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Mohammad Nami – Sleep and Brain Health for Seniors

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H. Brown
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Dr. Mohammad Nami - Sleep and Brain Health for Seniors
Dr. Mohammad Nami – Sleep and Brain Health for Seniors

Do you know that poor sleep habits are the main cause of the increase in mental health problems?

As our lives continue to get busier, sleep becomes less and less of a priority. The consequences are more than just tiredness – poor quality or quantity can lead not only to issues with cognitive function but also an increase in confusion as well as personality changes.

These changes make it difficult for seniors who suffer from these disorders to make good decisions regarding their daily routine.

Also, Poor sleep and mental health go hand-in-hand. Research shows that people who don’t get enough good quality sleep tend to experience more anxiety and depression than those who do. Sleep deprivation is also linked with an increased risk for suicide attempts! So it goes without saying that getting a good night’s rest is crucial for your overall well-being.

Joining me today is Dr. Mohammad Nami, he will share tips on how you can improve your sleeping patterns.
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Bio:

Dr. Mohammad Nami is a highly accomplished neuroscientist. He has published over 150 peer-reviewed papers and book chapters, He also serves as the National Brain-Mapping Lab Advisory Board member for Neuroscience spends his time teaching neuroscience to medical students.

He has been hailed as one of the world’s foremost experts in sleep medicine, with his work being published in numerous journals including The Lancet, Brain Research Reviews, and Neurosurgical Review.

He also serves as the National Brain-Mapping Lab Advisory Board member for Neuroscience. Dr. Nami is a Visiting Professor at the Society for Brain Mapping and Therapeutics and Brain Mapping Foundation, Los Angeles CA. He is also currently enrolled in EWHC at Harvard Medical School, Boston MA where he studies sleep disorders such as narcolepsy or hypersomnia which are characterized by excessive daytime sleepiness due to disrupted nighttime sleep patterns.

Learn more about Dr. Mohammad Nami:
LinkedIn: https://www.linkedin.com/in/mohammad-nami-md-phd-23436556/

Transcript:

Hanh:
Hi, I’m Hanh Brown. And thank you for tuning in. This conversation is live streaming on all the various social media platforms. Do you know that poor sleep habits are the main cause of the increase in mental health problem? Well, as our lives continue to get busier, sleep becomes less and less of a priority. The consequences are more than just tiredness or quality or quantity. Can lead, not only to issues with cognitive function, but also an increase in confusion as well as personality changes. These changes make it difficult for seniors who suffer from these disorders to make good decisions regarding their daily routine, poor sleep and mental health go hand in hand research shows that people who don’t get enough sleep. I should say enough, good quality sleep tend to experience more anxiety and depression than those who do. Sleep deprivation is also linked to increase risk for suicide attempts. So it goes without saying that getting a good night’s rest is crucial for your overall wellbeing. So joining me today is Dr. Mohammed Nami. He will share tips on how you can improve your sleep pattern. Dr. Mohammed Nami is a highly accomplished neuroscientist. He has published over 150 peer review papers and book chapters. He also serves as the national brain mapping lab, every advisory board member for neuroscience. He also spends his time teaching neuroscience to medical students. So Dr. Mohammed, welcome to the show.

Mohammad:
Thank you very much. I’m very, very pleased to be here. And thanks for making that happened.

Hanh:
Great. Thank you. Look forward to this conversation because sleep affects everybody, but particularly adverse impact on seniors. So our bodies let’s back up on a personal side. Can you share with us something, your, your day to day activities and I guess what brought you to being so passionate about sleep and cognitive study?

Mohammad:
Yeah, you’re right. I am passionate about sleep and cognitive studies and it all started like 10, 15 years ago. And maybe almost like 15 years ago. I was I was after having completed my course of study as a medical doctor, as an MD and I was thinking, okay, well, I’m good at pretty much chose my own course to go for further studies and just. Or postgraduate qualifications. And because just, I wanted to learn more about something which has not been the puzzle, which has not been really solved yet. And I was interested in the concept of neurology and neuroscience and psychiatry and everything, which relates to the brain, this miraculous work in between our ears. And then. I didn’t like the high school science that much. I D I didn’t like the questions that you can find the answers literally in the back of the book. So I was thinking about something that like to explore myself, and then I’ve found my way into the field. A PhD in the study of neuroscience, and then what I was doing, my studies and, and I mean, of course, work in and PhD in neuroscience. Then I tapped into, and I just bumped into the concept of epilepsy research. Then when I was doing epilepsy research, I found out that some people with epilepsy, they finally have some abnormal behaviors during their sleep. Then I was immersed in the very questionable and mysterious world of sleep science and sleep medicine. Then I found my own way and I pretty much chose my own course to go into steady sleep as, as my thesis. Then I did like years and years of humble experience in sleep research. Then I did my fellowship in sleep medicine as a clinical fellowship a scholar and also practitioner. And I’m now you know, just the director of the brain cognition of behavior. At the department of neuroscience at Shiraz, university of medical sciences in Iran, where we have like 18 PSU students sleep is a part of a research and studies, also cognitive investigations. And we do have a brain health center. We, we see many seniors with sleep problems and when we together, we agreed that this is going to be the topic of discussion. It was so fascinated. So let’s let’s get a start. I, then I know that as long as you a steer to process, we’re going to see, well.

