Cheryl Quimba: Growing up in an intergenerational household, Carleara Weiss remembers lying awake at night listening to her grandmother and great grandmother snoring—from three bedrooms down the hall, with the door closed. It turns out both women had been suffering from obstructive sleep apnea, and about 10 years later, they both developed Alzheimer's.

Carleara Weiss: At the time, we didn't know that loud snoring was something that should be investigated.

Cheryl Quimba: Today, few people understand the link between sleep disorders and cognitive decline better than Weiss, a former geriatric nurse who's now an assistant professor of nursing at UB and a renowned sleep expert. Her current research examines how sleep affects the brain and what that means for neurodegenerative diseases like Alzheimer's.

Welcome to Driven to Discover, a University at Buffalo podcast that explores what inspires today's innovators. My name is Cheryl Quimba, and in this episode, I'll be speaking with Dr. Weiss about her research findings and about sleep in general—why we do it, what happens when we don't, and what we can do to make sure our bodies get the rest they need.

Thank you so much for joining us, Dr. Weiss.

Carleara Weiss: Thank you so much for having me.

Cheryl Quimba: Can you tell us about how your childhood, in particular your experience with your grandmother and great grandmother, influenced your career path?

Carleara Weiss: Yes. So I grew up in an intergenerational household, so my mom, myself, my great grandmother, my grandmother, we are all in the same house. And because of that, taking care of my family members, my older family members, was something very natural, and that influenced my choice to become a geriatric nurse.

In addition to that, I noticed that they would snore loudly. It would shake the house, really. And it was kind of something that we laughed about, didn't pay too much attention, and 15, 25 years ago when we experienced that, there was not enough research about how loud snoring could be a symptom for obstructive sleep apnea, especially in post-menopausal women. So back then, we ignored those symptoms, and we did not do the right things to investigate and also to help them get treatment and preserve their brain health by sleeping better.

So, once I became a geriatric nurse and started learning more about the correlations between those symptoms, that became something very important for my research.

Cheryl Quimba: So, let's back up a bit. Why is sleep so essential on a basic biological level?

Carleara Weiss: So, sleep is the backbone of health, right? It’s one of the pillars for our well-being, and how well we sleep impacts our physiological functioning, immune system, also helps with cognitive health and brain health, hormone regulations, how our immune cells grow during sleep, hormones such as growth hormone also are impacted by sleep. So having the appropriate hours of sleep and good quality of sleep dictates how well our body is going to function during the day.

Cheryl Quimba: Wow, okay, so sleep has a major impact on all these different systems of the body. Okay, so there's a surge of interest in sleep on social media right now, as I'm sure you've seen. There's an absolute plethora of products out there to help us sleep. So, is quality sleep becoming a bigger problem for us as a society or is this just something that's becoming more recognized?

Carleara Weiss: I think it streams from the problems that we have as a society, that the 24/7 structure of our society impacts how well we sleep at night, increasing our anxiety, and usually, if you have a deadline or are doing some crunch time at work, the first thing that we drop is sleep.

However, during the pandemic, people were spending more time at the house, and that allowed them to have more time to sleep, and they noticed a difference in their well-being. So with that comes this search for what can help them sleep better. And it's very important that people are paying more attention to sleep, but also, we need to be careful with what we are taking from social media, right? Social media is not medical advice, so we still need to be mindful of seeking reputable sources or sources that are evidence-based to help us sleep better. But I see it as a positive thing that more people are paying attention to sleep and really trying to find ways to sleep better.

Cheryl Quimba: Interesting. So it sounds like it's a little bit of both, like modern lifestyles are impacting our ability to have quality sleep, but people are also just thinking more about it and how to improve it and optimize sleep in their lives.

Carleara Weiss: Yes, yes. And some research that came out recently says that between 30 and 60% of U.S. adults have some type of sleep problems, that being insomnia related to being stressed at work or some family problems happening, and other problems such as obstructive sleep apnea that are not diagnosed. So it's a lot of people really needing help to sleep better. So it is important that we pay more attention to what we're doing.

Cheryl Quimba: Okay, so full disclosure, I'm one of those people who struggle to fall asleep. I'm sure you often hear from people who share their sleep challenges with you. So what are your top tips for poor sleepers?

