Report Links Improved Brain Health to Sleep

Published in Pawtucket Times on January 16, 2017

Seven to eight hours of sleep per day may be key to maintaining your brain health as you age, says a newly released consensus report issued the Global Council on Brain Health (GCBH). The report’s recommendations, hammered out by scientists, health professionals, scholars and policy experts working on brain health issues at meeting convened by AARP with support of Age UK, in Toronto, Canada in late July 2016 Toronto, translates the scientific research evidence compiled on sleep and brain health into actionable recommendations for the public.

An AARP consumer survey released this month [in conjunction with GCBH’s report] found that 99 percent of age 50-plus respondents believe that their sleep is crucial to brain health, but over four in 10 (43 percent) say they don’t get enough sleep during the night. More than half (about 54 percent) say they tend to wake up too early in the morning and just can’t get back to sleep.

As to sleep habits, the adult respondents say that the most frequently cited activity that they engage in within an hour of bedtime are watching television and browsing the web. One-third keep a phone or electronic device by their bed. Nearly 88 percent of the adults think a cool bedroom temperature is effective in helping people sleep. Yet only two in five (41 percent) keep their room between 60 and 67 degrees. Finally, the most common reason people walk up during the night is to use the bathroom.

“Although sleep problems are a huge issue with older adults, it’s unfortunate the importance of sleep is often not taken seriously by health care professionals,” said Sarah Lock, AARP Senior Vice President for Policy, and GCBH Executive Director. “It’s normal for sleep to change as we age, but poor quality sleep is not normal. Our experts share [in GCBH’s report] the steps people can take to help maintain their brain health through better sleep habits,” said Lock, in a statement released with the report.

Sleep Vital to Brain Health

The new GCBH recommendations cover a wide range of sleep-related issues, including common factors that can disrupt sleep, symptoms of potential sleep disorders, and prescription medications and over-the-counter (OTC) sleep aids. The consensus report is jam-packed with tips from experts, from detailing ways to help a person fall asleep or even stay asleep, when to seek professional help for a possible sleep disorder, and the pros and cons of taking a quick nap.

Based on the scientific evidence, the GCBH report says that sleep is vital to brain health, including cognitive function, and sleeping on average 7-8 hours each day is related to better brain and physical health in older people.

The 16-page GCBH consensus report notes that the sleep-wake cycle is influenced by many different factors. A regular sleep-wake schedule is tied to better sleep and better brain health. Regular exposure to light and physical activity supports good sleep, says the report.

According to the GCBH report, people, at any age, can change their behavior to improve their sleep. Persistent, excessive daytime sleepiness is not a normal part of aging. Sleep disorders become more common with age, but can often be successfully treated. People with chronic inadequate sleep are at higher risk for and experience more severe health problems, including dementia, depression, heart disease, obesity and cancer.

“A 2015 consensus statement of the American Academy of Sleep Medicine and the Sleep Research Society mirrors the recently released GCBH report recommending that a person sleep at least 7 hours per night, notes Dr. Katherine M. Sharkey, MD, PhD, FAASM, Associate Professor of Medicine and Psychiatry and Human Behavior who also serves as Assistant Dean for Women in Medicine and Science. “Seven to eight hours seems to be a ‘sweet spot’ for sleep duration,” she says, noting that several studies indicate that sleeping too little or too much can increase risk of mortality.

More Sleep Not Always Better

Sharkey says that individuals with insomnia sometimes use a strategy of spending more time in bed, with the idea that if they give themselves more opportunity to sleep, they will get more sleep and feel better, but this can actually make sleep worse. “One of the most commonly used behavioral treatments for insomnia is sleep restriction, where patients work with their sleep clinician to decrease their time in bed to a time very close to the actual amount of sleep they are getting,” she says, noting that this deepens their sleep.

Sleep apnea, a medical disorder where the throat closes off during sleep, resulting in decreased oxygen levels, can reduce the quality of sleep and is often associated with stroke and other cardiovascular diseases, says Sharkey. While sleep apnea is often associated with men (24 percent), it also affects nine percent of woman and this gender gap narrows in older age, she notes.

