Category Archives: Sleep problems from Parkinson’s

Understanding The Positive Health Benefits of Gratitude

“If the only prayer you ever say in your entire life is ‘thank you’, it will be enough.” Medieval German Theologian Meister Eckhart

“The smallest act of kindness is worth more than the greatest intention.” Khalil Gibran.

Preface: Gratitude is good for you. The Roman philosopher Seneca said, “Nothing is more honorable than a grateful heart.” The Roman senator Cicero remarked, “Gratitude is not only the greatest of virtues but the parent of all others.” Recognize the health benefits of being grateful.  Why? Gratitude will lead you to the fountain of hope; it is good for your heart, soul, mind, and practicing gratitude will be beneficial for your life with Parkinson’s.

Introduction: In the backdrop of having a chronic disorder like Parkinson’s disease, it is easy to get trapped and driven down emotionally from its daily burden. Life happens and we are constantly making micro- and macro-decisions, big and small changes in direction, and it seems to me the list grows with time. Today’s post is centered on gratitude, not to complicate your life, but as a reminder that being thankful can improve your health all on its own.

“Develop an attitude of gratitude, and give thanks for everything that happens to you, knowing that every step forward is a step toward achieving something bigger and better than your current situation.” Brian Tracy

Gratitude Defined: [grat·i·tudeˈɡradəˌt(y)o͞od/] Gratitude is from the Latin word gratus, meaning “pleasing” or “thankful,” Words from the Latin gratus have something to do with being pleasing or being thankful. To feel grateful is to feel thankful for something. Gratitude is a feeling of thankfulness (Merriam-Webster). Thank you in several languages is shown below (image credit).

h-GRATITUDE-640x362

“No duty is more urgent than that of returning thanks.” James Allen

Studies on Gratitude and Health: Doing a PubMed search for “Gratitude” reveals >1000 papers/chapters/books; searching for “gratitude and health” shows >500 citations.  Outside of PubMed, there are numerous reviews and magazine/newspaper/journal articles describing the health benefits of being thankful (having gratitude).  In the end, I will list several for your further viewing/reading. Here are some highlights linking gratitude and a better life.

  • Blessings vs. Burdens- In 2003, Emmons and McCullough published a landmark study of gratitude and well being entitled “Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-being in Daily Life”.  They described 3 experiments, two groups were healthy college-aged students and the third group was adults with various neuromuscular disorders.  Within each separate study, some subjects were asked to maintain a journal on a weekly basis for 10 weeks, and others on a daily basis for 2 or 3 weeks.  They all kept records of both positive and negative effects they had experienced; including their behavior coping with these events (health behavior and physical symptoms), and their overall appraisal of life.  Subgroups from each study were asked to focus their journal entries on different things: (Group A) this group recorded things for which they were grateful (they were “counting their blessings”); (Group B) this group recorded things they found irritating and/or annoying (they were “counting their burdens”); and (Group C) this group recorded things that had a major impact on them.  After compiling the data from the 3 experiments, two trends stood out. (1) The participants from ‘Group A’, those recording things for which they were ”grateful’, showed much higher levels of well-being compared to Groups ‘B’ and ‘C’; and this was particularly evident when compared to those recording events that were ‘annoying or irritating’. (2) The positive effects of gratitude in the 10 week study, compared to the 2 or 3 week studies, showed not only better well-being; these participants also showed social and physical benefits.
  • Feeling Happy- In a separate study from 2002, McCullough et al. reported that recording your blessings on a regular basis was linked with increased happiness. In a separate study, Kurtz et al. (2008) showed that this feeling of happiness through gratitude was sustained for several months.
  • Optimism– A study by Overwalle et al. (1995) found a positive link between the ability to express gratitude and the feeling of well-being; suggesting these individuals had an improved/optimistic outlook of their future.
  • Strengthening Bonds and Building Relationships- The link of happiness from gratitude was shown to strengthen bonds, enable friendships, and support social networks.  The results from Reynolds (2008) showed that by practicing gratitude, participants felt more cared for/loved by others.
  • Mapping Neural Networks of Gratitude- In a 2015 paper entitled “Neural correlates of gratitude”, Fox et al. used magnetic resonance imaging (MRI) to map the effect of gratitude in volunteers. They tested a hypothesis that gratitude activity would be linked to brain regions associated with moral cognition, value judgment and theory of mind. Their results showed that gratitude was correlated with brain activity in the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC), which supported their hypothesis (see drawing below).

