Top Tips for an Amazing Brain. Dr. Sumeeth Bhat and Dr. Beenish Khwaja

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1 Top Tips for an Amazing Brain Dr. Sumeeth Bhat and Dr. Beenish Khwaja

2 The Amazing Brain Sumeeth Bhat, M.D. Family Physician Medical Director, Legacy Medical Group-Cornell Beenish K. Khwaja, D.O. Neurologist - Legacy Medical Group Neurology & Sleep Medicine Medical Director, Legacy Mt. Hood Sleep Center

3 Brain Health What can you do to protect your brain besides wear a helmet

4 Importance of the Brain Helps regulate a lot of things > Memory > Emotions > Breathing > Balance > Perception > OVERALL LIVING!!!

5 Disease Definition: French/English origin meaning lack of ease How does it occur Environment Genetics Behavior

6 Diseases of the Brain Memory > Alzheimer's Disease and Mild Cognitive Impairment Movement > Parkinson s Speech > Stroke Emotions > Depression And many other things!!

7 Prevention How can we prevent disease? >Diet: modify our input >Activities: change our output

8 What to eat!!!

9 Healthy Brain Diet Mediterranean Diet > Definition: high in fruits/vegetables, whole grains, beans, nuts, seeds Olive Oil Lean Meats (fish, chicken) Drink wine

10 Mediterranean Diet Food Pyramid

11 Why Mediterranean Diet Decreased rates of: > Alzheimer s Disease > Cardiovascular Disease > Parkinson s Disease > Cancers Increased > Longevity of life

12 Specifics Which foods are good for you > Berries like strawberries/blueberries High in Flavonoids: anti-inflammatory and antioxidant effects > Whole Grains High in fiber: helps prevent strokes/heart attacks

13 Specifics Alcohol: How much is safe? > Females: 1/drink per day, 7 drinks/wk > Males: 2 drinks per day, 14 drinks/wk Remember Alcohol does have calories This does NOT apply to those with addiction history or certain health problems

14 Healthy Diet Mediterranean diet is just one example Eating a healthy, well balanced diet is the key > Eating sugars in moderation > Avoiding processed foods > Limiting soft drinks > Monitoring portion sizes

15 Starving yourself is not a diet

16 Tobacco Smoking more than doubles your risk of stroke Study of over 10,000 people in Sweden > Tobacco responsible for 39% of strokes Risk goes away within 2-4 yrs after quitting

17 Lifestyle Activities 3 groups > Mental > Social > Physical

18 Mental Activity Memory training, use of memory cues, and organizational aids improve function in healthy older adults Exercising your brain is key > Reading, writing, reflection are all important

19 Social Activity Staying socially engaged > Associated with less cognitive decline Avoiding isolation > Friends, family, etc. Being engaged with local community > Volunteering, community groups, social activities

20 Physical Activity Physical exercise is KEY! How much? > 150 minutes per week of moderate intensity (walking) > 75 minutes per week of vigorous intensity (jogging) Will help prevent: > Stroke, Heart Attack, Diabetes, Cancer, Depression: You Name It!!!

22 3/14/2014 LEGACY HEALTH 22

23 How does Activity Work? 3 theories for mechanism > Cognitive Reserve hypothesis Improve the connections in the brain by improving performance of neurons > Vascular hypothesis Improve performance of blood vessels and therefore reduce stroke and heart attacks > Stress hypothesis Improve body s ability to function by lessening strain on brain

24 In Summary Healthy Diet goes a long way Moderate alcohol consumption Not smoking is key Activity is very important > Mental exercise > Socially engaged > Physical exercise of 150 min/wk

25 Extra Motivation for Brain Health!!

26 SLEEP AND THE BRAIN Beenish K. Khwaja, D.O. Legacy Medical Group Neurology & Sleep Medicine Director, Legacy Mt. Hood Sleep Center

27 Sleep is Required for Survival Rats deprived of sleep die within 2-3 weeks of continued sleep deprivation. Rats with sleep debt live about five months compared to the normal 2-3 years. Humans deprived of sleep can become paranoid and hallucinogenic. 100,000 auto deaths per year are attributed to sleepiness- especially among teens.

Sleep We spend 1/3 of our lives asleep. Sleep is an active process. No organ or regulatory system shuts down. Slight decrease in metabolic rate Some brain activity increases during sleep.

28 Sleep We spend 1/3 of our lives asleep. Sleep is an active process. No organ or regulatory system shuts down. Slight decrease in metabolic rate Some brain activity increases during sleep. Delta waves Many parts of the brain are as active as awake periods i.e. REM sleep At least 2 hours of dream state per night. Specific hormones increase during sleep. Growth hormone Melatonin Specific cues exist for regulation of sleep e.g melatonin, light.

