Alzheimer's disease, sleep and brain health

S1: It's time for Midday Edition on Kpbs. Today , we are talking about your brain and what you need to know to keep it healthy. I'm Jade Hindman. Here's to conversations that keep you informed , inspired , and make you think. There are many causes of dementia.

S2: Your old timers is one of the causes , and it's the most common cause , unfortunately , of dementia.

S1: We'll talk about the causes , prevention and the most promising treatments for Alzheimer's disease. Plus , find out what the latest research says about the impact sleep has on our brain health. That's ahead on Midday Edition. June is Alzheimer's and Brain Awareness Month , a time to raise awareness of dementia and bring attention to treatment options for a disease that affects more than 55 million people. Here to talk more about the disease and the best defenses we have to fight , it is Dr. Dale Bredesen. He's a neuroscience researcher and Alzheimer's expert , as well as author of the book The End of Alzheimer's. Dr. Bredesen , welcome to Midday Edition. It's good to have you.

S2: Great to be here , Jay. Thank you.

S1: Often we hear the terms Alzheimer's disease and dementia used interchangeably , but there is a difference between the two.

S2: So dementia is global cognitive decline. So it is when you're typically losing memory activities of daily living. ET cetera. And it is a very late stage. So you really you start with a pre-symptomatic stage where you don't know that this underlying degeneration is occurring. Then you go to a second phase , which is called subjective cognitive impairment. When you know that there's something wrong and your spouse may know , but you're still scoring normally on cognitive tests if you're to be tested. The third phase is called mild cognitive impairment , and by definition , then you've lost the ability to score normally on these various cognitive tests. And the final stage , the fourth stage is called dementia. That's where you're actually losing your activities of daily living. You may have trouble driving , you may have trouble caring for yourself. You may have trouble paying the bills and doing your everyday activities. So that's dementia. Now , there are many causes of dementia , but the most common cause is Alzheimer's disease. So Alzheimer's disease is actually described pathologically. You look in the brain , you see plaques and tangles and you say , Ah , that's Alzheimer's disease. So yes , you're right that Alzheimer's is one of the causes and it's the most common cause , unfortunately , of dementia.

S1:

S2: That's been a real problem in this illness. People tend to wait because they've been told over the years there's nothing that can be done for it. There's nothing will prevent it or delay it or reverse it. And we've seen time and time again that's that's no longer the case. So the early things that you can look for are things that often are confused with just normal aging. And again , that's been another issue. People keep thinking , well , as normal aging when they're actually in the earliest stages. So it may be that you forget where you parked your car. It may be in memory is a very common problem. New things. You know , you forgot what you did earlier in the day. You forgot what you were going to do later in the day. You know , you lost your keys. And people will often say , well , that's just normal aging , but unfortunately , that's just putting off the problem. So you want to find out what's going on and you want to find out if there's something you can do about it. And then there are people who have the non amnestic , in other words , non memory related early symptoms. And those tend to be things that you may get lost driving your car. You may have trouble searching for a word , you may have trouble recognizing faces. That's a relatively common one. You may have trouble with so-called executive function. So planning , these are people that actually tend to lose their jobs because they no longer plan and execute the way they did. And , you know , unfortunately , we're seeing this earlier and earlier. And there was an important epidemiological study about a year and a half ago showing that Alzheimer's is showing up in younger and younger people. There is a big increase in people in their 40s and 50s. So , again , for people who are having changes , please get evaluated. And for those who are 40 or over , please get on active prevention. You know , we all know that you should get a colonoscopy when we turn 50. I think everyone's pretty much aware of that. And if you are 40 or over , please get a Cognos copy. It's a fairly simple combination of things where you can get some critical blood tests that most doctors are not doing. Unfortunately , you want to get a Cognos copy and find out. Do your blood tests suggest that you're at risk for Alzheimer's and you want to get a simple online cognitive test. And then if you're already having symptoms , you want to include an MRI. But if you're not symptomatic , you don't need to include that.

S1:

S2: So you can talk to your physician , you can go to a neurologist and you can or you can literally go online and just go my Cognos copy and you can actually get it that way. So there are many ways to do this , but you want to talk to someone who is experienced with prevention and early treatment of cognitive change before it gets to the. Stage.

S1: And , you know , some doctors are trained in that and some aren't.

