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Is There a Link Between Sleep and Dementia?

Is There a Link Between Sleep and Dementia?

It is well known that individuals with a diagnosis of Alzheimer’s disease experience disrupted sleep-wake cycles, frequently sleeping during the day and wakeful at night. However, there is new evidence that poor sleep may actually contribute to the onset, and be an early symptom of, Alzheimer’s disease and other forms of dementia.

In 2013, researchers at the Johns Hopkins Bloomberg School of Public Health published findings in JAMA Neurology examining the association between sleep duration and quality, and amyloid buildup in the brain, a common biomarker for Alzheimer’s disease. The researchers studied 70 older adults, who were part of the ongoing Baltimore Longitudinal Study of Aging. Using PET brain scans, they found that those who reported receiving under five hours a night, or who slept fitfully, had higher levels of beta-amyloid in the brain than those who slept over seven hours a night.

Another study, published in Neurology in 2014, looked at sleep patterns in 167 older Japanese American men. The men with the lowest blood oxygen levels at night (sleep apnea), were four times more likely to have brain damage caused by “mini-strokes” that often proceed a diagnosis of vascular dementia. In addition, the men who spent the least amount of time in deep sleep were more likely to show loss of brain cells and brain atrophy. However, unlike the Johns Hopkins study, the researchers found no association between sleep disturbance and higher amyloid levels in their brains. Nonetheless, prior studies have shown that treating sleep apnea may improve cognition, and because sleep apnea is also linked to high blood pressure and cardiac problems, it should always be taken seriously.

Lastly, poor sleep is a very common complaint in older adults who also tend to self medicate using over-the-counter sleep aids containing diphenhydramine (Benadryl), an anticholinergic medication. A large study published in JAMA Internal Medicine in January 2015 by the University of Washington linked taking anticholinergic medications at high doses, or over a long period of time, to a significantly increased risk of developing dementia. This is the first study to suggest that dementia risk can be linked to the frequent use of anticholinergic medications. Furthermore, the effect may not be reversible even years after people stop taking these drugs.

It is very important to tell your physician if you are having sleep problems and provide a list of any over the counter medications that you use to treat insomnia. Also, be aware that many over the counter medications contain diphenhydramine, including cold medications.

Here are some other general tips for getting a good night’s sleep:

•    Follow a regular schedule. Try to sleep and get up at the same time each day, even on weekends. Napping in the late afternoon or evening may keep you awake at night.

•    Develop a bedtime routine. About 30-45 minutes before bedtime each night, do the same things so your body will know that it’s time to sleep, such as reading a book, listening to soothing music, or soaking in a warm bath.

•    Your bedroom should be dark, not too hot or too cold, and as quiet as possible.

•    Be sure you have a comfortable mattress and pillow.

•    Exercise at regular times each day, but not within 3 hours of your bedtime

•    Be careful about when and how much you eat. Large meals close to bedtime may keep you awake. However, a light snack in the evening may help you to sleep better.

•    Stay away from caffeine late in the day. Caffeine (found in coffee, tea, some colas, and chocolate) is a stimulant that can last several hours.

•    Drink less liquid in the evening. Waking up to go to the bathroom and turning on a bright light breaks up your sleep.

•    Avoid alcohol close to bedtime. Even small amounts make it harder to stay asleep.

•    Avoid using over-the-counter anticholinergic medications unless recommended by your physician or other medical provider.

•    Use your bedroom only for sleeping.

•    After turning off the light give yourself about 15 minutes to fall asleep. If you’re still awake and not drowsy, get out of bed. When you feel sleepy again, go back to bed.

Memory Care at Assisted Living at NewBridge on the Charles 

NewBridge on the Charles offers the Gilda and Alfred A. Slifka Memory Care Assisted Living Residences to seniors with early stage and mid-stage Alzheimer's Disease and/or a related dementia. The Memory Care Assisted Living Residences at NewBridge on the Charles provides a personalized and meaningful assisted living experience for residents based on the history, preferences and goals of each individual. Short-term stays now available. 

Learn more about Memory Care at NewBridge

Elaine Abrams, MPH, RN, CHES's picture

About the Blogger

Program Manager, Alzheimer’s & Dementia Care at Hebrew Senior Life until June 2015

Elaine Abrams, MPH, RN, CHES, has more than 25 years of nursing, public health, and health education experience. Her areas of expertise include community health assessment, program development and management, and health communications. A graduate of University of Connecticut Graduate Program in Public Health, Elaine has held several leadership roles including President-elect at the Connecticut Public Health Association, the state affiliate of the American Public Health Association, where she also served for several years on the Board of Directors. 

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