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More Daytime Sleepiness, More Alzheimer’s Disease

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September 6, 2018

Excessive daytime sleepiness linked with brain protein involved in memory-robbing disease

Analysis of data captured during a long-term study of aging adults shows that those who report being very sleepy during the day were nearly three times more ly than those who didn’t to have brain deposits of beta amyloid, a protein that’s a hallmark for Alzheimer’s disease, years later. 

The finding, reported Sept. 5 in the journal SLEEP, adds to a growing body of evidence that poor quality sleep could encourage this form of dementia to develop, suggesting that getting adequate nighttime sleep could be a way to help prevent Alzheimer’s disease.

“Factors diet, exercise and cognitive activity have been widely recognized as important potential targets for Alzheimer’s disease prevention, but sleep hasn’t quite risen to that status—although that may well be changing,” says Adam P.

Spira, PhD, associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health.

Spira led the study with collaborators from the National Institute on Aging (NIA), the Bloomberg School and Johns Hopkins Medicine.

“If disturbed sleep contributes to Alzheimer’s disease,” he adds, “we may be able to treat patients with sleep issues to avoid these negative outcomes.”

The study used data from the Baltimore Longitudinal Study of Aging (BLSA), a long-term study started by the NIA in 1958 that followed the health of thousands of volunteers as they age.

As part of the study’s periodic exams, volunteers filled a questionnaire between 1991 and 2000 that asked a simple yes/no question: “Do you often become drowsy or fall asleep during the daytime when you wish to be awake?” They were also asked, “Do you nap?” with response options of “daily,” “1-2 times/week,” “3-5 times/week,” and “rarely or never.”

A subgroup of BLSA volunteers also began receiving neuroimaging assessments in 1994. Starting in 2005, some of these participants received positron emission tomography (PET) scans using Pittsburgh compound B (PiB), a radioactive compound that can help identify beta-amyloid plaques in neuronal tissue. These plaques are a hallmark of Alzheimer’s disease.

The researchers identified 123 volunteers who both answered the earlier questions and had a PET scan with PiB an average of nearly 16 years later. They then analyzed this data to see if there was a correlation between participants who reported daytime sleepiness or napping and whether they scored positive for beta-amyloid deposition in their brains.

Before adjusting for demographic factors that could influence daytime sleepiness, such as age, sex, education, and body-mass index, their results showed that those who reported daytime sleepiness were about three times more ly to have beta-amyloid deposition than those who didn’t report daytime fatigue. After adjusting for these factors, the risk was still 2.75 times higher in those with daytime sleepiness.

The unadjusted risk for amyloid-beta deposition was about twice as high in volunteers who reported napping, but this did not reach statistical significance.

It’s currently unclear why daytime sleepiness would be correlated with the deposition of beta-amyloid protein, Spira says. One possibility is that daytime sleepiness itself might somehow cause this protein to form in the brain.

previous research, a more ly explanation is that disturbed sleep—due to obstructive sleep apnea, for example—or insufficient sleep due to other factors, causes beta-amyloid plaques to form through a currently unknown mechanism, and that these sleep disturbances also cause excessive daytime sleepiness.  

“However, we cannot rule out that amyloid plaques that were present at the time of sleep assessment caused the sleepiness,” he added.

Animal studies in Alzheimer’s disease models have shown that restricting nighttime sleep can lead to more beta-amyloid protein in the brain and spinal fluid. A handful of human studies have linked poor sleep with greater measures of beta-amyloid in neuronal tissue.

Researchers have long known that sleep disturbances are common in patients diagnosed with Alzheimer’s disease—caregiver stress from being up with patients at night is a leading reason for Alzheimer’s disease patients to be placed in long-term care, Spira explains. Growing beta-amyloid plaques and related brain changes are thought to negatively affect sleep.

But this new study adds to growing evidence that poor sleep might actually contribute to Alzheimer’s disease development, Spira adds.

This suggests that sleep quality could be a risk factor that’s modifiable by targeting disorders that affect sleep, such as obstructive sleep apnea and insomnia, as well as social- and individual-level factors, such as sleep loss due to work or binge-watching TV shows.

“There is no cure yet for Alzheimer’s disease, so we have to do our best to prevent it. Even if a cure is developed, prevention strategies should be emphasized,” Spira says. “Prioritizing sleep may be one way to help prevent or perhaps slow this condition.”

“Excessive Daytime Sleepiness and Napping in Cognitively Normal Adults: Associations with Subsequent Amyloid Deposition Measured by PiB PET” was written by Adam P. Spira, Yang An, Mark N. Wu, Jocelynn T. Owusu, Eleanor M. Simonsick, Murat Bilgel, Luigi Ferrucci, Dean F. Wong, and Susan M. Resnick.

This study was supported in part by National Institute on Aging extramural grants AG050507, AG050745, AG049872, and AG050507-02S1, Intramural Research Program (IRP), National Institute on Aging (NIA), National Institutes of Health (NIH) and by Research and Development Contract HHSN-260-2004-00012C.  

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Robin Scullin at 410-955-7619 or rsculli1@jhu.edu.

Source: https://www.jhsph.edu/news/news-releases/2018/more-daytime-sleepiness-more-alzheimers-disease.html

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Healthy Sleep Habits

Sleep Better | Johns Hopkins Medicine

Linkedin Pinterest Babies and Toddlers Health

The normal amount of sleep varies depending on the age of your child.

Age Average nighttime
sleep Average daytime
sleep
Newborns to 3 months 8 to 9 hours
(waking through the night to feed)
8 hours
6 to 12 months 10 to 12 hours
(usually sleeps through the night)
5 hours
2 years 10 to 12 hours 4 hours
(fewer naps after 12 months of age)
3 years 10 hours 1 hour
4 to 6 years 10 hours Usually no nap

Helpful tips for healthy sleep habits

The following are some helpful tips for establishing good sleep habits for your child:

  • Newborns don't have a set night or day schedule for the first several weeks of life. It is best for a newborn not to sleep longer than 5 hours at a time in the first 5 to 6 weeks as their small bodies need frequent feedings.