S2: And the reality is , yes , with all the things that we are all exposed to , in fact , many of us do have changes. And certainly with Covid 19 , how often do we hear about brain fog ? This is something that comes up all the time. And unfortunately , these are early symptoms that can ultimately lead down the road to more serious demented illness. So it's I think it's a good idea to get in early and ask the ask your physician whether he or she is experienced in this area and has done these sorts of evaluations.

S1:

S2: It is a complex chronic illness. In other words , you have a whole set of things that are critical for making your brain run normally to make and keep the synapses , the connections in your brain , and therefore , that you could say , well , one thing. Well , that maybe the most common thing would be to become insulin sensitive. But that's really just one thing. We think in terms in this way their Alzheimer's is driven by two major things. One of them is energetics to the brain. So getting enough oxygenation , getting enough blood flow , getting enough mitochondrial function , getting enough ketones , all these things that are critical for the energy that your brain needs to make and store new memories. And the second piece is inflammation. It's the activation of the older part of your immune system , the so called innate immune system , and especially the memory component of that which lives in several places in your body. It lives in your bone marrow. It lives in your these so-called tissue macrophages , things that in your brain are the microglia that we hear about so often in Alzheimer's. And it also lives in your endothelial cells , the cells that make your the internal part of your blood vessels. And so these are the two big things , the energetics and the inflammation that we hear so much about with Alzheimer's disease. So when you develop this problem , when you are developing dementia , you have typically too much inflammation and too little energy to support what your brain is trying to do. Therefore , there are actually seven basic things that we can all do. These are diet , exercise , sleep , stress , brain training , detoxification and some basic supplementation. Those are the basic seven. And interestingly , each of these has important components. So for example , the type of diet that actually works best in terms of prevention and treatment is a plant rich , mildly ketogenic diet with appropriate periods of fasting. And this is actually quite helpful. It improves your ability to detoxify , it improves your gut microbiome , it improves your glycemic status , it improves your lipid status. So it helps in many , many different ways.

S1: So that's one.

S2: And that's that's the critical thing. We call this Keto Flex 12 three because it is a plant rich , mildly ketogenic diet. And then interestingly , in the exercise , this is really important for in part for making ketones. It improves that it's important to make you insulin sensitive. So it helps there. But it's also important to get your blood flowing and get the oxygenation to all areas of your brain. And so a common thing that people use is called use , which is exercise. With oxygen therapy , you can literally hop on a bike and be exercising while you're getting oxygen. And this actually helps to perfusion and get oxygen to the far reaches of your brain. And by the way , it's another reason that it's important to know if you have sleep apnea , if you're dropping your oxygenation at night , that is not a good thing for your brain and it does increase your risk for cognitive decline. Fourth one then is stress. Stress is very bad for your cognition and actually leads to shrinkage. Of your brain that's been well documented. So managing that each of course , for so many of us , there's no problem with the stress coming on and then resolving. So stress with resolution is what we are evolutionarily designed to handle , but it's that chronic stress that is bad for you. And then the fifth one is brain training. Of course , Professor Mike Myers won the prize several years ago and he is the father of brain training and has shown over the years that appropriate brain training with things like brain HQ very , very good for inhibiting cognitive decline , reducing your risk. And then the sixth thing is detoxification. So many of us are exposed and of course work on air pollution over the years has shown an increased risk for cognitive decline in people who are exposed to air pollution. There are also ties to mercury , organic pollutants as well as bio toxins. Things , for example , that are made by mold. So all of these things are toxins were exposed to. Of course , some of it is through the food we eat and things like that. The air we breathe , the water we drink , all of these can be a concern. And so detoxification is very helpful for reducing risk. And then finally , some targeted supplements. You know , many people are low on their vitamin D , The low vitamin D has been associated repeatedly with increased risk for cognitive decline. Vitamin B12 , if that is low , it is also associated with increased risk. So again , these are easy things to check and easy things to address , but there are also things related to the inflammation itself. And I'm sure you've heard things like omega threes repeatedly showing up as reducing risk. And recently a nice article published on Extra Virgin Olive Oil , which actually got some very nice results , actually did better than the drugs that remove the amyloid in terms of actually improving people. So that was very exciting. So I think we're seeing again and again that there are many things to do. It used to be said that there was nothing you could do to prevent , reverse or delay cognitive decline. Now it's turning out that the armamentarium we have is quite large , but it suggests that everyone should get evaluated early on.

