Alzheimer's: sleep disturbances may be an early indication
Various scientific studies have established a link between sleep disorders and dementia. It has been observed that people with Alzheimer's disease sleep little. It has also been shown that lack of sleep and sleep disorders are often associated with a decrease in cognitive performance. Healthy sleep, on the other hand, can positively influence the course of dementia.
In Germany, approximately 1.7 million people are affected by dementia. Most of them suffer from Alzheimer's disease. Despite decades of research, this disease is still incurable. However, it can be delayed, especially if diagnosed early and treatment started early. Sleep disturbances can be an early sign of dementia, experts say.
First signs of the first minimal cognitive impairments
According to a recent report by the German Geriatrics Society (DGG), more and more adults over the age of 60 suffer from sleep disorders. Meanwhile, about half of this age group in Germany complains of considerable difficulty falling asleep and staying asleep.
"This can be an early sign of the first minimal cognitive impairments," says Professor Geert Mayer, former medical director of the Hephata Clinic in Schwalmstadt. “Alzheimer's dementia or another neurodegenerative disease could be present. Conversely, dementia can also lead to increased sleep disturbances - it's a two-way relationship," explains the neurologist and sleep physician.
The neurologist examines the exact links between sleep quality, resilience and disease and looks for solutions suitable for those affected. Individual sleep hygiene, sufficient light exposure and physical activity seem to be the key to healthy sleep, especially for older people.
Double the risk of developing dementia
According to the information, systematic studies have been able to show that disturbed nocturnal sleep, fragmented by waking phases of different durations, is relevant for the development of Alzheimer's disease.
From about the age of 65, the risk of developing dementia doubles. Increasing age therefore remains the most important risk factor.
However, there are other factors that promote the development of dementia: For example, genetic – familial – susceptibility to certain diseases or cell damage caused by free radicals with corresponding neuroinflammation, ergo inflammation of brain tissue.
Disruption of mitochondria, the powerhouses of human cells and energy providers for the body, can also advance Alzheimer's disease.
Improve sleep structure
"An improvement in sleep pattern from middle age, associated with the avoidance or targeted treatment of comorbid sleep disorders - that is, sleep problems that occur in addition to an illness underlying disease - can lead to resilience against dementia," explains Geert Mayer.
This has now been well proven, for example in the case of obstructive sleep apnea, in which breathing is repeatedly reduced or stopped during sleep due to narrowing of the pharynx.
This has also been recognized in so-called restless leg syndrome, a chronic neurological condition with restless leg movement during sleep, which can lead to frequent nighttime awakenings.
“In order to clarify the long-term effects, those affected should definitely seek a conversation with their family doctor. With her or him, it is important to precisely define the quality, duration and structure of sleep in order to initiate specific advice or treatment", explains the doctor.
Behavioral or behavioral therapy measures
"If the sleep disorder has persisted for years, sleep diaries should be kept and, if necessary, sleep laboratory tests should be arranged so that the extent of primary or comorbid sleep disturbances can be assessed," Mayer recommends. .
Behaviour-oriented measures or behavioral therapies for the treatment of the sleep disorder are the top priority.
"This includes, for example, individual sleep hygiene rules, which define a suitable sleeping environment, what you eat before going to bed and fixed bedtimes. In addition, it is particularly important that elderly people remain physically active and get enough daylight. If necessary, additional light therapy can be prescribed, ”explains the expert.
For patients with chronic insomnia, cognitive behavioral therapy is more effective in the long term than taking medication. In the case of people who already have dementia, these measures can be supported by relatives or professional caregivers.
Increased risk of comorbid sleep disturbances in patients with dementia
As stated in the communication, the risk of a comorbid sleep disorder is five times higher in people with dementia and thus contributes to sleep fragmentation. “Because of this fragmented sleep, the brain cannot find adequate rest. The increased transmission of stimuli and information leads to a change in sleep behavior, which in the long term leads to a deterioration in cognitive functions,” explains Mayer.
This affects both the deep sleep phases and the so-called Rapid Eye Movement (REM) sleep phases, which are characterized by rapid eye movements with closed eyelids. In middle age, these phases occupy between 20 and 25% of sleep and increase in duration during the night.
According to current knowledge, the REM phase is a very active state of sleep, similar to wakefulness, responsible for stress management, information processing and memory consolidation.
“It is precisely these phases that are now reduced by sleep fragmentation, which impairs the glymphatic system of cellular waste disposal in the central nervous system, which is mainly active during sleep. Breakdown products such as amyloid plaques - protein deposits - can no longer be sufficiently excreted. They accumulate and in turn promote dementia,” explains the neurologist.
So far, however, it has not been possible to make an accurate prediction of the risk of developing dementia based on the type of sleep disorder present. "It's a multifactorial process that we still need to look at much more closely," Mayer says. (ad)
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This text corresponds to the specifications of the specialized medical literature, medical guidelines and current studies and has been verified by health professionals.
This article contains general advice only and should not be used for self-diagnosis or treatment. It cannot substitute a visit to the doctor.