Hanh:
Great. Well, thank you. Thank you. So now our bodies change as we get older. And one of those changes is that our sleep schedules start to shift. So let’s talk about the significance of sleep disorders in older adults. What is sleep disorder and what risks come from having asleep disorder?

Mohammad:
No, If we’re going to tap into the concept of neurological and also psychiatric issues, which result from an adequate sleep or an efficient sleep, specifically in the elderly and also senior population. We’ve got to bear in mind that there is a general saying in neuroscience that the sleep is of the brain or the brain and by the brain. So when we do not take enough and efficient sleep, then one of the key organs, which is going to be negatively affected and the quality and quantity of the processing, and also the functionality of that organ is going to be negatively hampered. It’s the brain. Right? So, and we, we don’t care about the brain, that mode, because that works so impeccably and precisely that we even do not realize that we have a brain behind our ears behind our eyes. Sorry. And like what we, sometimes we forget that we’re having the eyeglasses wear. Okay. That’s like we sometimes, if we have the very, very tiny little spec and my scheme that I show to several doctors, but I never checked up my brain. I never checked up my sleep quality. Sometimes when people come to our doors and you’re complaining about sleep problems specifically, when we’re talking about this year population, they are really an advanced, critical situation. They might even lose their lives if the problem is not correctly diagnosed and properly treated. Okay. But many people, if they have some, predicaments, some specific easy to handle problem with sleep, they say, okay, I snore every ones snore. I have bad dreamings I have nightmare disorder. Everyone goes forward, goes through a bad dreaming and nightmare stuff, but some people I have to screening, many people have to have screenings, so no big deal, but they do not follow that up with a sleep specialist sometimes because they do not even know that there is something called sleep, especialty. They do not know that we have sleep specialists. We got people that are, they have expertise in evaluating the wide, a range of sleep related predicament. As you know, we got more than 80 types of sleep disorder. Many of them, they got some serious things to do with the brain. So when we do not care about or sleep, then we’re not care about, or when we’re not caring about or brain health. So brain health, as you indicated very beautifully in your in your introduction sweep and brain health are really interdigitated. And when we talking about the health healthy aging, we need to scrutinize the prerequisites for a healthy sleep. And this is exactly what we’re going to deep dive as we’re just moving down to just down the road of discussion together with you.

Hanh:
Great. Great. Absolutely. Thank you for that insight now. What are some morning signs of a sleep disorder?

Mohammad:
You know, if I hear the question correctly, you were asking about the neuroscience of sleep disorders.

Hanh:
Yeah. What are some of the warning signs of sleep disorder? How can you tell if let’s say a person or a senior is going through a sleep disorder?

Mohammad:
Exactly. So if we. Are not aware of the quality of our sleep and how we sleep overnight. Then we can see some symptoms during the day. If I’m a scholar, if I’m a student, if I’m a person like an executive person, a person who needs to use the brain very, very precisely and effectively throughout a day. And I realized that I do not function as I use to. So I forget about the things very easily. I wonder about, I misplaced the objects. I do not have this cognitive agility and the cognitive aptitude that I used to have before. It does not have anything to do with the age. I mean, even younger people, they must come up with some subjective cognitive impairments and they go to a doctor, they say, okay, I got memory prob. The doctor does the examination, which is not the rule. They do not do the examinations for a memory all the time. Sometimes they be directly go for prescription or the medications, but best scenario, they do the active evaluations and okay. And I would say, okay, Ms. Pan, okay. Mohammad or whoever you got subjective, cognitive impairment, memory problems. Here are some vitamins or on the, what, which are going to help you or some memory enhancers, but they do not do the trick. Because the problem is somewhere else, we are just pruning the tree. I mean, we’re just decorating this tree and just going for very minuscules. But the problem is the roots of that tree. If we are not targeting the root cause of the problem for the cognitive impairments specifically, when we did not expect that to happen as a popular scenario. Then it is like by prescribing medications or going for cognitive rehabilitation as if we were not doing a good health. I mean, as if we’re riding on water. Okay. So because of that, we got to be very, very cautious about the symptoms. If the person has gotten morning fatigue, dry mouth and easy fatigability irritability, lack of impulse control person goes, angry, very easily. Something very, very minor is going to drive the person off the bowl. So this is not something expected. And over and above people would have issues with their blood pressure, with obesity, they got diabetes and they go to the endocrinologist. They go to the internal medicine experts. They’re taking a bunch of medication, but the medication is not really helpful. You know what? This is. There, there is an, a statement written our book. And it says if someone is taking the anti-hypertensive medications for hypertension and the hypertension is still uncontrolled, go and check to sleep. And also obesity I am on diet. I’m doing very, very heavy exercise, but I fail to lose my weight. And one of the reasons behind that is that I do not take a good sleep, so let’s catch up some sleep. And by that we can have a better chance for living a healthier life in different dimensions. So, cognitive impairments in reply to your question, number one, which is unexpected. And I mean, lack of mood control, depression, anxiety, and easy irritability and anger and aggression. And also when people have got some physical issues, you have like metabolic symptoms. By that they got to just, it rings the bell. So the dock, the people need to go and see a doctor specialist for that. In some occasions they gotta be doing undergoing sleep tests, which is literally referred to as polysomnography or like sleep checkup if you like.

