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Anthea Rowan

This is the 12th instalment in a series on dementia, including the research into its causes and treatment, advice for carers, and stories of hope.
As the daughter of an Alzheimer’s patient and an intermittent insomniac, I register with alarm that sleep disturbances might elevate dementia risk.
Over the years, accumulated research suggests there is a strong link between insomnia and cognitive impairment.
Having only five hours of sleep a night can increase dementia risk by 30 per cent for adults over 50, one study says. Another notes that sleep-related movement disorders can increase the risk by almost four times for middle-aged and older adults.

Broken sleep may heighten the effect of the APOE4 gene – known to expose carriers to a dementia risk – on cognitive decline.
Restricting sleep can interfere with the blood-brain barrier, the tightly locked layer of cells that defend your brain from harmful substances, germs and other things that could cause damage and impose stress on the brain.
Exercise will keep you alive, professor says, but won’t help you lose weight
Regular use of benzodiazepines – frequently prescribed for insomnia – nearly doubles the risk of dementia in older adults, while the use of so-called “Z-drugs” – a class of sleeping tablets that includes zopiclone, zaleplon and zolpidem that don’t have benzodiazepines in them – increases the risk of cognitive decline by 33 per cent, and all-cause dementia by 79 per cent.
A 10-year study published in January seemed to confirm the link between insomnia and a higher risk of developing dementia. But it also threw out a surprising positive.
The study analysed data from more than 6,000 respondents, measuring sleep-initiation insomnia (trouble falling asleep within 30 minutes of going to bed); sleep-maintenance insomnia (trouble falling asleep after waking up early); and sleep-medication usage.

Sleep-initiation insomnia was associated with a 51 per cent increased dementia risk, and sleep-medication usage with a 30 per cent increased dementia risk.
But sleep-maintenance insomnia – falling back to sleep after waking up in the middle of the night or too early in the morning – was associated with a 40 per cent decreased dementia risk.
Professor Roger Wong, of the department of public health and preventive medicine at the State University of New York’s Upstate Medical University, is one of the authors of the study. He explains why different types of insomnia might have varied dementia risk levels.

First, he explains that 60 to 80 per cent of dementia cases are caused by Alzheimer’s disease.
“The hallmark for this disease is the build-up of a toxic protein in the brain called ‘plaque’. Good quality and quantity of sleep are important because there has been research done in both rodents and humans indicating that sleep is essential to drain away this plaque when we sleep. Inadequate sleep increases the build-up of plaque in the brain.”
Wong says the leading theory for why sleep is so important for cognitive health is because it supports the “glymphatic system” – the system that accommodates waste clearance, including brain plaque – from the central nervous system.
“It’s also very possible that good sleep is needed to maintain good mental and physical health, which are strongly linked to dementia risk.”

So if sleep initiation insomnia poses a dementia risk, why does waking up in the middle of the night and being temporarily unable to go back to sleep potentially reduce that risk?
Wong says his personal interest in this topic is the result of his father’s insomnia – he wakes up around 3am and can’t fall back to sleep.
His theory is that most people don’t just lie in bed after waking up prematurely. “Instead, people like my father engage in cognitively stimulating activities, which then decreases dementia risk.”
These could include reading, listening to a podcast or even getting up and doing something in the quiet of night: gardening, making jam.

Sleep aids, Wong explains, which many insomniacs resort to in a desperate bid to get some shut-eye, can heighten dementia risk.
“Many sleep aids are anticholinergic, which disrupts a neurotransmitter in our brain called acetylcholine, which is essential for memory.”
Sleep aids that are anticholinergic include many over-the-counter sleep products, such as Tylenol PM. Some antidepressants have an anticholinergic action, as do a number of anti-allergy meds like benadryl (diphenhydramine). Cholinergic drugs – on the other hand – activate receptors for acetylcholine.
How to sleep, eat and work out better, and handle stress? They’re linked
My mother has, over the years, been prescribed various cocktails of drugs, first for resistant depression – which in itself presented with severe insomnia; she was often unable to get to sleep at all – and later for an irritable bladder.
A number of these score a “3” on the anticholinergic burden calculator, meaning that they bear a “severe” anticholinergic burden. At several times in her life, she has been prescribed more than one of these at any one time, elevating that burden to a high-risk 9 or 15. Her prescription accentuates her dementia risk, and she already has depression and persistent sleep-initiation insomnia.
To protect your brain, the message is to try to get to sleep without resorting to any chemical aids – that is, sleeping pills. Take them only when prescribed by a doctor and for short periods of time.
‘I bore you to sleep with my soothing voice’: podcasts to nod off to
The Mayo Clinic of Rochester, in the US state of Minnesota, advocates establishing a peaceful bedtime routine; avoiding coffee from noon onwards; taking a warm shower or bath in the hour or so before bed; and staying clear of device use in the late evening.
Some other measures it suggests: avoid clock watching; go to bed only when you’re sleepy; stick to a routine of going to bed and getting up at the same times; and if you do wake up at night and don’t drop back to sleep within half an hour, get up and do something until you feel sleepy again.
I read or listen to podcasts. My hot tip: find one with a soporific soundtrack.
Like what you read? Follow SCMP Lifestyle on Facebook, Twitter and Instagram. You can also sign up for our eNewsletter here.