S1:

S2: In general , Vitamin D three has been studied more and is thought to be more associated with brain health.

S1: Have you found what you've heard on today's show about brain health helpful ? And what would you like to know more about when it comes to brain health ? Give us a call. (619) 452-0228. Leave a message or you can email us at midday at pbs.org. Coming up , the conversation continues with the treatment advances for Alzheimer's disease.

S2: You know , you're going to see a lot of changes in this next decade and therefore , people are going to be able to prevent and reverse cognitive decline.

S1: You're listening to Kpbs Midday Edition. You're listening to Kpbs Midday Edition. I'm Jade Hyndman. We're talking about Alzheimer's disease , what we know about it and what we can do to help prevent and treat it. I'm speaking with Dr. Dale Bredesen. He is an Alzheimer's disease researcher and expert. You know , we talked a lot about prevention , but what is the state of treatment for the disease ? Has it improved in recent years ? Absolutely.

S2: So we reported the first the first reversals of cognitive decline in patients with Alzheimer's or these pre dementia conditions back in 2014. So we're coming up on ten years. And actually , some of the patients started as early as 2012 and are still doing very well. So not everyone gets reversal of cognitive decline , but we've seen it repeatedly and we published a trial last year , so it's freely available online. Anyone can look at it in which 84% of the people actually improved their cognitive scores as opposed to just slowing their decline. So we're very enthusiastic about that. And we're just starting a new randomized controlled trial at six sites around the country. It's in Hollywood , Florida , Nashville , Tennessee , Cleveland , Ohio , Sacramento , here in California , the Oakland and San Francisco. And so that will be going on for the next about a year and a half or so. So we're very enthusiastic about that. And yes , the as you can imagine , the earlier you start , the easier it is and the more complete it is. What we do is identify for each person what are the drivers. It's different for each person. You know , we've been told , well , this is about misfolded proteins or it's about amyloid , but the reality is those are responses. Ultimately , this is , as I mentioned earlier , this is related to energetics and inflammation. Those are the two big players. And for different people , that's going to be caused by different things. Some people are inflamed because they they're eating horrible food or they have a leaky gut or they've been infected with a Lyme disease or they have poor oral microbiome or they have chronic sinusitis , you just go right down the list. There are many different things that can increase your inflammation and many different things that can reduce your energetics. It may be that you have sleep apnea. It may be that you have some vascular disease. It may be that your you know , again , that you're eating a horrible diet. So all of these things can play into this. So for each person , then we evaluate all the different contributors and some people will have 15 or 20 different contributors. And then you address those things. That is what has gotten the best outcomes so far. And again , I would encourage people to read the freely available paper online , which which came out from our trial. This is in the Journal of Alzheimer's Disease.

S1: When it comes to brain training , you see a lot of games apps promising to improve your brain health.

S2: So so here's why it's not a simple yes or no there. So for some of them and I mentioned Brain HQ simply because that's the one that's had the most publications , there have actually been scientific studies that were published. One of the programs , for example , is called Double Decision. Another one's called Hawkeye. Those are ones within Brain HQ that have been shown to decrease risk. Of course , when these came out , everyone said , Oh , you just have to make a brain game. Well , there's no evidence , though. So that may and may help. May not help. We just don't know. Professor Resnick , who originated this , showed that there were certain characteristics such as increasing the processing speed that are desirable for getting the best outcomes. So for a lot of these , we don't know. And as you probably know , it has been somewhat controversial. There have been claims that it really doesn't do what is claimed to do. There have been other studies published where you do get some impact. The argument would be that in general , just doing that alone may be a little bit helpful , but doing it on the backbone of the other six things is likely to be more helpful getting the right diet and exercise and so forth and so on is likely to give you the best chance.

S1: Are certain groups of people more likely to be afflicted by this illness , Alzheimer's , more than others ? Absolutely.

