The Myth Of The Need For 8 Uninterrupted Hours Of Sleep
Before the advent of the lightbulb, we went to sleep when it got dark. Interestingly, heading to bed around 7:00 or 8:00 p.m. meant that we had about 12 whole hours of restful time, so it was natural for us to wake up in the middle of the night.
The eight uninterrupted hours of sleep is a modern notion that, unfortunately, causes many sleepers a great deal of concern. But we should learn to rethink the way we sleep.
Whats ultimately most important about sleep is the quality of it, not the quantity.
Our modern lives simply dont let us get the rest we need. Laptops and smartphones naggingly chirp and glow at us all day long, ad nauseum. If we could truly unplug, we might find the peace of mind we need to get that rest.
But most of us dont have that luxury. So what can we do to get the sleep we so desperately need? It may simply mean accepting that waking up during the night is part of normal human physiology, says sleep psychologist Gregg Jacobs.
What Sleep Problems Can Be Caused By Dementia What Sleep Problems Can Be Caused By Dementia
Insomnia Insomnia.
Insomnia includes a wide range of sleep problems, such as taking a long time to fall asleep, waking up often during the night, having nightmares and waking up early in the morning. These result in the person not getting enough good-quality sleep.
Insomnia is a common problem for people with dementia, and different causes include the following:
- The person may be struggling with pain or discomfort.
- They may have other health conditions that make sleep more difficult, such as heart or breathing problems, heartburn, constipation, urinary tract infections or incontinence.
- They may be feeling anxious, stressed or depressed.
- They may be taking medications that cause insomnia as a side effect. This is common with drugs prescribed to improve dementia symptoms, such as donepezil, rivastigmine, or galantamine.
These drugs can also lead to very vivid dreams or nightmares. If this happens, they may find taking their medication in the morning rather than at bedtime helps.
There are drugs that can help a person get to sleep more easily. However, most have unpleasant or potentially dangerous side effects, such as dizziness and an increased risk of falls. This makes them less safe for a person with dementia to take. They tend to only be prescribed for very short-term use when the person has severe sleep problems.
Excessive daytime sleepiness Excessive daytime sleepiness.
For more information on hallucinations and delusions see Changes in perception.
What Is The Body Clock
Our bodies sense natural light to know roughly what time of day or night it is. We also get a sense of time from routine daily activities such as mealtimes, to create a sleep and wake cycle over 24 hours.
This tells our brains when its time to go to sleep and when to wake up again .
The body clock of a person with dementia may become damaged, making it harder for them to feel awake and alert during the day, and sleepy during the evening.
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Do People With Alzheimers Sleep More
People with Alzheimers and other forms of dementia often sleep for long periods and may need to sleep during the day.
As Alzheimers progresses, it causes an increasing amount of damage to the brain, and the individual becomes weaker. A person may feel exhausted after everyday tasks, such as communicating, eating, or trying to make sense of the world around them. People may sleep more during the day as the symptoms worsen.
Additionally, medications that doctors prescribe to treat Alzheimers can contribute to sleepiness. These medications may include antipsychotics, antidepressants, antihistamines, and sleeping pills.
Sleep Six To Eight Hours Each Night
In the first study, researchers at Harvard Medical School studied more than 2,800 individuals ages 65 and older participating in the National Health and Aging Trends Study to examine the relationship between their self-report of sleep characteristics in 2013 or 2014, and their development of dementia and/or death five years later. Researchers found that individuals who slept fewer than five hours per night were twice as likely to develop dementia, and twice as likely to die, compared to those who slept six to eight hours per night. This study controlled for demographic characteristics including age, marital status, race, education, health conditions, and body weight.
In the second study, researchers in Europe examined data from almost 8,000 participants from a different study and found that consistently sleeping six hours or less at age 50, 60, and 70 was associated with a 30% increase in dementia risk compared to a normal sleep duration of seven hours. The mean age of dementia diagnosis was 77 years. This study controlled for sociodemographic, behavioral, cardiometabolic, and mental health factors, although most participants were white, better educated, and healthier than the general population. In addition, approximately half of the participants had their sleep duration measured objectively using a wearable accelerometer a device that tracked their sleep using body movements which confirmed the questionnaire data.