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Wellness

Can lack of sleep raise dementia risk? Yes, studies say – but with one exception

Having only five hours of sleep a night can increase dementia risk by 30 per cent for adults over 50, one study says. Photo: Shutterstock

One tip to overcome insomnia is to avoid clock-watching. Photo: Shutterstock

Taking a warm shower or bath in the hour or so before bed may help you fall asleep – and stay asleep. Photo: Shutterstock

Professor Roger Wong of the department of public health and preventive medicine at the State University of New York’s Upstate Medical University. Photo: Roger Wong

Sleep aids can heighten dementia risk, Wong says. Photo: Shutterstock

Can’t sleep? Try getting up and engaging in cognitively stimulating activities, like reading or making jam. Photo: Shutterstock

How can you prevent dementia? Free brain health online tool teaches the risks and gives essential tips on avoiding it

The new free “Think Brain Health Check-in” online tool from Alzheimer’s Research UK doesn’t test your memory but checks how well you’re looking after your brain and gives tips to help prevent dementia. Photo: Shutterstock

Dr Susan Mitchell is head of policy at Alzheimer’s Research UK. Photo: Dr Susan Mitchell

The Think Brain Health Check-in asks how often you challenge your brain - and then highlights why challenging your brain is key to staving off dementia. Photo: Shutterstock

Getting a good night’s sleep every night is one way to lower the risk of developing dementia. Photo: Shutterstock

Up to 40 per cent of dementia cases could be prevented if people were mindful of the risk factors for the illness and made lifestyle changes to prevent them. Photo: Shutterstock

How to keep your brain healthy as you age: eat a heart-healthy diet – such as the popular Mediterranean diet or newer Mind diet

Eating heart-healthy food such as by following a Mediterranean diet or its variant the Mind diet can help prevent cognitive decline. Mind combines the Mediterranean diet with foods that reduce blood pressure. Photo: Shutterstock

The nutrients in Mind diet foods also have anti-inflammatory properties. Inflammation is a natural process, but sustained use or over-activation of our immune system can cause damage, says Thomas Holland. Photo: Thomas Holland

The cardiovascular benefits of the Mediterranean diet could contribute towards brain health, says Oliver Shannon. Photo: Oliver Shannon

 A higher adherence to a Mediterranean diet was associated with a 23 per cent reduced risk of dementia in a recent study. Photo: Getty Images

‘I was feeling helpless with fatigue’: how Ayurvedic detox therapy panchakarma helped a yoga teacher end 5 years of poor sleep, and how it can work for you too

A healthy meditation and yoga teacher who hadn’t slept properly for five years visited a specialist of Ayurvedic panchakarma (detox and purifying therapy, above).
Photo: Ananda in the Himalayas

Chandan Malatkar Chandramohan consults with a guest at the Ananda in the Himalayas resort. Photo: Ananda in the Himalayas

In “shirodhara”, an Ayurvedic medicinal practice, a continuous stream of oil is poured between the eyebrows. The treatment is used to improve memory, address other neurological disorders, and normalise sleep patterns. Photo: Ananda in the Himalayas

“Pizhichil” involves lukewarm herbal oils being poured oil slowly and rhythmically on the entire body with light pressure. It is used to strengthen immunity, lubricate the joints, liquefy toxins and increase flexibility. Photo: Ananda in the Himalayas

It is important to be mindful of what you eat and the environment you dine in. Photo: Ananda in the Himalayas

Lifestyle

Health & Wellness

Health

Decoding dementia

How caring for a parent with dementia taught me about symptoms, prevention and why seeking out the latest research is so important

Author Anthea Rowan (right) with her mother.

