A Good Night’s Sleep Could Ward Off Alzheimer’s

Fascinating recent study; points to a significant function of sleep – housekeeping – of sufficient intensity that it cannot be performed while we are awake. Apparently, the brain has it’s own lymph system – the glymphatic system, which is up to 10x more active during sleep, and readies things for the next day. Interesting to see which sleep stages this is linked to – slow wave (N3) is a likely candidate…

As we learn more about potential ways to ward off dementia and Alzheimer’s disease as we age, from exercise to diet to web surfing to marijuana use, a new study makes the case that getting a good night’s sleep just might be the most important thing we can do.

Our brain cells produce toxic waste products each day as they work. The new study, published this week in the journal Science, shows that while we sleep, the brain literally flushes out this gunk. The self-cleaning process, which scientists observed in resting mice, is a powerful illustration of the medical importance of sleep. Researchers had suspected that this self-cleaning went on in our heads each night, but the new study put the process, and its intensity, in far clearer focus. For example, the team witnessed that when the mice slept, brain cells actually shrunk in size, expanding the spaces in between them by as much as 60 percent and facilitating the flushing of waste.

“It’s like opening and closing a faucet,” said University of Rochester neurosurgeon Maiken Nedergaard, who directed the study.

At minimum, the research highlights the potential importance of regular sleep in slowing dementia, as well as the possible neurological risks of consistently getting too little sleep. When we stay up until late into the night, we may be preventing our brains from flushing toxins effectively. This may also explain why we can feel uncertain or cranky when we are sleep-deprived and perhaps why migraines and seizures appear to be exacerbated by poor rest.

A year ago, Nedergaard’s team identified the network for flushing waste from the brain and named it the glymphatic system. During this cleansing, cerebrospinal fluid circulates through brain tissue, carrying waste matter into the bloodstream toward the liver, where it is detoxified. Similar systems, she noted, have been detected in the brains of dogs and baboons. Neuroscientists now widely assume that this self-cleaning takes place in humans as well, but the next step will be to directly observe the process.

A New Window on Sleep
Scholars have long wondered about the biological purpose of sleep. The idea that we sleep to conserve energy has been somewhat debunked; studies have found that the brain uses almost as much energy at rest as it does when we’re awake. Another theory held that a full night’s sleep was necessary to lock in memories, but as Nedergaard and others have pointed out, seven or eight hours appears to be excessive for this purpose, given what we now know about the speed of human memory processing.

A body of research does connect consistent sleep to the maintenance of human metabolism, which is why experts typically recommend that people trying to lose weight always get a full night’s sleep. But the new study indicates that a primary reason for sleep, and the reason it feels so restorative, is that we awake with the remains of the previous day’s activity cleared from our heads.

A Step Toward an Alzheimer’s Treatment?
To observe the glymphatic system in mice, the research team injected rodents with beta-amyloid, a protein that builds up in clumps in the brains of Alzheimer’s patients, forming plaques. By tracking the animals’ brains in real time using an imaging process known as two-photon microscopy, they were able to watch fluid move between cells. Researchers found that waste was flushed out of the brain cells of sleeping mice twice as fast as in those of conscious mice. “It was almost like you opened a faucet,” Nedergaard said.

Experts expressed hope that the new findings could lead to treatments for neurological ailments associated with cell waste in the brain, including Parkinson’s disease as well as Alzheimer’s and dementia. Scientists will be following up on the tantalizing possibility that Alzheimer’s is exacerbated not as much by the buildup of beta-amyloid plaque in the brain as by an impaired ability to flush it out. If that turns out to be true, then the development of a drug to facilitate or force the self-cleaning process could be a major breakthrough. Doctors may also achieve better results by coordinating dementia patients’ treatments with their sleep schedules.

“I’d be a fool not to pay attention to this,” Washington University neuroscientist Randall Bateman, an expert in amyloid-beta research, told the Science News blog.

