Healthy aging talk by Stanford geriatrician (lots about sleep and over-medication)

Despite the fact that this email is about a talk given at a caregiver conference, there is nothing caregiver-specific about this email.

The Avenidas Senior Center Caregiver Conference was in late October 2017. Brain Support Network volunteer Denise Dagan attended the conference and shared notes from several of the talks a few weeks ago. One highlight was the talk by Stanford geriatrician Mehrdad Ayati, MD. The title of his talk was “Caregiving for Your Immune System.” Denise says “Dr. Ayati included some exceptionally useful information everyone should know about sleep.”

Denise’s notes are copied below.



Notes by Denise Dagan, Brain Support Network Volunteer

Speaker: Mehrdad Ayati, MD, geriatrician, Stanford University
Topic: Caregiving for Your Immune System
Avenidas Senior Center Caregiver Conference
October 21, 2017

Longevity doesn’t ensure a good quality of life.

Healthy aging doesn’t mean more pills, more doctors, more tests, and more supplements.

In studies of long-lived populations, the most important factors contributing to longevity was:

– Environment (safety and security, including socioeconomic status)
– Nutrition (influenced by finances, education)
– Lifestyle (very social societies with tight family and friendship bonds tend to live longer)
– Luck
– Disuse (lack of exercise and mobility)
– Genetics (only 25% influential on longevity)
– Disease (vaccinations, exposure to air/water/food/insect born illness)

The biggest thing doctors can do to help someone age well is to get them to modify their lifestyle. Doing that involves the same advice given to all caregivers:

– Exercise
– Have good nutrition
– Stimulate your brain (learn something new every day and be social)
– Stay up to date with your own health maintenance
– Get good sleep

Physical evidence of aging at the cellular level is the length of our telomeres (the tips of our chromosomes). Telomeres shorten with each cell division. If/when telomeres become too short the cell dies.

A 2013 study looked at study participant’s genes at the beginning and end of a 3-month period of improved diet, exercise and socializing. They found an increase of telomere length in that short a period, which correlates to healthier aging and overall lower cancer risk.

Sleep is a huge factor in maintaining our health and wellness. Adults should get 6-8 hours of sleep. Normal sleep goes through four stages in 90-110 minute cycles. Sleeping pills interfere with these cycles. Restorative sleep is in stage 3, just before the REM stage (Rapid Eye Movement, which is when we dream). There is actually 20% more brain activity during REM sleep than when we are awake.

There are two proteins that influence our sleep:

Adenosine – a product of muscle use, it builds up throughout the day and as it increases in quantity you become sleepy. This is why doctors recommend exercise to improve sleep. Note: Caffeine blocks adenosine receptors in the brain, preventing adenosine’s access to the brain while caffeine is present. That is why caffeine keeps you awake.
Melatonin – part of our circadian rhythm (day/night awake/sleep cycle). It builds up as a result of sunlight exposure through the eye. That exposure can be restricted by cataracts, retinopathy, stroke, Alzheimer’s, and more, resulting in sleep disruption. Wearing sunglasses in the late afternoon also restricts sunlight exposure at a critical time of day and can disrupt sleep.

Sunlight exposure and exercise can reduce agitation and help sleep for those with dementia.

Sleep is a restorative, regenerative time. During sleep the glymphatic system clears byproducts from the brain, including adenosine. If you don’t sleep well, you wake sleepy because adenosine is still present in the brain.

During sleep the brain migrates short term memories from the hippocampus to long term memory. This process doesn’t happen when sleeping pills disrupt your sleep cycles.

Dr. Ayati shared a circadian rhythm and sleep cycle chart with us showing when melatonin begins to affect our sleep, the fluctuation of blood pressure and heart rate throughout the day and night, etc. Click on this link to see the chart:

In people from middle age to the elderly it is normal to wake early and sleep early.

Teens typically have about a 2 hour delay from adults, so they sleep later and wake later. Early morning sunlight exposure may offset that delay and bring their sleep/wake times earlier. About 10% of teens have sleep disorders later in life.

The invention of the lightbulb allowed people to stay awake past darkness, when it is normal for us to be sleeping. More recent technologies (screens) further influences our sleep/wake times leading to increased rates of diabetes and obesity. We don’t get enough sleep because we use technology after dark, and we eat late, after our circadian rhythm has reduced our digestive activity for the night.

Over-medication is also a huge problem, especially due to medication interactions. Doctors tend to prescribe according to protocol, sometimes without thinking, “Does it make sense to prescribe a preventative medication to an elderly patient?” Statins, for one, don’t make any sense to start in someone who’s already 80 or 90 years old.

The effect of medications on the elderly is largely unknown because the elderly usually don’t participate in drug trials. When a new medication is released to the market doctors don’t even have anecdotal evidence (yet) of how well it will work for an elderly person or if it will interact badly with other medications.

Drug Cascade Syndrome – One example:
A patient complains about not sleeping well. His doctor prescribes a sleeping pill. The sleeping pill causes lack of energy and motivation. The doctor prescribes an antidepressant. The antidepressant causes weight gain. The doctor prescribes a statin and blood pressure medication.
If the doctor had taken the time to investigate more and implore the patient to change his lifestyle, the patient wouldn’t now have metabolic syndrome.

Maintaining good mental health and cognition goes a long way toward healthy aging, also. Dr. Ayati recommends learning or doing something challenging to our brains. We didn’t used to think that the brain could develop new pathways. In fact, now we understand that we only lose neurons faster as we age because older people have less activity, more anxiety, more depression, and less learning than young people who are in school, launching careers, rearing children, and more physically active.

In fact, one study found that taxi drivers in London have the largest hippocampus (short term memory center) in the brain. They have to adjust their routes depending on construction, traffic, passenger demands, etc., whereas bus drivers who follow a route set at the beginning of every day, did not have large hippocampus.

So, get out there! Move as much as you can (without hurting yourself) and learn something, volunteer, be sociable, and age healthfully.