winner. In last week's contest, Henry G of Canton, Massachusetts correctly texted that Switzerland was the only country that prohibits ownership of just one Guinea pig. Their reason is that since Guinea pigs are such social creatures, one Guinea pig would get lonely. So having just one is considered animal abuse in Switzerland. This week's contest bit more difficult. If you were the first person to reply correctly, we'll get back to you to talk about your story, and if it fits our guidelines, we'll set up a time for you to be recorded online and featured at the specifically for seniors.com website, your story page among other storytellers. Today's question. You ready? What are the only four words in the English language? To end in the letters d o u Ss, again, the only four words in the English language. To end in the letters d o u ss, be the first to text that answer to 7 8 1 6 1 3 0 3 9 3.

Larry (02:53):

Again, 7 8 1 6 1 3 0 3 9 3 before Saturday, October 2nd, 2023 at 12:00 AM And you'll get a chance to tell your story and I'll tell you the answer next week. This is the fifth episode in specifically for seniors podcasts in conjunction with Hebrew Senior Life and Orchard Cove series on cognitive fitness. In the first episode, we spoke with Dr. Alvaro Pasquale Leone on brain health and cognitive fitness. In the second episode of the series, we reviewed the relationship of physical exercise and brain health. In the third, we discussed challenging your brain and learning new things. In the fourth, we discussed food and brain health. Today, specifically for seniors welcomes Dr. Jennifer Brinkerhoff and Jodi Bornstein for a discussion on sleep and brain health. You met Jodi in a previous episode. Jodi is an occupational therapist with Hebrew Senior Life's Therapy House Calls program. Dr. Jennifer Brinkerhoff is medical director at Orchard Cove's Wellness Center. Dr. Brinkerhoff received her medical degree from University of Virginia School of Medicine and completed her residency in internal medicine with a primary care focus and a fellowship in geriatrics at the University of Colorado Health Sciences Center. Dr. B is certified in internal medicine by the American Board of Internal Medicine with a certificate of added qualifications in geriatrics. Dr. B Jody, welcome to specifically for seniors.

Jodi Bornstein (05:05):

Thank you for having us. Thank you.

Larry (05:08):

Let's start with a basic non-specific question. How does inadequate sleep affect physical and brain health? Who wants to start?

Jodi Bornstein (05:23):

I can start with the simple answer there. You know, you have a terrible night's sleep, you wake up the next day, you have some difficulty concentrating, you have some changes in your mood. You might be a little bit grumpy a little down, some trouble with your memory, some trouble with your attention focusing, maybe a little bit of weakness, some balance, trouble that day. Certainly it has a lot a, a great impact on your day. That's just from one sort of bad night's sleep. If you have a chronic sleep deficit that can lead to really some poor performance and physical deficits, cognitive deficits I think it also puts you at a higher risk for developing more medical complications down the road.

Dr. Brinckerhoff (06:09):

It does, and in fact, the information, the data that they look at for chronic insomnia is a little bit on the scary side in a sense that it does impact risk for cognitive decline and, and risk of a sooner death. So, you know, whether it's through falls or whether it's through cognitive changes, most things in geriatrics get complex because it means looking at the whole body and all the parts of the body that break down. But the, the studies have shown that seven to eight hours a night of sleep or within a 24 hour period is really the cutoff for when you start to see those those changes in risk. And two hours of that really good deep sleep is necessary every night for optimal optimal health.

Larry (07:02):

Before we get into sleep and cognition, let's just basically review the four sleep stages.

Dr. Brinckerhoff (07:12):

Okay, so the four stages of sleep. Sleep is broken down into REM sleep on one side with the rapid eye movement and the non REM sleep. So non REM sleep, there's three stages of that. The first stage is when you just just are falling asleep. Usually it lasts about five to 10 minutes. You're in a very light stage of sleep. You could still be woken up quite quickly. And that amount of time actually they've looked and it increases with age. So people who are older stay in stage one, sleep longer. Stage two sleep is the, a little bit deeper. You spend about half your time there, your brain is getting organized. You're starting to to store some memories there, and that lasts about 20 minutes each cycle. And then stage three sleep is that deep, slow, really wonderful sleep. That happens for about 20 to 40 minutes each night. And that's when your body really is repairing, your brain is repairing and your, your whole immune system is affected there. That's stage three, that delta sleep, that deep sleep. And then there's the REM sleep, which is considered the dream, the dream state, and that also has its own movements, its own the eye eye moves, but the muscles of the body do not move. And that happens near the end of the cycle of sleep. So again, there's non REM and REM sleep. Those are the two main ones.