– Gary Drevitch, Contributor

Sleepwalking Through Life

I have often joked with my wife, that I have to keep quiet about what I do for a living at any gathering. Sleep and psychiatry, it turns out, are two things people really have on their minds; and in today’s fast times, everyone seems to be stressed by working too much, and sleeping too little. On the other hand, I am equally amazed by people I meet who exercise regularly, eat healthy organic food, use meditation apps, only to tell you, on line at Starbucks, that they often only get 5 to 6 hours a night of sleep in their busy lives. I wonder about myself sometimes, as I savor a good cup of coffee in the morning, after staying up too late reading the night before. A lot of times, I couldn’t even tell you what I read, as boldly fought off sleep to the very last minute, with the power of my smartphone and the internet behind it.

The tremendous importance of sleep to our well being has been a lesson I have learned numerous times in my career as a psychiatrist. I continue to advocate that it should be a vital sign, along with blood pressure and pulse, of our general state of health. It affects everyone, young and old, and here’s some fascinating stories, that have changed my practice of medicine.

The youngest patients, I recall, were the 10 year old kids that came to Stanford, diagnosed with attention deficit disorder (ADHD), with minimal improvement on stimulants, like Ritalin or Adderall, still struggling at home and in school. These kids, it turned out, had stuffy noses, and slept on 3 pillows, fitfully through the night. Something else was going on, their tonsils were huge; and sleep tests confirmed sleep apnea (fragmented sleep because of poor breathing). The tonsils came out, and within several months, I remember to this day being hugged by moms who were so happy that their kids were off medication, sleeping soundly through the night, and not “hyperactive” anymore. Miraculous, I thought.

Then there are the middle aged patients who come worriedly to see me asking the question “Doc, I think I have Alzheimer’s, I forget movies, words, and walk into rooms and forget why!” Much to everyone’s relief, it often turns out to be a sleep problem. Our minds package up memories and practice for upcoming situations in sleep, and the value of sleep is both in quantity and quality. So many amazing studies have tested people, asked to memorize a list of words, then given a chance to sleep. More sleep, has always resulted in better recall, improved ability to learn everything from word lists, to emotional responses, to swinging a golf club. Emotions? Let’s not forget that sleep deprivation is a form of torture – and I’ve also seen so many people become emotionally “unstable” – tearful for no reason sometimes, overreactive, and irritable. One man knew he needed to catch up on his Zzz’s when after a few nights of poor sleep, he would cry over a dropped paper clip.

And the comes the energy or depression question, “Do you feel like doing things and lack the energy, or just don’t feel like doing things at all?” Fatigue can all too often look like depression, and in many instances, there is a very fine line between the two. The next time you’re on your drive home, spacing out at a stopped traffic light, thinking “woe is me, and what’s the point of all this anyway,” ask yourself if what you’re really missing is your bed, and some shut eye. Indeed a very large proportion of people I have worked with, diagnosed as attention deficit, bipolar, or treatment-resistant depression, benefit tremendously from the optimization of sleep.

I have often joked that everything you need to know about sleep, your grandmother taught you. Indeed, this is half true, in the sense that more sleep and more regular hours of sleep are a good thing. Sleep is affected most often by our habits; electronics, television, and late night web surfing to the edges of the internet. Yes we all lack some degree of discipline. But for many people, it is hard to fall asleep despite their best efforts. Anxiety is so often an overlooked factor – and we call this “battlefield sleep” or “thin sleep.” It’s the vigilant sleep one would get, sleeping in a dangerous situation, like a battlefield – with a lot of trouble falling asleep, waking up often and easily, and trouble sleeping in (no matter how late you went to sleep). Life is not a battlefield, but for anxious people, it often can be, and this becomes a nightly pattern, with fatigue and large amounts of caffeine, sometimes alcohol by the day’s end, to counter. And so the cycle repeats, sometimes for decades of people’s lives; and important experiences can often  become lost in a sleep deprived, caffeinated blur.

What to do? Sleep more and sleep better. Make sleep your health priority. Focus on habits and the use of electronics, and keep sleep on a regular schedule. Besides the quantity of sleep, look into the quality – does sleep feel light? How many times a night do you wake? Do you snore, or kick around a lot during the night? A great app to start this investigation is called SnoreLab (free on the iTunes store) – which basically records audio all night, and can show you just what happened before you woke at 4AM last night – I use this app myself, and recommend it to everyone. You spend one third of your life sleeping, and it affects every aspect of your waking life, promise. From memory to mood, to immunity, to weight loss and diabetes, and even risk of cancer, sleep has profound effects. Even more exciting, several recent studies have found that sleep can be used as part of a protocol to reverse mild dementia, and increase longevity.

