.

Good evening, I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now and it's twenty sixth year Matters of the Mind is a live call in program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues you may call me here in the Fort Wayne area at (969) 27 two zero or if you're going outside the Fort Wayne area you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis where our broadcast seen live every Monday night from our spectacular Beebs Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you have any questions concerning mental health issues, you may write me via the e-mail at Matters& of the Mind our one word at WSW Edgard That's Matters of the Mind at WSW Edgard and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver is a habit more of a psychological or a physical problem.

Do brain changes occur when people form habits?

Well, you're thinking very progressively there because you're right on target.

Brain changes occur when people form habits now probably five or ten years ago I would have told you a habit is something psychological.

We need to break the cycle.

We need to break our routines and just change the habits.

But now we know that your brain physically changes when you have habits and you establish routines on a day to day basis.

Let's think about good habits like exercising 30 minutes five days a week if you establish a good habit where you're exercising five days a week, your brain physically changes to actually accommodate that kind of habit.

>> That's why you want to be able to carry out that habit and you don't feel right if you don't and that can go for adaptive habits that can go for constructive habits and it can also apply to habits that aren't that good for you.

So think about another habit such as cigaret smoking.

>> Not only is the nicotine affecting the dopamine transmitter in the middle of the brain look in the middle of the brain there dopamine is affecting that part of the brain when you smoke cigarets.

>> But it's not just the nicotine that forms the habit with cigarets is the routine the time that you smoke the routine that you you will do as you smoke you will have certain other types of things around you when you're smoking cigarets or the timing of smoking cigarets.

So the cigaret smoking is not just all about the nicotine, it's about the whole experience and that whole experience causes brain changes and what happens is you'll have certain areas of the brain that will become more fluffy and we call this neuro neurogenesis but with neurogenesis and after Genesis is another term it's basically are you just you're branchin of your neurons are becoming more fluffy and it's like a tree that's maybe growing from sixty thousand little branches up to one hundred thousand branches.

>> Those branches become more fluffy as you established good or bad habits depending on the situation and it's difficult to break habits because your brain doesn't like to change that much.

>> So when you try to change and go to a different routine, to a different habit, you have to physically change the brain structure and in doing so you can but it's sometimes difficult to do and you can create some anxiety and sometimes it causes a disruption of your motivation when you're trying to do that.

>> So exercising is a great habit for many, many people to have but they have to get the motivation.

>> They have to do the initiative to do it.

Many people struggle with exercise when they're depressed for instance because when you're depressed exercising is the last thing you want to do because you don't have the get up and go.

You don't have the energy, not the motivation and you just have a hard time getting out the door.

But once you exercise, for instance, you can then have more of that motivation.

You feel better after you exercise rarely unless somebody overdoes it they rarely people will not feel any worse when they exercise.

>> They actually feel better when they exercise.

So exercise can be kind of painful and uncomfortable while you're doing it but especially 30 minutes after exercise is a lot of brain chemical changes that occur for the good and people can feel a lot better overall so habits can change the brain structure and it's good to try to reverse those to create more healthy exercises.

Thanks for your thanks for your email.

Let's go to our next caller.

Hello Diane.

Welcome.

Let's go to Maggie.

Hello Maggie.

Welcome to Matters of Mind.

Maggie, I want to know about the coping mechanisms for watching parents as they get older.

My dad is reaching an age where you have to take his keys and every conversation goes bad.

What I'm getting and I'm getting frustrated it really depends on what kind of conversations you're needing to have at this point.

Maggie, as parents get older, it's important for the adult children to be able to still to still be able to encourage them to still be able to support them financially and physically and take care of their social needs in some cases.

And if they're developing dementia, which I think you kind of alluded to that possibility where you have to take away the keys remember what taking away the Keys represents taking away the Keys represents taking away freedom and independence and being able to have the flexibility that an older adult has been experiencing for decades since they were an adolescent they were able to drive here all of a sudden they're not supposed to drive.

Some of the older adults will have less trust with their children when that occurs.

That's who it's often something that needs to build over the course of time.

