The statistics indicate that world’s 45% of population isn’t getting enough sleep. The US Centers for Disease Control and Prevention is addressing it as "public health problem," as inadequate sleep can induce the diseases like diabetes, stroke and cardiovascular disorders. Now, the science is suggesting that diseases like Alzheimer’s and dementia could be added to that list. It is evident that people suffering from Dementia and Alzheimer’s suffer from sleep issues like insomnia, sleepwalking and daytime sleepiness, just like cognitive disorders like Lewy body dementia and frontal lobe dementia.
But can poor sleep actually increase the risk of dementia? Let’s take a deeper look.
Sleep and dementia
A body of research in both mice and humans validates that inadequate sleep leads to higher levels of soluble beta amyloid. Beta amyloid is a protein that folds and forms the sticky plaques that cause the death of brain cells and slows down information processing. Deposition of amyloid in brain tissue is known as the first pre-clinical stage of Alzheimer’s and it occurs even before the symptoms of dementia kick in.
A number of studies in cognitively normal people and one in mice have established a connection between sleep inadequacy and deposition of amyloid plaques. The research in mice was mainly interesting because it showed that mice who slept well reduced the levels of beta amyloid, successfully clearing toxins from their brains.
A new study in Neurology, the journal for the American Academy of Neurology, is adding to that research by looking at the relationship between sleep quality and levels of various proteins and inflammatory markers in the cerebrospinal fluid of 101 cognitively healthy adults with an average age of 63.
All participants had known risk factors for Alzheimer's, such as family history or evidence of the APOE gene, which is associated with a greater chance of developing the disease.Their sleep quality was rated on a standard scale that measured amount, quality and trouble sleeping, along with daytime drowsiness and naps.
"Participants in our study were willing to undergo a lumbar puncture to move research on Alzheimer's disease forward," said co-author Barbara Bendlin of the Wisconsin Alzheimer's Disease Research Center. "Analyzing this fluid allowed us to look at markers related to Alzheimer's disease such as plaques and tangles, as well as markers of inflammation and nerve cell damage."
Tangles and cell damage
Tangles are created by damaged tau, a protein responsible for cell stability and structure. Recent research points to tau-tangle accumulation as a possible step beyond amyloid plaques in the development of actual signs of Alzheimer's disease.
By comparing the spinal fluid against self-reported sleep problems, Bendlin and her colleagues found that the subjects who had sleep issues were more likely to show evidence of tau pathology, brain cell damage and inflammation, even when other factors like depression, body mass, cardiovascular disease and sleep medications were taken into account.
"Our findings align with the idea that worse sleep may contribute to the accumulation of Alzheimer's-related proteins in the brain," Bendlin said. "The fact that we can find these effects in people who are cognitively healthy and close to middle age suggest that these relationships appear early, perhaps providing a window of opportunity for intervention."
That's important, Bendlin added, because delaying the onset of Alzheimer's in those at risk by a mere five years "could reduce the number of cases we see in the next 30 years by 5.7 million and save $367 billion in health care spending."
"Another new finding in this study is that daytime sleepiness, and not just disrupted nighttime sleep, is associated with early changes of Alzheimer's disease," said Dr. Yo-El Ju, an assistant professor of neurology at Washington University's Sleep Medicine Center.
Ju also studies the association between sleep and dementia, and she co-wrote an accompanying editorial for the new study.
"Overall, this study confirms the relationship between early Alzheimer's disease and sleep disturbance," Ju said, "and (it) expands -- in terms of both time and symptoms -- the window in which sleep-wake problems can be assessed for and treated, with the hope of reducing the risk of dementia due to Alzheimer's disease."
One of the limitations of the study was that the sleep problems were self-reported. Bendlin and her colleagues are recruiting people at risk for Alzheimer's to be studied in a sleep lab, where objective measurements can be taken.
"If it turns out to be the case that an intervention which improves sleep also results in less amyloid being deposited in the brain, that would provide strong support for implementing interventions before people start to show cognitive decline associated with Alzheimer's disease," she said.
Dr. Rudolph Tanzi, who directs the genetics and aging research unit at Massachusetts General Hospital, agreed.
"Increasing amounts of evidence indicate that getting at least seven to eight hours of sleep is essential for brain health and function," Tanzi said. "In the deepest stage of sleep, the brain cleans itself out of plaque and other toxic materials that trigger Alzheimer's disease. This reduces brain inflammation and is entirely consistent with this exciting new study."
Which problem came first?
Not everyone with sleep problems in the study had abnormalities in their spinal fluid. For example, those with obstructive sleep apnea showed no association. Bendlin stresses that much remains to be discovered about the link between sleep and dementia.
"Not everyone who experiences sleep problems should now worry about developing dementia due to Alzheimer's disease," she said, adding that there is not yet a clear cause and effect relationship.
"Animal studies suggest sleep affects development of brain changes, but brain changes in turn also affect sleep," Bendlin said. "In terms of figuring out which comes first, brain changes or sleep problems, that will be difficult to tease apart, because the effects really do appear to be going in both directions."
"In experimental studies, there does seems to be evidence of both chicken and egg," said neuroscientist Jeffrey Iliff of Oregon Health and Sciences University. "You can drive it either direction. So there may be a bio-directional interaction."
That's good news if true, he said, because it means we have may have some control over whether we develop dementia.
"No, the public can't remove amyloid plaque," Iliff said. "But if sleep disruption is promoting this process, then improving sleep is half of the solution to slowing the process of dementia as it develops over one's life."
Keith Fargo, director of scientific programs and outreach for the Alzheimer's Association, agreed: "This new study suggests there may be an opportunity to improve cognition and possibly reduce dementia risk through early diagnosis and effective treatment of sleep disorders."
The new study has made novel revelations that there might be a chance to improve cognition and reduce the risk of neurodegenerative disorders like dementia and Alzheimer’s through early diagnosis and efficient therapy for sleep issues.
(With ANI Inputs)