18.04.12.ACC_mPFC_Thalamus.

“Let us be grateful to people who make us happy.” Marcel Proust

 Linking Gratitude to the Anterior Cingulate Cortex and Basal Ganglia:  The anterior cingulate cortex (ACC) can be described as a ‘neural network interface’ between emotion, sensation, and action. The ACC is linked anatomically with brain areas associated with each of these functions. An important interaction of the ACC is highlighted by its reciprocal connections to the reward centers of the brain, which includes the orbitofrontal cortex, insula, and the basal ganglia. Thus, the ACC is a target for the dopamine-expressing neurons from the substantia nigra (part of the basal ganglia; see figure below).  Understanding the reward of gratitude within the brain has given us an appreciation to what leads to a healthier and happier self. To further augment the benefits of gratitude, we enlist neurotransmitters (serotonin and dopamine):

serotonin.A Squeeze of Serotonin-  Serotonin is an elixir that boosts our mood, enhances will-power and eliminates self-doubt. The anterior cingulate cortex (ACC)  releases serotonin (i) when we write about gratitude and (ii) when we reflect about the positives in our lives (and our work).

dopamine.A Drop of Dopamine- Dopamine makes us feel good. With respect to practicing gratitude, we release dopamine (from the substantia nigra in the basal ganglia) (i) when we express gratitude for what’s good in our lives and (ii) when we offer gratitude for someone who has helped us thrive at life/work,

5379005_orig

“We must find time to stop and thank the people who make a difference in our lives.” John F. Kennedy

Gratitude Promotes the “4H Club” That Includes Happy, Healthy, Heartfelt, and Hopeful: I am neither a psychologist nor a neurologist, but I truly enjoyed reading the Emmons and McCullough (2003) paper described above (“Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-being in Daily Life”).  First, it was well-written and easy to follow.  Second, they asked and answered some very important questions linked to gratitude.  Clearly, their work was preceded by other studies; however, their results likely provided a foothold for others to launch their ideas about how gratitude influences the human condition. In summarizing many studies, the folks at Happier Human (What About Happiness?) posted an amazing article entitled “The 31 Benefits of Gratitude You Didn’t Know About: How Gratitude Can Change Your Life” (click here) along with the figure below showing the huge overall impact of gratitude on human happiness (credit).

Benefits-of-Gratitude5

Remember, I am not a psychologist.  However, I felt that four major themes could be used to represent the positive impact of gratitude. Borrowing from the ‘4H Club’ name, the benefits of gratitude could make someone Happy, Healthy, Heartfelt, and Hopeful (see Figure below). And there are numerous studies to support the positive impact of gratitude on these four aspects of life (see references cited at the end).

Screenshot 2018-04-10 23.49.01

“To give thanks in solitude is enough. Thanksgiving has wings and goes where it must go. Your prayer knows much more about it than you do.” Victor Hugo

Pursuing Happiness Through Gratitude and How to Achieve it: The best strategy for expressing gratitude requires your investment of time to create and maintain a gratitude-journal.  The idea is for your gratitude-journal to have short statements where you describe your gratitude, you reflect on your positive life-events, you give thanks to others, you think-ponder deeply, and write 3-5 things per time and you decide on the frequency (every few days, more or less, but you decide).   Here are some examples:

