FIRST:  WHAT RESEARCH SAYS ABOUT WHY WE NEED A GOOD NIGHT’S SLEEP FOR BRAIN

HEALTH (research reports edited by Nancy Emerson Lombardo, Ph.D. July 2012)

SECOND: TIPS FOR GETTING ADEQUATE SLEEP  (SEE SECTION BELOW)

Sleep Duration, Sleep Disorders, and Circadian Patterns are Risk Factors and Indicators of Cognitive Decline  

AAIC Alzheimer’s Association International Conference Press Release          www.alz.org/aaic/mon_1030amct_irregular_sleep.asp

VANCOUVER, July 16, 2012 – Four studies reported today at the Alzheimer’s Association International Conference® 2012 (AAIC® 2012) in Vancouver suggest a relationship between sleep quality and quantity and risk of cognitive decline, and that interventions to normalize sleep duration and correct sleep disorders may not only improve quality of life, but have potential to reduce or prevent cognitive decline.

“We know that sleep patterns change as people age and that poor sleep affects overall health. What we don’t know for certain is whether poor sleep has long-term consequences on cognitive function,” said William Thies, PhD, Alzheimer’s Association® chief medical and scientific officer.

“The studies presented today at AAIC suggest that cognitive health declines over the long term in some people with sleep problems. The good news is that tools already exist to monitor sleep duration and quality and to intervene to help return sleep patterns to normal. If we do this, there is the possibility that we may also help people preserve their cognitive health, but that needs to be tested,” Thies added.

Too little and too much sleep are associated with lower cognition

Growing evidence suggests that sleep duration that is shorter or longer than the recommended seven hours per day may increase risk of cardiovascular disease and type 2 diabetes. However, little research has been conducted examining whether sleep duration influences cognition among older individuals.

Elizabeth Devore, ScD, of Brigham and Women’s Hospital, Boston, and colleagues examined data for more than 15,000 participants in the Nurses’ Health Study. All were age 70 or older at their first cognitive examination between 1995 and 2000. Follow-up cognitive assessments were conducted every other year for six years. Participants’ daily sleep duration was categorized as ≤5, 6, 7, 8 or ≥9 hours (7 hours per day was considered normal). Average sleep duration was self-reported in 1986 (when women were ages 40 to 65) and 2000 (when women were ages 54 to 79).

The scientists found that:

  • Participants who slept 5 hours per day or less had lower average cognition than those who slept 7 hours per day.
  • Those who slept 9 hours per day or more also had lower average cognition than those who slept 7 hours per day.
  • Too little or too much sleep was cognitively equivalent to aging by 2 years.

When the researchers evaluated the effects of change in sleep duration from mid- to later- life, they observed that women whose sleep changed by 2 hours per day or more had worse cognitive function than those with no change in sleep duration, independent of their initial sleep duration.

Comment: Since this is an observational study, not a clinical trial,  it is unknown whether the observed sleep patterns cause, or are caused by,(or are coincidental to) the changes leading to cognitive impairment.

Sleep disorders, circadian disruptions associated with increased risk of cognitive impairment

As people age, they are more likely to develop problems with sleeping, such as insomnia, sleep apnea and disruptions in circadian rhythm. (Circadian rhythms are physical, mental and behavioral changes that follow a 24-hour cycle.) Whether these problems affect one’s cognitive function or risk of developing mild cognitive impairment (MCI) or dementia is not definitively known.

“Studies that have explored the relationship between sleep and dementia are often cross sectional and depend on the participant’s self-report rather than objective measures of sleep quality,” said Kristine Yaffe, MD, of the University of California, San Francisco.

Instead, Yaffe and colleagues conducted a series of studies evaluating more than 1,300 older women (≥75) enrolled in a large multi-center study to investigate the relationship between objectively measured sleep quality (using actigraphy* and polysomnography**) and adverse cognitive outcomes.

* Actigraphy is a method of monitoring rest/activity cycles. A small sensor unit is worn, usually on the wrist, to measure gross motor activity. The unit continually records the movements it undergoes.  ** Polysomno-graphy, also known as a sleep study, is a comprehensive recording of the physical changes that occur during sleep. The PSG monitors many body functions including brain, eye movements, muscle activity or skeletal muscle activation, breathing functions, and heart rhythm.

Over five years, the researchers assessed cognitive function and clinical cognitive status (normal, MCI or dementia) and obtained objective measures of sleep parameters, including sleep apnea, night-time wakefulness, total sleep time, and shifts in circadian rhythm.