Hanh:
Wow. You know, I knew that it was important. But I guess it’s common that in general people don’t see the value of that because we treat other symptoms that are perhaps more on the surface, but it sounds like underneath it all the core reason could be just getting proper sleep. So thank you. Thank you. So now what in society today? What do you think the status of understanding of sleep disorder?

Mohammad:
Oh, wow. That’s not good. I mean, it’s nothing better than disappointing. Many, many, even not only at the public level Ms. Pan. But also at the level of the overall practice in general practice of the healthcare providers, they we as healthcare providers we very, very scarcely scrutinize the sleep problem. And we just ask various the professional questions from the referrals and okay. Do you have a good sleep? And the patient says kind of, and that’s it. Okay. Do you have a good asleep? That’s it? No, not really. And then maybe I prescribed some medications which are like downers or a sleep aid medications. Many of these medications are really like poisons. I mean, at short term, they are going to help with some sleep catch-up, but long-term, they are going to really complicate the sleep problem because we get addicted to those medications. Many of those medications has got really high addictive potential. All right. And the risk of addiction and dependence would the best scenario. Your tolerance is very high for many of the sleep aid medications, and like, Hydronautics and sedatives. We just prescribed those medications. We are not asking about those sleep habits, the healthy sleep habits. We are not asking about the features and facts and numbers. I mean everything about the quality and quantity of the sleep as a biological, healthy behavior. Some people they just take because, generally speaking as a, like a middle-aged person, we need to have like eight hours of sleep. But the fact of the matter is that many people throughout 20 hours of like seven hours of sleep on average, but many other people you’re taking less. And it’s been shown that the people who are taking less than six hours of overall sleep throughout 24 hours, less than six hours, they have 63%. Higher risk for developing neuro-psychological and neuropsycho pathological centers. Okay. So by time to having a wide range of neurological cognitive psychiatry, psychology, and psychological issues. Okay. But we do not ask about the number of sleeps. The number of sleeping hours, we do not ask about the symptoms like snoring, like a witnessed apneas or cessation or pauses, and the breathing we do not ask about repetitive, wakes after sleep onset. We also failed to ask more questions about the abnormal behaviors, less like sleep, talking, sleep, walking, moaning, tooth grinding some people they have sleep, unfortunately that’s a sad scenario. I know, but I can recall. Five six patients that were to pass 20 past like 15, 20 years of practice that I had. I can recall five patients that they were, that they lost their lives, unfortunately, because of sleepwalking. So did just fill up this year at staircase. They got out there at room and they just fell off and they just had their, a head injured. Oh, maybe they had some abnormal behaviors, which were very risky and they, they did. And they took some medication. They overdose themselves, why they were asleep. They were walking, they opened the cupboard, they took the medication. They had like 10, 20 of those pills without even knowing that. Some people had sleep paralysis and they have issues. They were very intensely scared. I mean, the thing was just happening to them. Like a demon sitting on their chest would, well, when, shortness of breath and everything got a gut issues, they have the increased depression of cortisol and nor epinephrin and they got you know, like, my, my cardial infarction or a stork is of many people specifically elderlies. My father, your father, his mother, her mother. Okay. They lose their life. God forbid someday some night at the middle of the night and those stroke and M.I. miocardial infarctions that predominantly happened in the early morning. Yeah.

Like for three to four or five, 6:
00 AM. And they say, okay, that guy, or that gentlemen had like stroke had M.I. and unfortunately passed away. But what was the reason? The reason was he has been snoring for years. He has been having hypoxia. He’s been having fluctuation of the blood pressure during sleep. He has been having dysrhythmias in a heartbeat. He has been having some dysregulation in the immune system. He’s been having some issues with the endocrine parameters and they were all hand in hand with the sleep by a parameters and nobody was aware. I was not really paying enough attention to those problems. You know, Ms ha Ms. Brown, when I was about to start my career in the study of sleep predicament. Many of my colleagues and the Quantis is different. Just coming to max, coming back to me and say Mo what? Why do you go to study, sleep as your future career? That’s not complex. So we sleep and then we wake up. It’s easy. Okay. Just go and study something, prestigious, something complicated, something that you’re going to learn a lot about it. And I was like, yeah, double. I mean, I was you know not, not pretty much sure that there’s no right way that I’m going to, that I’m going through. And am I going to find quite good opportunity for learning? And I can tell you after 15, over 15 plus years of, of studies and being a restless learner throughout this years, every single day, I’m learning something new about sleep. Every single patient who is coming to our doors is a new case scenario. And I have not seen even two single individuals that based sleep quite identically. So everyone sleeps very uniquely and our brain go through a specific journey, which is very, very unique. So the sleep. Problems or sleep disorders are very varied and wide varied across the us and across individuals and a sleep pattern. The sleep mapping, if you like the matte walrus lip is different. Okay. Does that kind of resonate to the question that your asking?

