Disordered sleep is correlated with the development of Alzheimer's disease and is one of the first symptoms (often beginning years before other symptoms). (Zasshi, 2019) (He, 2019)(Irwin, 2019) (Oh, 2019)(Borges, 2019)(Song, 2019) (Sani, 2019) (Havekes, 2019) (Wang, 2020) (Erum, 2019) (Bah, 2019)(Cardinali, 2010)(Liguori, 2020)

The risk of AD from sleep disturbances was 7x higher than controls in patients who carried the ApoE4 gene. (Burke, 2016, 2018)(Grau-Rivera, 2020) Even one night of lost sleep leads to beta amyloid accumulation (Shokri, 2018) Studies suggests that vascular impairment, leading to blood brain barrier dysfunction, may be involved in the sleep issues surrounding AD (Li, 2019)

Circadian Rhythm

Sleep is when we heal - body and mind. It’s important to sleep on an empty stomach so your body can shut down mTor and activate autophagy. (Zeng, 2019) Autophagy is imperative for body repair and brain clean up. (Ma, 2012)(autophagy)(Fultz, 2019)(Chauhan, 2019)(Carroll, 2019) (Orr, 2013) Beta amyloid is cleared during autophagy in deep sleep. (Patrick, 2019)

Sleep disorders are found in more than half of all AD patients. The Suprachiasmic nucleus (SCN) and circadian clock are intimately involved. (Erum, 2018) (Musiek, 2015)(Oh, 2019) Sleep quality is related to CSF Alzheimers pathology. (Sprecher, 2017)(Winer, 2019) (Shamim, 2019) Tau proteins may upset/change circadian cycling (Arnes, 2019)

Our bodies are designed to follow the light/dark cycle of the sun/moon. The more we can mimic our evolutionary development, the closer we will be to optimum health. Shift workers and people with disordered circadian cycles are more prone to disease (Panda) Circadian rhythm is correlated to heart attacks and correcting daylight timing/exposure may reduce illness (Brainard, 2016) (Kantermann, 2007) (Manfredini, 2018) Small vessel disease and lesions are associated with poor sleep quality and 24 hour circadian disruption. (Zuurbier, 2015) Circadian rhythm disruption was shown to be correlated with dementia in a review of 32 studies assessing rest/activity rhythms and dementia. (Smagula, 2019)

The Suprachiasmatic Nulceus and Hypothalamus

Our circadian rhythm is controlled by the suprachiasmatic nucleus (SCN) in the hypothalamus. (Koch, 2017)The light in our eyes is particularly important in controlling our biological clocks through the SCN (How the SCN works.) Disrupting the SCN, leads to poor memory processing. (Fernandez, 2014) The suprachiasmatic nucleus appears to be more severely affected than other parts of the hypothalamus in Alzheimers and in degenerative aging. (Baloyannus, 2017)

The hypothalamic–pituitary–adrenal (HPA)-axis and glucocorticoid concentrations can reset the circadian clocks. Light activates the adrenal gland and the timing of glucocorticoid release through the SCN. (Kalsbeek, 2011) (Ishida, 2005) Melatonin cycling is controlled by the SCN (Claustrat, 2005)(Hansen, 2012)(Farracioli, 2013)(Reppert, 1981) Melatonin is neuroprotective and melatonin cycling is involved in neuropsychological disease. (Lee, 2019) Melatonin disturbances and pineal calcification are seen in AD patients. (Song, 2019) Melatonin cycling is involved in sleep, depression, and dementia. (Hansen, 2012)

Adequate daytime light exposure is required in order to produce enough melatonin at night (Tosini, 2016)(Lifespa). Blue light and light exposure prior to bedtime reduces the capacity to produce melatonin and/or delays the time of production. (Gooley, 2010)(Boyce, 1987) Melatonin secretion was found to be decreased and delayed in Alzheimer's patients versus healthy controls. (Manni, 2019)