The scientists found that:

  • Participants with sleep-disordered breathing or sleep apnea had more than twice the odds of developing MCI or dementia over the five years compared with those who did not have sleep-disordered breathing.
  • Women who developed a disruption of their circadian rhythm (delay in the acrophase) over the five years were at increased risk of developing MCI or dementia compared with individuals who did not.
  • Participants with greater night-time wakefulness were more likely to score worse on tests of global cognition and verbal fluency than those without it.

“We believe that these results indicate that the relationship between sleep disordered breathing and dementia may be connected to the decrease in oxygen associated with sleep apnea and not to disrupted patterns of sleep,” Yaffe said.

“Overall, our findings support a relationship between sleep disturbances and cognitive decline in late age. They suggest that health practitioners should consider assessing older people with sleep disorders for changes in cognition,” Yaffe said. “In addition, with additional long-term research, treatment of sleep disorders may be a promising method of delaying the development of MCI and dementia.”

**** END OF ALZ ASSN PRESS RELEASE EXCERPTS  (go to their website to see more) ****

An earlier publication by Yaffe details the relationship between sleep disorders and cognitive impairment.

15 August 2011. In older women, brief suspensions of respiration during sleep (apnea) may cause more than daytime drowsiness, increased cardiovascular risk, and insulin resistance—it may also lead to mild cognitive impairment (MCI) or dementia. Results published in last week’s Journal of the American Medical Association showed that women with sleep-disordered breathing (SDB)—pauses in breathing or reduced ventilation quality during sleep—are more likely to develop cognitive impairment five years later. Hypoxia seems to be the culprit, the authors concluded.

Intermittent oxygen deprivation could be responsible, the authors suggested. Increased hypoxia—a higher percentage of total sleep time in hypopnea or apnea and greater oxygen desaturations per hour, rather than total sleep time or sleep fragmentation—was associated with MCI or dementia. If that’s the case, CPAP or supplemental oxygen therapy could mitigate sleep apnea’s harmful effects, the authors wrote. “No medications are known to prevent the progression of mild cognitive impairment to Alzheimer’s disease or dementia, so treating at-risk patients with CPAP for sleep-disordered breathing is a prevention strategy that may be worth testing,” wrote Nicola Canessa and Luigi Ferini-Strambi of the San Raffaele Scientific Institute in Milan, Italy, in an accompanying JAMA editorial.

“Given the high prevalence of both sleep-disordered breathing and cognitive impairment among older adults, the possibility of an association between the two conditions, even a modest one, has the potential for a large public health impact,” wrote the authors led by Kristine Yaffe of the University of California, San Francisco, and Katie Stone of the California Pacific Medical Center Research Institute in San Francisco.

References:  Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011 Aug 10.

Another Study reported in Web MD in February 2012 also used actual sleep studies to measure the amount of awakenings and actual sleep, and linked these to the amount of beta-amyloid in participants spinal fluid. 

This study reported that the poorer your sleep, the more likely you may be to develop preclinical (i.e. normal mental function) Alzheimer’s disease, as measured by the amount of beta-amyloid in spinal fluid or seen on brain scans.  The study is preliminary. It finds an association, but not a cause and effect.

“We found that if people had a lot of awakenings during the night, more than five awakenings in an hour, they are more likely to have preclinical Alzheimer’s disease,” says researcher Yo-El Ju, MD, assistant professor of neurology at Washington University School of Medicine in St. Louis.

Ju and her colleagues evaluated 100 men and women aged 45-80. All were free of dementia at the study start. Half of them have a family history of Alzheimer’s disease.

For 14 days, the men and women wore a device that measures sleep. They also completed sleep diaries and questionnaires.

People slept an average of six-and-a-half hours, although they spent about eight hours a night in bed.

About 25% of the 100 people had evidence of pre-clinical Alzheimer’s disease due to abnormal indicators reflecting amyloid plaques. Those who woke up most frequently, more than five times an hour, were more likely than the others to have these abnormal biomarkers.

Those who spent less than 85% of their time in bed actually sleeping were also more likely to have preclinical Alzheimer’s disease, they found.

About half of the group had more than five awakenings an hour, and about half spent less than 85% of their time in bed sleeping, Ju says.    She says the sleep-measuring device may slightly overestimate the number of awakenings, but that ”people actually do wake briefly quite frequently during a regular night of sleep.”

Ju cites animal studies finding that sleep changes drive the accumulation of amyloid. She suspects that is the case for people, too.

Meanwhile, getting a good night’s sleep is advised. “Everyone should prioritize their sleep,” Ju says. “We don’t value sleep as much as we should. Sleep is a very important function that allows the brain to rest.”