Larry (08:51):

Is one of the stages more important for cognition than the others?

Dr. Brinckerhoff (08:56):

There's a debate, but what, what I can understand and what I've understood for a while that the stage three non REM sleep, that really, really deep, deep restorative sleep actually is really important. 'cause It's like sleep for the brain. It, it, it allows the brain to recharge and, and helps the lymphatics clear things through. And the, the sleep, the waves are actually synchronized throughout the whole brain. So that's a really important one for cognitive health. And then REM sleep is also important for cognition in a different way though. It, it, your brain is actually just as active during rem sleep as it is when you're awake. So you're, if that's the time that your body is, your brain is saving new memories, if you've learned something new, it's when those new things are getting incorporated. So that piece of cognition is improved during REM sleep, but power naps can do the same thing. You can have a REM sleep and a power nap, and that can help you to sort of incorporate new things you've learned. So they're both stage three. Sleep and REM sleep are both important for different aspects of brain health.

Larry (10:12):

Now as we age, our sleep changes, as you mentioned before. How does it change?

Dr. Brinckerhoff (10:23):

I, I guess it's, it's, yeah, it's hard. Jody, do you wanna talk about it or do you want should I? Yeah,

Jodi Bornstein (10:29):

I mean we can, we can chime in together. It really does. It depends on the person. It depends on what's going on with them medically. I do think we focus a lot on the medical sort of comorbidities and lots of things that are going on, but there are so many social and life changes that occur as well as we get older. It might be a loss of a spouse or it might be a new move into a new location. You have to get used to a whole new routine. Some aches and pains in the body, certainly things that have crept up over the years that make it more difficult to have a good sleep. You might have some issues with your with your bladder that are waking you up at night, some extra anxiety. So there is a psychological component. There's certainly a, a physical component to sleep and how it changes us as we age. And it changes as we age.

Dr. Brinckerhoff (11:22):

And the studies have looked at, you know, the, the fact, how do the stages change as you age? So it's hard with the chicken or the egg as in geriatrics. Oftentimes it is, but we see that stage one sleep increases with age so that older adults are getting more of stage that stage one sleep and less of the, that deep sleep that is, that can be so helpful. But like I said, remember that they've done studies looking at, you really only need two hours of that deep sleep each night. But, you know, we go through the all cycles multiple times in a night. So even though each time you go through a cycle, you might only get 30 minutes of deep sleep depending on how many times you're going back through the cycle. You can, the minutes are cumulative and they're not always associated with getting up. You think, oh, I wake up three times to pee. Am I only having three cycles of sleep? They're not the same thing. So you can cycle twice, for example, while you're, between the time you go to bed and then the time you wake up the first time mm-hmm. <Affirmative>. So you could actually be having two stages, two times that you go through the cycle and have that deep restorative sleep within that cycling, and you haven't woken up at all.

Dr. Brinckerhoff (12:43):

But they do say with age that, that the stage one sleep, it can, can be harder to fall asleep, harder to stay asleep, and you have less of that deep sleep. And you also, you actually have less growth hormone, less other things that are complicated in our brain with our hormonal access and our immune system that change with time. So again, it's a little bit of the chicken and the egg, but it's a lot of both internal workings about your sleep and brain health. And then also the external factors that, that we, we know we have a lot more control over. And so those, that's where Jody and I try to come in, in terms of helping people both understand what's happening, but then also get the best chance for a great night's sleep that they can. Yeah,

Larry (13:32):

We hear a lot of people in my generation say, oh, I'm old so I don't need as much sleep. Is that valid?

Dr. Brinckerhoff (13:43):

I think when you, if you compare it to a baby, so for example, babies need, you know, 14 hours of sleep and teenagers, you know, and then it goes down to maybe 10 hours of sleep. But, but I don't think it's fair to say I don't need sleep as I get. I don't need as much as I get older. I think it, it is important to get a good basic amount of sleep. I think when people say that, I think it's the, they're voicing more about the struggle of how they've accommodated to what they're able to get. And because there is a reality that many people are really only getting four or five hours of sleep, and when you have to live that life it's tough. It's tough because it doesn't, it's not something that we can just fix it, it takes a lot of different interventions and we can push you more towards six hours of sleep. But if you're a person that's convinced you only need four hours a night to sleep, then that's a cha That becomes a challenge in and of itself in the conversation of how do we make progress? What, what is your experience, Jody? Do you think that people <crosstalk> Yeah, I totally agree. Especially

Jodi Bornstein (14:51):

When you're in the mindset where you tell yourself that you're not a sleeper or you don't need sleep, you won't sleep, you know, and then, or you're thinking about getting a lot of sleep and then you're stressed about getting that sleep. There are so many very important psychological factors that play in, and so we really focus on sort of setting the environment and the behaviors to promote or to optimize your sleep. Can get into the very specifics on that, Larry, when you're ready for that.