Hanh:
Oh, absolutely, absolutely. So it sounds to me the quantity of sleep is obviously measurable, but the impact, the consequences and the disorders are not as readily tangible or measurable. And I think that’s why people underestimate the value of it. That’s, that’s my opinion. No, I know you’ve touched on sleep apnea. So let’s talk a little bit more about that. So has sleep apnea always been a big deal in the medical field and elaborate and how do people get it and how do you pick kit?

Mohammad:
Oh, of course it is. You know, actually in our day-to-day practice, what we see is that into sleep clinic, where the majority of the people that are coming to the clinic are suffering from sleep apnea and they are suffering from that at the very, very intense, profound, and advanced level. They don’t refer to a doctor unless they have something really critical. Okay. Because they S they think sometimes when people snore. Other people either might find it funny. Good. That’s good. Is a snoring. That’s funny or it’s not funny. It’s not funny at all. And that is tragic because snoring is like a sign, like a fever. If I have the fever, if I have, this is a symptom, right. And behind this. I might be having some other underlying issue, like an infection or something. And when I snore in a in a fraction of cases, we call it like epidosic snoring, or habitable story, which is fine. Okay. No big deal. But when, in majority of the cases, when they have a, I mean, loud snoring, a high pitch snoring, but the sound of the snore is audible from a next door. Okay. And those cases were facing a problem, which is called hypopnea or we have flow limitation. This means that like 30% to 60% of the air, which is supposed to be inhaled and the oxygen is supposed to be exchanging my lungs and the oxygen will be delivered to the brain and other vital organs. That is being stolen. Okay. So I’ll put in, take in enough air into my lungs. I wouldn’t have enough oxygen to nourish the vital organs with the oxygenation. If you can relate to that. So by this people at least have hypopnea, which means flow limitation while they were sleeping. And the ma that might be obstructive, that might be central. By central hypopnea is the brain does not send enough signals for effective breathing. That’s the central problem. I mean, the area in the brainstem, which is responsible for the depth and the frequency of breathing behavior does not work well specifically during sleep. And by that I got pauses and the culprit for this pauses is the brain. The other scenario is that the brain goes beautifully well, but the problem is here and the back could have throat in the upper airway. I got high resistance of the tissue, so we have upper airway resistance and that’s the syndrome. So by this, the back of the float is very bulky. It’s very crowded with the tonsils, with the low line soft palate, with the wide base of the tongue and all these things. We’ll just stand back when I just when I sleep like in a supine position, like a belly up position. Okay. So these are to just stand back and just sort of close. Back of the throat or airway. So by this people would find, well, this is not normal. I see my grandpa. I see my dad when they’re sleep, they got some pauses and they got, this is snorting and some weird, very noisy and loud sound. And by that they wake up, they do like confusional behavior and then they back to sleep. And this happens like over tens and 10 times. Okay. Tens and tens of times overnight, I got people that they have like eight, nine hours of sleep and he has 200 episodes of apneas or hypopneas so this is what I’m going to emphasize here. So what would like to stress is that the number of hypopneas plus apneas per hour? That is an index. We can not guess about that. We can not an estimated by just looking at the person we got to do sleep tests. We got to undergo polysomnography to figure out what is the apnea hypopnea index. So what is literally very, very popularly. We were referred to that as AHI. AHI is a number of respiratory events within an hour. On average during my sleep, if it is more than five, something is not right. If it is between five to 15, I’m having like mild to moderate, obstructive sleep apnea, hypopnea syndrome. If it is between 15 to 50, then I got severe obstructive sleep apnea, hypopnea syndrome which is, which is just, known as OSAHS. So I got OSAHS and the number of AHI is between 15 and 50. So I got severe, but you know, the, the sad part that many, many of the people that we see in the clinic, they have the AHI more than 50. This means that they have profound OSAHS with critical level of O2 desaturation of oxygen. Desaturation If I do not treat that person tonight, very, very frankly, literally he might die the next night. Okay. And I have unfortunately, and sadly seen some cases, some referrals, some patients that lost their lives. Okay. But the good news is that when we diagnose the sleep apnea specifically in the elderly population, specifically in the gentlemen. Okay. Our, our, our daddies, our grandpas are more at risk as compared to the ladies. Okay. So when we’re talking about the seniors, male senior’s They have more, of course, if they have the short neck, if they have, the, the, the fats neck and a also, I mean the next or conference or the size of the Kohler. I mean, you, you check that, we normally check that in the clinic with the size of the kohler. If it is, wide and short neck, if they have obesity, if their AHI, if a BMI is more than 30, for example, or a body mass index I, I suppose the many people are familiar would be BMI when it is more than 30. This means that I’m suffering from obesity or at least over on overweight. So, and when they snore and when they have excessive daytime sleepiness during the day, these are the red flags. So, if I am talking about a grandfather, a father who has more than eight, more than 80 years of more than 50 years of age, he has obesity. He has short neck and wide neck. And also the person, and if the person has got issues with snoring, snorting, the pauses and the breathing, and most, most importantly, if the person has got some issues with excessive daytime somnolence or very, the person is very sleepy, it’s talking to you is dozing guff. And I, I remember, like a lady was talking to me about his as father, her father. And she was telling me like, you know, doc, my father takes the spoon. And is going to just take the food and the midway through he falls asleep or we’re talking to my father and he’s asleep, or he just takes some knots or something is just cracking the knots and he cracks the nut and then is got this dosing guff because when we have this eight Tonia or the paralysis is a lack of the muscle tone in the neck muscles, this means that we might have. Probably have had a long-term sleep deficiency. And because of that, when we fall asleep, we directly go to the REM sleep and. REM sleep is a period of sleep, which is in depth, asleep, depth of asleep. And this is exactly where we are dreaming. Okay. So some elderly people, when they have dementia, When they have early stages of Alzheimer’s type dementia or my cognitive impairment, progressive questionable dementia, some sort of problems with that kind. When they fall asleep, they hallucinate. Oh, Dave, see, they hear something and they show weird behavior. Many of these people, unfortunately when they’re, when they are not sufficiently examined medically, they are being misdiagnosed for the people who have. Auditory hallucination. Okay. This is like, it’s like a psychotropic medication. So I’m going to give you a medication which is normally prescribed for the people who have got auditory hallucination. Why did I prescribe that? Because you, you told me that you have auditory visual hallucination. Okay. But the problem is not that the problem is REM is like sleep onset REM period. Some of these people tend to have symptoms similar to narcolepsy. So it’s a huge, long, long story. But to cut the story short, what I like to put here in brackets and put an asterisk above it is that sleep issues ranging from insomnia to all respiratory problems, sleep disorder, breathing, they become even more prevalent. And elderly population and seniors are our daddy, our mom, our grandpa, grandma. They aren’t the people who are even at more risk compared to the younger generation to experience devastating and sometimes worrisome different levels of sleep-related predicament. And that relates directly, which if we have time, we’ll be touching on that. Hopefully it has really, really solid link with dementia. So the, I mean the better we sleep the later we’ll have a chance for to make dimentia.

