The decrease in the quantity and quality of the NREM SWS as well as the disturbances of sleep will therefore increase the AB plaques.[29][30] This will first take place at the hippocampus level, from which memory is dependent.[29][30] This will result in cell death at this level and will contribute to diminished memory performances and cognitive decline found in AD disease.[29]
Interestingly, the glymphatic cleanrance occurs during the NREM sleep, and more specifically the NREM SWS sleep.[29][30][32] As seen previously, it is a sleep stage that decreases in normal aging.[30] So there is less glymphatic clearance and an increase in AB burden that will form the AB plaques.[32][29][30] Therefor, in AD sleep disturbances will amplify this phenomenon.
Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances.[52] Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.[citation needed]
People who have insomnia don't feel as if they get enough sleep at night. They may have trouble falling asleep or may wake up frequently during the night or early in the morning. Insomnia is a problem if it affects your daytime activities. Insomnia has many possible causes, including stress, anxiety, depression, poor sleep habits, circadian rhythm disorders (such as jet lag), and taking certain medications.
Sleep apnea is a common (and treatable) sleep disorder in which your breathing temporarily stops during sleep, awakening you frequently. If you have sleep apnea you may not remember these awakenings, but you’ll likely feel exhausted during the day, irritable and depressed, or see a decrease in your productivity. Sleep apnea is a serious and potentially life-threatening sleep disorder, so see a doctor right away and learn how to help yourself.
Idiopathic hypersomnia: a chronic neurological disease similar to narcolepsy in which there is an increased amount of fatigue and sleep during the day. Patients who suffer from idiopathic hypersomnia cannot obtain a healthy amount of sleep for a regular day of activities. This hinders the patients' ability to perform well, and patients have to deal with this for the rest of their lives.[15]
Fatigue during the first trimester of pregnancy is likely caused by changing levels of hormones, such as progesterone. Toward the end of pregnancy, some women find it difficult to sleep because of the uncomfortable size of their abdomen. Some women are too excited, anxious, or worried about becoming mothers to sleep well. Other women who are pregnant complain that vivid dreams prevent them from getting restful sleep. Sleep apnea, especially if it's severe and causes your blood oxygen level to drop during sleep, is a risk to the fetus.
If sleeping with a mask on doesn't work for you, other options are surgery; oral appliances; and newer, minimally invasive outpatient surgical treatments. These include the Pillar procedure, which involves using permanent stitches to firm up the soft palate; coblation, which uses radiofrequency to shrink nasal tissues; and even use of a carbon dioxide laser to shrink the tonsils.
Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted.[35]
What to do: If you suspect you have a circadian rhythm disorder, take steps to get your body onto a regular sleep schedule. Choose a bedtime and wake-up time that work for you, and follow the same routine each day, even on weekends. This can be tough for those who have to get up early during the week but like to stay up later on weekends, but do your best to craft a compromise between your work week and weekend habits. The important thing is to avoid the trap of sleeping from 10 p.m. to 6 a.m. during the week, then suddenly shifting to late nights and late mornings on the weekends. This will inevitably leave you with insomnia on Sunday night, which in turn sets you up to start the week exhausted on Monday morning.
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