Episode Details

Episode 42: Baker’s Cyst.

What is a Baker’s cyst and how to treat it? Alzheimer’s disease may be linked to sleeping pills, polyarthalgia question. 

Today is March 1, 2021.

Arreaza: Spring season is here! A renewal of life and a renewal of hope in the future, and for some, a renewal of allergies. But we will not talk about allergies in our intro today, we will talk about dementia.

Civelli: Research is increasingly showing that poor sleep correlates to dementia[1]. In 2019, an article was published by the Alzheimer’s Association International Conference (AAIC) which highlighted several links between sleep medication, sleep disorders and dementia, while also showing us what we still don’t know.  

Arreaza: Investigators at Utah State University (go Aggies! – my wife told me to say that) found interesting sex-related differences: For Men who reported using sleep medication for sleep issues, there was a 3-fold risk of developing Alzheimer’s disease than men who did not use sleep medications. Women however had different results. For Women who did NOT report having any sleep disturbance but still used sleep meds, the risk of Alzheimer’s disease was nearly 4x’s greater. However, in Women who DID self-report sleep disturbances at baseline, but also took sleeping pills, there was actually a 33% reduction in risk for Alzheimer’s disease. 

Civelli: Another study by investigators at University of California, San Francisco (UCSF) did not echo these findings. They found no sex-related differences, and they adjusted for a variety of genetic and lifestyle confounders. In this UCSF research, frequent sleep meds and later dementia were strongly correlated – but only in Caucasian adults. The specific sleep medications were not identified however, some meds such as benzos, antihistamines, antidepressants, or others were included. 

Arreaza: At the University of East Anglia in Norwich, England, in 2018 it was found that long-term exposure to anticholinergic drugs, some antidepressants and antihistamines were specifically associated with a higher risk of dementia, while use of benzodiazepines were not.

Civelli: Meanwhile in pursuit of physical proof: 337 brains from the U.K. brain bank were examined. 17% and 21% had known benzodiazepines and anticholinergic chronic exposures. Slight signals in neuronal loss in the nucleus basalis of Meynert were identified. Whether benzodiazepine exposure relates to dementia remains controversial.

Arreaza: Suvorexant (Belsomra), the only orexin receptor antagonist that regulates wakefulness, is being tested in Alzheimer’s disease. This targeted therapy decreases sleep fragmentation and increases total sleep time. It may be the future. We will see.

Civelli: Lastly, although not a magic bullet, trazodone, has been shown to increase total sleep time in patients with Alzheimer’s disease without affecting next-day cognitive performance, and even slowing down cognitive decline in patients who complained of sleep disturbance. According to Dr. Karageorgiou of UCSF “You’re not going to see long-term cognitive benefits if it’s not improving your sleep, So, whether trazodone improves sleep or not in a patient after a few months can be an early indicator for the clinician to continue using it or suspend it”. More prospective research is needed. 

Arreaza: The bottom line is: Dementias are associated with serious circadian rhythm disturbances. Physicians are encouraged to focus on improving sleep to help patients with, or at risk for, dementia by consolidating their sleep rhythms. So, what will you do to help your patients sleep better today? 

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, Cali