If melatonin has not cleared enough by morning (it is time and sleep phase dependent) then your eyes will hurt and you will wake up groggy in the morning. (Tosini, 2016)

Sleep Apnea

Sleep apnea disrupts deep sleep cycles and has been shown to affect physiological markers for Alzheimers and increase dementia risk. (AAN, 2019) (Baril, 2018) (Sharma, 2017)(Chang, 2013) (alz.org) (Bubu, 2019) Around half of all Alzheimer's patients have had sleep apnea at some point in their life. (Emamian, 2016)(Gaeta, 2019) Sleep apnea is damaging to deep sleep but also results in hypoxia that may be related to AD development. (Przybylska, 2019) Larger studies are needed to confirm the true prevalence of sleep apnea and dementia, but disrupted/disordered sleep is definitely involved in AD/dementia. Hypertension is linked to sleep apnea, especially hard-to-treat hypertension (NIH)

Having a thick neck is associated with sleep apnea. Bodybuilders frequently have sleep apnea and many die young because of it. (bodybuilding.com) (Li, 2012) (Katz, 1989)(Katz, 1990)(Pillar,2008)

Snoring has been shown to be more common (twice as common) in cognitively impaired people. Larger studies are needed for more confidence. (ErkinsJuntti, 1987)

Bruxism

Grinding teeth leads to lower sleep quality and less deep (restorative) sleep. (Kim, 2014) Magnesium supplementation can reduce bruxism and improve sleep quality (sleeptrack) Grinding teeth also damages the enamel and allows for bacterial infiltration. Teeth grinding is associated with mental instability, stress, and less social health and is frequently mentioned on alzheimers forums. (Kwat, 2009)(Sutin, 2010)

Sleep Treatment

One study on sleep treatment showed that those taking medication for sleep disorders did not have an increased risk of Alzheimers or dementia. This was a subanalysis of 6700 patients. It may or may not have been funded by the company of the drug used (zolpidem/Ambien). (Burke, 2019)

A review of 38 Alzheimer's sleep disturbance treatment studies showed mixed results. Most sleep treatments were found to be ineffective. Bright light therapy was found to be the most beneficial. (Salami, 2011) (Figueiro, 2019) A review of 27 studies altering light exposure in patients with Alzheimer's had mixed results. (Canazei, 2019) Keep in mind that once AD has started, most treatments have shown little benefit.

Better sleep consolidation resulted in reduced risk of AD over a 6 year period and attenuated the effects of the ApoE4 gene. (Lim, 2013)

Mouse studies suggest that brain damage (tau build up) as a result of sleep loss is associated with body temperature. Lower body temperature meant greater tau accumulation. (Guisle, 2019) Movement during sleep and sleep study data are being evaluated as early indicators of AD and parkinsons (Liu, 2019)(Cook, 2019)

Blocking Blue light (using blocking glasses) improved sleep efficiency and manic symptoms in bipolar patients (Tone, 2020)

Research suggests that people with neurodegenerative disease sleep longer in the supine (on the back) position and that healthy controls prefer to sleep in the lateral decubitus position (on their side). (Levendowski, 2019) They have found that sleeping on the back and sitting collapse the internal jugular veins (in people with vein issues) and may lead to decreased cerebral drainage. (Simka, 2019)

ACTIONS:

Get a full night's sleep. And make sleep a priority, keeping a regular schedule. Go outside and be in the sun every day - especially in the morning, to set your circadian clock for the day. Put blue light filters on your phone and computer settings for evening hours. Limit screens at night, especially in the 2 hours before sleep. Do not eat 3 hours before sleep. Do not fall asleep to the TV. Use low blue light LED or regular incandescent bulbs at night. Wear a sleep mask if you have street lights shining through your windows or night lights in your house. Get enough sunlight or indoor light LUX in the daytime. Consider sleeping on your side, use a sleep pillow or foam blocks to keep you from rolling?