Evidence points to 1 in 10 individuals older than 65 having dementia, and approximately another 22% of older adults have some mild cognitive impairment. This statistic may be alarming, but it stresses the importance of addressing cognitive health in the geriatric population. Adequate physical activity and sleep are associated with a lower risk of cognitive decline and are two practical health approaches to addressing this issue. Cognitive decline is a public health concern for this population, and lack of physical activity and sleep disturbances are two lifestyle factors that contribute to it. The aim of this article is to provide a deep understanding of this critical health topic and look at ways to incorporate lifestyle modifications to improve physical activity and sleep for older adults, thus improving their cognitive health and quality of life.

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The Impact of Physical Activity on Cognitive Health

Physical activity is described as any type of body movement using skeletal muscle and requiring energy expenditure. Physical activity can also include movement during leisure activities or transporting oneself from place to place. However, it's a combination of both moderate and vigorous physical activity that has been indicated to improve health. The combination of both is better than either alone (each on its own does offer health benefits). The many health benefits of physical activity for older adults include improved blood flow to the brain, enhanced neuroplasticity, and reduced risk of cognitive decline. 

Evidence shows that older adults with higher physical activity have fewer chronic conditions, including dementia and less depression, sleep longer, and are more likely not to smoke or drink alcohol during the week. The recommended physical activity guidelines for seniors include 150 minutes a week of moderate-intensity movements, such as a brisk walk, or a vigorous activity, such as jogging for less time, and about 75 minutes to get the same results. It is also recommended that they do some strength training at least two days a week, including movements and postures to improve balance, like with yoga exercises.

The Role of Sleep in Cognitive Function

Sleep comprises cycles of sleep stages in which there are four stages and several cycles. The four stages include REM (rapid eye movement) and non-REM. The first three stages are considered non-REM, and the last stage is REM. Typically, there are between four to six cycles per night, with cycles ranging from 70 minutes to 120 minutes. Sleep is shown to be essential for cognitive health as it improves memory consolidation, brain detoxification, and hormonal regulation. There is an association between length of sleep and cognitive performance in older adults, with an optimal sleep time of six to eight hours improving cognition. Some common sleep disturbances in older adults generally concern any type of disrupted sleep pattern that includes difficulty falling or staying asleep, amount of sleep, or abnormal behaviors with sleep.

Here are some strategies for improving sleep quality in seniors:

• Create a conducive sleep environment
• Manage chronic conditions such as pain
• Avoid drinking liquids before bedtime to decrease urinary frequency
• Avoid heavy meals before bedtime; a light snack may be beneficial. Warm milk, containing a natural sleep-inducing amino acid, can aid in promoting sleepiness.
• Steer clear of stimulants, like caffeine, at least 3 to 4 hours before bedtime.
• Incorporate consistent physical activity into your daily routine, but refrain from vigorous activity within 3 hours of bedtime.
• Establish a consistent sleep schedule.
• Avoid daytime naps.
• Keep the bedroom free from distractions like cell phones, computers, television, or tablets.
• Refrain from tobacco use, particularly before bedtime.
• Reserve the bed exclusively for sleep or intimate activities.
• If you cannot fall asleep within twenty minutes, try doing a quiet activity such as reading or listening to soothing music.
• Whenever possible, avoid relying on sleeping pills, as they can lead to dependency and exacerbate sleep issues.

The Interplay Between Physical Activity and Sleep 

Researchers explored the impact of physical activity on sleep patterns and cognitive function and showed an intricate interplay between physical activity and sleep. Evidence has shown a synergistic effect of exercise and sleep on cognition, as exercise not only promotes better sleep but also enhances cognitive abilities. The relationship between physical activity and improved sleep is well-established, with exercise helping to regulate sleep patterns. With exercise, the body experiences more restorative sleep, which in turn can boost overall brain function.

Here are some practical tips for incorporating physical activity into a sleep-friendly routine:

• Start with a brisk walk in the morning for 3-5 days out of the week, totaling 150 minutes for the week
• Incorporate strength training at least two days a week. 
• Establish a consistent routine by choosing exercises that are fun. 
• Try jogging instead of walking for a total of 75 minutes for the week. 
• Keep it interesting and combine balance movements from exercises such as yoga into the strength training program 
• Avoid vigorous exercise before bed to promote quality sleep. 

Conventional Approaches

The conventional approach to assessing the association between sleep and cognitive health involves approaches such as sleep studies and cognitive assessments. A sleep study to evaluate an individual's sleep patterns and identify any sleep disorders like sleep apnea can be utilized to determine if poor sleep quality or sleep disturbances may be affecting cognitive function. Additionally, cognitive assessments, such as the Montreal Cognitive Assessment (MOCA), are employed to measure various aspects of cognitive abilities, including memory, attention, and problem-solving skills. Healthcare professionals will use these assessments to gain insights into how sleep quality or sleep disorders may impact cognitive health. 