Larry (15:16):

Sleep is also important in controlling inflammation, which can affect brain health, correct?

Dr. Brinckerhoff (15:25):

Yes. It, it, during that deep stage of sleep that delta sleep there is an increase in your growth hormone, which is actually necessary for tissue repair. And that they think it sort of starts to push and flush the lymph system through your brain re removing toxins. It's almost like taking the trash out. You know so once, once, if you, if you, you can imagine what your apartment would look like, for example, if you never took the trash out for a month, it, the, the brain needs that deep sleep time to allow those lymphatics to push through and really clear out the toxins that have built up and, and, and they've actually tracked and seen that it can help remove toxins such as amyloid plaques, which we know can be related to memory changes and cognition. So yes, it is true that, that the brain is doing a lot of housekeeping while we're sleeping.

Larry (16:23):

We talked about aging affecting sleep. Why, what, what's the mechanism?

Dr. Brinckerhoff (16:34):

You know, I think that it's a combination of the external factors as we talked about that, that, you know, e either your prostate or your, you know spousal situations, depression all these things that eventually can happen happen still as you age. So, and, and more often your prostate is gonna be bigger or you're gonna be on medications that might impact your sleep because you have chronic conditions that do that. It's not necessarily true that everybody who gets old has trouble sleeping though. So it's not, age is not the only factor. It's just I think it as most things in geriatrics, it's, it's this multifactorial situation that happens as your brain ages, but, but growth, for example, growth hormone, we know we've measured it, we don't know why necessarily, but growth hormone production re is reduced in older people. So that's one factor because growth hormone is one of the things that prompts our body you know, under psycho when we're asleep to help with that lymphatic push and that cleaning out. So atrophy of our glandular production or hormone production that does impact sleep. And that's something that happens as we age.

Larry (17:59):

Does our circadian rhythm change as well when we age?

Dr. Brinckerhoff (18:05):

You know, I think circadian rhythm is a way of describing the cycling of the, of the sleep. And so, you know, I think it does in a sense that, that, as I said, that stage one sleep seems to increase. So that would be, in essence the same thing as saying the circadian rhythm changes.

Jodi Bornstein (18:23):

I think, I think it just in terms of the rhythm, you know, as we get older in terms of your routine and your circadian rhythm is helped by setting, you know, an early start to your day outside and getting that natural light exposure early in the morning. And sometimes as we age, we're not getting out as early in the morning or we're not necessarily going outside as quickly as we used to. So I think that does impact us as we get older. And it is really important if you can try to get out, we'll talk about some strategies, but one of the strategies is to try to get some light exposure pretty early in the morning and sort of set your circadian rhythm as much as possible.

Dr. Brinckerhoff (19:03):

And gosh, isn't it so, you know, in older people I just think about vision changes and so how is the light getting in? How is the light getting filtered through those things like cataracts or, yeah, you know, there are changes in vision that happen more commonly in older bodies, specifically with your eyes, and that also impacts the light that is filtered in. And,

Larry (19:25):

And I would imagine that shorter days in the winter become a bit of a problem as well. Jet lag. Yeah.

Jodi Bornstein (19:33):

Yeah, it's true <laugh>. That's why it is important to try to get out early if you can get some light exposure even in those very short winter days.

Larry (19:45):

What are some of the common sleep disturbances as people age

Dr. Brinckerhoff (19:50):

Urinating at night? Is something that is a sleep disruption that's common in, in older adults. Pain, having pain or aches and bursitis in different hip joints, you know specifically in shoulders if you, if you're a side sleeper versus being on your back different acid reflux can be an issue that wakes people up more at night as you lose the structure and compliance of the esophageal lining for some people, medications that people take, I mean, there's prob I probably, there's probably a list of maybe 30 things that we could say that are, yeah, but those really are some of the main ones. Mobility and to be able to exercise during the day impacts your sleep at night. 

