Doctors should ask how much sleep people are getting and recommend sleep studies if there sleep isn’t sufficient. There are also specific things that people can do to make it more likely that they get more and better sleep, and doctors should be going over these.

Home sleep trackers are much cheaper and easier to use these days, and it seems that there would be a benefit for everyone to wear one, at least part of the year, to have data to give to their doctor. We now have the means to really see if people are sleeping enough or not, and I suspect the issue in the past is that it is hard for people to accurately judge their own sleep performance.

It’s not just sleep length that matters, but rather sleep quality — specifically you want to make sure you are getting enough REM and slow wave sleep. So while we do need therapeutic interventions for people who already have Alzheimer’s, we really aren’t doing anything to prevent people from getting it in the first place.

I was listening to a podcast with neurophysiologist Louisa Nicola, and I swear she said that 95% of Alzheimer’s is now seen in people without a genetic predisposition to it. That is to say that people’s lifestyle decisions around sleep, food, and exercise are the issue. Here is a link to the podcast (no transcript unfortunately): https://podcasts.apple.com/us/podcast/whoop-podcast/id144550...

Why on earth do people (you're not alone, I know) prefer to assume that direction of causation, rather than that the underlying condition that leads to Alzheimer's causes sleep disorders too?

It's well known that sleep disorders are associated with other neurological or mental disorders.

I think there is a pervasive disease of thinking where people associate science and smart people with counterintuitive statements, so every obvious relationship gets inverted.

And can you answer the basic question of why sleep is even necessary at all?

Lack of sleep is eventually lethal, and I read a very interesting study a couple years ago that seemed to have a plausible mechanism and stunningly reasonable methodology, but I haven't heard anything about it since then. So I still don't know if it was fake or something, because it seemed like it should get a Nobel Prize. Although it used fruit flies so perhaps it didn't generalize.

It's generally known that after 3 or 4 days of total sleeplessness there is permanent psychological damage which is probably physiological in nature. IIRC There was a radio show host who hosted his show for several days straight as a stunt and it really messed him up.

I didn't write that phrase precisely because people turn off their brains and learn nothing from it! It's become worthless.

The alternative to A -> B is B -> A, or C -> A and B.

You seriously think that running through those possibilities in your head is "dogmatism"?

Who then is the authority on which one of those is privileged and which require further research to validate, when they are all consistent with the evidence so far?

Had to Google that, though it does sound temporary?

Pure speculation of course, but it seems possible that low quality sleep would impair this system.

How is that an explanation? Something has to drive the sleep disorder. It's too vague to be blaming for anything. It's not a thing.

May be there are multiple thing that drives sleep disorder and and then that causes Alzheimer.

Or perhaps it’s just idiopathic/random/aging or environmental exposures that are less to do with lifestyle decisions. I’ve known plenty of people with Alzheimer’s and many of them tend to have had healthy lifestyles including healthy sleep - I would love to see any data that implicates meaningful risk reduction with “one weird trick” in sleep or diet - the common denominator was mostly old age.

I never quite understood what you're supposed to do with all the information about when you fall asleep, when you awake, when you have REM.

Okay you can quantify how bad your sleep is (though I guess you can just feel that in your daily life to a large extent). But what's the next step? Prove to a doctor you actually have bad sleep bc they don't take your word?

Or are you supposed to make some life adjustments based on the information?

> I was listening to a podcast…

HN comments in a nutshell.

Think about that before you go off on your hobby horse about whatever stereotype you despise the most.

Anybody you could find on reddit or anywhere else can comment here if they find it and want to.

I think it was years before I even knew who Peter Thiel was, and I've never been to California in my life.

Had a quick look at her Instagram - "80% of brain gray matter is modifiable by exercise so by hitting the gym you can now stave off Alzheimer's by 20 years"

> 95% of Alzheimer’s is now seen in people without a genetic predisposition to it

That's with our current knowledge of the genetic aspects of Alzheimer's, which probably isn't complete.

> That is to say that people’s lifestyle decisions around sleep, food, and exercise are the issue

Could be due to other reasons as well. Or most likely a combination of genetic + environmental. That's why these kind of illnesses (schizophrenia, depression) are so hard to crack, there's so many variables.

Sleep studies can tell if you have sleep apnea, where you might "think" you had a full night's sleep, but it was disturbed by disrupted breathing.

So it might be worth getting one anyway. Hopefully the tech will get to the point where your fitness watch can do it all. The last sleep study kit I had was quite bulky and wearing it probably affected my sleep!

I really have the least amount of respect for sleep clinics I have had the displeasure of working with.

It wasn't the worst night of sleep of my life, but it definitely wasn't the best. The beds were cheap and simple, all the wires and electrodes were annoying, and the rain on the metal prefab clinic building was loud.

To be honest, I went because my partner complained about my snoring. If it meant a $3-4k bill, I would not have gone.

Sleep apnea is the most common sleep disorder, and it's easy to identify with equipment that you take home and use for a night. If you have it, there are different treatment options depending on the cause.

Other disorders are more difficult to treat, and sometimes they just don't have an answer. I'm still struggling with my sleep issues - they can describe it based on a full sleep study, but there's not a good categorization for it in the DSM, which means they can't even say if it's physiological, psychological, or a combination of the two. That makes it very hard to treat.

I'm certainly aware there is a correlation, but unfortunately my life is not so structured that I can get sufficient sleep.

Would you have a reference for such a device? I assume that this is not an app in a phone, but something that actually measures the sleep phases?

> Are doctors not already telling people to get good night’s sleep? Are healthy diet and exercise not already universally recommended?