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Loss Of Neurons Not Lack Of Sleep Makes Alzheimers Patients Drowsy
Reviving Awake Neurons Could Be the Solution to Their Sleepiness, UCSF Study Shows
Image by Grinberg Lab
The lethargy that many Alzheimers patients experience is caused not by a lack of sleep, but rather by the degeneration of a type of neuron that keeps us awake, according to a study that also confirms the tau protein is behind that neurodegeneration.
The studys findings contradict the common notion that Alzheimers patients sleep during the day to make up for a bad night of sleep and point toward potential therapies to help these patients feel more awake.
The data came from study participants who were patients at UC San Franciscos Memory and Aging Center and volunteered to have their sleep monitored with electroencephalogram and donate their brains after they died.
Being able to compare the study participants sleep data with microscopic views of their post-mortem brain tissue was the key to answering a question that scientists have been pondering for years.
We were able to prove what our previous research had been pointing to that in Alzheimers patients who need to nap all the time, the disease has damaged the neurons that keep them awake, said Lea Grinberg, MD, PhD, a neuropathologist who, along with psychiatrist Thomas Neylan, MD, is a senior author on the study, which appears in the April 4, 2022, issue of JAMA Neurology.
Lack Of Sleep And Alzheimers Risk
Can lack of sleep cause Alzheimers? Recent studies confirm what many of us already know: sleep gets worse as we age. Starting around middle-aged and older, people often wake more frequently at night, sleep less deeply and wake too early in the morning. Could these sleeping issues be putting us at risk for cognitive decline or even Alzheimers disease?
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Sleep Disorders Commonly Associated With Alzheimers
Estimates suggest that up to half of all people with Alzheimerâs experience sleep problems. Sleep in Alzheimerâs tends to be fragmented and often distributed across a 24-hour period rather than following the regular rhythms of sleeping during the night and waking with the light.
Many people with Alzheimerâs sleep excessively during the day and struggle to sleep during the night-time hours. Itâs thought that this dysregulated sleep may result from damage to areas of the brain that control the body clock.
Our body clock refers to an internal system within our body that controls numerous physical processes related to wake and sleep. Itâs well established that the body clock is dysregulated in Alzheimerâs disease.
Studies have shown that for people with Alzheimerâs, neuronal loss and tangles of tau protein can be observed within the part of the brain responsible for controlling the body clock. 16
This part of the brain also regulates release of melatonin, the hormone that signals to our brains that itâs time to sleep.
In people with Alzheimerâs, melatonin levels are known to be reduced and, in more advanced Alzheimerâs, the timing of melatonin levels rising and falling has been shown to be disturbed.17
People with Alzheimerâs also commonly experience sleep disorders including:
- REM sleep behaviour disorder
- sleep problems arising from mood disorders.
Report On Systematic Reviews And Meta
Because of the availability of several epidemiological studies on the association between sleep disturbances and cognitive disorders, recent systematic reviews and metaanalyses have been conducted on this topic. Almondes and collaborators5151. de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: systematic review and meta-analysis. J Psychiatr Res. 2016 Jun 77:109-15. https://doi.org/10.1016/_i.jpsychires.2016.02.021 analysed five community-based prospective cohorts aiming to evaluate the risk of dementia in people with a history of insomnia. They found an association of insomnia with a significant risk of all-cause dementia .
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Glucose Hyperglycemia And Advanced Glycation End Products
Chronic hyperglycemia associated with insulin resistance could influence cognitive performance. Hyperglycemia is associated with deterioration in mood and cognitive function in patients with type 2 diabetes .
