Dr. Roger Wong: Insomnia, Sleeping Pills, and the Brain

Research shows that getting enough healthy sleep can reduce the risk of dementia. It cleans contaminants from the brain, and in fact, it’s so vital to brain health, just a single night of lost sleep has been shown to have possible long-term effects. However, scientists are still looking for answers when it comes to understanding insomnia and the sleeping pills people use to combat it. 

While some studies indicate that certain medications for insomnia can increase dementia risk, lack of sleep can also be a risk factor for cognitive decline. In a recent study, one group of scientists found that certain sleeping medications may even be able to help clear the brain of certain problematic proteins — the biomarkers of Alzheimer’s disease.  

Dr. Roger Wong, an assistant professor at SUNY Upstate Medical University, has joined the quest for answers about the complex relationship between sleep, insomnia, sleeping medications and brain health. When Wong’s aging parents started having difficulty sleeping, he zeroed in on the link between insomnia and dementia. While his previous research had focused on dementia prevention through lifestyle behaviors, when he looked at the literature, he didn’t see clear indicators of what his parents’ insomnia meant for their dementia risk. “I am not a sleep researcher, but this is personally affecting my family right now,” he told Being Patient in a Live Talk. “I want to see what is going to happen if I look at the data.”

In the resulting study, published in the American Journal of Preventive Medicine, Wong and colleagues dove deep into the link between sleep and brain health by studying different types of insomnia. They found that sleep-initiation insomnia, which is trouble falling asleep in 30 minutes and using sleep medication, was associated with higher levels of dementia. Strangely, the study also found that sleep-maintenance insomnia, or having trouble falling asleep after waking up, was associated with a lower instance of dementia in their study. 

Wong shared key insights on sleep and his study. Here are three of his takeaways on insomnia and the brain to remember.

1. Getting healthy sleep is like running a dishwasher cycle in your brain

When asked about what sleep does for your brain, Wong cited the well-known metaphor of a dishwasher for the brain’s internal cleaning system, called the glymphatic system. “During the day, like, let’s say, hypothetically, you put some dishes in your dishwasher, and then during the day, you have a buildup of dirt and grime.” 

That dirt, grime, and residue of the plates are “ the beta-amyloid proteins that we know are associated with dementia risk.” He also explained that the plates in this dishwasher metaphor are “the nerve cells in our brain.” 

When in a deep sleep, “all of this is drained away, and the beta-amyloid is drained away during the nighttime,” he said. “That is why deep sleep is critical for us.” 

The glymphatic system has been studied in rodents as well, Wong said. “A lot of this research has been done on rodents, where if you give them disruptive sleep, and they don’t, they’re not sleeping, and you see this buildup of beta-amyloid. And it’s not until they get deep sleep that it’s actually cleared away.” 

According to Wong, ensuring you’re getting enough sleep allows your brain to go through this important cycle and foster important brain health. With clean plates or clean nerve cells, you’re better set up and considerably more well-rested.

2. Taking sleeping pills as directed by a doctor is fine — in moderation

While long-term use of sleeping pills is linked with higher dementia risk, “popping these pills once in a while is probably fine,” Wong told Being Patient. “I mean, I do this, too. Like in lots of research, including one [study] of mine that I just recently published, it’s only really through long-term use [that sleeping drugs become a brain health problem.]”

In the dataset he used for his study, the question Wong set out to answer about sleeping pills was: “Do you use sleep aids to help you sleep at night?” This is a bit of a vague question, he said. Of the data he studied on sleep aids, “it could be prescription Ambien, or it could be Tylenol PM or Nyquil, so it’s unclear what type of sleep aids [the study participants] are using.” 

Ultimately, from Wong’s study, he drew the conclusion that long-term use of any of these sleeping aids is associated with an increase in dementia risk. That doesn’t mean, however, that there is a definitive cause-and-effect relationship between sleeping drugs and dementia.

“With other medications that older adults take, it can be unclear whether the sleeping medicines are a significant cause,” he noted.  For example, he pointed out: “Benzodiazepines are linked with increased dementia risk, but oftentimes, a big issue with these studies is that older adults are not just taking one medication. They’re taking multiple medications. So it’s really hard to kind of disentangle if it’s truly those sleeping drugs that are linked to dementia or maybe these other drugs that are also linked to dementia.” 

Taking sleeping aids every once in a while or for a period of a couple of weeks will not significantly impact brain health, Wong said. Plus, with a recent study from Washington University’s Sleep Medicine Center finding that the insomnia drug suvorexant (brand name Belsomra) helped clear Alzheimer’s proteins, there’s still more research needed on what sleeping pill medication means for the brain. 

3. If you’re having persistent sleeping issues, consult a specialist

For people experiencing persistent insomnia or other sleep issues, Wong recommended speaking with a sleep specialist. While short-term sleeping pill use is not associated with increased dementia risk according to Wong’s research, sleep medications “haven’t really been shown to be effective for more chronic sleep disorders. Actually, I would say you shouldn’t,” he added.

“For those with more chronic sleep disorders, I would encourage you to talk to your health provider about non-pharmacological interventions.” For non-pharmacological interventions, he mentions that CBT — or cognitive behavioral therapy — is often used to help with long-term insomnia. 

“Cognitive behavioral therapy for insomnia, which is typically around one to two months for the complete number of sessions,” he said. “It’s been shown to be really effective in having long-standing benefits to improving your sleep.”

Beyond CBT, promoting healthy sleep habits is also vital. These are approaches you may have heard of before, such as “trying to go to bed at the same time every night, not using a smartphone, watching TV or your phone at night when you’re trying to fall asleep, because that is going to make you sleep longer as well, or you won’t fall asleep as fast if you do those sorts of things,” Wong said. 

If you have sleeping issues, considering these approaches can make the difference in falling and staying asleep — and that’s good for the brain.

Katy Koop is a writer and theater artist based in Raleigh, NC.