29 Regulation of Sleep

32 Sleep Patterns 4 stages of sleep during a normal night Stages 1-3 (non-rem) and REM (rapid eye movement) During non-rem sleep, many of the restorative functions of sleep occur. Memories and thoughts from the day are processed. Stages progress cyclically. 1-3, then REM, restart back at stage 1 One complete cycle takes about minutes. First few cycles have relatively short REM sleeps. REM sleep time increases in later cycles.

34 Stages of Sleep

35 Rapid Eye Movement (REM) Sleep Brain waves increase to the awake level. Most dreams occur during this stage. If awoken in this stage, most people remember their dreams. Physical changes during REM. Increase in H.R., B.P., and breathing rate Breathing more shallow and irregular Eyes jerk rapidly Limb muscles temporarily paralyzed Some loss of temperature regulation Men may experience erections Most people have 3-5 intervals of REM each night. Infants spend 50% of time in REM. Adults spend nearly half of time in Stage 2. 25% in REM, other 25% divided among other stages Progressively spend less time in REM as we age

38 How Much Sleep Do We Need? Most adults need 7 ½ -8 hours to function well. About 10% require more or less sleep. Pregnant women need more sleep.

40 Scope of the Problem An estimated 50% of Americans are sleep deprived. 30% average less than 6 hours per night. 7 out of 10 have trouble sleeping. 1/3 of Americans have symptoms of insomnia. 40 million suffer from some long term disorder. 20 million experience occasional problems.

41 Contributors to Sleep Deprivation Not going to bed! Inadequate time in bed Must be productive mentality Attitude that sleeping is not necessary Poor Sleep Hygiene Using electronics in bed About 95% of people use some type of electronics in the hour before bed. Young adults (19 to 29 year olds) are more than eight times as likely as baby boomers to text in the hour before bedtime--52% of them texted compared to 5% of boomers. People who text before bed were less likely to get a good night's sleep, more likely to wake up tired, to be characterized as sleepy, and more likely to drive while feeling drowsy.

Animals just don't have the same sleep and wake cycles that we do.

42 Contributors to Sleep Deprivation Poor Sleep Hygiene (Cont d) Pets in Bed According to a survey by the Mayo Clinic Sleep Disorders Center, 53% of people who sleep with pets say that their animals disturb their sleep. Animals just don't have the same sleep and wake cycles that we do. Alcohol or caffeine/stimulants before bed Alcohol acts as a sedative at first, but then a few hours later when blood alcohol level drops, it will wake you up again. Sleep Disorders Sleep Apnea Insomnia Restless Legs Syndrome

Impact of Poor Sleep The cumulative effects of sleep loss and sleep disorder represent an under recognized public health problem.

errors, and many of these may be the result of insufficient sleep. Insomnia costs the average American worker 11.

National Sleep Foundation survey has revealed that 60 percent of adult drivers about 168 million people say they have driven a vehicle while feeling

43 Impact of Poor Sleep The cumulative effects of sleep loss and sleep disorder represent an under recognized public health problem. According to the Institutes of Medicine, over one million injuries and between 50,000 and 100,000 deaths each year result from preventable medical errors, and many of these may be the result of insufficient sleep. Insomnia costs the average American worker 11.3 days, or $2,280 in lost productivity each year. That adds up to $63.2 billion for the whole country. National Sleep Foundation survey has revealed that 60 percent of adult drivers about 168 million people say they have driven a vehicle while feeling drowsy in the past year More than one-third of adult drivers (103 million people) have actually fallen asleep at the wheel. National Highway Traffic Safety Administration estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year.

Decreased ability in controlling emotions and behavior.

44 Effects of Sleep Debt Poor grades and school performance in children. Increased anger, fear and sadness. Decreased ability in controlling emotions and behavior. Decreased ability to focus, sit still, and complete work. Increased use of stimulantsespecially caffeine and nicotine.

46 Sleep & Memory Sleep itself has a role in the consolidation of memory, which is essential for learning new information. Although the exact mechanisms are not known, researchers think that specific characteristics of brainwaves during different stages of sleep are associated with the formation of particular types of memory.

47 Declarative Memory Non-Declarative Memory

48 Sleep & Memory REM sleep plays an essential role in the consolidation and acquisition of learned material. In one research study, individuals engaged in an intensive language course, were observed to have an increase in REM sleep. Further studies have suggested that REM sleep seems to be involved in declarative memory processes if the information is complex and emotionally charged, but probably not if the information is simple and emotionally neutral. REM sleep seems to plays a critical role in the consolidation of procedural memory.

49 Impact of Sleep Deprivation on Learning and Performance Focus, attention, and vigilance decrease, making it more difficult to receive information. Decrease in brain function causing loss of ability to access previously learned information. Loss of ability to make sound decisions and inability to accurately assess the situation, plan accordingly, and choose the correct behavior. Judgment becomes impaired. Sleep deprivation can also negatively impact mood which affects our ability to acquire new information and subsequently to remember that information.