Author Anthea Rowan (right) with her mother, who has Alzheimer’s disease, the most common type of dementia. Photo: Anthea Rowan

Anthea with her mother. Photo: Anthea Rowan

Studies suggest that regular exercise lowers the risk of cognitive decline by 35 per cent. Photo: Getty Images

Staying active can help prevent or delay the onset of dementia, studies suggest. Photo: Shutterstock

Why should you have a brain scan to test for dementia when there’s no cure? Knowing can help you delay its onset, neurologist says

It can be daunting to get a brain scan to test for signs of dementia, but a neurologist behind new research reveals the advantages of knowing early. Photo: Shutterstock

New research has found that dementia can be detected as early as nine years before symptoms manifest, and this could have significant implications for treatment. Photo: Shutterstock

Timothy Rittman, the neurologist who led the dementia research at Cambridge University. Photo: Cambridge University

A brain scan showing signs of dementia. Photo: Getty Images

Lizzie Perry, founder of This is Dementia, with her father, who was diagnosed with the disease at 58. Photo: This is Dementia

The approval in the US of a new drug that slows the onset of Alzheimer’s makes Rittman hopeful about the future of dementia treatment. Photo: Cambridge University

Why women are more likely to have dementia than men as they age, and how exercise and engagement can help lower your risk

Women may be at a greater risk of developing Alzheimer’s than men for a number of reasons: biological, societal or cultural. Experts suggest exercise and social engagement can help offset the risk. Photo: Getty Images

The spread of tau – the protein that clumps into the telltale tangles of dementia – may contribute to Alzheimer’s disease. Photo: Shutterstock

Female twins with a male co-twin were less likely to be diagnosed with dementia than female twins with a female co-twin. Photo: Shutterstock

Prenatal care and monitoring pregnant women’s health is key, as it may impact cognition and dementia risk in later life. Photo: Shutterstock

Taking regular exercise is key for women – and men – to reduce the risk of dementia. Photo: Shutterstock

How high or low blood pressure increases the risk of dementia, and why it’s never too late, or early, to adopt a healthy lifestyle to manage it

Having blood pressure that is too high or too low has been linked to a higher risk of dementia, but it’s never too late to start living a healthy lifestyle that will help maintain optimal blood pressure. Photo: Shutterstock


An optimal blood pressure reading, easily measured with a home device, is around 120/80. Photo: Shutterstock

Dr Ruth Peters was lead author of a study looking at the links between blood pressure and dementia. Photo: Dr Ruth Peters

It’s never too late, or too early, to start thinking about brain health and living a healthy lifestyle. Photo: Shutterstock

Problems with reasoning, planning, judgment, memory and other thought processes may result from damage caused by impaired blood flow to the brain – which may be brought on by high blood pressure. Photo: Shutterstock

6 dementia fighting tips from Dr Sanjay Gupta and Marc Milstein, experts on brain health – walk, talk, read, learn, relax, and eat and drink properly

We can protect ourselves against the risk of dementia with some simple lifestyle practices. Exercising (above), eating a good diet, drinking less alcohol, socialising, reading more and trying new things all help keep the brain sharp, say brain experts including Dr Sanjay Gupta. Photo: Shutterstock 

The cover of one of Dr Sanjay Gupta’s book. Photo: Simon & Schuster

The cover of Marc Milstein’s book. Photo: Marc Milstein

Drink alcohol mindfully and ask yourself why you are having that drink. Photo: Shutterstock

Learning new things creates new brain cell connections and helps keep your mind sharp. Photo: Shutterstock

Reading is good for brain health. Try to read a wide range of book styles, and join a book club to discuss with others what you are reading. Photo: Shutterstock

During sleep, our brains are restored and repaired, so relaxing is important if we’re going to get those seven hours of quality sleep. Photo: Shutterstock

Relationships keep us engaged, interested and interesting, and may help prevent dementia. Photo: Shutterstock

‘Like a light switch’: how sundowning syndrome affects dementia sufferers – and their carers; what it is and tips for how to cope

A person with dementia may experience “sundowning” syndrome - towards the end of the day they become more agitated, confused, panicked, resistant to instruction and restless. This affects their carers, too. Photo: Shutterstock

A person in bed, unable to sleep. Conservative estimates suggest about 20 per cent of dementia patients experience sundowning at some point.