Hanh:
So now can anyone be affected by sleep disorders during all stages of life? Or are there other factors at play such as hormonal production and so forth?

Mohammad:
Yeah, it’s a very, very important question. Thank you for bringing that up. And yeah, we, we might be having sleep issues with the kids and, newborn. If they have track of Malaysia that issues with the breathing or they have like issues with initiating or maintaining sleep. I the youngest kid that I’ve examined for a sleep was like two months old. And the elder, the eldest one that I, the oldest one that examined was like 102. But for that person, it was very, very, senior, like 102 years of age. I was not really going to help that person, but you know what, why I did this sleep test because the person was like, I don’t know how many nights I’m allowed to sleep from now on, but I’d like to check if I got some problem that I overcome that problem, and I’m going to enjoy the sweet slumber even more than before. That was the reason that that person was examined, but the sleep the sleep problem can just happen within the life span. If, but some specific age spectrum are really more important. For instance, in children, we got specific insomnia, which is called behavioral insomnia of childhood, or we have a wide range of sleep related behavioral disorders and also sleep epilepsy syndromes, and for the youngsters and also teenagers, we might be having issue with addictive behavior. You misusing overusing technology, poor sleep habits, not following the sleep hygiene recommendations. So they do not go to bed early and they wake up very late the meat of the day and for the, for the middle aged people, as I said, we started to have some specific concerns about the sleep related breathing disorders, specifically middle-aged men. But when it comes to ladies at childbearing age, They got issues with their Perry menstrual syndrome. When we have the fluctuation of the hormones, they might be having issues with, with the duration of sleep and also the quality and the buyer parameters on sleep. So the sleep is not going to be refreshing enough for them. And they, when they wake up in the morning, they feel that what they have been really unrested and also for the during pregnancy. And I’ve published a couple of Humboldt papers regarding the range of sleep problems. And during pregnants. And in each of the trimesters, during pregnancy, we’re facing a specific, range of sleep problems and later into life for ladies when we’re facing the drop in the sex hormone. And also they do have issues with the Perry, with the premenopausal. So when the are just entering the menopausal state, then they start to have the hot flashes. They start to have issues with the with the integrity of the sleep cycles with the proportion of the sleep stages. So maybe some people do not know about what I’m talking about. Now we have stage one, stage two, stage three or N one and two and three shallow asleep somewhere in between and deep sleep. Okay. And one, two and three, and then we have remisly. And N 1, 2, 3, and grim sleep. Generally, we just put them really integrated. This is called a sleep cycle and we have four or five sleep cycles every night. It’s like a journey it’s like, we’re going up and down and up and down and up and down then wake up in the morning. Okay. So this is called sleep stages and the collection of those sleep stages together within like ninety minutes, it’s called the sleep cycle. So it should go through a specific integrity and pattern. So people, as they age, they lose this in sleep cycle integrity, and they lose this pattern, this structure, the engineering of the different, stages. And the map of the sleep is, is in many instances is going to become distorted. That’s why. Sleep problems are really salient when we’re putting into the perspective, the population like seniors.

