Dementia

The majority of brain waste clearance occurs during sleep. The glymphatic system eliminates neurotoxins such as β-amyloid and tau from the brain during sleep and is largely inactive during wakefulness. Sleep fragmentation and the consequent reduction of slow-wave sleep interrupt this process. Optimizing sleep could improve glymphatic clearance, be a preventative lifestyle intervention for healthy brain aging, and mitigate dementia progression.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination. Identifying sleep disorders, as exampled below, that fragment sleep is critical to dementia prevention and care as it could slow cognitive decline.

• Sleep-Disordered Breathing

  • Lapses in breathing can deprive oxygen to the brain and fragment sleep. The apneas and hypopneas are associated with oxygen desaturations and arousals. They act as micro-concussions, cumulatively leading to traumatic brain injury.

• Sleep Periodic Limb Movements

  • Periodic arm and leg movements during sleep can lead to arousals that fragment sleep. Many individuals with sleep periodic limb movements also have restless legs syndrome.

• REM-Sleep Behavior Disorder

  • Individuals can act out their dreams, sometimes in dangerous ways. While it may be a dementia harbinger, dream-enacting behavior itself fragments sleep. 

• Circadian Dysrhythmias

  • Dementia damages the suprachiasmatic nucleus, a part of the brain that is responsible for our internal sleep-wake clock. This dysfunction results in individuals not following a regular sleep-wake cycle, sleeping excessively during the day, and less at night. The irregular diurnal sleep pattern is a manifestation of sleep fragmentation.

The goal is to optimize sleep, especially slow-wave sleep. By optimizing your sleep-wake cycle and reducing sleep fragmentation, as exampled below, we hope to augment glymphatic clearance of β-amyloid and tau and mitigate your risk of developing or progressing dementia:

• Starting CPAP or Bi-Level or, if necessary, special forms of Bi-Level that treat obstructive and central sleep apnea..

• Treating restless legs syndrome and sleep periodic limb movements with perineal muscle neurostimulation, iron supplements, medication, and non-medication therapies.

• Identifying and eliminating the cause of awakenings from sleep

• Utilizing light therapy to advance or delay your sleep cycle

• Prescribing medications such as the dual-orexin antagonists to consolidate sleep.

In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:

• Ensuring your bedroom environment is conducive to sleep

• Eliminating sources of sleep interruption like light and noise

• Optimizing your diet as food can promote and hinder sleep

• Assessing your nighttime habits and rituals

A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep and anxiety.