  • I hit golf balls at the driving range 2 days in a row this week, what fun;
  • Spring weather finally has arrived, it waited ’til now but that’s OK;
  • Got 6.5 hours of sleep one night last weekend (yay!);
  • A reader of the blog wrote to tell me how much he appreciates and values my blog posts [and that he was my biggest fan (thank you so much)];
  • I’ve enjoyed teaching my undergraduate class this semester;
  • Thankful for all of my favorite Physical Therapists who inspire me to exercise and to stay healthy (“Keeping your body healthy is an expression of gratitude to the whole cosmos — the trees, the clouds, everything.” Nhat Hanh);
  • So very proud of CJ for presenting her poster this week at the University Undergraduate Student Research Day;
  • Very thankful for the incredible help Marissa and Shelby have provided me as Teaching Assistants this semester;
  • Look forward to seeing my sisters in the near future;
  • Having lunch tomorrow with 2 former students from my undergraduate class, and this week I went out for lunch with the current class (I learn much from these events);
  • Received an amazing thank-you note from a former student;
  • Very fortunate to have Susan in my life, look forward to catching up soon.

“For each new morning with its light, For rest and shelter of the night, For health and food, for love and friends… Feeling gratitude and not expressing it is like wrapping a present and not giving it.” William Arthur Ward

Benefits of Gratitude and Health in the Presence of Parkinson’s: The anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) of the brain are the key components that respond to gratitude. There is no doubt that people-with-Parkinson’s experience the benefits of gratitude and the 4H’s (Happy, Healthy, Heartfelt, and Hopeful).  However, the ACC communicates with the basal ganglia, which implies some role for dopamine. Thus, we must believe we still synthesize enough dopamine to realize the positive effects from gratitude (well, this is what I believe).

In closing, as I said at the start, I am convinced that gratitude will lead you to the fountain of hope; it is good for your heart, soul, mind, and practicing gratitude will be beneficial for your life with Parkinson’s. May you continue to be thankful. May the positive effects from gratitude provide you a constant source of happiness and good health that are reinforced by heartfelt feelings and hope for years to come.

“Thanks are the highest form of thought.” Gilbert K Chesterton

References For Your Further Reading:
Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. Journal of personality and social psychology. 2003;84(2):377-89. Epub 2003/02/15. PubMed PMID: 12585811.

Fox GR, Kaplan J, Damasio H, Damasio A. Neural correlates of gratitude. Frontiers in psychology. 2015;6:1491. Epub 2015/10/21. doi: 10.3389/fpsyg.2015.01491. PubMed PMID: 26483740; PMCID: PMC4588123.

The 31 Benefits of Gratitude You Didn’t Know About: How Gratitude Can Change Your Life (click here).

McCullough ME, Emmons RA, Tsang J. The grateful disposition: a conceptual and empirical typology. J Pers Soc Psychol. 2002;82:112–127.

Kurtz JL, Lyubomirsky S. Towards a durable happiness. In: Lopez SJ, Rettew JG, eds. The Positive Psychology Perspective Series. Vol 4. West-port, CT: Greenwood Publishing Group; 2008:21–36.

Overwalle FV, Mervielde I, De Schuyter J. Structural modeling of the relationships between attributional dimensions, emotions, and performance of college freshmen. Cognition Emotion. 1995;9:59–85.

7 Surprising Health Benefits of Gratitude (click here).

Martins A, Ramalho N, Morin E. A comprehensive meta-analysis of the relationship between Emotional Intelligence and health. Personality and Individual Differences. 2010;49(6):554-64. doi: https://doi.org/10.1016/j.paid.2010.05.029.

Alspach G. Extending the tradition of giving thanks recognizing the health benefits of gratitude. Crit Care Nurse. 2009;29(6):12-8. doi: 10.4037/ccn2009331. PubMed PMID: 19952333.

Emmons RA, Crumpler CA. Gratitude as a Human Strength: Appraising the Evidence. Journal of Social and Clinical Psychology. 2000;19(1):56-69. doi: 10.1521/jscp.2000.19.1.56.

Ma LK, Tunney RJ, Ferguson E. Does gratitude enhance prosociality?: A meta-analytic review. Psychological bulletin. 2017;143(6):601-35. Epub 2017/04/14. doi: 10.1037/bul0000103. PubMed PMID: 28406659.