Hanh:
Absolutely. Well, let’s go a little deeper dive to sleep and dementia. Okay. So clearly not getting enough rest can lead to a weakened state and it might also lead to dementia. So can you go into a deeper dive in the correlation between sleep deprivation and dementia?

Mohammad:
Exactly. So the, the science between sleep deprivation, a memory problem is really deep and it’s very long. And. So, when we go back into like 30 years ago, we got early papers that they are, that they were just examining the detrimental impact of sleep loss or totalistic deprivation on the animal models, in the laboratories and how the memory is going to be negatively impacted. Right. So there is no question regarding the impact of lack of sleep to the memory and cognitive predicament. And the reason behind this has been really, various Italy, a lot of two over to T or the past 10, 15 years, because now we know that sleep deprivation causes the accumulation of the pro-inflammatory mediators in the brain. And those mediators that are inflammatory, mainly the are a cytokines or interleukins. Some of them are cold. This is really interesting. They called Def ligand. These are the ligands. These are the proteins. These are the peptides that when they attach to the surface of the neurons, they caused cell death. Posta right. So the cell death is like, if that calls that is called apoptosis. So when we have the predominance of the pro-inflammatory cascades within the cells and the micro environments between the brain cells specifically to new lawns, then by time, we’re going to have this apoptotic pathways really ignited. Then we have the accelerated process or lots of the brain tissue. And when the brain tissue is going to be susceptible to this lack of oxygenation, number one, number two is that they give it, we have the accumulation and like building up of the toxic materials in the brain. And then we did not get enough sleep. Then this goes on and on, and that’s going to be accumulative process because we got compelling evidence showing that. The toxic materials and those inflammatory materials, the waste materials, if you like in the brain, they are slight up from the brain during the sleep. And only during sleep. Because we got a system that is composed of two components number one, the lymphatic system in the brain. And number two is the glial system. Lyle are glial cells are supportive cells. They are not neurons by the very similar, right. So they are like two different corridors, number one, lymphatic and number two glial. So this collective system is as referred to as GLI emphatic system. And the glial emphatic system is responsible for clearing up the brain from the waste material during sleep. If we don’t sleep well, then the brain would not get a chance of getting cleared off from the waste material. And those waste materials are generally toxic and they cause cell death and the cells within the, I mean the temporal parts of the brain that we call them like hippocampus, which is a very, very critical structure. Or coding and decoding or the memory function. So when the hippocampus and a part of HIPAA capital structures and make the lens structures and deep seated structures in the lateral part of the brain, I mean the sides of the brain, when they get trunk by time, people will start having issues with memory, learning, attention, language. Decision-making reasoning, planning, executive functions and so on and so forth. So by this, the person will come to a doctor, come to the healthcare provider, get examined. And unfortunately, again, I’m going to re-emphasize reiterating. This is under attended many, many doctors and nurses and healthcare providers. They don’t really pay enough attention to the importance of sleeping, that kind of thing. So to just directly goes, go for a cognitive rehabilitation or they go for stimulation of the brain. I mean, the most sophisticated approaches that we have are it right? TMS T E S or the stuff like that. But the common practice is that we go for medication prescriptions. And also cognitive rehab number of rehab. It does not do the trick because the problem is with backup sleep. The problem is with the related sleep problems that I said, they are very, very in your mirrors. We got more than 80 types of different sleep disorders. We got at least 14 different types of insomnia. It’s not like, okay, I got insomnia welfare. I’m fine. I’m going to give you a sleep aid medication, go and take it. No, that’s not it. We need to scrutinize. We need to really isolate what kind of insomnia is might veer and what is the exact sleep related disorder or the combination of those sleep related symptoms that we need to target. And I said that the good news is that for 80% of the instances, we can slow down the progression. We can treat the patient in a very, very efficient way because we got very, very good remedies. Provided we have a distinct precise diagnosis. We can provide distinct, precise treatment and remedies for that, but that’s not the common way that now we’re saying in everyday practice does answer your question?

Hanh:
Yeah. Wow. So is it true that lack of sleep can decrease cognitive function by up to 40%?