S2: And this is why it's actually important to check your get get checked out. Here's the thing. Three quarters of the population has no copy of a single of a specific gene called ApoE4. So in other words , they have about three or about two. These are the other common ones. And their total , their lifetime risk. It's not zero , but it's about 9%. It's not terribly high for getting old timers. If you have a single copy of ApoE4 , and that's 75 million Americans , most of whom don't know it , unfortunately , your risk is now up to 30% If you've got two copies and that's about 7 million Americans , again , most of whom haven't checked and don't know it , then you are your risk is up above 50% , up around 70 or so percent , depending on other genes. And so , unfortunately , you know , you may you're likely to get you most likely will get Alzheimer's during your lifetime. Now it's. Been said in the past. Don't bother to check your status , which you can do on 23 and me or your physician can check it or lots of the Cognos copy includes it. Lots of ways to do this , but people have been encouraged not to do it because they're told there's nothing that can be done. And I think this is really done a disservice to people. There is a tremendous amount that can be done. And in fact , all the various prevention things that we've talked about are very helpful. There's a wonderful website , in fact , set up by a woman who is about 44 and who was developing cognitive decline in her late 40s and who's now ten years in and doing absolutely beautifully. Her cognitive scores went from 35th percentile to the 98th percentile. So I encourage you , if you find out that you're ApoE4 positive , don't worry , simply get on prevention and you can look on It's called apoe4.info and check out that wonderful. It's a nonprofit website trying to help people who are ApoE4 positive and most of them are on various forms of the protocol we develop for prevention and doing very , very well.

S1: And so this test , it's something that you can ask your primary care physician for. I mean , do they know that this is something that they should probably be testing for on a regular basis ? Absolutely.

S2: And you only need to get tested once during your lifetime because it's your genetics. So the gene isn't going to change. So you only need to get checked out one time. Now , the copy you may want to repeat in five years to see if things have changed because that looks at your biochemistry. But as far as your genetics , once you know what your status is , that's it for your life.

S1: That's that's really interesting. You know , like I feel like and tell me if I'm wrong on this , that , you know , doctors in general really aren't testing for these things. They're really not considering a lot of brain health issues and preventative measures to make sure that one's brain stays healthy.

S2: You know , it's such a good point. If you go back to the 1940s and 1950s , people weren't checking your cholesterol and they certainly weren't checking your LDL particle number and things like that. But over the years , this has become accepted with more and more epidemiological studies showing how important these things are in vascular disease. The same thing is happening now in brain disease , where , as you say , doctors aren't checking your status and they should be. They're not checking some of these things. Some of them now , some of them are checking your vitamin D , to be fair. But some of these things , they may not check your homocysteine or they may not check your CRP , which is an inflammatory marker , or they may not check your TGF beta one , which is a different inflammatory marker. Things like that are now coming into more and more common use as people realize , Oh , these are important things to check so that we can actually prevent and reverse cognitive decline. So I think you're you're going to see a lot of changes in this next decade. And therefore , people are going to be able to prevent and reverse cognitive decline like never before. And we're seeing it every day now with people getting better. So we're going to be able to get better and better looks and not have to do so many very expensive Pet scans and things like that get better and better looks at the underlying biochemistry for what will ultimately potentially cause dementia. And more and more people will be able to avoid dementia. The reality is dementia should be a rare problem. It's an incredibly common problem right now. It dwarfs the pandemic. So we've had over a million Americans who've died from Covid 19. About 45 million of the currently living Americans will die of Alzheimer's disease If we don't get people on active prevention and early treatment. Let's avoid all that we can really working together , we can really reduce the global burden of dementia.

S1: Dr. Bredesen , you have just really imparted a lot of invaluable knowledge with us , and I am so appreciative of that.

S2: Thank you so much for having me , Jade And I really hope to see a reduction in the number of people with dementia in the coming years.

S1: I have been speaking with Dr. Dale Bredesen , author and neurodegenerative disease expert. Dr. Bredesen , again , thank you very much.

S2: Thank you , Jade.

S1: Still ahead , the conversation continues with how our brains are impacted by sleep and the lack thereof.

S3: One of the worst things about insomnia is the anxiety about having more insomnia.

S1: Kpbs Midday Edition is back after the break. Welcome back. You are listening to Kpbs Midday Edition. I'm Jade Hindman. We just heard about some of the things to look out for when it comes to Alzheimer's disease and ways we can prevent its onset. One subject that came up was sleep and how it may have a connection to our brain health , with some studies finding potential connections between poor sleep and dementia. We wanted to talk more about sleep and its connection to both our brain health and overall well-being. I'm joined now by Dr. Steve Posada. He's a neurologist and medical director of the Scripps Clinic Viterbi Family Sleep Center in La Jolla. Dr. Posada , welcome.

S3: Thank you. It's nice to be here.

S1: Glad to have you. So we've been talking about Alzheimer's disease and ways it can be prevented and treated. Getting adequate sleep came up as a preventative measure.