Jodi Bornstein (20:36):

I'd say from what people really report to me working with them at home is that it's typically the getting up a lot to go to the bathroom at night. Pain, like Dr. Brinkerhoff said, shoulders, hips, knees back, and sleep apnea. So many folks have an I C P A P mask and they cannot put them on by themselves or they find 'em very disruptive or difficult to manage. And that's a big issue for getting a good night's sleep.

Larry (21:03):

Yeah, I'm glad you brought up sleep apnea. That tends to be more than just a sleep issue. It becomes a health issue with cardiac problems and so forth.

Dr. Brinckerhoff (21:18):

Specifically, I think, you know, it it, they do think that up to 30% of people suffer from sleep apnea. I find a very low rate of compliance with the masks because of, I know there's been more and more interventions recently with more nasal masks instead of the sense of covering the mouth that can feel quite suffocating for people. So we do always encourage people to, if they had a negative experience, say 20 years ago, 25 years ago, that, you know, to get retested and to try to understand with the goal really of being increased daytime alertness because of course the main symptom of sleep apnea when it's functionally affecting your day-to-day life is you're so tired during the day. So always the goal is to try, but the sleep apnea causes the, the pauses during breathing and really re interrupts your REM sleep. And if you're not able to get into the REM sleep or into the deep sleep phases, then those toxins in the brain are really building up at a level which over years and years can be, you know, quite impactful in terms of cognition and brain health functions for your entire body.

Jodi Bornstein (22:34):

I do think it's important, sorry to highlight what Dr. Brinkerhoff said in that if you tried something and it didn't work for you, it is worth revisiting. I have a person I'm working with right now who, you know, she's very claustrophobic and was so uncomfortable wearing the mask and was doing terribly during the day. She was falling asleep in, she stopped exercising, she was feeling very lethargic and very down. And so I had her revisit the clinic and they provided her with a new chin strap to help and reposition the mask. And she is wearing it consistently every night. And she feels so great during the day now there's such a change. So I do think it's important to not give up on that and to try again and see if there's an adjustment that can be made to your specific case or your own needs.

Larry (23:21):

And as a dentist who did quite a bit of work with oral appliance therapy for snoring and sleep apnea, there's always that option to try as well.

Dr. Brinckerhoff (23:33):

I, I have worked with several dentists in the area and you know, people that have dental bridges and it has allowed them to have changes in their sleep along with different positions they can sleep in. You know, it's not as though it's an all or nothing thing and just because you can't wear the mask, there's not other things you can do that you can sleep in a certain position on the side, or you can try using these dental bridges or appliances and, or you can try even oxygen at night if your oxygen level is running low. So there's, there's things we can talk about but it's not as though, just don't mention it to the doctor because I'm not wanting to wear that mat.

Larry (24:12):

We mentioned, you mentioned daytime drowsiness and daytime napping. That can be good and it can be a problem as well for sleep,

Jodi Bornstein (24:28):

Basically that we have come up with is based on the literature, is that it's okay to get that restorative sleep during the day if you need to take a nap, but you really need to make sure that it's done, you know, before 3:00 PM and that you're limiting it really to no longer than I would say 30 minutes, 45 minutes is a stretch. Some points in the literature, say 20 minutes is the maximum. So really you wanna think about a half an hour, it's probably more than enough in terms of taking a nap during the day. And you wanna make sure that you're waking yourself up by setting an alarm or making sure that somebody wakes you, because once you start over napping during the day, obviously you're gonna have a difficult time falling asleep that night. And then a cycle sort of creates itself a negative cycle.

Dr. Brinckerhoff (25:12):

Giving yourself time to wake up is also another thing. You know, it's sort of telling myself, oh, I'm just gonna sleep for this amount of time, and then expecting you're not gonna have that little piece of waking up to deal with is, is not a good strategy. Just give yourself enough time, even if you really only asleep for the 20 or 30 minutes, you've gotta give yourself enough time before trying to jump up and get down to dinner and get changed and, you know, push yourself when you're in that sort of semi awake state again,

Jodi Bornstein (25:43):

Especially napping in the winter time when we're in the northeast, it's very dark and it can be a little disorienting when you wake up. I do recommend not in your bedroom, but at another room in the house having a clock that is helpful. We'll show you if it's morning, afternoon, or evening for those nappers who get a little disoriented when they get up. So really trying to be aware of what the daylight is like and how long your nap is, is really important.