Mohammad:
It is. Yeah. So there was an, a study in 2016 and that was published in nature. Okay. And the study was what’s called a share study and that was like a population based study. And they were, examining the cognitive function of the elderly people or the seniors. Many of them were entitled into the daycare Sanders and some of them are, were homesteading. All right. So they were examined for their cognitive aptitude for cognitive form. And it was shown that they have 40% decline in their cognitive aptitude in their cognitive I mean parameters and they did the retrospective analysis for the history of a sleep problem. So it’s like a retrospective cohort, right? So the looked back. Those people who have had at least 40% of sleep cognitive decline, they found to have over 70% prevalence of sleep related issues. Okay. So 70% of the people, this is the take home message from that article, from that research, 70% of the people that they have sleep issues and they do not take care of that. Would end up with 40% decline in their cognitive performance within next 10 years. And that’s stunning. Right. And that’s really stunishing because it has been also shown in another set of publications and, evidence-based I mean, literature that when, if I do have sleep problems, sleep snoring, for example, or insomnia, if I’m not treated, if I have apnea, if I’m not treated. My the, the onset of dementia or my cognitive impairment is going to be advanced for 10 years. So if I’m supposed to be afflicted with NCI or dementia, by the age of 70, if I’m not treating my sleep apnea, I will certainly get it by the age of 60. And that is not our assumption. This is evidence-based literature. Okay. This is science. So if I do not treat my snoring, I would have sleep. I mean the onset of the dementia to advance for like five years. So 10 years, five years advancement, early, early risk or a dementia. This is really something. And this is true. I mean, this is like, the facts that we are now referring to in our books. And if two people, if I in you, for example, let’s say that we’re middle-aged all right. If I am you, we both of us genetically, we’re hearing a gene. Which is going to increase the constitutional risk for being afflicted with dementia at the age of 60. Okay. Like I know that you’re familiar with many of the people who are watching this. There was a gene called HIPO Epsilon E one or E four. . Okay. So these are the genes and these are new. I mean, since 2004, they have been discovered. So these equal Epsilon four is a gene. I have it you have it. I snore. I have sleep breathing disorder. You don’t. I get diagnosed with advanced dementia Alzheimer’s type at the age of 60, you are 70 and you’re as sharp as attack because you do not have a sleep related problems. So this has been shown that those who have the background or genetic predisposition for dementia. And concurrently they have sleep problem. That would be at a substantial, increased risk for developing dementia Alzheimer’s type as they age. So these are really something that I’m a very fortunate to just share the idea here with you. So if your dad, your mom, your loved one your wife, your husband, or someone has got some signs and symptoms of sleep related problems. Let’s go, let’s go for it. Let’s about that important.

Hanh:
I think that’s great. The fact, we can have these conversations bring awareness so that people can take proactive actions, right. As opposed to going in to see and have it checked when it’s too late. So I think it’s wonderful. Now let’s talk about technology. So do you think that technology is affecting our sleep or taking time away from it? And what do you think we can do about it?

Mohammad:
Yeah technology of both for the younger generation and both for seniors, that should be a really regulated, I mean, the use of technology should be regulated. We need to use the technology and not vice versa. So the technology should not be using this. I mean, the screen time people are looking at watching films or just, browsing the social media for hours. And specifically when it comes to the evening hours, that’s going to be a really toxic and it’s going to leave a detrimental effect. The, the, the secretion of the protein or neuropeptide or hormone in our brain, which is called melatonin. Melatonin is not a hive narcotic agent, but that is a Kronos therapeutic. Like, uh, like a criminal biological agent, what it means is that it just sets the timing for sleep and wakefulness. So if this is secreted right in a timely manner and correctly, based on the expression of the genes and stuff. So by that, I’m going to have a good pattern for my sleep wake. But if it does not, I’m going to just, lose the benefit of having a timely, efficient and enough sleep hours of sleep. So partly that’s because I intentionally and purposefully I’m changing my date sleep and wake habits. Right. And specifically that is a really, really significant red flag, for or, or the youngsters. I mean the adolescence, they are overusing the technology. And we are using this even more and more as we develop newer technologies. Okay. So we were just, immersed in the social media, like crazy. And we do not take care about the number of hours that we’re, dealing with it. And also we have this exposure to the technology. I’m sorry to the blue light. I mean to the screen. And it’s been shown that, looking at the stream, a screen directly as a, like a seven inches cream or like one hour that would decrease the secretion of melatonin for 45 to 70%. So I’m just killing the suppression on my melatonin. If at night, the time that my brain, my mind is going to slow down, it’s going to, I mean, when we have the sun down, we need to have the technology down. Right. So, okay. That’s fine. We use the technology during the day, but let’s refrain from using mobile computers, TV, whatever. During the evening. All right. And not only that but, but also it’s really important that technology can be useful because it enriches our social interactions with other people. We are just, lighting golf, rooms with, with lights with boats, and that is. That needs also to be regulated.

So let’s just dim the light after 9:
00 PM. Let’s not use TV, mobile cell, mobile phones I mean, computers and stuff like that. Let’s refrain from drinking. Whatever’s stimulant drinking any stimulant substance, like caffeine, like coffee or, or tea or chocolate stuff like let’s refrain from them or whatever is taken as an stimulant. Yeah. To our brain and by experience, I listened to my biology. I listened to myself and I know if I eat that stuff, I wouldn’t be able to have a respite of slumber. So by that I would not take it from this time later. Also let’s take care about some, some a positive sleep related habits that we collectively refer to them as a sleep hygiene measures. Okay. So if the people just look for the word, sleep hygiene and Google it, that will find a bunch of data there. So just follow the sleep hygiene cheklist. Make sure that we’re going to do it right. And even more precise from now on, and by this, we’re going to just provide ourselves with a gift. And that is the sweet slumber. And that is the beautiful experience of refreshing and good sleep. Okay.

Hanh:
Amen to that. Oh gosh. Isn’t that a problem? It’s a, it, it’s like setting boundaries for yourself. It’s easy to set boundaries for your kids. Right. But when it’s we as adults having to monitor and control our own usage, With technology at night. What I also found out is not only, like you said, has adverse effect on your sleep, but you know, that blue light is not good for your vision and your skin.

Mohammad:
Correct.

