Poor sleep may seem like a minor problem when it becomes part of the routine: interrupted nights, difficulty falling asleep, waking up tired or spending the day sleepy. However, rest serves fundamental functions for the brain, and when these disturbances persist over time, they deserve attention.
On this topic, Para Ti spoke with Dr. Antonela Nasello, a psychiatrist and specialist in Sleep Medicine and Chronobiology applied to cognitive performance and mental health. The specialist explained what happens in the brain while we sleep, what relationship exists between chronic poor sleep and processes associated with neurodegenerative diseases such as Alzheimer’s, which signals should prompt us to seek consultation, and what habits we can adopt to improve our rest.
“A good rest is the most active process”
-What is the relationship between sleep quality and brain health? What happens while we sleep that makes a good rest so important?
-I like to think of the brain as a very busy city. During the day the traffic is chaotic, energy is spent, and waste is produced. When you sleep, it’s not that the city turns off, but that the heavy maintenance crew comes in. Biologically speaking, this is literal. We have a mechanism called the glymphatic system, which becomes super active in the deep stages of sleep and is responsible for sweeping away the metabolic waste that accumulates simply from being awake.
Besides that thorough cleansing, sleep is the exclusive moment in which we consolidate memory and process the emotions of the day. What I often see in my practice is that people still believe sleep is a passive state or a “power off” button. The reality is that a good rest is the most active and necessary process so that the next day your brain can focus and not misregulate what you feel.
“Sleeping well in middle age is one of the most effective neuroprotection strategies”
-Can long-term poor sleep promote processes related to neurodegenerative diseases like Alzheimer’s? What do we know today about that relationship?
-This is one of the topics we are investigating most today in sleep medicine, and we know there is a strong bidirectional relationship. As I mentioned with nightly cleaning, there are two specific proteins, beta-amyloid and tau, that are closely linked to the development of Alzheimer’s disease. They are precisely cleared from the brain more efficiently during deep sleep.
When a patient sleeps poorly for years, whether due to insomnia or untreated sleep apnea, that cleaning stage becomes fragmented. The evidence shows that the accumulation of these toxic proteins begins long before the appearance of memory loss symptoms.
Note that this does not mean that if you have a spell of poor sleep you will get sick, not at all. But it does tell us that sleeping well in middle age is one of the most effective neuroprotective strategies we have at hand.
“Many people come to the clinic thinking that living tired is normal in adulthood”
-Are there signs during sleep that should catch our attention and lead us to consult a specialist? For example, frequent awakenings, insomnia, snoring or daytime sleepiness.
-What surprises me most in clinical practice is how accustomed we are to feeling unwell. A huge number of people come to the office thinking that living tired is normal in adulthood, and it clearly isn’t.
A clear red flag is intense snoring, especially if the person sleeping beside you notices pauses in your breathing. That can be sleep apnea, which basically means your brain misses oxygen in spurts throughout the night.
Another alarm is the unmanageable daytime sleepiness, that physical urge to fall asleep in a meeting or while driving. And of course, if it takes you more than half an hour to fall asleep, or you wake up early in the night with your head racing and you can’t fall back asleep. If this happens more than three times a week for a couple of months, it’s no longer stress, it’s a condition that requires evaluation and specific treatment.
“Sleep isn’t fixed overnight; it is built from the moment you wake up”
-What concrete changes can we incorporate into our routine to improve sleep quality and protect our long-term brain health?
-I always tell my patients that sleep isn’t fixed overnight; it’s built from the moment you wake up. Our biological clock needs clear signals to organize itself, and the most powerful of them all is light. Therefore, the ideal is to expose yourself to natural light, or to bright light if you use light-therapy devices, in the first hour after waking. That tells the brain that the day has started and programs your clock so that at night it makes you sleepy.
It also helps a lot to maintain regular schedules. Go to bed and wake up at the same time every day, even on weekends. To promote deep sleep, which physically restores you, pay attention to the room temperature, which ideally should be cool, between 18 and 20 degrees Celsius.
Try to have dinner about three hours before going to bed and cut screen use two hours before. And finally, avoid alcohol at night. Sometimes it feels like it relaxes or sedates you, but in reality it destroys the quality of REM sleep and you pay for it dearly the next day.
Dr. Antonela Nasello, Psychiatrist. Specialist in Sleep Medicine and Chronobiology applied to cognitive performance and mental health, @dra.nasello.psiquiatra