But when somebody develops dementia and they have poor judgment, it's a gradual process not uncommonly but you have a shrinkage of this left side of the brain over here especially right side is some degree of the hippocampus that's the memory center of the brain and it shrinks up.

People have trouble with their memory so they don't remember that they ran into a post last week.

They might have trouble with judgment where and physically they might have trouble with vision and many times people as they get older will have a hard time moving their neck about so that give them difficulty with a range of motion in terms of visual field when they're in the car.

>> So there's a lot of reasons why somebody might need to have the keys taken away.

>> But I think if you were to check in on them on a regular basis, a very consistent time what you don't want to do and I'm talking to adult children of older parents about this all the time you don't want to have this kind of situation where the parent kind of haphazardly calls you because they have something on their mind that's going to very significantly disrupt your life .

>> It's important for you to regularly communicate with your parents unless there's emergency obviously.

But tell them you'll be calling at a certain time on a certain day on a regular basis and they will expect that call and make sure to follow through with it.

What you don't want to do is what I sometimes encounter where a parent is calling an adult child six or seven times a day just because they have something on their mind they might have forgotten something they remember they want you to pick up something at the store that will cause a tremendous amount of stress both ways and you have to set your boundaries in that in that matter if somebody's going into assisted living setting, for instance, you want to make sure they develop their own social contacts.

You don't want to become their primary social network.

You want to encourage them to mean that maintain that socialization because a predictor for depression with older dalts will be social isolation.

And this was something that we saw that was just devastating during the covid pandemic restrictions when a lot of these assisted living settings and the nursing homes had to shut down and they were not allowed to have visitors that went on for quite some time and it was devastating, devastating for the mental health of these people because they needed that social connection.

So it's important to be able to set those boundaries as an adult child keeping in mind that you need to still support ,respect and honor your parents.

>> And I always tell people that when you care for your parents in their older years it'll be one of the most difficul things you've ever done.

But it'll also be the most gratifying.

You'll learn a lot about yourself.

You'll learn a lot about your upbringing.

You'll have a greater understanding of how you became the person you became because if you think about it, a lot of us start to emancipate from our parents when we're early adults 18, 20, 22 years of age and then we're off on our ways and next thing you know twenty years later forty years later perhaps you're needing to take care of them and you get to know them all over again and you start to reminisce about circumstances that you might not have understood as a child.

It's a tremendous means of of almost psychotherapy as you're going through the different memories and you're having an understanding why you to this day might be doing things as you are possibly as a means of modeling your parents behavior or even things that were learned as a child.

>> Diane, thanks for your call.

Let's go to our next email about our next email.

>> I think we have another email.

There are an email reads there it is not a favor.

>> Why do I feel the need to change my appearance whenever gets life gets challenging we often hear about this more so with women than men.

>> Women will be very likely to change their hairstyles or change your clothes.

They might change their hair coloring.

You ought to be careful about permanency of different changes.

For instance, many people will get tattoos based on how they're feeling and you don't want to do something that you might later regret.

So if you change your hairstyle, change your color of your hair.

Yeah, People just physically are trying to change their appearance with the perception that if they change their appearance they'll feel a little bit differently and sometimes it gives people a little bit of a thrill or a rush to change their appearance in that way.

>> And not that's not uncommon that the key will be to not do something that's necessarily permanent that will remain there when you're feeling in a different way.

>> Let's go to color.

>> Our next caller is from I believe it's from Diane.

Oh, there it is.

Diane, you're you're calling about having significant short term memory loss, not being sure if it's due to chemotherapy or possibly early dementia.->> What's the best wad out what's the best kind of assessment that you need?

>> Diane, you mentioned chemotherapy.

It's very, very common to for people to have difficulty with what's called chemo, chemo, brain chemo, brain chemotherapy after effects will be characterized by having difficulty with memory fatigue, difficulty processing information.

It's kind of like having a brain that's on a slow Internet speed and just taking time to process information.

It's very common with chemotherapy and you want to be assessed by a clinician who's going to be able to take a look at the whole picture.

>> Were there any after effects of the chemotherapy might have affected you metabolically such as causing you disturbances in your thyroid disturbances and glucose B twelve vitamin B nine which is folic acid.

