“I've always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept; All the little monsters closed up in a steamer trunk at the foot of the bed.”
This simple quote from David Benioff, an American TV producer and screenwriter, is close to the scientific truth about sleep and its effects on mental and overall health. Most notable is the growing evidence of a relationship between lost, fragmented and disordered sleep and the incidence of dementia and Alzheimer’s disease, the most common form of dementia.
These neurological disorders, which cause deterioration of cognition, memory, focus, and attention and manifest themselves during the latter stages of a person’s life, are of major public health concern as the large Baby Boomer population enters old age. The Alzheimer’s Association estimates Alzheimer’s disease now impacts some 5.8 million Americans, resulting in health-related costs, including hospice and long-term care, of some $290 billion. One point of hope for Alzheimer’s patients is that lithium microdosing may be helpful in stopping Alzheimer’s from advancing.
Just published in the January 2020 issue of Neurology is research indicating that acute sleep loss or disrupted sleep — even in young, healthy people — is linked to increased levels of the protein tau in cerebral spinal fluid. Abnormal accumulations of tau are believed responsible for creating neurofibrillary tangles found in the brain cells of Alzheimer’s patients.
Authors of an earlier study, which monitored nearly 300 elderly women for five years, determined that almost 45 percent of those who experienced sleep apnea – disordered breathing problems during sleep — developed either dementia or mild cognitive impairment, considered a precursor to Alzheimer’s disease, compared to only 31 percent of participants who slept normally.
What Is It About a Good Night’s Sleep?
In describing results of research published in 2019 in Science Advances, neuroscientist Maiken Nedergaard calls restorative sleep a brain cleanser. Nedergaard is the discoverer of the glymphatic system, a pathway allowing cerebral spinal fluid to enter the brain and clear it of natural waste products during deep, non-REM (rapid eye movement) sleep when cerebral blood flow volume falls.
Although the question remains whether buildup of waste byproducts due to sleep deprivation actually damages functioning of the brain’s neurons, evidence suggests that dementia, Alzheimer’s, and other neurological disorders are associated with sleep problems like insomnia, daytime fatigue (hypersomnia), sleep apnea, and circadian rhythm abnormalities. Also well described is how the normal aging process reduces the amount of time a person spends in sleep, including deep sleep, and heightens the risk for sleep fragmentation, including difficulties falling or remaining asleep.
Any Pill, or Cure, Out There?
Until recently, commonly prescribed sleep medications, including over-the-counter sleep aides, have been in a class of drugs known as anticholinergics; they work by blocking the action of acetylcholine, a neurotransmitter that plays an important role in arousal, attention, memory, and motivation. Unfortunately, these drugs tend to suppress restorative deep, slow-wave sleep, and REM sleep and can lead to dependency. A study announced during the Alzheimer’s Association 2019 International Conference actually demonstrates a connection between these sleep medications and an increased risk for developing dementia and Alzheimer’s disease.
But hope may be on the horizon.
At the 2019 American Academy of Neurology Annual Meeting, researchers offered evidence of the effectiveness and improved safety of a newer drug, suvorexant, in treating insomnia among patients with mild to moderate forms of Alzheimer’s dementia. Other clinical studies show this medication, marketed under the name Belsomra, allows patients to fall asleep more quickly and promotes restoration of more natural sleep without dependency, making the drug potentially helpful in improving the sleep of patients in early stages of dementia. Scientists also report in the Journal of Clinical Psychiatry that suvorexant may provide protection against delirium in older patients. In the future, suvorexant might even prove effective in treating insomnia in people of all ages.
Tips for Better Sleep
Of course, most desirable sleep comes au naturale – without medication. Here are tips from the National Sleep Foundation for achieving healthy rest:
- Follow a regular sleep schedule. Go to bed and get up about the same time every day.
- Avoid caffeinated drinks, alcohol or heavy meals or strenuous and stressful activities just before bedtime. Take time to “wind down.”
- Exercise daily, but do so, whenever possible, in the morning or early afternoon.
- Keep the bedroom at a cooler temperature and use the room strictly for sleeping – not for watching television or riding a stationary bicycle.
- Use a comfortable mattress and pillow.
- In the evenings, stay away from bright lights, which promote wakefulness.
- If you cannot fall asleep, get up and read or do some other relaxing activity until becoming drowsy.
Should all else fail, contact a physician. Sleep is vital to health; don’t shortchange it.