Larry (26:10):

Let's get back to talking about safety and waking up in the middle of the night you get up to go to the bathroom to do whatever. Yeah. Is there a procedure that we really should follow rather than just jumping up and getting out of bed?

Jodi Bornstein (26:29):

Definitely. this is my hot topic as an OT <laugh>, this is my, my zone. So I really recommend thinking about your bed height for starters, making sure that your bed is at the appropriate height so that you get up and sit up on the edge of the bed. You're kind of at a 90, 90 degree angle for your hip and your knee that you can touch the floor comfortably. If you can't, you wanna think about lowering that bed or lowering the mattress. You wanna think about getting maybe a grab bar to put on the side of the bed, something that you can sort of stabilize yourself with. We do recommend not jumping out of bed even though you feel like you have to run to the bathroom. You really should be sitting there for about 30 seconds trying to make sure that you feel stable before getting up.

Dr. Brinckerhoff (27:13):

Actually don't know that they will have a better chance of being successful and staying continent. If they wait those 30 seconds, they think, oh my gosh, I have to go and get there quickly. But what they don't realize is that their bladder is spasming the whole time. Yeah. That they're trying to move. So they're sloshing around the, the urine is sloshing around and their bladder and their bladder is spasming when they're feeling that urge to go and they're much more likely to be incontinent rather than sitting on the side of the bed and waiting for the urge to pass and then gain

Jodi Bornstein (27:46):

And gaining and gaining that control and getting a little bit of control as you stand up and you're aware of your core muscles that time. But along the way since we're talking about safety, I'll put my little plug in for proper lighting during the night. You don't wanna have a big, huge light that comes on and really wakes you up since we're talking about sleep. You wanna get back to sleep, but you wanna make sure that your path to the bathroom is well lit. So I really recommend motion sensor lights that you can adhere to your wall. So one in the bedroom, one along the way to the bathroom if it's far one in the bathroom, making sure that you can really get on and off your toilet easily, that it's accessible for you so you don't have these barriers to deal with during the night that will wake you up, or that you have to be sort of hyper aware of. So you might really wanna make sure that that's set up well for you and that there's no clutter on your way from the bathroom, from your bedroom to the bathroom.

Dr. Brinckerhoff (28:39):

And what do you think about shoes, Jody?

Jodi Bornstein (28:42):

So that's a great question. I think it depends on your flooring and it depends on your own body. So if you have, you have sort of sensory changes in your feet, or if you have a slippery floor and you sleep in socks, that's a different story. If you have very comfortable slippers that are very worn on the bottom, I don't recommend wearing those. So there are times where we recommend going barefoot and there are times that I recommend wearing slippers that have a back to them and that are provide enough structure and support. So it really depends on the person. You have to be sort of hypercritical of yourself and say, I really love these slippers, but they're so worn out, I'm gonna slip on them. So really be aware of what you're putting on your feet, and there are people who can't make it to the bathroom at all. And for those people, I recommend keeping a urinal by the bed or having a bedside commode if it's easy for you to empty it or for someone to help you empty them in the morning. I really wanna try to minimize your risk of falls at night. That would definitely keep you awake. So <laugh>,

Dr. Brinckerhoff (29:42):

I've, how many patients ask me, you know, I'm not really urinating that much Dr. Gra, if it's just a little bit, is it okay that I don't get up because, and and I say yes, because if you're prioritizing sleep and, and you're, that's also of a benefit to yourself mm-hmm. <Affirmative>. So if it's just a little bit of urine and you are able to use a bedside urine or, or even to, you know, use an extra heavy pad and the depends, then that's okay too because what you're saying is I'm prioritizing my brain health and my sleep over some of the urine, you know, and we can help to protect the skin. Yeah. But, but we, let's talk about it. Let's talk about what, what is, what is a priority for you and, and how, how do you function best in your apartment?

Jodi Bornstein (30:29):

And I do think when we're talking about getting up at night a lot to go to the bathroom, you do wanna think about your behavior in the evening. What are you doing before you're going to bed? So we typically recommend that you stop really drinking quite a bit, you know, two to three hours before you go to bed. I often recommend during that quiet time as you're preparing to go to bed for like a half an hour or an hour, if you're able to sort of sit or lie down with your legs elevated, then go to the bathroom and then go to sleep, that could be very helpful too with reducing some of the nighttime wakings. Again, it's really specific. Each person has their own physiological issues going on. But as a general rule, these are helpful tips. Alcohol and caffeine we can talk about as well.

