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Better Sleep, Better Lives

January 02, 2020

We need sleep. Not just to recharge so we are ready to face another day but so our bodies can accomplish the maintenance necessary to ward off serious health issues.

Research has linked insufficient sleep with chronic diseases and conditions such as diabetes, cardiovascular disease, depression, and even Alzheimer’s disease. Women have higher rates of sleep disturbances than men, including insomnia and adverse changes to their daily patterns of sleep. These irregularities are more likely for women than men to increase with age.

Now, Women’s Health Research at Yale, with support from WHAM! Investigators Fund, has launched a new study on an intervention to provide strategies that optimize sleep and promote healthy aging in women. Specifically, for women 50 years and older, the study will assess whether the intervention can improve cognitive and emotional health and reduce brain and blood biomarkers that indicate elevated risk for Alzheimer’s disease and related dementias (ADRD).

Currently, women make up two-thirds of the 5.5 million people with ADRD in the United States.

“Sleep irregularities are a leading reason why women report decreased quality of life — they can even lead to a level of despair that can increase risk for suicide,” said Dr. Hilary Blumberg, the study’s principal investigator and Director of Yale’s Mood Disorders Research Program. “On the other hand, more regular patterns of sleep reduce stress levels and improve emotional and cognitive health.”

People often recognize differences in how they feel and in their thinking and memory after even one night of sleep deprivation, Blumberg said. In this new study, pre and post intervention magnetic resonance imaging (MRI) brain scanning research will be performed to show that the intervention improves brain functioning in areas that are critical to cognition and emotion. These areas are located in prefrontal cortex and temporal lobe structures, specifically the amygdala and hippocampus, and are known as frontotemporal brain circuitry.

Dr. Blumberg, a professor of psychiatric neuroscience, and her team have found sex-dependent differences in this circuitry in response to stress. For example, frontotemporal circuitry in females is more sensitive to adverse effects of stress than in males. “Frontotemporal circuitry changes,” Blumberg said, “can increase risk for ADRD and depression — which occur at higher rates in women.”

Dr. Blumberg’s team adapted an existing therapy, called Social Rhythm Therapy. The adaptation, known as SLEEP-SMART (Sleep Self-Monitoring And Regulation Therapy), is a 12-week intervention to regularize sleep and other daily rhythms. It is administered by a trained therapist either in person or remotely through a smartphone or laptop computer application. It produced preliminary data in younger adults showing not only improved sleep but improvements to the functioning of brain circuitry and emotional health. The new study will use a modified version to focus on a critical understudied cohort, women ages 50 years and older experiencing trouble sleeping.

Strategies for promoting healthier sleep patterns include finding ways to help wake at a consistent time such as setting an alarm to a favorite tone, waking up to the smell of brewed coffee, communicating with someone first thing in the morning, and letting the sun shine in to start the day. It is important to also have a consistent bedtime that can be helped by a comfortable bedtime room temperature, shutting down devices before bed, and using window blinds. Regular daytime activities can help too, such as planning regular meals, exercising, and socializing.

“We help participants examine their entire day, from the moment they wake up, to meals, activities, daily tasks, and social interactions, all the way to their bedtime preparations,” Blumberg said. “There are many factors that influence sleep patterns, and even small changes can make a difference.”

The participants receive complete diagnostic assessments, including family histories, blood tests for biological indicators of elevated ADRD risk, cognitive interviews, and functional MRI (fMRI) scans of the brain before and after completing the SLEEP-SMART program. They also wear a watch that tracks activity and sleep.

“Ultimately, our goal is to share the beneficial SLEEP-SMART strategies as widely as possible,” Blumberg said. “This could have a far-reaching impact for improving healthy aging for women and reducing risk for ADRD, depression, and early mortality.”

Submitted by Rick Harrison on December 12, 2019