Trey Todd is a neuroscientist at the University of Wyoming. Photo: Trey Todd

Sundowning was coined in 1987 by Lois Evans of Penn Nursing at Pennsylvania University. Photo: University of Pennsylvania

The pineal gland in our brain produces melatonin, which is what helps prompt us to sleep and awaken. In a broken system it is disrupted. Melatonin supplements might help fight sundowning. Photo: Shutterstock

Taking a patient with sundowning syndrome for a walk at a consistent time each day, morning or evening, may alleviate symptoms. Photo: Shutterstock

Getting out into the daylight early in the day is good for our sleep patterns, whether we have dementia or not. Photo: Shutterstock

Healthy marriage, healthy mind? Dementia risk lower for people married a long time, studies show; expert suggests why

Research suggests that people who have stayed married for a long time have a lower risk for dementia because they feel less lonely, are more likely to eat well and exercise more, and are more cognitively engaged. Photo: Shutterstock

Vegard Skirbekk is a researcher at the Norwegian Institute of Public Health. Photo: Norwegian Institute of Public Health

Anthea Rowan’s parents on their wedding day. Photo: courtesy of Anthea Rowan

A long-time married partner represents a security that provides a buffer against stressors. Photo: Shutterstock

Anthea Rowan and her husband on their wedding day. Photo: courtesy of Anthea Rowan

If you live with a partner long term, you are more likely to develop healthy daily patterns, to eat well and exercise more. Photo: Shutterstock

‘Dementia village’ that’s the first of its kind helps residents live normal lives, has a restaurant, theatre and supermarket – and no one wears a white coat

Residents are free to live their lives as they like at the world’s first “dementia village”, The Hogeweyk in The Netherlands. Photo: The Hogeweyk

The Hogeweyk, a “dementia villlage” in the Netherlands, provides care and a familiar and safe environment in which people with dementia live while retaining their own identity and autonomy as much as possible. Photo: The Hogeweyk

Jannette Spiering is the senior managing adviser and co-founder at The Hogeweyk in the Netherlands, which offers “humanising care for people with dementia”. Photo: The Hogeweyk

Residents relax around the fountain in the theatre square at The Hogeweyk. Photo: The Hogeweyk 

Residents of The Hogeweyk respond positively to their increased autonomy. Photo: The Hogeweyk

Residents at the healthcare facility take part in a painting class. Photo: The Hogeweyk

Hearing loss dramatically raises the risk of dementia, so why are so many people in midlife doing nothing to prevent it? A test is easy to arrange

Hearing loss has been linked to a higher risk of dementia and cognitive decline,  say experts, who recommend testing for preventable hearing problems (above).  Photo: Getty Images

Alison Huang, a senior research associate at the Cochlear Centre at Johns Hopkins, in the US, says hearing loss makes the brain work harder to process sounds. Photo: Johns Hopkins

Jiang Fan from the School of Public Health at China’s Shandong University. Photo: Shandong University

Checking your hearing in midlife is crucial, and can help you stave off cognitive deterioration. Photo: Shutterstock

Can HRT reduce dementia risk? New hormone replacement therapy studies say yes, upending 2002 reports

HRT use has been linked to better cognition, blood flow and brain size and a reduction in all neurodegenerative disease in recent studies. Photo: Shutterstock

HRT (hormone replacement therapy) use has been linked to better cognition, blood flow and brain size and a reduction in dementia and other neurodegenerative disease in recent studies. Photo: Shutterstock

If HRT is started after the age of 65, brain cells will have already been deprived of oestrogen for many years. This could mean there is a decline in neuronal connections – the brain’s messaging system. Photo: Shutterstock

HRT was found to be most effective when introduced early in menopause, says Anne Marie Minihane, director of the UK’s Norwich Institute of Healthy Ageing at the University of East Anglia. Photo: University of East Anglia

Dr Andrea Kwakowsky from at the University of Galway in Ireland believes the “critical period” for starting HRT is within five years of menopause. Photo: University of Galway

Dementia and ACB scores: how common prescription and over-the-counter drugs raise the risk of memory loss and cognitive decline

Certain common drugs, including antihistamines, antacids, antidepressants and anti-anxiety medicines, can disrupt the neurotransmitter acetylcholine, dubbed the “memory molecule” increasing the risk of dementia. Photo: Shutterstock

