‘Fractured’ Sleep = Trouble for the Brain

Trouble falling asleep, frequent nighttime awakenings, and waking too early in the morning may do more than cause frustration and fatigue. Recent research suggests that these types of sleep disturbance may actu-ally cause shrinkage of the brain—often a sign of cognitive decline.

WHAT YOU CAN DO

The following strategies may help reduce sleep disruptions without the need for medications;

  • Improve your “sleep hygiene” by striving to go to sleep and wake up at about the same time every day; avoid daytime napping; use your bed only for sleep or sex; cut down on or eliminate caffeine, alcohol and nicotine; and avoid exercise and heavy meals within four hours of bedtime.
  • Avoid using light-emitting devices before bedtime. New research suggests that the effects of light from smart phones, tablets, and computers within an hour of bedtime can lead to disrupted sleep.
  • Seek treatment for mental and physical disorders that can interfere with sleep, such as pain, depression, anxiety, sleep apnea, acid reflux, thyroid problems, congestive heart failure, and restless legs syndrome.
  • Reduce stress by getting regular exercise and using techniques such as visualization and meditation to help you relax before bedtime.
  • Expose yourself to daylight. Get outside in the sun if you can. Exposure to bright light in the day and early evening can help prevent sleep problems.
  • Think agreeable thoughts. Focus your attention on pleasant thoughts and memories as you fall asleep, and switch your mind gently away from thoughts that are upsetting.
  • See a sleep specialist for a thorough assessment covering your sleep history (e.g., when your problems began and physical or lifestyle changes that preceded the onset of sleep problems), stress lev-els, current medications, environmental factors, and other issues that might interfere with sleep.

“Research has long associated insufficient sleep with a range of cognitive, attention, and emotional deficits, including impairment of memory and concentration, and greater risk for dementia,” says Maurizio Fava, MD, Executive Vice Chair of the Department of Psychiatry and Director of the Clinical Re-search Program at MGH. “This study focuses on the effects, not of shorter sleep, but of poor quality sleep, and shows that frequent sleep disruption, even in people whose sleep endures for many hours, also has negative effects on the brain.

“These findings underscore the importance of addressing sleep problems, especially in older individuals who may be more vulnerable to sleep disruption. Practicing good sleep hygiene, avoiding behaviors that might interfere with a good night’s sleep, and seeing a medical care provider for help with chronic sleep problems are essential to protecting brain health and functioning (See What You Can Do).”

Cell deterioration

The negative effects of fractured sleep on brain volume were described in a paper published in the Sept. 9, 2014 issue of Neurology. Working with 147 older adults, researchers compared brain scans and participants’ answers to questions regarding how long it took to fall asleep, how well they slept, how often they awoke during the night, and how sleepy they felt during the day. The results revealed that participants who reported poor sleep quality were more likely to experience atrophy over time in parts of the brain involved in thinking, reasoning, memory, planning, and problem-solving.

Other research helps explain why older adults may be especially vulnerable to sleep disruption. Scientists have identified a small group of cells in a region of the brain called the intermediate nucleus that steadily degenerates with age. These cells, which contain a neurotransmitter called galanin, act as a type of “sleep switch” that appears to be essential for allowing sleep. A study published Aug. 20, 2014 in the online issue of Brain Research suggests that the number of cells in this region may decline by 50 percent or more between young adulthood and old age. In autopsies conducted on a group of older participants in a long-term study whose sleep activity had been recorded, the researchers found a direct association between sleep quality and the number of cells containing galanin that were still intact in participants’ brains. Those participants with fewer of these cells had experienced greater difficulty sleeping, and those with the fewest cells showed signs of Alzheimer’s disease, the post-mortem examinations revealed. Since in earlier research the study authors had observed that eliminating galanin-containing cells caused sleep disruption in animals, they concluded that the loss of these cells in the human subjects was likely also the cause of their disturbed sleep.

“Recently, the FDA approved a new sleep medication called suvorexant (Belsom-ra®), which mimics the actions of the galanin-containing cells in the intermediate nucleus,” says Dr. Fava. “The drug promises to avoid the unwanted side effects associated with many other sleep medications.”

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