So you want to make sure you& assess all these different factors that might be contributing to the after effects of the chemotherapy itself.

>> Now early dementia, early dementia is somebody having dementia basically under the age of 65 years of age there are some instances when people are having dementia earlier than 55 years of age and that's considered to be quite early with the onset of dementia if you're having dementia in the early stages like that, not uncommonly it could be related to alcohol use.

>> So the first thing you want to do is make sure you're giving up alcohol Diane being a female name.

>> Well, if you're female you're twice as you're three times as likely to have trouble with alcohol related dementia compared to a man because you metabolize alcohol at one third the rate of a man.

So three drinks for a woman is like nine drinks for a man throughout their lives.

So the alcohol is metabolized in the stomach and the liver and women have less alcohol dehydrogenase which is an enzyme that breaks down alcohol.

Women have one third less of that than men.

>> So for that reason alcohol will have a much more toxic effect on women compared men and it's that toxic effect is that area that I mentioned before the hippocampus that's the part of the brain that alcohol will readily shrink down and cause people to struggle with memory and concentration.

>> So if someone has early memory disturbances, we're going to look at several different things, look a lot of different metabolic reasons .

We're going to look at any medications including recent chemotherapy.

Some medications can dull the memory in different ways.

>> And the bottom line with that as you look back to say, you know, when did the memory disturbances start if you can identify that the memory disturbances started right about this time, did you start any medication about that time?

And then we work backwards so sometimes we have to kind of figure out what was the temporal correlation with the memory disturbances themselves.

We'll look at any difficulty possibly with depression people who get depressed, clinically depressed where they do enjoy things they have trouble the energy motivation, their win gets taken out of their sales and they will have trouble with processing speed and they just can't think as quickly as clearly and they will have memory disturbances that for a lot of people in their 50s, 60s and 70s they'll wonder if they have dementia itself and it's used to be called pseudo dementia where it was a kind of dementia.

It really wasn't a dementia.

The memory disturbances were more related to depression and the difficulty processing speed.

So a lot of different ways to assess that.

Start with your primary care clinician or your oncologist if you had chemotherapy.

Oncologists have a very good understanding of the after effects of chemotherapy.

Could this be a wait and see phenomenon?

Are there things they can do for you?

Primary care clinicians is going to look the whole metabolic picture including as I've mentioned many, many times with people looking to sleep apnea.

>> If you have snoring or witnessed pauses in your breathing in nighttime, you need to be assessed for sleep apnea or sleep apnea is charactrized by not getting enough air flow to the lungs because you're snoring or you're pausing your breathing.

>> Not enough air flows to the lungs at night time will give you less oxygen to the brain as we all get older we're more prone to having sleep apnea and it's very important that people get assessed for that because it's a very treatable condition for low energy, poor concentration and memory disturbances and interestingly enough sleep apnea untreated over the course of time is a risk factor for developing dementia.

Sleep apnea can give you so many problems metabolically but it can also increase the likelihood you have dementia later on because it's lack of oxygen to the brain is not good for the brain.

>> Thanks for your call.

Let's go our next caller.

Hello Dave.

>> Welcome to Matters of Mind.

David mentioned the vertigo that lasted a month and went away on its own.

>> Why is that happened, Dave?

I would refer you to an ear, nose and throat doctor for that.

I'm a psychiatry.

I hear about vertigo sometimes and vertigo is a sensation.

Things are kind of spinning one way or another but with vertigo.

Yeah.

You want to check with an ear, nose and throat doctor it's typically an inner ear problem and an inner ear problem can give you difficulty with spinning or vertigo can also give you difficulty the ringing in the ear and sometimes nausea that triad as it's called Manyara syndrome because a doctor by the name of Munier talked about it one time and wrote about it.

>> So vertigo is something that if it comes and goes like that could be from an inner ear infection increase congestion at least that's what the ear, nose and throat doctors tell me.

So that's something you can discuss with the ear, nose and throat doctors.

>> Dave, thanks for your call.

Let's go our next caller.

Hello Charlotte.

Welcome to Matters of Mind.

Charlie, you mentioned that you tried every sleep medication including antipsychotics to give you a side effects such as restless leg syndrome and nothing works.

