No matter your age, getting sleep issues diagnosed and treated as soon as you notice them is in your best interest. Recent research out of the University of California, San Francisco (UCSF), found that people in early middle age—about 40 years old—who have sleep problems may show signs of advanced brain age by late midlife.
“Earlier research linked sleep problems to poor thinking and memory skills later in life, putting people at higher risk for dementia,” says Clémence Cavaillès, PhD, a postdoctoral scholar in UCSF's department of psychiatry and behavioral sciences and an author of the study published in Neurology in 2024. “For this study, we used MRI brain scans to determine participants’ brain age, and the data suggests that poor sleep is linked to nearly three years of additional brain aging as early as midlife.”
The study included 589 participants, more than half of whom were women. Researchers found that poor sleep quality, difficulty falling or staying asleep, and early morning awakening were linked to the greatest brain aging, especially when people consistently had these problems over five years.
Addressing the Risk
The findings highlight the importance of investigating sleep interventions early on to preserve brain health later. “Sleep has to be part of our precision medicine toolkit.… It impacts our memory and cognition, immune system, cardiovascular health, metabolism, weight, [and] how we look,” says Rachel Marie E. Salas, MD, MEd, FAAN, FAASM, professor of neurology and assistant medical director of the Johns Hopkins Center for Sleep and Wellness.
The risk of having a sleep disorder increases based on age; genetics; stress, depression, anxiety, and other mental health conditions; schedule changes, such as jet lag or shift work; and certain medicines and recreational drugs. People over 60 have a higher risk for having an undiagnosed sleep disorder, Dr. Salas says.
If you snore, stop breathing during sleep, or wake up with headaches, talk with your doctor about being evaluated for obstructive sleep apnea (OSA). Studies show that 80 percent of people with OSA—in which the airways become blocked, causing repeated, intermittent (10 seconds or more) interruptions of air flow during sleep—do not know they have the condition, says Dr. Salas. Studies have shown that untreated OSA is a serious medical condition that can cause or contribute to daytime fatigue, mood disorders, high blood pressure, recurrent heart attack, stroke, irregular heartbeats, liver problems, and type 2 diabetes. OSA also may contribute to memory and concentration problems.
Medical conditions that affect the brain and nerves—such as Parkinson's disease, multiple sclerosis, and traumatic brain injury—also may raise your risk of sleep problems. Heart and lung diseases, cancer, diabetes, and chronic pain may cause problems, too.
To be at their best during the day, people need an adequate amount of sleep at night and good quality sleep, says Jennifer Rose V. Molano, MD, FAAN, professor in the department of neurology and rehabilitation medicine at the University of Cincinnati College of Medicine. If you still feel tired after sleeping, talk to your doctor.
Stress also can play a role in how well we sleep. “We all have stress. We all handle it differently,” Dr. Salas says. “We sleep with our phones or stay up late to binge the latest episodes of our favorite shows. We all have a circadian rhythm, meaning most humans are set to go to bed at 11 p.m. and then get up by 7 a.m. When our sleep times are variable and we don't have a set schedule, the brain asks, ‘What are we doing?’”
Social media brings its own brand of stress. “We might see vacation photos on Instagram and think, ‘I wish I were there,’ or see that someone got a promotion at work and want that for ourselves,” she says. “It comes down to this: People need to make sleep a priority and have the right environment that relaxes them and promotes good rest.… We need a more personalized approach.”
Connect with a Sleep Center
While some smartwatches have sleep tracker functions, they might not give accurate readings, according to guidance from Johns Hopkins Medicine. A medical sleep study, on the other hand, can provide exact data by monitoring a person's brain waves while they rest.
If your sleep quality concerns you, ask your physician for a referral for an assessment by an accredited sleep center. The American Academy of Sleep Medicine's patient education website can help you find one.
While these evaluations once required patients to spend the night in a sleep lab, many centers now provide take-home sleep studies. In these, patients receive monitoring equipment to use in their own bed, which makes the process easier and usually is less expensive than a center-based test. “Still, the home sleep studies may not pick up sleep apnea or can report a false negative,” Dr. Salas says. “When somebody has a more complex health history, say, advanced dementia or very severe Parkinson's disease, we bring them into the lab for a sleep workup.”
Sleep testing is key for diagnosing OSA, Dr. Salas says, noting that women are less likely than men to choke or gasp loudly with the condition; it may be quiet when they stop breathing. “Ask your bed partner what they hear when you're asleep.… Or if you don't have a bed partner, ask the people you vacation with,” she says.
A continuous positive airway pressure (CPAP) machine with a pressurized mask can reverse OSA. It delivers constant, steady air pressure to help you breathe. Newer models even provide a morning data report. Patients should experiment with mask sizes and first practice during naps. Use the machine nightly, even while traveling.
CPAPs do not work for everyone, so check with your doctor about alternatives, such as mandibular advancement devices or even surgical interventions.
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