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Comment by pfisherman | Hacker News Reader

> Helping people get a good night's sleep -- without drugs -- would likely help, if only to stave it off in those at risk.

Are doctors not already telling people to get good night’s sleep? Are healthy diet and exercise not already universally recommended? Do we not already warn people against smoking and excessive drinking? Have we not implemented sin taxes to disincentive these unhealthy behaviors?

Obviously these efforts, while beneficial are not even close sufficient. Thus there is a large unmet need for therapeutic intervention. Whoever is able to meet that need will be handsomely rewarded, and rightly so, because they will have meaningfully improved the health and quality of life of many many people.

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I think the argument here is that recent research indicates that a chronic lack of sleep can cause Alzheimer’s, and I don’t think most people realize that. Beyond that, telling people to try to get more sleep is not really medicine. It’s not really specific or actionable, and it doesn’t help people with understanding how to get more and better sleep.

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...

> Doctors should…

> I was listening to a podcast…

HN comments in a nutshell.

Remember, anyone can comment here. It doesn't cost a thing and doesn't even require a valid email.

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.

>recent research indicates that a chronic lack of sleep can cause Alzheimer’s

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.

While you may be right (FFI fatal familial insomnia, not foreign function interface) is an amyloid disease and the amyloid seems to cause insomnia, not vice versa -- there are some real proposed mechanisms suggesting that lack of sleep prevents clearance of junk in the brain, that then cause the cell death associated with Alzheimer's.

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.

https://en.m.wikipedia.org/wiki/Peter_Tripp

Had to Google that, though it does sound temporary?

You're basically just reinforcing parents comment (correlation does not imply causation) because those studies mention the same problem with their design thus they can't come to a valid conclusion.

A valid conclusion can come from studies for which, in this case, there was no funding because of poor rhetoric like this. Correllations which merely suggest causation are indeed sufficient as the focus of hypotheses. Scientists too often forget that a hypothesis is a valid part of the scientific process, and the aversion to adoption of one without an attempt to gather further data about it is shoddy, unprofessional, and more reminiscent of dogmatic orthodoxy than of science. The next time you think to say "correllation does not imply causation", maybe think to ask if anything more can or should be learned about either the correllation or the cause being investigated, and consider that such obstruction of efforts to collect more evidence is precisely why the present data is inconclusive. The fact here, from TFA, is that there was no such problem with the studies' design, but rather with the myopic cognition of those who obstructed them.

>The next time you think to say "correllation does not imply causation"

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?

The arrow of time really does help an inference of causation. However with Alzheimer's patients we're not generally taking brain biopsies of old people to surveil for Alzheimer's plaques, so we don't have the arrow of time in either direction.

So our current economic system causes mass mental disorders and sleep disorders, causes alzheimers. Got it. Does the paper recommend revolting?

Do you have an example of a different economic system where people don't have any of those issues?

One possible explanation would be glymphatic system dysfunction (failure to clear “junk” during sleep): https://pubmed.ncbi.nlm.nih.gov/34025481/

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

Where is the proof that sleep loss does not cause Alzheimer’s and only reverse is true?

For the sake of argument, let's say that we're not allowed to question the claim that "sleep loss causes Alzheimer's".

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.

We should question and find proof. But should not dismiss the possibility without looking.

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

> if there sleep isn’t sufficient

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!

More often then not, they tell you 'inconclusive' results unless you are observed snoring and waking or having some sort of sleep obstruction. And then you get to pay a $3-4k bill for the worst night of sleep of your life, if you were in the States.

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

$3-4k sounds steep? I guess that is where they provide the accommodation. I had a take home one and it was much cheaper (privately paid IIRC, not subsidized by government). Outside of the US.

They provide the accommodation and then have like 10 people being monitored by 1-2 technicians overnight. It is pretty lame to be billed the amount they did for the equivalent of a couple hundred dollars of overhead and then manhours.

The problem is that we don't understand most sleep disorders.

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.

Outside the U.S., I paid exactly nothing for a night in a sleep clinic. I had the option of a take home kit, but I happen to live within walking distance of the hospital where the clinic was located, so I chose to sleep there.

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.

Yeah, I mean I would definitely recommend going to a hospital in Thailand for the sleep study rather than UCSF's sleep clinic. You might even save money with the cost of room, board, and plane tickets included.

My fitness watch can record SpO2 levels during sleep, that should be enough to tell you if you possibly have a problem. It is a fitbit sense.

Genuine question. How is sleep tracker information actionable?

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?

If you know what times you normally enter Deep/REM sleep, you know what times it's important to get to sleep by and to not be disturbed at those points in the night. They certainly vary by person and environment, but night to night they are fairly stable. Also, a lot of people are in denial about their sleep issues, "I don't hear any snoring".

> 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.

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.

>a chronic lack of sleep can cause Alzheimer’s, and I don’t think most people realize that.

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

> Home sleep trackers are much cheaper and easier to use these days

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?

> neurophysiologist Louisa Nicola

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.

>> Helping people get a good night's sleep -- without drugs -- would likely help, if only to stave it off in those at risk.

> 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.

Whoever agrees with the philosophical idea of “Sin taxes” deserves whatever fascist world they end up creating. The idea that I owe someone because I decide to indulge in something unhealthy for me implies that other people own me.

Isn't this a natural aspect of any system of government run "universal" healthcare?

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.

No, because most states with a state-run healthcare system simply recognize that health is a basic human right. It's not about incentives, or efficiency, it is about basic human decency.

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.