7 Ways to Boost Your Gratitude (click here).

Reynolds DK. Naikan Psychotherapy: Meditation for Self-Development. Chicago, IL: University of Chicago Press; 1983.

O’Connell BH, O’Shea D, Gallagher S. Feeling Thanks and Saying Thanks: A Randomized Controlled Trial Examining If and How Socially Oriented Gratitude Journals Work. Journal of clinical psychology. 2017;73(10):1280-300. Epub 2017/03/07. doi: 10.1002/jclp.22469. PubMed PMID: 28263399.

Sirois FM, Wood AM. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2017;36(2):122-32. Epub 2016/10/28. doi: 10.1037/hea0000436. PubMed PMID: 27786519.

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend.” Melody Beattie

 Cover photo credit: https://visitsrilanka.com/news/its-blooming-spring-22-great-uk-walks/

Sleep Disturbances in Parkinson’s and the Eagles Best Song Lyrics

“There is a time for many words, and there is also a time for sleep.” Homer, The Odyssey

“Man is a genius when he is dreaming.” Akira Kurosawa

Précis: There are many manifestations associated with Parkinson’s; one of the more frustrating aspects is the alteration of sleep patterns.  Herein is a brief overview of sleep disturbances in Parkinson’s.  And in a recent evening of insomnia, I compiled a list of some of my favorite lyrics by the American rock band “the Eagles”.

Sleep problems associated with Parkinson’s: The vast majority, >90%, of people-with-Parkinson’s have some sleep-related problems. The factors related to disrupted sleep pattern in Parkinson’s can broadly be classified as follows:  (1) Parkinson’s-related; (2) treatment-related; (3) psychiatric-related; and (4) other sleep-related manifestations. For further review, please see the following articles: Garcia-Borreguero et al., “Parkinson’s disease and sleep” (click here for the PubMed citation); Barone et al., “Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson’s disease” (click here for the PubMed citation) and Chaudhuri et al. “Non-motor symptoms of Parkinson’s disease: diagnosis and management” (click here for the PubMed citation). An expanded description of some of the sleep disturbances in Parkinson’s is given below:

  • Parkinson’s related motor symptoms that could alter sleep patterns include disruption from tremor, difficulty in turning over in bed, impairment of voluntary movement (akinesia), abnormal muscle tone that results in muscular spasm and abnormal posture (dystonia), and painful cramps.
  • Therapy-related nocturnal disruption of sleep from legitimate Parkinson’s drugs, e.g., dopamine agonists, levodopa/carbidopa, and certain antidepressants. The known side-effects of the ‘gold-standard’ of treatment levodopa/carbidopa include: dizziness, loss of appetite, diarrhea, dry mouth, mouth and throat pain, constipation, change in sense of taste, forgetfulness or confusion, nervousness, nightmares, difficulty falling asleep or staying asleep, and headache.
  • A significant portion of people-with-Parkinson’s exhibit psychiatric symptoms.  The most frequent manifestations, which could alter one’s sleep pattern include vivid dreams, insomnia, hallucinations, psychosis, panic attacks, depression, and dementia.
  • Finally, there are other sleep-related disorders linked to Parkinson’s, which include excessive daytime sleepiness, insomnia, restless legs syndrome, periodic leg movements, and sleep apnea.

“Daytime sleep is like the sin of the flesh; the more you have the more you want, and yet you feel unhappy, sated and unsated at the same time.” Umberto Eco, The Name of the Rose

Sleep-related problems from Parkinson’s: Many people-with-Parkinson’s have a difficult time sleeping throughout the night. With or without Parkinson’s, a good night’s rest is critical to feeling well. Thus, understanding and treating the cause of the sleep-related disorder from Parkinson’s is important.  The list described above is somewhat intimidating; especially in trying to sort out the primary-cause(s) of sleep problems from Parkinson’s. My sleeping problems seem to be related to the timing of when I take levodopa/carbidopa (I need to re-focus my effort to take it at the right time each day; not late in the evening), renew my nightly melatonin therapy (3 mg capsule 1-2 h before sleep); sleep apnea (now being treated by CPAP), and stress related to my work deadlines/professional goals-expectations (now being dealt with by increased time for exercise and better use of mindfulness-meditation).

