Ben Franklin’s astute words, “Early to bed, early to rise, makes a man healthy, wealthy, and wise,” have finally been proven scientifically (at least the healthy part, and especially pertaining to women).
A recent study by UCSF, Harvard Medical School, and Brigham and Women’s Hospital, published in The Journal of the American Medical Association (JAMA), investigated the quality of sleep in older women—as related to the incidence of mental deficiencies and dementia. Well established risk factors for developing cognitive impairment and dementia include: family history, hypertension, vascular disease, and smoking. We have always believed, but without definitive evidence, that sleep quality was correlated to diminished mental function in aging. We know with certainty that sleep deprivation and sleep apnea cause daytime sleepiness and diminished fine motor coordination. In fact, it has been shown that after only eight hours of sleep deprivation, one’s mental and physical functioning is affected in ways similar to being legally drunk.
The JAMA study examined which type of sleep problem is of most concern. The study defined “older women” as greater than 81 years of age and it subjected participants to overnight sleep studies that assessed the quality of sleep, as well as baseline mental function testing. A common finding in people as they age is “sleep-disordered breathing,” often called obstructive sleep apnea (OSA). This means frequent arousals during sleep with concomitant low oxygen (hypoxia). Ultimately, these frequent sleep interruptions do not allow the body and brain to enjoy the restorative phases of sleep that are critical to optimal functioning during the day.
When restoration is interrupted, the body and brain are put under tremendous amounts of stress. In the JAMA study, two groups were formed as a result of the sleep evaluation: those with normal sleep and those with OSA. As a side note, many people have sleep-related complaints that fall under the category of “insomnia.” These include frequent awakenings, difficulty falling asleep, early rising, not enough sleep, and sleep apnea (with those accompanying pauses in breathing often associated with snoring). Before we get to the punch line of the study, which of the aforementioned “complaints” do you think has the most impact on future cognitive function? Take a guess and then read on; you might be a bit surprised.
It is not the duration of sleep or even the number of nighttime awakenings that have long-term repercussions on our ability to concentrate—rather it is the number and duration of apnea episodes associated with hypoxia (low-oxygen concentration). What does this mean? First, remember this study investigated older women, aged 82. Many of you might ask, “How does this affect me now and should I get checked for sleep apnea right away, well before my 82nd birthday?” The short answer is—yes. This new study points out that cognitive impairment and dementia are associated with poor sleep. In addition to mentation, there are other medical issues associated with sleep apnea. Diabetes, high blood pressure, lung disease, heart arrhythmias and heart attacks, unplanned weight gain, and strain on personal relationships are all conditions closely related to this sleep disorder.
It is wise, although not common, for doctors to screen patients for sleep apnea. Sleep symptoms to watch for are snoring, gasping, making choking sounds, experiencing breathing interruptions, jerking around in your sleep, as well as morning headaches and daytime sleepiness. Bed partners and loved ones are generally the best reporters of these symptoms. In our practice, almost all of our patients are screened for obstructive sleep disorders, including sleep apnea, with a short and simple questionnaire.
There have been significant technological advances in the diagnosis and treatment of OSA in the last few years. Today, home sleep tests are even available and many effective treatments are simple, safe, and convenient. While CPAP (a mask worn at night that blows air into the airways to keep them from collapsing) often remains the first line of treatment for many patients, minimally invasive treatments are also available—the Pillar procedure (to stiffen the soft palate), dental appliances (to favorably position the tongue), and lifestyle changes. Furthermore, the growing awareness around sleep issues has spawned clinics that specifically work to solve these problems.
As we grow older, we also desire to maintain our quality of life—to live in a world in which we can enjoy conversation, memory, and intellect. To do this, it is critical that we take sleep seriously. These are preventable problems. In short, it is not a matter of how long we sleep, or if we are easily aroused from sleep. The quality of the sleep that we do get is more important. Most of the symptoms discussed here can easily go unnoticed and can only be detected by a sleep study. This is highly recommended since we now know that sleep problems lead to illness—and in older women, these sleep problems can even lead to dementia.
Dr. Matthew Mingrone is a board certified ENT physician who founded Sereno, The Center for Snoring Solutions.
Dr. Jordan Shlain is the founder and medical director of Current Health Medical Group (currenthealth.md). Dr. Shlain is an assistant clinical professor at the UCSF Medical Center and a medical economics lecturer at UC Berkeley.