It can occur in free, capitalist societies too. And not in the sense that they "restrict" like an omnipotent government, instead they discourage what is bad and promote what is good. E.g. we have private medical health care here in SA and one of the biggest providers offers all sorts of free goodies and incentives and discounts. They literally partner with stores to get you discounts and points on healthy food choices. Now, I know they also use this data for other purposes but they also happen to help the health of the market. If we can keep it up without having the profit motive distort the benefits too much then its a win win.

As a counter example, look at how many countries have state funded healthcare with restricting unhealthy food or behaviour. By my count 66 countries have state funded health care and 0 have restrictions on unhealthy food or behaviour, (I admit my count was limited)

> "0 have restrictions on unhealthy food"

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.

So in the 66 countries you're referencing, none have restrictions on alcohol or tobacco? No warning labels, taxes or restrictions on sale?

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

so-called "sin taxes" are morally neutral but economically efficient. Explanation: one of the problems with taxation is that taxes distort the economy by changing prices which change consumption; "sin goods" have inelastic demand functions--smokers still want their cigarettes--so taxation doesn't change consumption, which lessens side effects of the taxation, for example not increasing unemployment of cigarette workers.

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.

I suppose the logical question is what defines justification for any tax on anything; if this can be defined perhaps we can establish reasoning for what items should be taxed and not be taxed.

In an unregulated system there are strong "sin incentives" created by (some) market forces. In a way people are manipulated to become passive couch potatoes craving trash food and sugary drinks, staying awake to binge watch some netflix series. It seems fair that governments take some corrective measures.

So it would seem you are suggesting we have no free will/agency? If so you cannot take credit for any achievement you accomplish or lay blame on anyone for anything no matter the deed because we would be nothing but products of our environments

We are social animals. You derive a lot of benefits from living in society, it has a price.

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.

Are you implying that just because a question is raised, one must be “following” some teaching or sect?

The idea that you "decide" to indulge in something unhealthy for you, and it was a free decision and companies had nothing to do with it, is a complete joke. We know humans are biased, we know we evolved to like fats more than salad and sugar more than water, we know advertisers influence us, we know companies spend tens of thousands of people's work and billions on advertising and that vastly outpowers a single person's ability to "choose freely", we know companies wilfully mislead and take advantage of our social nature (look at that respectable admirable sports star associated with our product! Look at the work of Edward Bernays and 'Torches for Freedom' getting women to start smoking cigarettes by associating them with the women's liberation movements) and take advantage of our judgement of colour and contrast and intensity (the same product in a cheap box looks less desirable than it in a bright stylish box - and both product, box and brands might be the same company behind the scenes), and our human decision fatigue and temptation for convenience by putting sweets near checkouts. We know companies specifically target children for their suggestibility with methods like adding toys to cereal boxes, advertising during Saturday morning cartoons or loot boxes in games. We know companies lobby for regulations which help them or hurt their competitors. We know society is organised so the big get bigger - McDonalds can outspend a startup Salad bar by millions to one. We know companies pay scientists to lie about the safety and efficacy of their products, and to hide results that say the opposite.

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.

Are you implying that we have no free will and that we lack the agency required for responsibility of our action? Dangerous doctrine there if so; it would imply that all criminals no matter how heinous the crime are victims of the system and thus cannot be punished without said punishment being just an emotional expression of vengeance. It would also mean that you could never take credit for anything you have done because it is just a reaction to your environment. These are only a few implications of a lack of free will/agency

I'm implying that people who dismiss the effects of the environment (advertising) on them by saying they Ayn Randian free-will themselves above it all, are either deluded or malicious. And that instead of systems which are openly hostile to humans which everyone must constantly burn free-will to defend against, we're a lot better acknowledging the predatory nature of advertising, and the limits and fallibility and weakpoints of free will, and en-masse building pro-people systems instead of pro-profit systems.

I would like to chime in here!

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

Are doctors not already telling people to eat healthy & exercise?

> 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.

Even in the presence of healthier lifestyles, the human body would still accumulate problems as part of the normal aging process. It's not like Alzheimer's would just go away if people started going on more walks and ate more vegetables. It's not an "emerging disease".

Maybe part of the problem is that we consider these things ”sins”, with all the subconscious burden of suffering for all eternity in a fiery pit thanks to a belevolent god who made that place, and who also loves you.

There is no money in preventative health care.

Maybe there should be? There’s got to be a startup there. Combine long term health insurance with a research arm that ensures the disease is cured and it never needs to pay out?

> There’s got to be a startup there.

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.

Single payer health care seems to be another reasonable way of aligning incentives, although as it’s critics will point out it also has other drawbacks.

There is plenty of money in preventative care. You should check vaccine sales numbers. A vaccine platform just got acquired by a drug company for over $3B.

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

There is a ton of money in preventative care. But even if you were right, we have no idea if prevention of Alzheimer's is even possible, or what it would take to do so.

I hear the exact same hot takes wheb diacussing life extension. 'eat healtheir', exercise more' etc...

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.

Diet, exercise, and good sleep are exactly the kinds of things that make people less frail at 90 (or 60 or 50). If you’ve ever met someone who isn’t frail when they are older it’s because they stayed active throughout their life. This doesn’t necessarily mean exercise, but it could mean doing lots of yard work, going on walks, etc.

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.

> Diet, exercise, and good sleep are exactly the kinds of things that make people less frail at 90 (or 60 or 50).

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...

I once looked at conditional lifespan data given that one reached a particular age. What was interesting that for India and Mongolia, countries with very different cultures, lifestyle, diet and climate, after 75 years the remaining lifespan was the same.

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.

Increasing levels of dementia are likely being observed because we have healthier older people than ever before. Anecdotally I’ve known 3 people with severe Alzheimer’s who were extraordinarily robust - healthy in every other way into their eighties. In a earlier era they likely would have been dead before their dementia became incapacitating.

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