S3: Of course , in late or bad Alzheimer's , almost all patients have sleep disturbance. But in terms of sleep contributing to Alzheimer's , there's a number of studies that show a relationship. That is to say , people who complain of sleep disturbance are more likely to develop Alzheimer's. But there is absolutely no definite cause and effect relationship between the sleep disturbance and the future development of Alzheimer's. It's a statistical awareness , but so far we're not aware of a definite cause and effect.

S1: And recent research found that spinal fluid is flushed during sleep.

S3: What you could say in mice. Starting about ten years ago , it became clear in a series of studies that cerebrospinal fluid will flow through the brain tissues and has sort of a clearing or flushing effect , taking out metabolic byproducts and taking out some of the markers of Alzheimer's , such as beta amyloid and tau protein. So there is a flushing effect that happens in sleep. Certainly it's been demonstrated in animals. Only recently has it been demonstrated that the same type of sleep related brain clearance occurs in humans and we're beginning to be able to study the effect of sleep on this clearance and even the effect of medications on the brain clearance.

S1: And we're going to get into that more , too.

S3: The complaint of sleep disturbance by people is a vague complaint , or shall we say , a non-specific complaint. It could be stress , it could be restless legs , it could be a shift working. So just the complaint itself of sleep disturbance , while it is connected with Alzheimer's disease , statistically sleep apnea is a special case because sleep apnea , one , it has a very good treatment. But two patients with sleep apnea have been shown to have higher biomarkers or blood and spinal fluid indicators of the possible development of Alzheimer's. So I think of all the questions about what sleep might do to affect Alzheimer's , sleep apnea is one of the more clear ones that we should investigate.

S1: How would you define poor sleep or does that differ from person to person ? Yes.

S3: And that's one of the problems with really trying to say there is a connection between sleep and Alzheimer's , because mainly the studies have been surveys in large databases where people simply are asked , do you have a sleep disturbance ? Yes or no , Mild , moderate or severe. So it's rather nonspecific , as I said. I think that people can think of it as either insomnia , meaning I don't sleep enough , I'm awake when I want to sleep or I'm unrestored by my sleep or sleep apnea , really in in our clinical day to day practice. And for most people , sleep disturbance can kind of mean either insomnia , which I think people know what that means , or sleep apnea , at least those are the two most important categories , the most numerous two categories of any kind of sleep problem.

S1:

S3: And as we age , that sleep becomes more broken up with aches , pains , using the bathroom. ET cetera. But 7 to 9 is very broad average. If people are really only sleeping 4 or 5 hours , they probably have a problem , a condition that should be investigated. It's quite rare for somebody to function normally , although some people do , on only 5 or 6 hours of sleep. So 7 to 9 hours is the usual answer.

S1: You know , one common way people try to get more sleep is by taking sleeping Aids , myself included. But you say that is not a good option when thinking about preventing Alzheimer's disease.

S3: They worsen memory. And there's pretty similar data to sleep problem that they contribute or are associated with Alzheimer's disease. So it's not as simple as , well , I'm not sleeping enough , so I'll take a sleeping pill. Unfortunately , it's not that simple. Hmm.

S1: Hmm.

S3: Generally speaking , those would be preferable as sleeping Aids.

S1: All right. And on that , when should someone actually consider taking sleeping pills to improve their sleep ? Are certain kinds better than others ? I guess the couple that we just mentioned.

S3: We just talked about the you could say the Ambien type and then the non habit forming type that you mentioned , trazodone and amitriptyline. But the standard treatment now for insomnia is a program that we termed cognitive behavioral therapy for insomnia or CBT. This is a series of specific instructions tailored to the person regarding such things as When should you wake up ? When should you get bright light ? When should you try to go to bed ? What should you do if you cannot sleep ? And it's a gradually it's a long term program that has been pretty much proven to improve the depth and the duration of sleep. And it's greatly preferable to sleeping pills when that fails. There are absolutely people who need pharmacologic , sleeping aids. And then then you have a decision to make which kind to give the person.

S1:

S3: There are a couple that got approved for relatively long term use , but it's the type of thing that needs to be evaluated every year or two. Do you need to take them ? Do you need to keep on them ? Really , what's best is to use , if you have to use a sleeping pill is to use it intermittently. And there we would be saying recommending 1 or 2 nights per week or maybe only for a week during a stressful week and then not be on it. Really , the worst thing is to be on one of the traditional sleeping pills every night for decades. That clearly is bad for people's cognitive abilities over time.

