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Veterans Day Wish: Let Sleep Defend Against Dementia

In 2015, the Aging Life Care Association highlighted the increasing prevalence of dementia among veterans in 2015.1 Some researchers estimate that more than 400,000 new cases of Alzheimer’s disease and other dementias will be identified by the end of 2020.2

Here we are, nearing the end of 2020 and dementia remains an ongoing problem. One central factor linking military veterans to patterns of dementia? Sleep quality.

The link between disturbed sleep and dementia

A large study of male veterans, published in 2015, found disturbed sleep to predict future dementia.3 More than 1 in 4 veterans were found at increased risk for developing it.3

With such a large segment of our veterans potentially facing this risk in their golden years, it makes sense to find understand why. Disturbed sleep continues to be a potential cause.

Veterans and military personnel experience disturbed or fragmented sleep for a variety of reasons. Common ones include frequent nighttime bathroom trips, reflux disease, or medication side effects.

But veterans also share risk factors specifically related to their time in service, which include chronic insomnia & sleep apnea.

One risk factor: Chronic insomnia

Chronic insomnia is an inability to fall asleep easily or maintain sleep. Chronic insomnia occurs in more than half of all post-9/11 veterans studied.4 It’s especially linked to posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and intense chronic pain.5

Also worth mentioning: there’s a two-way relationship between dementia and insomnia. For instance, neurodegenerative disorders like Alzheimer’s disease can also contribute to or further aggravate insomnia as well as alter sleep architecture.6

Another risk factor: Sleep apnea

Undetected and untreated sleep apnea is also common among veterans. Those with PTSD in particular face a higher risk for obstructive sleep apnea (OSA).7

A study of Iraq and Afghanistan veterans found a six-fold increase in sleep disorders in this group, with almost 5 percent diagnosed with sleep-disordered breathing.8 Combining OSA with TBI, PTSD, or mental health issues can seriously complicate matters.

What are the VA/DoD doing about it?

The US Departments of Veterans Affairs and Defense (VA/DoD) recognizes the ongoing dilemma of poor sleep among military personnel and veterans. Last February, they issued new clinical practice guidelines addressing both insomnia and OSA in its community.

Leading VA researcher and retired US Army colonel Dr. Vincent Mysliwiec authored them. Earlier this year, he told staff at the University of Texas Health Science Center at San Antonio in an interview that, "whereas in the past, problems with sleep disorders have been discounted, there is growing recognition of the importance of sleep health and treating sleep disorders" among our military veterans.8

The new guidelines place a higher priority on CPAP therapy, supporting proactive efforts to empower those who struggle with it the most. Usually, they’re the ones also living with PTSD.

For chronic insomnia among veterans, they promote cognitive behavioral therapy for insomnia (CBT-i). CBT-I remains the gold standard for treatment. A “mini” version—brief behavioral therapy for insomnia—may be helpful for some patients.

While sleep hygiene was discussed in these new guidelines, they specifically suggested that, by itself, it’s not adequate as a treatment protocol and “should not be used as a stand-alone therapy for chronic insomnia disorder.”

Finally, they suggested that clinicians avoid prescribing certain popular sleep aids. On this list? Antipsychotic drugs and over-the-counter agents such as antihistamines and melatonin, which have not been shown to be beneficial.

Dr. Mysliwiec expects these new guidelines to be "far-reaching and lead to necessary changes in clinical practice while helping to determine what clinical and research questions will need to be addressed in military personnel and veterans."

Within the context of dementia among veterans, there’s still much for researchers to learn.

What can veterans do in the meantime?

The web of problems that links sleep and neurological function to trauma is complex, depending a great deal upon the individual situations leading to the trauma.9 Suffice it to say, solving the problem of poor sleep and dementia among veterans isn’t going to be quick or easy.

Prioritizing sleep remains the challenge. Preventing sleep disruption can help modify or delay the progression of Alzheimer’s disease.10

However, the UK Alzheimer’s Society reminds us that there are different kinds of dementia associate with different kinds of sleep problems.11 Dementias that follow TBI may or may not develop into pure forms of Alzheimer’s, as one example.

What can veterans do to prevent or delay the onset of dementia?

  • Practice good sleep hygiene. It’s no cure-all, but these inexpensive lifestyle changes are easily applied and can create a solid foundation for getting more and better sleep.
  • Seek out a sleep specialist. They can investigate one’s sleep concerns through screening and lab testing and offer viable treatment solutions.
  • Identify and treat other co-conditions affecting sleep. Those familiar to veterans include chronic pain, mental health disorders, and heart disease.

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