Dr. Brinckerhoff (31:13):

Some people, so what you talked about, the medicine, the, the drinking before bed. You know, many times people have medicines and they say to me, but I need to take this one before bed. Yeah, yeah. And sometimes they do if it's a medicine, trying to help them or affect their sleep, like melatonin or magnesium. But other times it's a medicine that, like for example, statins for a long time people were told to take statins at night because it impacted muscle cramps or aches in their legs. And then hope, the hope would be that if they were asleep, they wouldn't be as bothered by the muscle cramps, but actually that's not the case. And you can take the statin anytime of day. But some people, because they were in that mindset of being told by their cardiologist however many years ago, think they have to wait all the way till right before they get to bed. And then they've got a list of medications that they've been told to take at night and they're doing it all right before sleep, when really they could be safely taking them right before dinner or right after dinner. So again, we encourage those type of one-on-one conversations about medications is so important with the primary care.

Jodi Bornstein (32:19):

Absolutely. You know, there are a lot of people who take diuretics and that makes you go to the bathroom very frequently. And I, you know, it really depends case by case. You have to discuss this with your doctor. But for instance, people taking their diuretic at night and then waking up every 20 minutes to go to the bathroom. So hopefully that's a conversation you can revisit with your doctor and say, can I take this early in the morning? That's typically recommended.

Larry (32:42):

You brought up Dr. B some medications that can affect sleep. Can you review some of the common ones?

Dr. Brinckerhoff (32:52):

Absolutely. So one of the most common ones I see for people that they ask me about or talk about is melatonin. That is something that I think is relatively safe, but unfortunately for some people it doesn't seem to work. But, but what I try to tell people is, interestingly, melatonin is not one that is just a chemical where like a benzodiazepine like Ativan or a sleeping pill, it's actually allowing you access to your circadian rhythm. So it might take about 20 minutes to work because the melatonin is trying to effectually catch you when you go, your body's own natural cycle goes into its rhythm of sleep. So it actually has been shown to reduce the time to sleep onset, which is what you want. But those are inconsistent results. And the side effect many people have is, is more vivid dreams.

Dr. Brinckerhoff (33:54):

And I think that's because what they, what they've noticed is that maybe the stage one sleep is reduced. So when you're coming out of rem you're more likely to remember the, the dreams and the dreams are more vivid with using melatonin for some people. The other medication that many people talk to me about or supplement is magnesium. Because magnesium has also been shown to help sleep and calm people, and it's relatively benign in a sense that it does not increase your risk for dementia. Like some of the other medications we talk about do. So magnesium, the best way to take that is either a GLI glycinate or a three eight type of supplement that can be absorbed better. Magnesium oxide is not one that is absorbed very well and does not been shown to help in people that are suffering from difficulty sleeping.

Dr. Brinckerhoff (34:55):

So magnesium, melatonin nonsteroidals and Tylenol have also been shown to help people, again, because I think some people are waking up with pain. So those don't affect the sleep architecture, but they help to reduce pain so they can help some people sleep better. The, the medicines like Ativan, lorazepam, Lunesta, Ambien, those medicines are in the benzodiazepine or non benzodiazepine receptor category. Those medications do work to help people. They help people fall asleep faster. They increase the amount of time that you're sleeping, but unfortunately they also have a side effect of increasing your risk of falling and increasing your risk of dementia. Because we think that what's happening is you're not having as much cleaning or as deep cycling of your sleep. It affects your sleep architecture in a way that is impacting the release and the removal of that lymphatic flow and those toxins from your system.

Jodi Bornstein (36:08):

Yeah. That's why I think it's so important. While I'm not discounting the medical piece and the medicine is very important, but it's so important I think to develop some very helpful strategies behavior wise to, you know, set your environment up properly, your behaviors up properly, maybe using some mindfulness. We can go into some strategies, but, you know, if you don't take your medicine one night or you forget to take it, you're gonna have a terrible night's sleep. If you're used to setting up your environment and your behaviors properly, hopefully you're creating a more consistent approach to your sleep, less fall in a risk of falls.