Comments on this sleep study:   “This [study] is another indication there are early brain changes [in Alzheimer's disease],” says Maria Carrillo, PhD, senior director of medical and scientific relations for the Alzheimer’s Association. “The trouble sleeping could reflect brain changes happening,” Carrillo tells WebMD.   Which way the association develops is yet to be determined, she says.

The study finding is not surprising, says UCLA’s Gary Small, MD. “We know that getting a good night’s sleep is important for the brain.”   Of the new research, “the causal relationship is not clear,” he says.

Dr. Small suspects that inflammation may be playing a role. Perhaps the lack of sleep increases inflammation. He and other experts believe brain inflammation and Alzheimer’s may be linked.

 

OTHER STUDIES SUGGEST FOR ALL AGES, SLEEP IS IMPORTANT FOR LAYING DOWN MEMORIES

Source: Alzheimer’s Research Forum on line   (www.alzforum.org)

Sleep is another factor that has more recently begun to be tied to cognition and even Alzheimer’s disease as it plays a crucial role in memory consolidation. In her Society for Neuroscience press conference, Rebecca Spencer at the University of Massachusetts, Amherst, suggested that one culprit in age-related memory decline could be poor quality of sleep. It is believed that during sleep, the brain replays the day’s experiences to code them into the memory banks, but that this process becomes choppy in older brains (see Gerrard et al., 2008). Previously, Spencer’s group showed that sleep fails to consolidate motor learning in older adults (see Spencer et al., 2007). However, other studies have shown that episodic memories can be consolidated during sleep in older people (see Aly and Moscovitch, 2010).

For this study, Spencer wondered whether the coding of a non-motor, sequential task would be affected by age. To test this, first author Laura Kurdziel taught 24 young adults and about 30 adults older than 50 to perform a computer task that required memorization of a sequence of colored doors in order to navigate through 10 virtual rooms. Kurdziel retested the participants 12 hours later. For half of each group, this time included a sleep interval during normal sleeping hours, while for the other half it did not. Kurdziel saw sharply divergent results for the young and old participants. Young adults who had had a chance to sleep made fewer errors on the task than those who had stayed awake. Older adults, however, got no cognitive benefit from sleep, and also made more errors overall than did younger participants. Spencer attributed this difference to the fragmented nature of sleep in older people, noting that seniors with more regular sleep patterns do better on memory tasks. She suggested that improving sleep quality could boost memory in aging adults. One hitch, however, is that researchers do not have a good way to “defragment” disordered sleep. Spencer said one possibility would be to use cognitive behavioral therapy to change sleep habits, as seniors who stay awake during the day and go to bed more tired sleep better than those who nap.—Madolyn Bowman Rogers.

 

TIPS FOR GETTING ADEQUATE SLEEP  (selections edited by Dr. Nancy Emerson Lombardo, July 2012)

Coping skills to Help Your Sleep – from the Mayo Clinic http://www.mayoclinic.com/health/insomnia/DS00187

No matter what your age, insomnia usually is treatable. Natural sleep is always the best. Avoid drugs if you can. The key often lies in changes to your routine during the day and when you go to bed. Try these tips:

  • Stick to a schedule. Keep your bedtime and wake time on a constant schedule.
  • Limit your time in bed. Too much time in bed can promote shallow, unrestful sleep. Try to cut the time you spend in bed by one hour a night for two weeks to see if it helps you sleep.
  • Avoid trying to sleep. The harder you try, the more awake you’ll become. Read or watch television until you become very drowsy, then go to bed to sleep. Get up in the morning at the same time as usual.
  • Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all clocks in your bedroom. The less you know what time it is at night, the better you’ll sleep.
  • Exercise and stay active. Get at least 20 to 30 minutes of vigorous exercise daily, preferably at least five to six hours before bedtime.
  • Avoid or limit caffeine, alcohol and nicotine. Caffeine after lunchtime and using nicotine can keep you from falling asleep at night. Alcohol, while it may initially make you feel sleepy, can cause unrestful sleep and frequent awakenings.
  • Reset your body’s clock. If you fall asleep too early and then wake up too early, use light to push back your internal clock. During times of the year when it’s light outside in the evenings, go outside for 30 minutes or obtain light via a medical-grade light box.
  • Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also check the labels of over-the-counter products to see if they contain caffeine or other stimulants, such as pseudoephedrine.
  • Don’t put up with pain. If a painful condition bothers you, make sure the pain reliever you take is effective enough to control your pain while you’re sleeping.
  • Find ways to relax. A warm bath or light snack before bedtime may help prepare you for sleep. Having your partner give you a massage also may help relax you.
  • Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can’t get by without one, try to limit a nap to no more than an hour and don’t nap after 3 p.m.
  • Minimize sleep interruptions. Close your bedroom door or create a subtle background noise, such as a running fan, to help drown out other noises. Keep your bedroom temperature comfortable, usually cooler than during the day. Drink less before bedtime so that you won’t have to go to the toilet as often.