Functional Medicine Labs to Assess Sleep and Cognitive Health in the Geriatric Population

The following are some functional medicine labs to help assess sleep and cognitive health in the geriatric population:

Cortisol Awakening Response (CAR)

The DUTCH CAR test is one of the most comprehensive assessments of cortisol function and its impact on conditions such as sleep disorders. It measures cortisol in the evening time as well as upon awakening to assess imbalances in cortisol secretion that may be disrupting sleep patterns.

Melatonin Profile

A melatonin profile involves measuring salivary melatonin levels at various points throughout the day to evaluate any deviations from the normal rhythm essential for a healthy sleep-wake cycle. This test is beneficial for those who are experiencing sleep issues.

Neurotransmitter Testing

Imbalances in neurotransmitters can create sleep disturbances. Neurotransmitter evaluation also provides insights into neurological function and health. The Neurotransmitter test measures over 30 molecules that are associated with neurotransmitter signaling and processing. This test can help assess both sleep and cognitive health in older adults.

Neural Zoomer

Taking a look at neurological antigens may be beneficial for the geriatric population to assess brain inflammation and overall brain health. The Neural Zoomer test evaluates antibodies that can help diagnose neurological disease and monitor early intervention strategies.

Supplements and Herbs For Sleep 

These supplements and herbs are all beneficial for establishing healthy sleep:

GABA

Research utilizing electroencephalogram (EEG) devices discovered that the addition of GABA led to a reduction in sleep latency of roughly five minutes. This implies that GABA supplementation may have the potential to expedite the process of falling asleep for individuals.

Lemon Balm 

Recent studies indicate that lemon balm may possess stress-reducing properties, enhance mood, and exert an anxiety-relieving effect. In a trial involving individuals experiencing stress and sleep difficulties, the administration of a particular lemon balm extract for a period of 15 days was linked to a decrease in anxiety symptoms and an enhancement in sleep quality.

Melatonin

Melatonin is a well-known supplement that helps improve sleep. Evidence shows that this supplement can improve sleep time, efficiency, non-REM sleep, and REM sleep latency.

Valerian

This herb has been shown to have properties that are effective for improving sleep and insomnia when taken as a supplement. It’s important to note that it may take up to four weeks to notice the impacts of this supplement. 

Strategies for Promoting Physical Activity and Sleep in Older Adults

Promoting physical activity and ensuring quality sleep in older adults is vital for maintaining their cognitive function and overall well-being. Here are some effective strategies to help achieve this:

Home-Based Exercises and Sleep Hygiene Practices:

Engage in home-based exercises that suit their preferences and abilities. A mix of aerobic, muscle-strengthening, and balance activities each week can help keep their bodies strong. Additionally, practicing quality sleep hygiene, such as maintaining a comfortable sleep environment and a consistent sleep schedule, or utilizing any of the other strategies mentioned previously can enhance the quality of their sleep.

Community Programs and Resources:

Older adults can benefit from community-based programs and resources that promote physical activity. These may include group fitness classes, walking clubs, or local senior centers that offer exercise classes tailored to their needs. Being part of a community can provide motivation and social interaction, making it more likely for them to remain active and maintain a healthy sleep routine.

Healthcare Provider Recommendations:

Older adults should consult with their provider for personalized recommendations on physical activity and sleep. Healthcare professionals such as athletic trainers can provide tailored advice based on individual health conditions and limitations. They can also address any concerns and be there for support and motivation.

Family and Caregiver Support:

Family members and caregivers play a crucial role in promoting physical activity and good sleep habits. They can provide encouragement, assistance, and companionship during exercise sessions. Additionally, caregivers can help establish a comfortable sleep environment and reinforce a regular sleep schedule.

Remember, it's never too late to start being physically active. Older adults should choose activities they enjoy and are suitable for their fitness levels to ensure long-term adherence. A variety of activities can make exercise more enjoyable and reduce the risk of injury. Every physical effort counts, whether it's walking, gardening, or even doing household chores. If external conditions are unfavorable, like extreme weather, older adults can explore indoor options, such as walking in a mall or following online fitness programs designed for home use.

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Summary

Physical activity and quality of sleep are key factors linked with cognitive health in the geriatric population. Inactivity is the leading risk factor for chronic disease and also increases the risk of mortality. There is also an interplay between increased physical activity and improved sleep quality. This interplay also has a positive impact on cognitive function, making these approaches a priority health strategy in maintaining cognitive and overall health in this population. Getting adequate sleep and staying consistent with regular exercise can be challenging. The strategies mentioned can be useful in improving sleep quality and incorporating sufficient physical activity for older adults. One approach that can simplify the protocol is to focus on incorporating consistent physical activity, as that has been linked to improving the quality of sleep and cognitive function. Testing to identify the underlying causes of neurological dysfunction and sleep issues can also be advantageous. Detecting these risk factors can enable practitioners to incorporate personalized interventions to improve overall health outcomes for this age group.