Chronic hyperglycemia leads to the accelerated formation of advanced glycation end products , commonly observed in obesity, diabetes, and AD . AGEs are a very large group of molecules formed from non-enzymatic glycation reactions that affect the structure and function of proteins, amino acids, and nucleic acids . Under inflammatory conditions such as acute sepsis, the interaction between AGEs, and their receptors in the brain results in the activation of pro-inflammatory genes in the blood, hippocampus, and prefrontal cortex. These changes are associated with neuroinflammation, increased A immunodetection, and enhanced Tau phosphorylation in the hippocampus. In this model, blocking RAGE inhibits neuroinflammation and neurodegeneration markers . Similar findings indicating that RAGE antagonist or RAGE knockout mice fail to present spatial memory deficits suggest that AGES play a role in cognitive impairment .
These mechanisms could also be involved in sleep restriction-associated cognitive impairment, because: isolated brain endothelial cells from sleep-restricted mice have lower levels of GLUT1 and decreased 2-deoxy-glucose uptake in the brain and sleep restriction increases the plasmatic soluble RAGE in rats .
Caring For The Caregivers
When we talk about the effects of Alzheimerâs on sleep, itâs important not to overlook the fact that thereâs a whole army of caregivers who are also at high risk of experiencing sleep problems.
Caring for someone with Alzheimerâs is a full-time task and it can be both mentally and physically exhausting. As a caregiver, if your sleep is being compromised or youâre struggling to sleep, then you shouldnât feel as if youâre fighting a lone battle.
Surveys show that around 70% of caregivers for people with dementia report problems sleeping. The majority sleep for fewer than seven hours per night and up to a fifth use alcohol or medication to get to sleep. 21222324
These figures are worrisome and show that thereâs a definite need for greater support for caregivers of people with Alzheimerâs.
Encouragingly, thereâs plenty of research looking into the best ways to improve the sleep and overall quality of life of people in caregiving roles.
Research has shown that non-medical interventions are successful in improving sleep in caregivers and may additionally help to reduce stress levels. 21
Sleepstationâs drug-free and clinically validated sleep improvement programme can help you to identify your sleep problems and will give you the tools you need to get your sleep back on track.
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Sleep Changes In Alzheimer’s Disease Dementia
Electroencephalographic studies on AD patients in the 1980s and 1990s provided valuable information about sleep patterns in AD dementia compared with the healthy elderly and neuropsychiatric disorders, such as depression. Sleep disturbances in patients with AD dementia were qualitatively similar to those seen in the healthy elderly3232. Peter-Derex L, Yammine P, Bastuji H, Croisile B. Sleep and Alzheimer’s disease. Sleep Med Rev. 2015 Feb 19:29-38. https://doi.org/10.1016/j.smrv.2014.03.007. However, the severity of the changes was usually higher, and the REM sleep had specific alterations. Wakefulness commonly increased and, consequently, sleep was more disrupted at night in AD dementia, with an increase in number and duration of awakenings, resulting in a shorter total sleep time and lower sleep efficiency3333. Vitiello M V, Prinz PN, Williams DE, Frommlet MS, Ries RK. Sleep disturbances in patients with mild-stage Alzheimer’s disease. J Gerontol. 1990 45:M131-8.. As a result, a higher percentage of stage 1 and 2 sleep and lower percentage of slow-wave sleep was observed in these patients3434. Petit D, Gagnon JF, Fantini ML, Ferini-Strambi L, Montplaisir J. Sleep and quantitative EEG in neurodegenerative disorders. J Psychosom Res. 2004 May 56:487-96. https://doi.org/10.1016/j.jpsychores.2004.02.001.
Table 2
How Alzheimers Affects The Brain
To understand the interplay between sleep and Alzheimerâs, itâs useful to understand a little of what happens in the brain with Alzheimerâs. Our brains are made up of many different types of cells but the most well known are neurones.
These cells transmit and receive electrical and chemical signals which allow them to convey messages throughout the brain and body. Itâs neurones that allow us to move, think, experience emotions and interact with the world around us.
In Alzheimerâs thereâs a gradual destruction of these cells. Initially, the disease attacks neurones responsible for memory 3, which is why confusion and forgetfulness are usually the first symptoms observed in Alzheimerâs.