Dealing with sleep-related issues from Parkinson’s is both complex and frequently multi-factorial. Therefore, given below are some websites that may offer guidance and suggestions to better handle your sleep disorder from Parkinson’s:

  • Nighttime Parkinson’s issues and how they can be treated (click here);
  • Sleep Disorders and Parkinson’s Disease (click here);
  • Sleep Disturbances (click here);
  • Parkinson’s Disease and Sleep (click here);
  • Problems with Sleep at Night (click here);
  • And from this blog: Sleep, Relaxation, and Traveling (click here); 7 Healthy Habits For Your Brain (click here);  and try dealing with the stress from and the reality of Parkinson’s using Contentment, Gratitude, And Mindfulness (click here).

“Am I sleeping? Have I slept at all? This is insomnia.” Chuck Palahniuk, Fight Club

“Frank, what’s your favorite line from an Eagles song?”:  A recent Sunday morning on the golf course, my golf buddy and good friend Kim asked Frank, what’s your favorite line from an Eagles song?”; yes, it came our of nowhere.  My initial response was “You can see the stars and still not see the light”.  He quickly replied “We live our lives in chains and we never even know we have the key.” And I followed up with “I’m standing on a corner in Winslow Arizona and such a fine sight to see.”  We talked briefly about the Eagles from the early 1970’s and their song lyrics; however, the thought stayed with me.  If you need a reminder about the Eagles: “The Eagles were an American rock band formed in Los Angeles in 1971 by Glenn Frey, Don Henley, Bernie Leadon, and Randy Meisner. With five number-one singles, six Grammy Awards, five American Music Awards, and six number one albums, the Eagles were one of the most successful musical acts of the 1970s.” [for more information, see https://en.wikipedia.org/wiki/Eagles_(band)%5D

“I grew up with another pretty darn good writer: Glenn Frey of the Eagles. We were very good friends, and we kind of studied it together.” Bob Seger

The lyrics from the Eagles songs take us to the limit(s) of our imagination: For me, great music has a memorable beat and meaningful lyrics; and you can just remember these songs years later. The Eagles were wonderful musicians, harmonized beautifully, and wrote songs with a lot of imaginative/descriptive lyrics. The other night, I started listening to the Eagles and decided to compile a list of some of their best (i.e., my favorite) lyrics. I had iTunes open and would start listening and then search for lyrics to certain songs (those that brought back the most memories).  I also used my Echo Dot by saying things like “Alexa, play Desperado by the Eagles”.   At 5:00 AM the next morning, I had 27 favorite lyrics from 24 songs; the result of a very fun and reflective evening.  There is no accompanying narrative to the included lyrics, just the song title/album title/album cover.  All lyrics for the songs by the Eagles were found here: http://www.azlyrics.com/

 “The records in the house I really remember were, well, Glen Campbell’s ‘Wichita Lineman’ and ‘Galveston.’ Even as a kid, I knew these songs were glorious. My dad also had records by Merle Haggard, Charley Pride, Waylon Jennings, and then there was also the Eagles and Don Henley. Anything Texas, which includes Don Henley, was big.”  Keith Urban

Album: “The Eagles” (1972)

01-eagles-1972

“Take It Easy”
I gotta know if your sweet love is
gonna save me
We may lose and we may win though
we will never be here again

“Peaceful Easy Feeling”
I like the way your sparkling earrings lay,
Against your skin, it’s so brown.
And I wanna sleep with you in the desert tonight
With a billion stars all around.

“Most Of Us Are Sad”
Most of us are sad
No one lets it show
I’ve been shadows of myself
How was I to know?

