June is Alzheimer's and Brain Awareness Month, an important issue altering the lives of so many people in our country. According to the Alzheimer’s Association, someone develops Alzheimer’s disease (AD) every 65 seconds and almost 6 million Americans have been diagnosed to date. This statistic is estimated to triple by 2050, as the millennial generation ages and transitions to senior citizenship. It costs hundreds of billions of dollars to provide the necessary care for people with dementia, which often falls on family members due to the rising costs of healthcare. For anyone who has a friend or family member battling AD, you know how devasting it is to watch the progression of the disease as memory fades and confusion sets in. Unfortunately, there is no cure for AD, and medication can only temporarily slow the symptoms. That is why it is important to do everything you can to protect your brain and reduce your risk now. According to Aaron Roberts, MD, PPG — Sleep Medicine, these measures include sleep.
The latest research
As more research is funded for AD, more evidence is supporting a strong link between sleep (or lack thereof) and its pathogenesis. Two recently published articles highlight this association. The first is an article published in JAMA Neurology showing elderly people who have excessive daytime sleepiness also have an increased accumulation of β-amyloid which is a protein in the brain associated with AD. Scientists speculate that sleep helps with the clearance of β-amyloid and reduces plaque buildup.
Another article published this past April revealed this accumulation can occur after just one night of sleep deprivation. This is not to say that missing one night of sleep will condemn you to developing AD, just like smoking one cigarette will not sentence you to getting lung cancer, but over prolonged periods of time the damage certainly adds up.
There are many causes for sleep deprivation and poor sleep; fortunately, many of these can be corrected with proper guidance. One major cause (especially in people who are obese and over the age of 50) is untreated obstructive sleep apnea (OSA). A longitudinal study followed over 200 cognitively normal elderly individuals for two years to assess the association of sleep apnea and amyloid burden. What the researchers found was an increased amount of β-amyloid in those with OSA compared to those without OSA. It is thought that the dips in oxygen level and increased sleep fragmentation from repeated airway obstruction throughout the night is a likely mechanism for this finding. Another study showed people with AD who are adequately treated with continuous positive airway pressure (CPAP) slowed the progression of the disease.
So, let’s say you sleep alone and no one has ever told you if you snore or not. How do you know if you have sleep apnea? An easy way to determine your risk stratification of having OSA is to fill out the STOP-BANG questionnaire. If you are at high risk, then speak with your primary care physician about getting a sleep study. Even if you are at low to moderate risk but have a strong family history of OSA or have a strong concern, it is still worth mentioning during your next annual physical.
A lot is still unknown about AD, but as time goes on more and more evidence is pointing toward poor sleep as a major risk factor. One day we might know the exact underlying mechanism of AD, but more research needs to be done. Until then, we should strive to get consistent good quality sleep and treat any underlying sleep disorders (such as obstructive sleep apnea) that can increase our risk of developing AD. Strive to get 7-9 hours of sleep per night as recommended by the National Sleep Foundation. If you need some tips on how to get good sleep, explore some past articles here. Lastly, do not be hesitant to talk with your primary care physician about getting evaluated for a sleep disorder or placing a referral to see a sleep specialist.