Later in the progression, neurones in other regions all over the brain are targeted and the person will lose their ability to live and function independently.
This loss of neurones is caused by a build up of certain proteins that form in plaques and tangles within the brain. If we think of the neurones as a giant highway connecting all of our brain and body together, then these protein build-ups act like road blocks and potholes.
They disrupt and ultimately stop information being sent from A to B within the body. The two main proteins so far identified in these processes are called beta-amyloid and tau.
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Is It Safe For Alzheimers Patients To Take Sleep Aids What Should I Do If I Experience Side Effects
The routine use of medications to treat sleep issues in patients with Alzheimers disease is not supported by current scientific evidence. Sleep aids carry extra risks for people with Alzheimers they can cause falls and injury, increase memory loss and confusion, and may have an overly sedative effect. Sleep aids are typically reserved for cases where all other options have been exhausted and should only be given under guidance of a physician.
Melatonin supplements have been studied as a possible option for improving sleep quality in Alzheimers patients. However, research examining the effectiveness of melatonin supplements in people with dementia has produced conflicting results. Some studies demonstrated a small benefit, increasing nighttime sleep by around 30 minutes, while other studies showed no benefit. There is also evidence to suggest that melatonin supplements may increase social withdrawal and depression in patients with dementia.
Normal Sleep Pattern Changes In Older Age
Research has documented a number of sleep changes that occur in healthy aging adults. These include bedtimes and wake times shifting to an earlier hour, taking longer to fall asleep once in bed, experiencing fragmented sleep, sleeping fewer hours per night, and spending less time in slow-wave and REM sleep. Although these changes parallel some of the sleep challenges seen in people with dementia, the sleep pattern changes in dementia patients tend to be more dramatic and disruptive.
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Sundowning How Behaviour Can Change As The Night Draws In
Sundowning is a term used to describe behavioural changes that usually happen in the late afternoon/early evening. People with Alzheimerâs may experience symptoms such disorientation, confusion, hallucinations, agitation and aggression at these times. 20
To some degree, sundowning is linked to the changes in the light/dark cycle, as it has been observed that incidence increases among dementia patients during winter when there is less natural light.
Another contributing factor can be increasing levels of mental and physical exhaustion that have built up over the day. This tiredness can intensify feelings of stress and anxiety.
Sundowning affects every person differently but for some it can mean that they find it difficult to sleep at night, often wandering and remaining highly agitated throughout the night-time hours.
Thereâs no one clear causative explanation for sundowning but thereâs a host of methods that can be used to try to reduce its effects.
Poor Quality Sleep Could Increase Alzheimer’s Risk: Researchers
The study, published in the journal Brain, doesn’t show that poor sleep causes Alzheimer’s, but it adds one more piece to the puzzle of what causes dementia.
“When people had their slow-wave sleep disrupted, their amyloid levels increased by about 10 percent,” said Dr. Yo-El Ju of Washington University in St. Louis, who led the study.
Many other studies have linked poor sleep with earlier onset of dementia and especially Alzheimer’s. And a study published last week in the journal Neurology found that levels of amyloid, the protein that clogs the brains of Alzheimer’s patients, rose with poor sleep.
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This study sought to identify the most important phase of sleep. Ju and colleagues recruited 17 healthy adults for the study.
“What we did was allow people to sleep a normal amount of time, but we prevented them from getting deep sleep or what is called slow-wave sleep,” Ju told NBC News.
“When we interrupted just the slow-wave sleep part, they still had an increase in amyloid. So this tells us it’s getting the deep slow-wave sleep that’s important for reducing the levels of amyloid.”
More than 5 million Americans have Alzheimer’s, and the number is expected to grow as the population ages. There’s no cure, and treatments do not work well. Drugs such as Aricept, known also as donezepil, and Namenda can reduce symptoms for a time, but they do not slow the worsening of the disease.
“It was pretty harsh.”
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