As the list of lifestyle disruptions from the COVID-19 pandemic grows, it’s becoming clear that sleep quality should be near the top. New schedules for remote working, increased anxiety, oversleeping, and isolation under quarantine can all contribute to disrupted sleep patterns, and the media is reporting a surge in people experiencing insomnia. As such, it’s important to recognize the connection between sleep quality and cognitive health.
Sleep disturbances and cognitive decline
Even in the best of times, insomnia is fairly common, with roughly one-third of the population experiencing occasional episodes of sleeplessness. Also, it’s now being reported as rampant among healthcare professionals and first responders in pandemic hotspots.
However, persistent insomnia is of particular concern for seniors. Sleep disturbance is a cardinal symptom of depression and anxiety, which can be rapidly and effectively treated with early recognition. This is particularly important as shelter-in-place, loneliness, health concerns about oneself and friends and family, and financial uncertainty increase risks for development or aggravation of mental health issues.
While understanding of underlying causes and associations are still unclear, sleep disturbances show a significant association with declines in cognitive health. A meta-analysis of longitudinal studies of sleep health showed increased risk of developing cognitive impairment for middle-aged and older individuals associated with 10 different metrics of sleep disturbance, including insufficient sleep (less than four hours per night), excessive sleep (more than 10 hours per night), and sleep apnea.
Alzheimer’s and non-REM sleep
Another line of inquiry has looked at the temporal associations of sleep disturbance and Alzheimer’s disease.
Disrupted sleep — specifically changes in non-REM sleep — appears to be associated with accumulation of amyloid plaque prior to development of clear cognitive symptoms. Researchers express promise that non-invasive sleep studies looking at non-REM sleep may hold promise as detecting Alzheimer’s risk at a pre-clinical stage in which other interventions may have promise.
Tips for improving sleep
There are several approaches for combating sleep disturbance in seniors:
- Recognizing and treating depression and anxiety
- Avoiding medications with high anticholinergic properties
- Creating a consistent sleep routine
- Avoiding stimulating late-night foods or activities
- Skipping naps if you’re having trouble sleeping
- Creating a quiet environment
- Layering bedding for temperature adjustments
- Addressing snoring issues
For more tenacious insomnia, cognitive behavioral approaches for insomnia (CBT-I) are aimed at improving sleep habits and architecture as an alternative to sleeping medications which may increase risks of falls, amnestic periods, and dependence.
Early detection of cognitive impairment
Among the many targets for modifiable risk factors in dementia, sleep deserves to be at or near the top.
As part of Alzheimer’s and Brain Awareness month, we encourage clinicians to discuss sleep quality and cognitive health with their patients. Assessment of current cognitive function also can be a vital part of the assessment of sleep disturbance.
BrainCheck, as another non-invasive approach, can be an important tool for early detection of cognitive impairment. Once the clinician establishes a patient’s baseline, using BrainCheck can track potential improvement in cognition with progress in sleep quality, as well as potential progression of cognitive impairment.