We returned last night from a trip to Seattle where we saw our new granddaughter in person for the first time and saw another son's new (to them) house. I also went through almost four hours of intense cognitive tests to update us on what's been going on in my brain. To cut through the anticipation, let me say that I feel well about the results. When they deliver the results (perhaps in 2 weeks) I expect to see actual improvement over last year. The young man who administered the test was looking at last year's results as he administered the tests. He couldn't say much, but he seemed very positive about how I was doing as we went along.
Before we went over to Seattle, I wrote to both my neurologist and neuropsychologist that I was not optimistic about how I would do. I've mentioned before that I have several informal tests that I apply to track changes in my cognition, and they hadn't been pointing in the right direction recently. I track sometime innocuous seeming absent mindedness and how well I can speak Spanish (which I do several times a week).
But the big variable is sleep. As we discussed in Beating the Dementia Monster, the first thing about sleep is that failure to spend time in deep sleep can apparently cause or exacerbate Alzheimer's disease. On top of that, memory and cognition on a given day are influenced by how well you slept the night before. This is why Matthew Walker cites studies showing that students who pulled all-nighters did poorly on their exams.
Last year, I was struggling with terrible insomnia. I had four hours of sleep the night before the test, and I'd had four hours of sleep the night before that. Needless to say, all of my doctors (and I) were disappointed in my performance. Insomnia continues to plague me, but I've made progress with some medications.
Mathew Walker and most other doctors caution against resorting to drugs to solve insomnia. Certainly some of the hypnotics, like Ambien, have been shown to make you feel well in the morning, but apparently prevented you from going into that all-important deep sleep during the night. I applied the sleep hygiene techniques that have been recommended, and it wasn't helping. (I intend to investigate meditation further, but I haven't seriously looked into that yet.) My neurologist and my sleep doctor concluded that it was time to try some sleep aids.
The first was a low dose of trazadone, whose day job is as an antidepressant, but it works as a sleep aid in low doses. It's been the go-to sleep aid for the elderly, especially for those with Alzheimer's disease. Unlike "nonbenzodiazepine receptor agonists," like Ambien and Lunesta, trazadone is not a controlled substance, and I've found that it does not cause dependence. I was able to quit cold turkey with no rebound effect. In fact, I slept well when I quit, perhaps because it was training my brain to sleep at certain times.
Why did I quit trazadone? It had not been working well to keep me asleep all night, at least at the dose my sleep doctor prescribed. Also, it was seriously aggravating my balance problem. I was now shuffling along, and I had some close calls with serious falls. My sleep doctor prescribed Belsomra, which was approved by the FDA for insomnia in the elderly, notably for those with Alzheimer's disease.
Belsomra is not generic, and so it's pricey. But even a low dose seems to work OK for me. On the other hand, it also seemed to cause me memory problems, so I went off of it a few days before my cognitive tests. I did not have a problem with rebound, and it also seemed to have trained my brain on when to sleep. I believe that having been taking the Belsomra, but then getting off of it a few days before my tests, contributed to how I did -- for better or worse, because I have yet to get my results back. Stay tuned.
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