Many older adults who were diagnosed with sleep apnea many years ago often times did not pursue medical treatment because the older CPAP devices were bulky and uncomfortable, says Sharkey, who acknowledges that this technology is much better today.

“We know how many questions adults have about how much sleep is enough, and the role that sleep plays in brain health and cognitive function,” said Marilyn Albert, Ph.D., GCBH Chair, Professor of Neurology and Director of the Division of Cognitive Neuroscience at Johns Hopkins University in Baltimore, Maryland. “This [GCBH] report answers a lot of these questions and we hope it will be a valuable source of information for people,” she says.

Simple Tips to Better Sleep

Getting a goodnights sleep may be as easy as following these tips detailed in the 16-page GCBH report.

Consider getting up at the same time every day, seven days a week. Restrict fluids and food three hours before going to bed to help avoid disrupting your sleep to use the bathroom. Avoid using OTC medications for sleep because they can have negative side-effects, including disrupted sleep quality and impaired cognitive functioning.
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The GCBH report notes that dietary supplements such as melatonin may have benefits for some people, but scientific evidence on their effectiveness is inconclusive. Be particularly cautious of melatonin use with dementia patients.

Naps are not always a cure to enhancing your sleep. Avoid long naps; if you must nap, limit to 30 minutes in the early afternoon.

“There has been such a steady stream of revealing brain-health reports that it would seem people would change their habits accordingly,” said AARP Rhode Island State Director Kathleen Connell. “Taking active steps is what’s important – and the earlier the better,” she added.

“The personal benefits are obvious, but we should be aware of the cost savings that better brain health can produce. If people in their
50s get on board, the impact on healthcare costs and a reduced burden of caregiving 20 years down the road could be significant,” Connell added. “At the very least, those savings could help cover other rising costs. We owe it to ourselves and to each other to assess and improve aspects of diet and exercise. And we should not overlook the importance of sleep.”

The full GCBH recommendations can be found here: http://www.globalcouncilonbrainhealth.org. The 2016 AARP Sleep and Brain Health Survey can be found here: http://www.aarp.org/sleepandbrainhealth.

Sleep Apnea is Hazardous to Your Health and Well Being

            Published May 25, 2012, Pawtucket Times

           In 2003, Rehoboth resident Art Warner got strong messages from his surrounding environment about his health, both during the day and at night.

           At that time Warner discovered he had great difficulty staying awake at his job, oftentimes falling asleep right at his desk.  Coupled with his sleepiness during work hours and his wife’s constant elbowing in the middle of the night to wake him up because of his loud snoring, a very tired Warner became extremely frustrated.  His worried wife would regularly watch as he stopped breathing during his sleep as he snored.  The overweight, middle aged man was finally forced to recognize the he had a health condition that could not be ignored.     

         After an examination from Warner’s primary care physician, he signed him up for a sleep lab study, which surprisingly revealed to the patient “sleep apnea.”  This serious sleep disorder caused hundreds of short stops of breathing each night, which kept Warner, a public relations executive, from getting a good night’s sleep.. 

          Ultimately, it was a medical treatment prescribed after the sleep lab study that would finally allow Warner to get the sleep he needed and stop his snoring. No longer falling asleep at his desk, or getting sleepy behind the wheel while driving his car, instead   a good night’s quality sleep has resulted in Warner living “a totally different life,” because he feels rested.. With this newly-found lifestyle, he has more energy to workout at the gym, and even stay up past midnight.       

Very Observable Symptoms

        According to the Sleep Apnea Association, 12 million Americans [including Warner] have sleep apnea, a common medical chronic condition in which the person has one or more pauses in breathing, or shallow breathing when asleep   The Washington, D.C-based group estimates that another ten million people may remain undiagnosed.

       Dr. Michael A. Pomerantz, a pulmonary specialist who reads sleep lab studies for Rhode Island-based Coastal Medical, reports that untreated sleep apnea is associated with an increased risk of high blood pressure, heart disease, stroke, obesity, diabetes, in addition to traffic accidents caused by falling asleep at the wheel. “Those are all pretty good reasons to be evaluated,” he says.