Dr. Brinckerhoff (36:44):

Right. It's usually, when it comes to medicines, there's always a downside. So one of the things we haven't talked about is people who have restless legs, for example. Mm-Hmm. Which is a condition that's pretty common. Patients will say to me, you know, my, my feet shake or my legs seem like they're moving, or I feel have an uncomfortable feeling in my legs. And you know, there are medications that help with that, but they also are gonna have side effects. So it, it's really important to talk to your doctor and say, is this impacting my sleep? How is it impacting my sleep? And let's weigh the risks and benefits of what is the ben, what is the benefit of this medication for me? And then what is the harm? And as Jody said, you know, occupational therapist can really be brilliant at providing interventions that have no side effect except for maybe it costs you $20 or it might mean, you know, some hassle with getting your box spring pulled out from underneath your mattress. But there's no side effect of that once it's been taken care of. And that's not the case typically when it comes to medications.

Larry (37:51):

So let's go over Jody, some of the non-medication strategies.

Jodi Bornstein (37:57):

Sure. So I think, you know, we have to think about what we call stimulus control and that if you're in bed, we've all had this experience where you wake up during the night or you're having trouble either falling asleep or staying asleep and you are tossing and turning and now you're associating your bed with not being able to sleep. In general, if your mobility is in relatively good shape, you can get up and transition out of the bed, go out of the bedroom, maybe sit in the living room chair, read, do something relaxing for a few minutes to try to, you know, get yourself calm again and then go back to bed. That's a very helpful tool instead of staying in bed and really struggling and now you're associating your bed with not sleeping. So that's one thing we like to talk about. I also have people, you know, we call this sleep restriction, is that you're really only using your bed for sleep for other things if you need to.

Jodi Bornstein (38:49):

But it's generally, you know, you really wanna associate it with sleep. So some people say, well, I get into bed at six 30 or 7:00 PM and I stay in bed all the way for 12 or 13 hours, but I hardly sleep because they're watching TV or they're doing other activities from the bed. It becomes their calendar management planning time. You really wanna try to associate that time in your bed with sleep. So try to limit the amount of other things you're doing in that period of time. I think being, you know, having a good sort of mindfulness routine or relaxation strategies that you can employ during the day that are also helpful to, during the night, people use some deep breathing techniques and there are a huge number of variety of breathing techniques that people find helpful during the night if they can't get back to sleep, there are apps that exist that help people fall asleep or get back to sleep.

Jodi Bornstein (39:45):

I can mention calm as one of the apps that people generally like to use, but getting into a good sort of mindfulness and relaxation strategy or usage during the day is also a helpful tool because it, you, you're used to using it so at night you can employ that strategy as well. And then we just talk about general sleep hygiene and sleep hygiene is really, it's referring to both your sleep environment and your behavior, what we're talking about. So sort of thinking about your caffeine intake or your alcohol intake, your liquids that you're having before bed, the temperature in your room. So setting that ambient temperature. I think it's supposed to be, it's a wide range, but the latest literature from Hebrew Senior Life, actually our very own research was 68 to 77 degrees Fahrenheit. 77 seems very warm to me, but I think it,

Dr. Brinckerhoff (40:39):

I, I'm not sure I'm, I'm not sure that that that data is gonna hold up for the next 10 years. <Laugh>, I think it's very much individual. 

Jodi Bornstein (40:48):

I think Dr. Brier Hoff and I like it at a cool, you know, 62 degrees, but that's not what they <laugh> recommended.

Dr. Brinckerhoff (40:54):

Right. Are aren't you Canadian?

Jodi Bornstein (40:57):

I'm Canadian. Mine. I sleep in the window open even in the winter.

Dr. Brinckerhoff (41:01):

Me too. So I, I, yeah, I

Jodi Bornstein (41:03):

Like it to be freezing

Dr. Brinckerhoff (41:04):

<Laugh>. Yeah. I think it's individual. But another one of the, you know, as you ta were talking, I just started thinking about, you know, the categories of quieting the mind internally and then addressing the external factors. And so, you know, some of the internal things that you can do, and it's not necessarily that you can expect yourself to learn how to quiet those internal mind thoughts and that are keeping you awake. You can't learn that in the middle of the night when you're already feeling stressed about not being able to sleep. So that's the piece that I think sometimes people don't, if you put the time in during the day to try to understand your mind and yourself and practice some of these things, then it'll be a lot easier than trying to learn it in the middle of the night. Even though you really wanna use it in the middle of the night, you've gotta practice it ahead of time, have access to those things which can in, you know, help you quiet your mind, practice them during the day so that at night that you can really employ them and try to help block out that stimuli of all those thoughts.

