Alzheimer’s Disease and dementia patients are frequently plagued by sleep disturbances. Despite several studies, it remains unclear as to whether poor sleep causes or worsens existing dementia or if dementia leads to poor sleep. It is highly possible that both are true.
William Jagust, a U.C. Berkeley neuroscientist conducted a study of human subjects and concluded that “over the past few years, the link between sleep, beta-amyloid, memory, and Alzheimer’s disease has been growing stronger.” He additionally concludes that “our study shows that this beta-amyloid deposition may lead to a vicious cycle in which sleep is further disturbed and memory impaired.”
The two regions of the brain that help regulate sleep are the basal forebrain and the reticular formation of the brainstem. Both of these brain regions appear to be damaged in dementia patients.
The immune system, the vascular system, hormones and almost every system in the body are impacted by sleep.
There are several different types of sleep disorders. These include sleep/wake cycle disorder, REM sleep behavior disorder(RBD), and sleep disordered breathing.
SLEEP/WAKE CYCLE DISORDER–also known as Circadian Rhythm Sleep Disorder is characterized by sleep patterns that occur at irregular times of the day. Changes in circadian rhythm are common in elderly people. They can manifest by either falling asleep and waking up very early or by waking up several times throughout the night, thus being deprived of one prolonged phase of sleep. These alterations in an optimum circadian rhythm are brought on by aging, reduced exposure to natural light and a decrease in physical activity.
SLEEP APNEA-There are two types of sleep apnea and both involve chronic snoring and/or a temporary loss of breath during sleep. OSA is obstructive sleep apnea and involves problems in the cardiovascular and/or central nervous system. These conditions cause inadequate levels of oxygen in the tissues and cells and can amplify dementia related symptoms. Often, this hypoxic condition impairs blood flow to the brain. Sleep disordered breathing episodes are quite common among Alzheimer’s and dementia patients.
RBD or REN SLEEP BEHAVIOR DISORDER–involves involuntary physical or emotional reactions during sleep.
While it has proven to be difficult to come up with an effective cure for sleep disorders, certain lifestyle changes can improve sleep issues. My opinion is that sleep medications requiring a prescription tend to exacerbate the problem and further compromise cognitive function. Having said that, there has been some success with melatonin, gaba, l-theonine and magnesium, but one must carefully experiment to determine both safety and efficacy.
A CPAP machine for disordered breathing is often used to alleviate snoring, facilitate breathing and can result in better moods, improved focus and a slowing of cognitive impairment.
Additional lifestyle changes include:
A consistent sleep schedule where one goes to sleep and wakes up at the same time every day. This has been proven to help maintain regular circadian rhythm patterns.
Regular exposure to outdoor light, particularly upon wakening can help reset one’s circadian clock.
Regular physical exercise and stretching are beneficial to healthy sleep patterns.
Nutrition-there are certain foods known to trigger one’s own production of melatonin and it is wise to avoid certain foods and beverages that impair sleep (alcohol and caffeine).
A very dark and cold room is most conducive to falling asleep and remaining asleep.
Whle it is promising that certain lifestyle changes can improve our sleep quality, it remains unclear as to whether the formation of the beta-amyloid protein or the poor sleep quality triggers the decline. As U.C. Berkeley neuroscience professor, Matthew Walker states, “…the more beta-amyloid you have in certain parts of the brain, the less deep sleep you get and, consequently, the worse your memory. Additionally, the less deep sleep you have, the less effective you are at clearing out this bad protein. It’s a vicious cycle.”
While the data is not conclusive as to whether poor sleep is a risk factor for dementia, entire books, website, podcasts, and even careers have been devoted to sleep.