In my neuropsychology practice, I estimate that fully half of the patients I see who have memory problems also have some sort of sleep difficulty. This is not just true of older adults who may be showing signs of age-related memory decline, but often for younger adults as well, including those who suspect they may have ADHD.
When considering the combination of sleep and memory problems, we have a chicken and egg issue. Which came first?
Over the past few years, I have seen many patients who complain of one or more of the following problems related to sleep:
- Difficulty calming one’s thoughts when trying to get to sleep
- Frequent waking in the middle of the night with stressful thoughts or worries
- Disordered breathing such as gasping or stopping breathing
- Nightmares or disturbing dreams
- Involuntary physical movement such as restless legs
- Getting only four or fewer hours of sleep a night on average
- Chronic daytime fatigue and mental sluggishness
When assessing whether someone might have a diagnosis such as dementia or ADHD, one of the things to consider is whether their problems with memory or concentration might be due to inadequate sleep or to an actual sleep disorder such as sleep apnea. For that reason, a common recommendation from a neuropsychological assessment is for a discussion with primary care physician about whether to have a sleep consultation.
Correcting a sleep problem can have significant positive effects on attention and memory, and often this is the first thing to do.
However, it is not a simple question of sleep disorder versus dementia or of sleep disorder versus ADHD. It’s more a matter of “how might sleep problems and attention/memory problems be related, and how might they be causing each other?” The combination of sleep problems and attention/memory problems is complicated, and sleep disturbance can be a prominent symptom of certain forms of dementia and ADHD.
For example, sleep disturbance is one of the defining characteristics of Lewy Body dementia (a form of dementia that includes sleep disturbance, movement disorder symptoms, visual hallucinations, and cognitive decline).
Similarly, some persons diagnosed with ADHD have a cluster of symptoms characterized by low energy, fogginess, and mental lethargy. This is commonly known as “sluggish cognitive tempo” (although I wish they’d come up with a better name for it).
It turns out the relationship between sleep problems and memory/attention problems can be bi-directional, and it’s sometimes not clear which is causing which.
Despite the complexity of the question of which problem is causing which, there are some things you can do that may simultaneously maximize the quality of your sleep and the quality of your attention and memory. These include:
1. Reconsider your use of caffeine.
While caffeine can certainly give you a boost of energy, it can become a circular problem in which you grow dependent of the jolt of caffeine to keep you alert during the day because it disturbs your sleep at night.
2. Reconsider your alcohol use.
While alcohol can make you feel tired and help you fall asleep, it does not help with sleep maintenance or overall quality of sleep.
3. Talk to your physician about your use sleep aids.
Whether you are using prescription and/or non-prescription sleep aids, you physician can help to determine if you have become dependent on them in a way this is ultimately harming rather than helping your sleep.
4. Implement changes to support better sleep.
Changing some personal habits (known as “sleep hygiene”), modifying your sleep environment and even creating a consistent sleep routine can help you achieve a better night’s sleep.
Tips for healthier sleep habits.
5. Learn mindfulness techniques.
Mindfulness exercises can help you to calm your thoughts at sleep onset, during the middle-of-the night or early morning awakening. Don’t let the word “mindfulness” deter you. Mindfulness is simply “paying attention to one’s experience in the present moment without judgment” and can be practiced in many ways … including breathing exercises, walking, engaging your senses, yoga, and more.
Nine ways to practice mindfulness
Sleep and memory are very much related, and my hope is that if you can get better sleep, your attention and memory will improve, and that if these improve, you’ll also sleep better.
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