S1: You're listening to Kpbs Midday Edition. I'm Jade Hindman. We've been talking about brain health and sleep. My guest is Dr. Stephen Posada. He's a neurologist and medical director of the Scripps Clinic Family Sleep Center in La Jolla. Sleep and sleeping problems are an issue for a lot of people , and we received some questions from our newsroom and wanted to share a couple of them with you.

S4: A sleep , not a real thing.

S1: So what can you tell us about sleep debt ? Does losing sleep on an ongoing basis have a cumulative effect ? Yes.

S3: Sleep debt is the amount of sleep that you're not getting. So maybe you need eight hours like a lot of people , but you only sleep six because of work or other duties. You accumulate a sleep debt and that can be measured by daytime performance and daytime sleepiness. And so it doesn't really accumulate like a credit card debt might gradually continue to accumulate. It plateaus , but it plateaus with the person functioning a little bit worse than they would be. And we know we can take , for example , the studies that take college students that are sleep deprived. And if you then say , well , now you're going to sleep seven , 8 or 9 hours per night , you can show improvements in their cognitive functioning. So there is such a thing as a sleep debt , but it sort of plateaus and it can be reversed with a few good nights of sleep.

S1:

S3: A sleep debt , even severe sleep debt from a total two night , say , of sleep deprivation because you were working. As a fireman or something like that. That amount of sleep debt is reversed in 2 or 3 nights of normal amount of sleep.

S1: All right.

S3: And it kind of feeds on itself in a negative cycle. So yes , resting , relaxing , meditating is absolutely better than pacing around and worrying that you're not sleeping.

S1: And of course , we know that the lack of sleep can really impact the brain. But for myself , for example , I used to work an overnight shift at a new station and had a heart attack because I just could not get enough sleep in. Going to sleep at 4:00 in the afternoon just did not work for me. So for weeks and weeks and weeks and weeks and weeks on end , I may have gotten an hour of sleep each night , possibly. But talk a bit about how a lack of sleep could really impact your overall wellbeing. Yes.

S3: Yes. Well , total sleep deprivation , we know in animal studies makes the animals sick. They gain weight , they lose their hair. All kinds of terrible things happen when you totally sleep. Deprive an animal for days and days. Now , one humans can't do that. We end up crashing after a couple of nights. But to your point about your own experience , shift work is a very difficult thing for many people to tolerate. It seems that some people do tolerate it well , but shift work is associated with multiple medical problems ranging from cancer , ulcer , high blood pressure and heart attack. And what exactly it is about the shift work that causes that is a little bit unclear. One is that , like you said , you're working when your body wants to sleep and then in the day you want to sleep , but your body is not able to sleep because of the circadian rhythm. So that's one aspect of just the lack of total number of hours of sleep per day. But there may be more than that in regards to the circadian rhythm aspect. But shift work for many people is very difficult and even people who are successful , shift workers , as I said , have more risk of those medical diseases I mentioned.

S1: And we've got another question from the Newsroom. Take a listen.

S5:

S3: But if you are , let's say , depressed and not taking care of yourself and you therefore don't get out of bed , your sleep might spread out and become more hours of the day. And so you could say that's too much sleep , but that's a person who's depressed or a person who's very ill in bed bound. They will sleep more. Some people with Alzheimer's sleep more. And sometimes that's a little bit of a blessing , even in fact. But generally speaking , in a in a healthy person , there cannot be too much sleep because your body wakes up.

S1: By nature , our bodies don't don't really get too much sleep.

S3: Sleep is so interesting that way because it sort of self regulates if you're if you're hungry or starving. Our bodies sleep less and it allows us to move around. If you're satiated and full and relaxing , maybe that you will sleep more. So sleep is really very adaptable to the environment , but there's not too much sleep. It's kind of , as I said , impossible in a normal , healthy person. But there can be too much time in bed. Somebody probably should not be sleeping and probably nobody should be lying in bed 11 hours a night hoping to get 11 hours of sleep. It's just highly unlikely. So there can be too much time in bed or when you're sleep deprived like your newsroom people , they're sleep deprived Monday through Friday. Then on Saturday morning , they let themselves sleep ten hours or so until noon. They might feel worse that day. That's part of the sleep catch up or the catch , as they say , catching up on sleep or removing the sleep debt. You might feel kind of bad because you , quote , slept too long. You really only slept too long because you were sleep deprived. Hmm.