 

Cognitive behavioral therapy: A new tool for treating insomnia

For years, people who spent their nights tossing and turning didn’t have many choices. But now there is an insomnia treatment that’s an alternative to pills, even for people with severe or chronic sleep problems. Called cognitive behavioral therapy (CBT), this relatively simple, short-term treatment has long been used to treat a range of problems, including depression, panic attacks, eating disorders and substance abuse. Now, it has also proved effective against insomnia. So effective, in fact, that for most people it works better than sleeping pills — with no side effects.   CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, an intractable, lifelong inability to get enough rest. What’s more, the effects seem to last — a year after CBT, most people still sleep soundly.

If  you snore or wake up tired after good night sleep: Recommend you get a Sleep Study To diagnose whether you have Sleep Apnea.   If you do have sleep apnea very very important:   USE C PAP machine if you have sleep apnea! It can save your brain!    (Dr. Nancy Emerson Lombardo)

 

TOP 12 FOODS FOR A GOOD NIGHT’S SLEEP

10 foods by RealAge with  two more (see italicized words) added by Nancy Emerson Lombardo, Ph.D.

 

The secret to getting a solid 7 to 8 hours? About 90 minutes before you want to nod off, head for the kitchen and make yourself some herbal tea, and/or a sleepy-time snack . For those trying to lose weight, might be better to stick with the tea and herbals. Keep any snacks light (around 200 calories), so you don’t overload your digestive system. Include one or two foods from the list below. All help to relax tense muscles, quiet buzzing minds, and/or get calming, sleep-inducing hormones — serotonin and melatonin — flowing. Yawning yet?

1. Bananas — They’re practically a sleeping pill in a peel. In addition to a bit of soothing melatonin and serotonin, bananas contain magnesium, a muscle relaxant.

2. Chamomile tea — Chamomile is a staple of bedtime tea blends because of its mild sedating effect, which makes it the perfect natural antidote for restless minds and bodies.

3. Warm milk — It’s not a myth. Milk has some tryptophan, an amino acid that has a sedative-like effect, and calcium, which helps the brain use tryptophan. Plus, there’s the psychological throwback to infancy, when a warm bottle meant “relax, everything’s fine.”

4. Honey — Drizzle a little in your warm milk or herb tea. Lots of sugar is stimulating, but a little glucose tells your brain to turn off orexin, a recently discovered neurotransmitter that’s linked to alertness.

5. Potatoes — A small baked spud won’t overwhelm your gastrointestinal tract as it clears away acids that can interfere with yawn-inducing tryptophan. To up the soothing effect, mash the potato with warm milk.

6. Oatmeal — Oats are a rich source of sleep-inviting melatonin, and a small bowl of warm cereal with a splash of maple syrup is cozy — and if you’ve got the munchies, it’s filling, too.

7. Almonds — A handful of these heart-healthy nuts can send you snoozing because they contain both tryptophan and a nice dose of muscle-relaxing magnesium.

8. Flaxseeds — When life goes awry, and feeling down is keeping you up, try sprinkling 2 tablespoons of these healthy little seeds on your bedtime oatmeal. They’re rich in omega-3 fatty acids, a natural mood lifter.

9. Whole-wheat bread — A slice of toast with your tea and honey will release insulin, which helps tryptophan get to your brain, where it’s converted to serotonin and quietly murmurs “time to sleep.”

10. Turkey — It’s the best-known source of tryptophan, credited with all those Thanksgiving naps. But that’s actually modern folklore. Tryptophan works when your stomach’s basically empty rather than overstuffed and when there are some carbs around rather than tons of protein. But put a lean slice or two on some whole-wheat bread midevening and you’ve got one of the best sleep-inducers in your kitchen.

11. Lemon balm tea also known as Melissa.  Calms the spirit and enhances memory.  (added by N. Emerson Lombardo)

12. Magnesium supplements. Helps relax muscles and helps you fall and stay asleep (added by N. Emerson Lombardo)   (go to Store)

What if none of these foods helps? Consider checking with your physician and asking about sleep clinics in your area.   Also Check out your sleep habits with this quick RealAge assessment to find out what’s keeping you up at night.    RealAge Article   http://www.realage.com/soothe-stress/sleep-hygiene-how-to-sleep-better-center/top-10-foods-for-a-good-nights-sleep?src=edit&chan=eat-smart&con=channel&click=c1t1&cbr=YSHN1100011&link=

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