I’ve really enjoyed seeing all of this year’s World Alzheimer’s Month content around risk factors and risk reduction, which has also included the Alzheimer’s Disease International (ADI) World Alzheimer Report 2023.
I’ve been fortunate to have had opportunities to contribute content around the 12 risk factors that ADI have highlighted, including for Care Choices – with lots of links to fabulous resources – and MacIntyre, where I wrote about the work I’ve been doing with some of the people MacIntyre support and their staff. I’ve also recorded a podcast for MacIntyre with my colleague Nicky Payne entitled ‘World Alzheimer’s Month with Beth Britton’.
Over the years on D4Dementia I’ve written about many of the risk factors being talked about for World Alzheimer’s Month, including looking at issues around eating and weight, isolation and loneliness, and most recently hearing loss and my experiences of taking a hearing test. However, for my 2023 World Alzheimer’s Month blog I want to write about a risk factor that has so far not been included in the Lancet Commission’s risk factor list but that I believe is really worthy of more coverage: Sleep…or rather lack of sleep.
The sleep factor
The role that sleep plays in our health throughout the life course, including after a person has developed dementia, is fascinating. Yet for many years I never really gave sleep much thought. I largely slept, like we all expect to, perfectly normally, short of the awful midnight phone calls when my dad had to go into hospital.
Then I experienced the sleep deprivation that comes with having children, and this was further compounded by a period of the most hideous insomnia that took my sleep down to 1.5 hours a night. Suddenly I knew the misery that not sleeping can bring, and over the weeks this went on I felt both the physical and mental effects of not sleeping.
I begged my GP for the magic solution, but she resolutely (and very kindly) wouldn’t prescribe me sleeping tablets and instead encouraged a range of non-drug options which did eventually work. I’ll explain what these were at the end of this blog.
Painful (literally) though the experience of insomnia was, it taught me a huge amount. Partly because I’m naturally inquisitive and did a lot of research, and also because I really took notice of how it made me feel. The fog in my brain was unlike anything I’d experienced before – or have experienced since – this period of insomnia and it got me thinking on those long, dark nights of wakefulness: if I couldn’t ‘fix’ my sleep, would this become the start of dementia?
At this point I should say that I’m not medically or scientifically qualified to authoritatively say if ongoing sleep deprivation can contribute to developing dementia. But I can say from a personal perspective that it’s the closest I’ve been to feeling like parts of my brain just weren’t working any more. I can also confirm how utterly frightening that feeling was.
The science
So, what do those more qualified than I say on the subject of sleep deprivation and the chances of developing dementia?
This year’s World Alzheimer Report (Page 19 onwards) says about sleep:
“Studies on the matter are especially complicated because of the ethical difficulty of arranging randomised control trials, which would involve leaving some people with sleeping disorders untreated. The studies that have been done have had mixed results, yet suggest that poor sleep patterns in middle age may contribute to a higher risk of dementia in later life.”
Dementia research charity BRACE, for whom I’m an Ambassador, are doing ongoing work investigating the links between sleep and dementia. You can watch Dr Liz Coulthard talking about sleep at a BRACE Conference, and a webinar from BRACE-funded Sleep Researcher Chloe Tulip, who herself struggled with her sleep.
Alzheimer’s Research have also published a huge amount of information relating to sleep and dementia.
The logic linking sleep deprivation and developing (or progressing) dementia
Clearly more understanding is needed into the links between sleep deprivation and developing dementia. In the meantime, it seems entirely logical to me to work on the proviso that with so many healing and processing functions happening within our bodies whilst we are asleep, if we are having poor quality or significantly shortened sleep over a long period of time (and some people are almost life-long insomniacs) this cannot be a positive thing for any organ or system within our bodies, not least our highly complex brains.
I know from my work with many different care providers that supporting sleep is a priority for them. It’s awful for a home care worker to visit someone who’s been awake half the night, finally got to sleep, and then been woken by the care worker’s visit, or care home staff who are unsure of how to support someone who’s awake for lengthy periods at night and then sleepy and missing meals and activities during the day.
How I ‘fixed’ my insomnia
I promised I’d finish with some tips about what has worked for me, although technically this title is a bit spurious. I believe that when your body has been capable of being a raging insomniac that it can always go back to that if you don’t keep working on creating the right conditions for sleep in your life. Think about it a bit like having to work on combatting an addiction.
My night-time routine now consists of low amber lighting, limited screens (sometimes easier said than done), relaxation as bedtime approaches, a warm shower and, if needed, a light snack (I get hungry at night). I find it’s my busy mind that stops me sleeping, so I use the Calm app for sleep stories once I’m in bed. I aim for the same bedtime and wake-up time (within reason with small people to look after) and I use a sleep tracker (mostly due to curiosity about my sleep). If I’m awake in the night, I only use minimal amber light or no light at all and I’ll put talking radio on (BBC Radio 4 / The World Service) to go back to sleep.
In addition, back when I tackled my insomnia head on I drank only decaffeinated drinks, took a magnesium supplement and listened to a sleep hypnosis app when I was in bed.
If you’re interested in more ‘official’ advice, I’d suggest reading the Sleep Charity guidelines on sleep hygiene and looking at ‘The 10 Commandments of Sleep’.
It’s also worth being aware of how any medication you’re taking may effect your sleep, and finding relaxation techniques that work for you – meditation, yoga, deep breathing etc. Some people benefit from therapies like CBT (Cognitive Behavioural Therapy), while other people may consider less orthodox options like purchasing a gravity blanket.
More information if you’re living with dementia or supporting someone who is
Dementia UK have published ‘Better sleep strategies’ for a person living with dementia, while the Alzheimer’s Society have lots of resources relating to sleep and dementia. I’ve also written about this topic in D4Dementia blog posts.
Until next time…
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