S1: Hmm. Interesting. All right. We've got another question from the Newsroom. Take a listen.

S6:

S3: So I'm a very much a morning person. And so when 8 or 9:00 comes around , no matter what I'm doing , I find myself falling asleep. So for that kind of person , being on the cell phone doesn't really matter. But. More young people in our society. There's a lot of people that the electronics contribute to them staying up later than they should , and then they have to get up earlier for their jobs so they end up sleep deprived. The general rule is you should take about an hour off of your electronics , off of your stress and try to do something relaxing and wind down before sleep. So one hour.

S1: And on technology , we see a lot of devices and apps that claim to track your sleep as well as other health data in general.

S3: They do a good job of estimating the wake and sleep time and a pretty good job of telling REM sleep , light sleep and deep sleep. And they can be a value in some people if they want to really kind of see what their pattern is. But where the wearables are really good are in normal , healthy people. So the wearables are very informative and they're probably accurate , but sometimes we find that they promote more sleep anxiety than sleep help.

S1:

S3: And so we do sometimes see people come into the sleep center that are worried about what their wearable device is showing them about their sleep. They may feel they sleep pretty good , but the device says only these many hours. And so they can be a two edged sword , but the data from them is often accurate and it can be informative for the right person.

S1: Mm And this question might be in the weeds a little bit , but you mentioned REM sleep and I know there's like there's three stages of sleep. Can you break that down for us and tell , tell me how many hours of each stage of sleep one needs to be getting.

S3: Well , the stages of sleep are like you said , stage one , two and three that are non REM. And then there's stage REM. And it's a little bit difficult to answer your question because the percentages of these stages vary greatly by age. They very , very strongly across the childhood spectrum , adolescence and then beginning around age 40 and continuing into the 80s and 90s , the sleep stages change. But in general , most middle aged adults are going to have 1 to 2 hours of the deepest stage of sleep , stage three , and that'll be in the first half of the night. And then they're going to have about 20 to 25% of REM sleep , which comes in cycles , mainly in the last part of the night. And then in very old age or in cases of sickness , most of our sleep is stage one and two , maybe with some REM. But as I said , most people have these 3 or 4 sleep cycles. Young people have much deeper sleep. That's important for hormonal changes and for growth , bone growth , for example. But most of those functions go away by by middle life. Hmm.

S1: Hmm. And you mentioned how much it varies from age. What about for toddlers ? I've got a toddler who just doesn't like bedtime. How much do do little children ? The little people in our lives need to be sleeping.

S3: Well , I think our recommendation there is in the ten hour range for teenagers , but down at toddler range , it can be as much as 12 hours per night. The biggest thing about sleep that's interesting to me. Well , one of the big things is that on the one hand , it is natural if we stay up late , if we stay up a lot , we get sleepy and our eyes closed and we go to sleep. But falling asleep is also a learned behavior. You remember you had your baby and you swaddled him or her and you said lullaby and a thumb and quiet and dark. That teaches us this is the environment where I let sleep happen to me. So for toddlers , a lot of it is about the learning aspect of it. You know , being alone , getting into the room more than just how much sleep do they need.

S1: Thank you for that advice. You know , so we've covered a lot of ground here when it comes to sleep.

S3: But if you're concerned about some kind of sleep problem , not getting enough sleep , not being refreshed by your sleep , often it's best to talk first with your primary care physician or primary care provider. That person will be able to ask. You the right questions , maybe do some kind of home test first , for example , to evaluate for sleep apnea , which is so important. And sometimes people end up at a sleep center for more complicated therapies or sleeping pills for the gram I mentioned earlier called cognitive behavioral therapy. But it starts by asking your doctor for advice on your perceived sleep problem.

S1: Dr. Steve Posada is a neurologist and medical director of the Scripps Clinic Vertebrae Family Sleep Center. Dr. Posada , thank you so much.

S3: You're welcome. Jade , Thank you.

S1: Did you find what you heard on today's show about brain health helpful and what would you like to know more about when it comes to brain health ? Give us a call at (619) 452-0228. Leave a message or you can email us at midday at pbs.org. You may hear your thoughts on the radio. I'm Jade Hindman. Thanks for listening.