Yeah, most people know they need a good night's sleep. Most people who miss sleep aren't willfully choosing to skip it but responding to the constant pressure of things like work and school. Things like 24 hours shifts are awful. Which is to say, people actually need help getting sleep, they can't just be told losing sleep is bad.

Jobs that force a lack of sleep should be considered a health hazard and phased out by policy.

They can also be popular with the electorate ("first they came for the smokers, and I didn't complain because I was not a smoker..") because people make moral judgments which is what you are complaining about, but that's not the reason economists favor them when it comes to advising politicians on tax policy.

To then whine that fighting back is 'facist' or to suggest that you're so smart you are magically not influenced by any of this is an embarassment. Companies are permitted to operate in society by the collective will of the people, not by divine right. And the people collectively see that a company is taking the piss, they can change the arrangement to improve it. Saying "company, your behaviour is hurting people's collective health, you need to pay some more taxes to cover it" is one way of doing that. If the company then passes the tax increase to you in the form of higer prices, instead of lower profits, that's up to them.

The very framing of it as "sin tax" as if it's a personal failing and not a deliberate corporate abuse of our biological desires and limits, is a kind of victim blaming that anyone "immune to advertising" oughtn't be falling for.

Get over it and stop following libertarian religious sects, their teachings are only going to make you feel miserable and turn you into the annoying libertarian everybody dreads to meet in a party.

If the state is paying for and controlling your access to healthcare, it seems obvious that restricting unhealthy food or behavior as preventative healthcare would go hand in hand.

Even a drug addict who practices unsafe sex and riding motorcycles to do mountain climbing and ski down the slope deserves Healthcare when something bad happens to them, exactly as much as the fitness yoga guru.

We do have those restrictions. Consider the UK's Bradford Sweet Poisoning of the 1858 when the standard of putting gypsum as cheap filler in sweets instead of more expensive sugar lead to an accident of using arsenic instead, and lead to regulations on danerous behaviour by chemists and on the adulterations of foodstuffs - https://en.wikipedia.org/wiki/1858_Bradford_sweets_poisoning

Trans fats have been regulated, e.g. in Canada: https://en.wikipedia.org/wiki/Trans_fat_regulation#Canada

The UK has a sugary drink tax: https://en.wikipedia.org/wiki/Sugary_drink_tax#United_Kingdo...

And of course there are regulations on insect contamination, mould and fungal contamination, on use by dates, on permitted/banned additives and preservatives, on quality of packaging material, on preparation and handling of eggs; the most egregious "unhealthy food" that causes serious sickness and death quickly has been restricted. What's left is a lot of "compounds over a lifetime of it" kinds of things.

And, of course, public smoking bans are an unhealthy behaviour restriction, so are drug bans.

None have different tax rates for staple foods than for packaged snacks or fast food? None have regulations about labeling of food for health claims or disclaimers?

Because all of those things are common throughout all the European countries I'm familiar with, but maybe your list didn't include any European countries

It's not that individuals don't want to sleep, it's that oftentimes AD, PD, etc pts will present with sleep problems over 20 years before disease onset, and it isn't because these patients aren't trying. These patients will present with sleep disorders like REM sleep behavior disorder, and these seem to predate these disease onsets, but may also be a symptom of early stages of the disease.

TDLR: its not that people don't want to sleep, its oftentimes that AD pts present with sleep disorders decades before onset

> 12 hours work/day

> ads for unhealthy food

> lots of cheap tasty unhealthy food products in supermarkets

Have we really done the best we can as societies that the only thing left is to find a drug?

Within a system that promotes and often demands unhealthy lifestyles, we are doomed to scramble to find ways to battle emerging disease to enable our sick lifestyles.

When all you have is a hammer something something.. In all seriousness, the majority of the developed world has solved the incentive problems with preventative care.

Wellness - dieticians, massage therapists, smart watches, etc - is a multibillion possibly even a trillion dollar industry.

None of these things are going to make anyone live to 150, and they sure arn't going to make you less frail at 90.

What we want are definitive treatments to both prevent and cure alheimers and given the options available in medicine id sure as hell prefer an expensive pharmacutical than something like brain surgery or weekly and exhausting procedures like dialysis.

People like to shit talk the pharma industry and theres a lot to shit talk it for but lets be clear here, a lot of pharmacutical solutions are god damned life changing miracles.

if someone deserves to be rich for their efforts it sure as shit should be people inventing medicine and not people in marketing or real estate or whatever.

I’ve never met a chronic inactive person who moved well as they aged.

We will need the pharma industry to treat Alzheimer’s and related conditions, but it is primarily lifestyle that we need to address to prevent it. Chronic lack of sleep will lead to all kinds of health issues, including dementia.

To a point. There are diminishing returns where genetics begins to play more of a factor.

For many people no amount of exercise is going to help them when they're 90 because they'll die before they turn 90. Jim Fixx[0] is the perfect example of this

Unless we develop a cure for Parkinson's disease I doubt Michael J. Fox[1] will live to 90, no matter how much exercise he does, because of the effects that disease has had on his body and the side effects from the treatments that he has received.

Another way to look at it is to substitute 90 with 100, 110, or 120. Or to think about what kind of exercise and healthy eating tips that you would recommend to a person with Down's Syndrome to help them live to be 90.

People who can should absolutely exercise and eat healthy food but that is no guarantee that they will live full healthy lives.

[0] https://en.wikipedia.org/wiki/Jim_Fixx#Death

[1] https://en.wikipedia.org/wiki/Michael_J._Fox#Parkinson's_dis...

Granted in both countries those who died after 75 lived presumably most of their life a traditional lifestyle with little influence of modern factors like junk food, TV at night, work stress etc. So we cannot conclude that those factors have no influence after 75th birthday. Still people should be rather skeptical about attributing to a particular factor really long life.