Most of us are sad it’s true
Still we must go on

Album: “Desperado” (1973)

02-desperado-1973

“Desperado”
It may be rainin’, but there’s a rainbow above you
You better let somebody love you (let somebody love you)
You better let somebody love you before it’s too late

“Saturday Night”
What a tangled web we weave
Go ’round with circumstance
Someone show me how to tell the dancer
From the dance

“Doolin-Dalton / Desperado Reprise”
The queen of diamonds let you down,
She was just an empty fable
The queen of hearts you say you never met

Album: “On The Border” (1974)

03-on-the-border-1974

“Already Gone”
Just remember this, my girl, when you look up in the sky
You can see the stars and still not see the light (that’s right)

“Already Gone”
So often times it happens that we live our lives in chains
And we never even know we have the key

“My Man”
No man’s got it made till he’s far beyond the pain
And we who must remain go on living just the same

“The Best Of My Love”
I’m goin’ back in time
And it’s a sweet dream
It was a quiet night
And I would be all right
If i could go on sleepin’

“The Best Of My Love”
But here in my heart I give you the best of my love

Album: “One Of These Nights” (1975)

04-one-of-these-nights-1975

“One Of These Nights”
The full moon is calling
The fever is high
And the wicked wind whispers
And moans

“Take It To The Limit”
If it all fell to pieces tomorrow
Would you still be mine?

“Lyin’ Eyes”
Ain’t it funny how your new life didn’t change things
You’re still the same old girl you used to be

Album: “Hotel California” (1976)

06-hotel-california-1976

“Victim Of Love”
Some people never come clean
I think you know what I mean
You’re walkin’ the wire, pain and desire
Looking for love in between

“Hotel California”
“Please bring me my wine”
He said, “We haven’t had that spirit here since nineteen sixty nine”
And still those voices are calling from far away,
Wake you up in the middle of the night

“Hotel California”
Some dance to remember, some dance to forget

“New Kid In Town”
You look in her eyes; the music begins to play
Hopeless romantics, here we go again

“Wasted Time”
And maybe someday we will find , that it wasn’t really wasted time

Album: “The Long Run” (1979)07-the-long-run-1979

“I Can’t Tell You Why”
Aren’t we the same two people who live
through years in the dark?
Ahh…
Every time I try to walk away
Something makes me turn around and stay
And I can’t tell you why

“The Sad Cafe”
Some of their dreams came true,
some just passed away
And some of them stayed behind
inside the Sad Cafe.

Album: “Eagles Live” (1980)08-eagles-live-1980

“Seven Bridges Road”
There are stars in the Southern sky
And if ever you decide
You should go
There is a taste of thyme sweetened honey
Down the Seven Bridges Road

Album: “Hell Freezes Over” (1994)

10-hell-freezes-over-1994

“Get Over It”
Complain about the present and blame it on the past
I’d like to find your inner child and kick its little ass

“Love Will Keep Us Alive”
I was standing
All alone against the world outside
You were searching
For a place to hide
Lost and lonely
Now you’ve given me the will to survive
When we’re hungry, love will keep us alive

“Learn To Be Still”
Now the flowers in your garden
They don’t smell so sweet
Maybe you’ve forgotten
The heaven lying at your feet

“Pretty Maids All In A Row”
Why do we give up our hearts to the past?

 Album: “Long Road Out Of Eden” (2007)

12-long-road-out-of-eden-2007

“It’s Your World Now”
A perfect day, the sun is sinkin’ low
As evening falls, the gentle breezes blow
The time we shared went by so fast
Just like a dream, we knew it couldn’t last
But I’d do it all again
If I could, somehow
But I must be leavin’ soon
It’s your world now

“I’ve dreamed a lot. I’m tired now from dreaming but not tired of dreaming. No one tires of dreaming, because to dream is to forget, and forgetting does not weigh on us, it is a dreamless sleep throughout which we remain awake. In dreams I have achieved everything.” Fernando Pessoa

Cover photo credit: https://s-media-cache-ak0.pinimg.com/originals/e5/aa/eb/e5aaeb8a5363fdeacccb567becee86b6.jpg

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