>> Any suggestion Charlotte, if you tried a lot of different medications for sleep, you might want to consider some of the newer ones that are coming out that are considered to be or Rexon or hypo kryten blockers or antagonizer.

>> So of the newer of the newer ones BHEL Samarrah they've got these are medications that block or Rexon.

>> So you've tried antipsychotic medications.

Antipsychotic medication will block serotonin type 2A receptors and induce doing so they can give you a nice deep sleep.

>> The problem is antipsychotic medications can also block dopamine receptors and if you block dopamine receptors you can have restless legs, you can have restlessness in general and a lot of side effects from the dopamine receptor blockade which you don't really need for relief of insomnia.

What you need is the serotonin to a blockade.

So if you want something for serotonin to a blockade, you want to take Trazodone as it which is an old antidepressant medication.

>> It came out in about nineteen, 1984.

>> I think it's been around for a long time.

Trazodone specifically and selectively will block serotonin 2A receptors at doses below about 150 milligrams a bedtime idea is a newer antipsychotic medication that has as its mechanism predominantly serotonin to blockade and theoretically it could be a really nice sleep medication.

It's used for other conditions like schizophrenia and bipolar disorder but the traditional antipsychotic medications you probably want to stay away from those for sleep.

So we have these other medications out there for sleep that work in different ways are rexon antagonists basically or Rexon is what goes sky high in your brain.

>> It comes from the Hypertherm kalmus and Rexon goes up when you're wide awake it keeps you awake or Rexon is also known as Hypo Hypocretin.

>> You might have heard about something called narcolepsy where somebody abruptly goes their knees buckle, they go into dream sleep very quickly.

They just fall asleep very, very easily.

Narcolepsy is a phenomenon where somebody just out of the blue has a drop in their level and it makes them real sleepy and they go right into dream sleep.

>> If you block or exit intentionally at bedtime it puts you to sleep easier.

medications I mentioned two of them that have readily available balsom around Vego have been out and they are indeed blocking or rexon itself.

So that's one mechanism Rosero as a medication has been around for a long time and specifically will block melatonin receptors if you block melatonin I'm sorry if it'll still stimulate melatonin receptors melatonin you can use that many people will find they don't get a lot of benefit from it if they have severe insomnia ,melatonin basically helps you get to sleep.

>> So melatonin comes from the pineal gland which is right in the middle of the brain.

>> Pineal gland is a little pea shaped gland right smack in the middle.

The brain there and the pineal gland will secrete melatonin when it gets dark.

>> So when you have less light hit in the retina, less light hit in the retina, then give the signal to the pineal gland to start releasing melatonin so melatonin can help you get to sleep works within a matter of a few minutes and helps you get to sleep but it doesn't stay in your system the whole night so it doesn't make a lot of sense to take an extended release high dosage melatonin melatonin is there for the purpose of helping you get a sleep half milligram maybe no more than three or three to five milligrams at bedtime is all what most people need.

But Rosero is a medication specifically and selectively stimulate the melatonin receptors and in doing so can work a little bit more effectively the melatonin itself.

>> So those are the main types of medication we're using now for people who are having difficulty with sleep.

But what quite frankly do Charlotte as I ask people about their sleep patterns because we want to make sure we call sleep hygiene but we want to make sure somebody getting to sleep about the same time every night they're getting up the same time every morning when you're having your last caffeine you've got to take a good look at that.

We want to have people consume caffeine earlier and earlier and not into the evening.

>> Some people are eating late at night.

>> Some people will exercise at seven or eight o'clock at night.

Many people will play on their computer games and they're the brightness of the computer screen.

The laptop or even the television will keep them awake so we have to kind of dissect some of the factors that might be keeping people awake and that's often the first thing that we will do will encourage people to write down their life worries earlier in the evening and take a look at them, shut the book up and this figure out what you can do about those worries and what you can't do about the certain worries and if you can do something about them OK, write down an action plan for that but don't do that right before you go to bed and definitely don't do that in bed.

>> You don't want to be worrying about things as you're going to sleep now some people have a condition called Attention Deficit Hyperactivity Disorder ADHD where their brain just doesn't shut off at night.