The writer, Anthea Rowan, with her mother. Photo: Anthea Rowan

Taking medications that block the action of acetylcholine can lead to memory loss, problems with spatial awareness, and cognitive decline. Photo: Shutterstock

Studies have found that anticholinergic drugs carried “significant’ dementia risk” for the over-65s. Photo: Shutterstock

Doctors need to be mindful of the risks posed by anticholinergic drugs, especially to an already at-risk population: the over 65s. Photo: Shutterstock

How to safeguard your ageing brain: build ‘cognitive reserve’ with mental and physical exercise, and stay active and socially engaged

The phrase ‘use it or lose it’ is not just a hypothesis, it’s a basic biological fact that holds as true for our brains as our muscles or bones. Photo:
Shutterstock

Our brains, like our muscles need regular use to stay healthy and flexible, say experts, and keeping our brains active builds our ‘cognitive reserve’, helping us to stave off dementia. Photo: Shutterstock

Geriatric psychiatrist Dr David Merrill recommends the active pursuit of activities that keep the brain sharp to stave off dementia. Photo: Dr David Merrill

Dorina Cadar says cultural and social engagement, reading, doing crossword puzzles, visiting art galleries, clubs and cinemas, and volunteering all increase our cognitive reserve. Photo: Dorina Cadar

Visiting an art gallery or doing something new and different are good ways to build up cognitive reserve. Photo: Shutterstock 

How yoga benefits dementia patients: new study uncovers brain-health boosts, supporting earlier research

Yoga has health benefits including better brain neuroplasticity, improved sleep quality, and more robust cardiorespiratory fitness, all of which help people experiencing cognitive decline or dementia. Photo: Shutterstock

Dr Diana Karamacoska is a research support programme fellow in healthy ageing and dementia at the NICM Health Research Institute at Western Sydney University. Photo: Courtesy of Diana Karamacoska

Yoga could be helpful in managing brain inflammation, particularly with its mindfulness component. Photo: Shutterstock

Wendy Du is the founder of Shan Studios in Hong Kong. Photo: Wendy Du/Shan Studios

Du has maintained a daily yoga practice for 10 years. Photo: Courtesy of Shan Studios

5 nutrients good for brain health that can delay dementia, or prevent it, and foods to eat with a high concentration of them

Research has identified some key nutrients we need in our diets to maintain good cognitive function and delay or prevent the onset of dementia. Photo: Shutterstock

Eating healthy isn’t just good for our bodies, it’s good for our brains, too. Photo: Shutterstock

Zahinoor Ismail, of the O’Brien Institute for Public Health at the University of Calgary. Photo: University of Calgary

Kale with pine nuts is a dish high in magnesium, and so good for brain function. Photo: Shutterstock

Oatmeal, and other wholegrain foods such as brown rice and quinoa, are rich in magnesium. Photo: Shutterstock

Mackerel is a fish that is especially high in magnesium. Photo: Shutterstock

Why you have to keep smiling at a dementia patient – you’ll feel better and it could evoke a positive response

A smile can bring a smile in return from a dementia patient, and may make them more amenable to your requests. Photo: Shutterstock

Author Anthea Rowan with her mother, who suffered from dementia. As a carer you’ve got to keep smiling, an expert on the condition tells her - and it’s not for the reason you might think. Photo: Anthea Rowan

Timothy Kwok, professor of geriatric medicine at the Chinese University of Hong Kong and Director of the Jockey Club Centre for Positive Ageing. Photo: Timothy Kwok

Dementia sufferers cannot be reasoned with, and their emotions can run the gamut from highly positive to negative in the course of a day. Photo: Shutterstock

Many dementia sufferers end up in residential care homes because caring for them is difficult and time-consuming – especially for family members with jobs. Photo: Shutterstock

The living room at Jockey Club Centre for Positive Ageing, in Hong Kong. Photo: Jockey Club Centre for Positive Ageing

‘An attack by aliens’: how to deal with a dementia patient’s delusions – experts’ tips for carers

Carers often find it challenging to calm a dementia patient down when they suffer from paranoia, hallucinations and delusions. Experts offer advice on what to do. Photo: Shutterstock

It can be heartbreaking for a carer, especially if they are a family member, when a dementia patient cannot recognise them. Photo: Shutterstock

Disinhibition, poor control or restraint over emotions or actions, is common in patients with advanced dementia. Photo: Shutterstock