50 Sleep & Memory Although current research suggests that sleep is essential for proper memory function, there are many unanswered questions. For example, certain medications will significantly, if not entirely, suppress REM sleep. However, patients taking these medications do not report any memory impairment. Similarly, injuries or disease causing lesions to the brainstem (and subsequently eliminating a person s REM sleep) have not resulted in any obvious loss of the ability to form new memories.

51 Sleep & Memory Not all researchers are convinced that sleep plays as prominent a role in memory consolidation as others believe. In experiments in which animals completed a course through a complicated maze, the animals' amount of REM sleep increased after performing the task. Some researchers believe that the increase in REM sleep reflects an increased demand on the brain processes that are involved in learning a new task. Other researchers, however, have suggested that any changes in the amount of REM sleep are due to the stress of the task itself, rather than a functional relationship to learning.

53 Sleep & Mood Chronic insomnia may increase the risk of developing a mood disorder, such as anxiety or depression. Insomnia is a reliable predictor of depression and many other psychiatric disorders, including all types of anxiety disorders. Studies have found that 15 to 20 percent of people diagnosed with insomnia will develop major depression. In one major study of 10,000 adults, people with insomnia were five times more likely to develop depression. Lack of sleep can be an even greater risk factor for anxiety. People with insomnia can be 20 times more likely to develop panic disorder. University of Pennsylvania researchers found that subjects who were limited to only 4.5 hours of sleep a night for one week reported feeling more stressed, angry, sad, and mentally exhausted. When the subjects resumed normal sleep, they reported a dramatic improvement in mood.

54 Sleep & Mood Mood and mental states can also affect sleep. Difficulty sleeping is sometimes the first symptom of depression. Anxiety increases agitation and arousal, which can make it hard to sleep. Stress also affects sleep by making the body aroused, awake, and alert. People who are under constant stress or who have abnormally exaggerated responses to stress tend to have sleep initiation and maintenance problems.

56 Stress Response When you experience a perceived threat (physical or psychological, real or imagined), your body s stress response is triggered.

57 Sleep & Stress When this stress response does not get resolved through relaxation, you may end up with a situation of chronic stress. Body remains in a continually stressed state, often without you even realizing it. This can make sleep difficult to come by, and less restful when it finally does come. You may wake up in the night between sleep cycles, because your stress response is triggered by fleeting thoughts and you are unable to get back to sleep quickly.

58 Stress Management Sleep Strategies Meditation can relax the body, turn off the stress response, and bring sleep more easily. Simple breathing exercise can reduce stress and tension in the body, lower stress hormone levels, and help sleep come more easily. Progressive Relaxation Technique involves learning to monitor tension in each specific muscle group in the body by deliberately inducing tension in each group. This tension is then released, with attention paid to the contrast between tension and relaxation. Paring down a busy schedule can also not only relieve stress (which can lower stress hormones), but can free up more time for sleep.

Sleep Hygiene Establish a relaxing routine.

59 Sleep Hygiene Establish a relaxing routine. Warm bath/shower Quiet activities Lower lights Maintain a regular sleep schedule. Go to bed and get up around the same time. Limit or avoid naps. Limit stimulating behaviors before bedtime. Limit caffeine after 2 pm Limit alcohol after dinner. Limit large or spicy meals. Limit vigorous exercise 4-6 hours before bed.

60 Sleep Hygiene De-stress, learn relaxation techniques. Physical and mental Maintain a regular physical activity routine. Physical activity helps with stress. Fitness reportedly helps with sleep quality. Do not go to bed hungry or full. Light snack of carbs and foods with tryptophan Practice stimulus control.

61 Stimulus Control Therapy Do not go to bed until you are tired and only when you feel ready to sleep. Use the bed only for having sex and sleeping, not working, reading, watching TV, eating, or other mentally stimulating activities. After going to bed, do not stay in bed if you remain awake for more than 20 minutes If you are unable to sleep after minutes in bed, get out of bed and leave the bedroom. You may consider some relaxing techniques or activities such as reading, listening to soothing music, etc. in another room. Get up at the same time every morning. Try to keep your weekend schedule as close to your weekday schedule as much as possible.

Let s Sleep On It. Session Overview. Let s Sleep On It. Welcome and Introductions Presenter: Rita Piper, VP of Wellness

Let s Sleep On It. Session Overview. Let s Sleep On It. Welcome and Introductions Presenter: Rita Piper, VP of Wellness Let s Sleep On It Let s Sleep On It Welcome and Introductions Presenter: Rita Piper, VP of Wellness Session Overview Why Sleep is so Important Types of Sleep Common Sleep Disruptors Sleep Disorders Tips