  • Older babies and children should have a consistent nap time and bedtime schedule.

  • Start a quiet time, such as listening to quiet music or reading a book, 20 to 30 minutes before bedtime. TV, smart phones, tablets, and computers should not be a part of the quiet time.

  • After quiet time, follow a bedtime routine, such as a diaper change, going to the bathroom, and brushing teeth.

  • Set a time limit for quiet time and the routine so it does not drag on and your child knows what to expect before bedtime.

  • Say goodnight, turn off the light, and leave the room.

  • Security objects, such as a special blanket or stuffed animal, can be part of the bedtime routine.

  • It is important for children to be put to bed awake so they learn to fall asleep themselves.

  • Babies should not be put to bed with a bottle. It causes problems with tooth decay and ear infections.

Helpful tips for children with poor sleep habits

Children can easily fall into bedtime habits that are not always healthy habits. The following suggestions can help when a child does not want to go to bed or is having trouble staying in bed:

  • If your child cries, speak calmly and reassure him or her, “You are fine. It is time to go to sleep.” Then leave the room.

  • Don't give a bottle or pick up your child.

  • Stretch out the time between trips to the room if your child continues. Don't do anything but talk calmly and leave.

  • Your child will calm down and go to sleep if you stick to this routine. It may take several nights for your child to get used to the new plan.

  • If your child is used to getting a large amount of milk right at bedtime, start to cut down the amount of milk in the bottle by 1/2 to 1 ounce each night until the bottle is empty and then take it away completely.

  • Sometimes children get their routine of night sleeping because of an illness or travel. Quickly return to good sleep habits when things are back to normal.

Sometimes, older children go through a stage when they revert back to bad sleep habits or develop new problems in going to sleep. The following are some tips to help parents with older children who have problems going to bed:

  • If your child gets bed, take him or her back to bed with a warning that the door will be shut (not locked) for 1 or 2 minutes if he or she gets bed.

  • If your child stays in bed, the door stays open. If your child gets bed, the door is closed for 2 minutes. Your child can understand that he or she has control of keeping the door open by staying in bed.

  • If your child gets out again, shut the door for 3 to 5 minutes (no more than 5 minutes).

  • Be consistent. Put your child back in bed each time he or she gets bed.

  • When your child stays in bed, open the door and give your child praise (for example, “You are doing a great job of staying in bed. Goodnight.”

  • Your child can be rewarded by earning a star on a calendar for staying in bed all night. You can give a special prize for a certain number of stars earned.

Reducing the risk for sudden infant death syndrome (SIDS) and other sleep-related deaths

Here are recommendations from the American Academy of Pediatrics (AAP) on how to reduce the risk for sudden infant death syndrome (SIDS) and sleep-related deaths from birth to age 1:

  • Make sure your baby is immunized. An infant who is fully immunized reduces his or her risk for SIDS. 

  • Breastfeed your infant. The AAP recommends breast milk only for at least the first 6 months. 

  • Place your infant on his or her back for all sleeping until he or she is 1-year-old. This can decrease the risk for SIDS, aspiration, and choking. Never place your baby on his or her side or stomach for sleep or naps. If your baby is awake, allow your child time on his or her tummy as long as you are supervising, to decrease the chances that your child will develop a flat head.

  • Always talk with your baby's doctor before raising the head of the crib if he or she has been diagnosed with gastroesophageal reflux.

  • Offer your baby a pacifier for sleeping or naps, if he or she isn't breastfed. If breastfeeding, delay introducing a pacifier until breastfeeding has been firmly established.

  • Use a firm mattress (covered by a tightly fitted sheet) to prevent gaps between the mattress and the sides of a crib, a play yard, or a bassinet. This can decrease the risk for entrapment, suffocation, and SIDS.

  • Share your room instead of your bed with your baby. Putting your baby in bed with you raises the risk for strangulation, suffocation, entrapment, and SIDS. Bed sharing is not recommended for twins or other higher multiples.

    The AAP recommends that infants sleep in the same room as their parents, close to their parent's bed, but in a separate bed or crib appropriate for infants.

    This sleeping arrangement is recommended ideally for the baby's first year, but should at least  be maintained for the first 6 months.

  • Don't use infant seats, car seats, strollers, infant carriers, and infant swings for routine sleep and daily naps. These may lead to obstruction of an infant's airway or suffocation.

  • Don't place infants on a couch or armchair for sleep. Sleeping on a couch or armchair puts the infant at much higher risk of death, including SIDS.

  • Don't use illicit drugs and alcohol. Don't smoke during pregnancy or after birth. Keep your baby away from others who are smoking and areas where others smoke.

  • Don't over bundle, overdress, or cover an infant's face or head. This will prevent him or her from getting overheated, reducing the risks for SIDS.

  • Don't use loose bedding or soft objects. Bumper pads, pillows, comforters, and blankets should not be used in an infant's crib or bassinet to help prevent suffocation, strangulation, entrapment, or SIDS.

  • Don't use cardiorespiratory monitors and commercial devices. Wedges, positioners, and special mattresses should not be used to help decrease the risk for SIDS and sleep-related infant deaths.

  • Always place cribs, bassinets, and play yards in hazard-free areas. Avoid dangling cords, wires, or window coverings to reduce the risk for strangulation. 

  • Avoid all exposure to smoke, alcohol, and illicit drugs.

Source: https://www.hopkinsmedicine.org/health/wellness-and-prevention/healthy-sleep-habits