>> They do great with second third shift jobs where they don't have to go to bed at any particular time but their brains often don't shut off because they have all these ideas and the ideas will often accelerate as it's getting quieter and many times it's getting darker for people.

>> So these people are the ones who like to do the second third shift jobs because they come home for work.

They can stay up for a little while.

They go to bed whenever they want then they get up a little bit later in the morning and that's as opposed to people that have to get up at six or seven in the morning routinely.

They really struggle a lot of times and we see that with adolescents adolescents their brains don't want to go to sleep typically at 10:00 or 11:00 p.m. when they should be able to get up first thing in the morning because adolescent brains by the nature of their brains still growing for some weird reason their circadian rhythm is disturbance is disturbed so they have what's called delayed circadian rhythm disturbance so they want to go to bed later and they want to sleep in later.

So ideally in a school setting for instance, school should be starting later in the day and ending later in the afternoon but practically that often doesn't work.

>> But from a brain functioning standpoint that often works out better.

>> Thanks for your call.

Let's go to our next email.

>> I believe I have another email.

All right.

Next email reads Dear dear father, my doctor told me that my anxiety is causing insomnia but after getting on anxiety medication there's been no changes.

What causes anxiety?

>> It depends on what kind of anxiety might be a factor there if your anxiety is causing the insomnia, we always try to address that because anxiety will often precipitate insomnia because you're worried about stuff and your doctor might have mentioned that your anxiety might be contributing to things into insomnia because you still have things on your mind at night and often have give people difficulty with getting to sleep and staying asleep because people might awaken in the middle of the night and they start worrying about things.

So that goes back to the sleep hygiene concept where you're writing down your worries earlier in the day or in the evening and and trying to address what you're going to do with your worries before you go to bed for many, many people they will go to bed.

>> The lights are out.

It's dark, it's quiet and all of a sudden they start thinking about stuff and that's what keeps them awake.

>> Well, medications can help with that to some degree.

But if you still are worrying about things, sometimes your worries can override the effect of the medication.

So we will often give medication to give you more of a sedating effect and help calm you down without causing memory impairment or difficulty with amnesia in the middle of the night we'll use medications like I mentioned Gabapentin, Trazodone, low dose dock's happen.

>> We have a lot of different medications in which we can use and these medications are for the purpose of just allowing you to be a little bit more relaxed.

>> The last thing you want to do to help you sleep at night is drink alcohol.

That was a common remedy twenty or thirty years go where people would have a couple beers at night time to help them relax.

>> If you do that yeah you'll be able to fall asleep but the alcohol wears off and you get a rebound effect typically in the middle of the night you don't get a good quality sleep number one but you also have insomnia in the middle of the night because the alcohol is indeed worn off.

So we'll often give people medications that will be not addictive and will be able to be something that gets out of the system by the next morning.

>> Many people will use diphenhydramine as antihistamine I mentioned are Rexon earlier as a chemical that stays elevated throughout the day.

Histamine does too.

So if you block histamine with diphenhydramine also known as Benadryl or maybe Dock's Doxil I mean which is a medication this in a lot of popular different sleep medications out there but these are the these are the kind of chemicals that are blocking histamine by blocking histamine.

They're just making you less awake and less alert and there's actually been studies done on docs on diphenhydramine that show that if you take Deiva diphenhydramine at nighttime and you take a driving test driving around KONE's the first thing in the morning until about noon you will have significant impairment even though you took the diphenhydramine just last night.

So you can have carryover effect the next day because if you block histamine you can have carryover difficulty with concentration and focus the next day.

>> So the first thing you do need to do is take a look at your lifestyle in terms of your your times for going to bed.

What are you doing the two ours before you go to bed now many people can watch a sitcom at nighttime.

>> They'll say it relaxes them and they sleep better.

Hey, more power to them.

That's fantastic.

But if that's been problematic for you and it's actually keeping awake because of the bright screen, the television or the computer, maybe you need to do something about that.

>> Thanks for your call.

Unfortunately I'm out of time for this evening.

>> If you have any questions concerning mental health issues that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WSW a dog I'm psychiatrist GPH and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

>> Thanks for watching.

Goodnight