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As published in Dimensions Magazine for Fall/Winter 2023.
A good night’s sleep feels so refreshing, and that’s thanks to the nightly cleaning cycle of the sleeping brain. During this process, called ‘glymphatic clearance’, watery fluid rushes along the brain’s blood vessels, delivering nutrients while clearing away waste.
Yeilim Cho, MD
The brain’s ability to clear out waste products during deep sleep not only regenerates our minds and bodies, but it’s also important to maintaining brain health and preventing dementia later in life.
Unfortunately, people with untreated sleep-related breathing disorders don’t wake up feeling well-rested. Obstructive sleep apnea, the most common of these conditions, causes a person to repeatedly stop and start breathing during sleep, altering their normal progression into deep sleep cycles and keeping them in a lighter stage of sleep.
Yeilim Cho, MD is a sleep medicine doctor and researcher at Veterans Affairs Mental Illness Research Education and Clinical Center, where she cares for Veterans with sleep disorders. Cho also provides education about sleep disorders and helps low-income and uninsured populations access diagnosis and treatment for sleep disorders at a free sleep clinic in Federal way.
“People with untreated sleep-related breathing disorders are losing that chance to fully regenerate their bodies at night,” says Cho. “I feel so bad when I see this happening because this problem can be treated.”
A CPAP device, the standard-of-care treatment for obstructive sleep apnea, helps keep the airway open during sleep. “I’ve heard many middle-aged people say that they can’t live without CPAP because they’ve noticed a dramatic improvement in daytime function and memory,” says Cho.
As an advocate for increased awareness of sleep-related breathing disorders in public and primary care, Cho hopes the medical field will adopt screening for these conditions starting at age 45 for people with risk factors such as male sex, older age, postmenopausal status, higher body mass index, and craniofacial and upper airway abnormalities.
In collaboration with the ADRC, Cho and her colleagues in the UW Iliff Lab are conducting a clinical experimental study in people newly diagnosed with obstructive sleep apnea. The team will assess glymphatic clearance in study participants using non-invasive brain imaging.
The study is designed to show whether and how sleep-related breathing disorders impair the brain’s ability to clear out waste products during sleep and whether CPAP treatment improves this crucial aspect of glymphatic function.
“I strongly believe that studying the glymphatic system will open up the door for us to understand the link between sleep disruption and cognitive decline,” says Cho.
If you suspect a sleep-related breathing disorder, Cho recommends asking your doctor about a referral to a sleep clinic, especially if your bed partner notices loud snoring or periods of stopped breathing. These days, tests for sleep apnea can be taken at home. • Genevieve Wanucha