Alex Dimitriu, MD

“Psychobiotics” To Naturally Improve Stress And Memory

Again more evidence supporting the tremendous role of the gut biome in maintaing physical as well as mental health. “The emerging concept of the gut microbiome as a key regulator of brain and behavior represents a paradigm shift in neuroscience. Precise targeting of the microbiome-gut-brain axis with psychobiotics — live microorganisms with a potential mental health benefit — is a novel approach for the management of stress-related conditions,” the authors of the study repot.

In this small study, 22 participants took a probiotic strain of Bifidobacterium longum daily for 4 weeks versus a placebo pill. Participants taking the probiotic lead to a decrease in anxiety, cortisol levels (a known stress hormone), improved performance on a visual memory task, as well as notable changes measured in brain activity on EEG.

45 Minutes To 2 Hours Of Morning Light For Weight Loss

Great article summing up two studies in the LA Times. In summary, morning sunlight, ranging in length from 45 minutes to 2 hours resulted in improved BMI (Body Mass Index measures), and reduced body fat composition. Among numerous variables investigated, the intensity and timing of morning sunlight were found to correlate most strongly with lower body mass indices. Morning sunlight is known to affect the hormones leptin and ghrelin (the latter known to increase appetite) – and the increased blue-wavelength frequencies of morning light are believed to underpin its efficacy.

Melatonin Agonist Substantially Lowers Delirium Risk

Delirium is a very common condition, often seen in the elderly population, with an incidence as high as 50% in some hospitalized patients. In addition to being very difficult for both patients, family, and care providers, it is also associated with an increased mortality risk, which makes prompt treatment imperative. The importance of the psychiatry-sleep connection is underscored by this recent study of ramelteon – essentially a more potent version of melatonin (which regulates our sleep wake cycles). In this recent study the researchers were able to lower the incidence of delirium by a staggering 32% vs 3% for placebo. This is a substantial and very meaningful finding, with the ability to markedly improve outcome in many patients.

Read about more about it here:  JAMA Ramelteon and Delirium

Trans-Cranial Direct Current Stimulation (Tdcs) – The Future Of Cognitive Enhancement?

tDCS – Transcranial direct current stimulation; involves the application of a very mild current for 20 minutes to the frontal lobes of the brain, through electrodes placed on the skin. Much to my surprise, this extremely simple and non-invasive technique is proving to have lasting effects on learning and cognition – in some instances, lasting as long as 5 hours after the treatment. The results are quite impressive and the data thus far seems consistent. The author of a recent study at Vanderbilt University states, “…when we up-regulate that process, we can make you more cautious, less error-prone, more adaptable to new or changing situations — which is pretty extraordinary.”

See the study here:

R. M. G. Reinhart, G. F. Woodman. Causal Control of Medial-Frontal Cortex Governs Electrophysiological and Behavioral Indices of Performance Monitoring and Learning. Journal of Neuroscience, 2014; 34 (12): 4214 DOI:10.1523/JNEUROSCI.5421-13.2014

Sleep Cleans Up The Brain

A similar system to our body’s lymphatic system, exists in our brain – and its called the glymphatic system. A day’s worth of activity for the most metabolically active organ certainly generates numerous byproducts, that at some point, have to get flushed out. It turns out that during sleep this system is in overdrive (a 60% increase in the drainage system).  I found this to be a groundbreaking study, which essentially reveals why the brain may have to be “off line” to do a massive clean up of this scale. I am eagerly awaiting further research into the particular phase of sleep involved, but I suspect slow wave sleep is the answer – and there may be pharmacologic ways of enhancing this.

Read more about it here:  New York Times

Insomnia: Definition, Prevalence, Etiology And Consequences

In this excellent article, Thomas Roth PhD; a leading sleep researcher discusses the far reaching effects of insomnia. This is a great article to provide background on this very common, yet very complex condition – with a prevalence of 30% of the population. Numerous and alarming consequences are discussed – ranging from increased risk of automobile accidents, depression, increased pain, and hypertension. Chronic insomnia was also marked by substantial social and career impairment. This work underscores the tremendous need for better treatments – for a condition that affects up to 1 in 3 of us.

Read the report here:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/