Hanh:
To me, that’s really important. As you age, you’ve got to wear those reading glasses and it’s not good for your skin from for many reasons, you know.

Mohammad:
That’s right. That’s right. And Ms. Brown, the other thing is that sometimes we’ve got to be quite cognizant about is that some people would have this disruption of the sleep wake pattern specifically in the aging process. When you have the process of accelerated aging or they got problem with this aggression of the melatonin, many seniors, they come to our setups and they complain about the you know, what we sleep late and we’ll wake up really late. Or sometimes we sleep okay. And the right time. But after like couple hours of sleep, we suddenly wake up and then we find it really difficult to fall back sleep. Right. So by this, there is some disruption or dysregulation of the secretion of melatonin, and then also the expression of the genes that are responsible for the production of melatonin and other related proteins in the brain. Right? So by this, sometimes we need to use the supplementary melatonin. But I am going to just reemphasize emphasize this as a key fact, melatonin is a steal and medication is a steal, a truck. So we need to be pretty cautious about overusing. Although it is an OTC medication, we can just go and buy mint melatonin without prescription, but using the melatonin has got a specific formulations and timing. Dosage instructions. So we need to be cognizant about the timing and the dose that melatonin is prescribed to the seniors at night to set them back to the right sleep, wake schedule, number one, and also in the morning when we have the carry on effect or the melatonin and the seniors object is find it very difficult and very, very, struggling to get out of the bed in the morning. And it got, I mean, Like the foggy brain in the morning. Okay. By that we’re just submitting them to light. So we’re just going to stop the process of the melatonin action in the brain. So we slow down the function of the melatonin by exposing the people in the morning time while they having their breakfast enjoyably. Okay. So they are exposed to blue light. There are expose to lights. And it also has dosing instructions. It also has the, I mean the duration stuff like that. So we need to know that for the criminal therapeutics, we also got to see a doctor. It’s not like, okay, I take a number of handful of melatonin tablets. And in the morning I’m going to have the sunlight and that’s up it’s gone. Oh, it is complicated. In some instances we need to consult with a, with an expert and we need to find a best way, which is going to help us as best as possible. Okay.

Hanh:
Now one last question. Okay. Now, what are your thoughts on the potential of using medical marijuana to induce a better nights sleep?

Mohammad:
Yeah. Marijuana bring on eyes, as a, is a hot topic. And we had got so, so many scientific notions and also evidence to support and also to counter act the beneficial effects of Marijuana. Marijuana is a medical med. And it has a potential to modulate the S I mean the, the kind of transmitter system in the brain, which is called the cannabinoid system. So Mariana and the effect of substance in the Marijuana, which is called THC is agonizing is causing an effect. On those I mean cannabinoid receptors. So the more we use Marijuana, the more parched the brain would be to get even more Marijuana. And that is not only the physical dependence, but the psychological dependence. That is different to the opioids because for the opioids it’s, we have more physical dependence, but for Marijuana and stuff like that, for cannabis, people would have the poor psychological dependence and we find it really helping with the people who’ve got sleep problem. Okay. So some people, they, they seek advice from the healthcare provider to use the THC oil or cannabinoid oil, or they all also, spraying the cannabinoid oil in Australia. So they might be using the patches. They might be using the creams they might be taking, or they might be smoking Marijuana or cannabis or the THC or cannabidiol. But yeah, in short term, that’s really a mat that, that works like magic. I mean, that, that helps them to have a very deep downstage of sleep. Not never like never before, but here’s the problem. When I over it, when I continue using cannabis for the betterment of our, of my sleep, then the mechanics in the brain that they are being linked to the cannabinoid system in terms of initiating and mentionings of sleep will be dependent to the cannabinoid system. So by time that I would draw myself from cannabis, then that’s the beginning of the burden I would start having insomnia. I would have insomnia even worse than before. And the next time that I’m going to get back to cannabis, that wouldn’t do the trick like before, you know what I mean? So it’s like a roller coaster. So I’m doing well. Not doing well. I’m doing worse than I’m trying to get. Well, it’s not like before, and then I will just get into trap and another trap and another trap. So it’s really important. It’s good. But under advice of a well trained, certified sleep expert, it can be prescribed, the derivatives of tetrahydrocannabinol cannabidiol or THC is being prescibed. In different formulations, but it should be under the care and control and monitoring of an expert physician.

Hanh:
Wow. Thank you so much just for this wealth of knowledge and underscoring, the value of sleep and quality sleep for, I guess everybody. Right. Particularly seniors. So is there anything else that you would like to add.

Mohammad:
No. The only thing that I just wanted to say is that I really, I want to cherish this opportunity and cherish this moment. Because this, this is being streamed in media and people have watched the, maybe the people will watch it later on and that’s going to be there forever. So many people later and following years will see this. And if I am you together, could at least partly enhance the understanding and the attitude of the people to the significance and salience of the problems sleep. Then we have done our mission. I mean, the mission is completed so far, so, and I would like to appreciate you for the efforts you put into this for making this happen. And thanks for having me.

Hanh:
Thank you. Thank you so much. All right. Take care.

Mohammad:
Really appreciate it. Thank you so much. And we’ll catch up later. Bye-bye.

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Episode 132

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