Jodi Bornstein (42:05):

I agree. Getting some very good physical, you know, exercise during the day is very helpful with having a better sleep and just employing some strategies to keep yourself active during the day is helpful with getting sleep. I do wanna make a plug actually, for some people, you know, they've set the environment right, they're doing everything right and they're still having trouble. They've tried medication and now they're obsessively thinking about how they're not sleeping and that becomes very difficult to sleep at that point. I do wanna make a plug. I think Dr. Brinkerhoff would probably agree with me that cognitive behavioral therapy is used very commonly to help people with sleep disorders. And the psychological aspect of it and I think can be very helpful. So along with some of these other tools that we're talking about, exploring that as an option is a, is I think a very good idea,

Dr. Brinckerhoff (42:54):

Right? They can help you practice those strategies that then you can use at the nighttime. And because it really is a strategy of working with your own mind to try to, if, you know, if anybody has been stressed, we all have where we're, we're, we're trying to help ourselves focus. It's, it's, it's really a muscle, just like your biceps or your triceps, the muscle of your mind to try to help you build your concentration and your ability to quiet things is something that, that professionals can help you to grow that strength.

Larry (43:26):

Jody, can you explain cognitive behavioral therapy?

Jodi Bornstein (43:32):

I am not a cognitive behavioral therapist, but the really the focus is on creating a new set of strategies to get rid of maladaptive approaches to sleep in this case. So helping you realize, you know, it's like a cycle and a pattern of your thinking and your thoughts and your behaviors and your actions and really sort of teasing out what is it that you're thinking about your sleep, why is it, what can you do to employ, to help yourself relax or to associate sleep in a different way. So I think from that perspective, it can be very helpful with sort of changing your mindset about sleep.

Larry (44:13):

Who, who do you see for this? For anyone who is interested?

Jodi Bornstein (44:16):

So there are people that are psychologists and social workers, clinical social workers who are trained specifically in cognitive behavioral therapy. So not everybody is. And it's really, it's easy to find, you know, through websites like, you know, website you can find someone. Sometimes the doctors recommend people. There are, you know, a number of different practitioners who have started learning about it and implying it, but it is going good to go to somebody who specializes in C B T. I think if you're going to go that route, and again, I'm not trying to say that that's the only thing, but it's something that we don't often even highlight. And it is available to help change your mindset and maladaptive thoughts and behaviors associated with sleep disorders.

Larry (44:59):

Jody, Dr. B, anything we missed?

Jodi Bornstein (45:04):

Well, getting a good mattress and pillow would be very helpful, I think making sure that that's comfortable. People have chronic neck issues, I think that makes a big difference. Or reflux and getting at the right sort of angle to sleep on. So really setting up your environment the best you can. Seeking help from your doctor, from therapists if you really are having trouble, because sleep is just so important in terms of its impact on your cognition, your physical strength and your health, your mood, your ability to engage with people around you. So it's not something that you wanna just say, well, I'm getting older, I can't sleep. This is the way it is, I don't buy it.

Dr. Brinckerhoff (45:42):

And, and one of the things I guess I would say just in two, well two things just in, we, we talked about changes, you know, as you age in your body that can be multiplicative, but especially when it comes to the medications. Really as a conversation to open up with your doctor about what medications you use and why one would work versus not work. It's not something to be avoided because you think that you know that, that you don't wanna talk about it or it's not a good thing. I mean, it's, it's, it is complicated. So in older people their body composition changes. There's, I I didn't mention that, that typically any type of primary care doctor would be aware and looking for the measuring the kidney function, the liver function, and talking about elimination of drugs there. And also the second thing is motivation is key in all of this.

Dr. Brinckerhoff (46:40):

So if you are, you know, motivated by all these different things, whatever opens the door to you thinking about how beneficial it can be to change up something that you're doing as a habit when it comes to your sleep, you can make big differences and changes and that can be very impactful for your day to day quality of life. And everybody I hear talking is it's, they don't wanna live longer. They wanna live a better quality. And this is a pathway to direct better quality of life. And if that is your motivation and you remind yourself of what that, that's what's motivating you and you then, then you're really opening the door to changing your mindset and to really, you know, embracing some of these ideas that could help you get an extra hour, extra two hours of sleep and feel so much better during the day. So thank you for asking us to talk about this

Larry (47:33):

And thank you both for coming on. It was a wonderful discussion and I'm sure it's gonna be of value to the listeners. Thank you so much.

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