        Snoring, night time awakening and day time sleepiness are three prominent symptoms of having sleep apnea, adds Pomerantz.  Frequently, a bed partner may observe heavy snoring or long pauses (lasting at least 10 seconds) in breathing during their companion’s sleep, causing the sleeper to wake up periodically throughout the night, states Pomerantz.   

         According to the medical literature, the typical sleep apnea male patient is over age 40, obese, and familial.  Smoking and alcohol also increase the risk of this medical condition.  Dr. Pomerantz, who has practiced his medical specialty for over two decades, adds that 50 percent of sleep apnea patients also complain of early morning headaches.   

  Diagnosing and Effectively Treating Sleep Apnea

        If sleep apnea is suspected, an over night visit at a sleep lab is considered to be the best diagnostic test to this serious medical condition, notes Dr. Pomerantz, who has  successfully completed his sleep board certification .  Among other things, the patient is hooked up to equipment by wires which monitor the level of sleep, in addition to the airflow to determine if the sleeper is breathing or not, the deepness of sleep, oxygen levels, chest wall movement, and pulse rate, he says.

       For treating milder cases of sleep apnea, Dr. Pomerantz recommends simple ‘life style’ changes and treatments such as shedding weight, avoiding alcohol, sleeping on your side or abdomen, or keeping nasal passages open at night by using prescribed medications.  A dental device can also move a jaw forward to make breathing easier.

      In moderate to severe cases, a C-PAP, or “continuous positive airway pressure” machine can deliver an increased air pressure through a mask covering the nose or mouth.  The air pressure generated by this machine is somewhat greater than that of the surrounding air, just enough to keep the person’s upper airway passages open, preventing the apnea and snoring.

       “Compliance with sleep apnea is not always great,” Pomerantz, says, because patients may feel discomfort with the C-PAP machines. “For some patient it’s only a matter of getting use to it and finding a more comfortable mask,” he says, because their masks may feel overly confining or obstructive.   

New Studies Link Sleep Apnea to Cancer

        In addition to those  research studies associating  sleep apnea with increased risks of hypertension, cardiovascular disease, depression and early death, the New York Times recently reported that two new research studies presented at the American Thoracic Society conference this week have discovered that this chronic condition  has been linked to an increased risk of cancer in humans.

             According to the paper, in one study Spanish researchers followed thousands of patients at sleep clinics, finding that those patients with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind.  Meanwhile, lead researcher Dr. Javier Nieto, chair of the Department of Population Health Sciences at the University of Wisconsin School of Medicine and Public Health, says that his study of 1,500 government workers studied over 22 years showed nearly five times higher incidence of cancer deaths in patients with severe sleep apnea to those without the disorder, a result that echoes previous findings in animal studies.

A Personal Note

             Clearly research studies show that not being treated for sleep apnea or using your C-PAP machine, if diagnosed with this chronic disorder, is hazardous to your health and well-being…

             As one afflicted with sleep apnea, this writer has experienced it all – from “denial” about the severity of my snoring to finally being sent by my partner to the couch for my very loud snoring that shook the walls of our house. Co-workers teased me about  falling asleep at noon time meetings or towards the end of my workday. Even with these severe symptoms, I denied having this medical problem for years until the urging of a  friend who had a severe case of sleep apnea nudged me to “get it checked out” .  With my ultimate diagnosis and finally the treatment with a C-PAP machine, my snoring has virtually ceased, and I now wake up refreshed and well-rested.  One of my few regrets in life was losing years of “deep” sleep because I chose not to see my physician to address my sleep apnea.    

        For more information about sleep apnea, visit the American Sleep Apnea Association’s website, www.sleepapnea.org. If you have sleep apnea symptoms, visit your physician.

       Herb Weiss is a Pawtucket-based freelance writer covering medical, healthcare and aging issues.  His Commentaries are published in two Rhode Island Daily’s The Pawtucket Times and Woonsocket Call.