Carleara Weiss: Oh, I'm sorry to hear that you have trouble sleeping. The first thing that I would recommend is having a consistent bedtime. So going to bed every day at the same time helps our biological clock understand when it's time to fall asleep and regulates the hormones that are needed to make us fall asleep and stay asleep. The second thing that I also recommend is waking up at the same time every day as part of this consistent sleep regimen, and also having more light when we wake up in the morning. With that light exposure, we can have the biological clock understanding that it's daytime and start shutting down melatonin. So we want to have that light during the morning, along with a consistent bedtime and wake-up time, but we want to reduce the light that we have exposed at night. So at least one hour before going to bed, shut down electronic devices, try to do some activities that promote relaxation and help the brain make the transition between being awake and asleep. And also less exposure of light at night helps the brain produce melatonin.

Cheryl Quimba: Okay, I'm going to implement that advice. So what are your thoughts on all the different sleep aids. There are over the counter things, supplements—are they effective or are they just masking the problem?

Carleara Weiss: That's a very important question, because one of the major sleep aids that we have in our country is melatonin. Melatonin is a hormone, not a dietary supplement, and the recommendations from the American Academy of Sleep Medicine is that melatonin dose should be up to two milligrams. And when we go to a grocery store or a pharmacy, we have 10 milligrams of melatonin, 20 milligrams of melatonin, fast-absorption melatonin. And because melatonin is a hormone being sold as a dietary supplement, there is no FDA regulation for that.

So a couple of years ago, some colleagues ran a study just taking everything that is in the grocery stores and the pharmacies and testing what is inside. And 97% of the products did not have the amount of melatonin that was described in the label, or they have other compounds along with melatonin that were not described in the label. So, I highly recommend people to seek advice from a medical professional before they take melatonin.

Other sleeping aids, for example, magnesium, L-theanine, that is very common now—the research on those components are still building up, so I would still be mindful and careful before taking them. There may be some consequences that we're not aware of.

Cheryl Quimba: Can you talk about lucid dreams? What are they, why do they happen, and why do only some people get them?

Carleara Weiss: That's a fun question. We don't have a definite answer why we have lucid dreams, but we have a definition for them. So lucid dreams are those dreams that the person is aware that the dream is happening while they're happening. So somebody that has a lucid dream, for example, they are dreaming that there's a tiger running and chasing them, and they will stop and say, “No, this is not real. I'm just dreaming,” and, “Tiger, go away!” And the tiger goes away, and they start dreaming about something else.

So that is a lucid dream, and as I said, the science is still evolving around this, and we don't know exactly why some people have those dreams. But there is a side of psychology research that is working with people that have PTSD and have the same lucid dream multiple times, and they try to use some psychological techniques to help them change the outcomes of the lucid dreams. So, for example, some colleagues are working with veterans that have PTSD, and they help them change the outcome of their dreams, and that is very healing for them.

Cheryl Quimba: Wow, that sounds like a very exciting frontier of research.

Carleara Weiss: Yes, because those dreams can be very distressful too, right? So helping them transition from a distressful dream to something that can be healing? It’s very important.

Cheryl Quimba: Let's dig into your research. So you're currently leading an NIH-funded study examining the links between sleep and Alzheimer's disease. Can you tell us about that work?

Carleara Weiss: Yes, I'm very passionate about this. It has a connection with my family and being a family caregiver. Based on the research that we know, having a specific sleep duration and specific sleep quality are important to help the brain clean up the toxins or the compounds that accumulate in the brain as we are going through our daily lives. So this accumulation of neurodegenerative biomarkers in the brain can be overturned when we sleep. We call this a glymphatic system that removes those biomarkers. And about 97% of the activity of this system happens during deep sleep. So if we’re not getting deep sleep, we're accumulating more and more biomarkers over time. And when we look at the brain images over time for people that accumulate those biomarkers, those are the neurofibrillary tangles that we see in people that have Alzheimer's disease and other dementias. So it's a direct correlation to have good sleep quality, good sleep duration, deep sleep, and the ability to clean those and delay the progression of neurodegeneration in the brain.

So my research looks at people that do not have a diagnosis for dementia or Alzheimer's disease, but have sleep problems. So I help them sleep better, and I track the impacts that sleeping better has on the biomarkers in the brain. And I'm very fortunate to see that some of the interventions that I'm doing are helping people sleep better with longer duration, more deep sleep, and really reducing the biomarker levels that we have in their system, in the blood. So it's very exciting research that I'm hoping that I can expand to larger populations in the future.

Cheryl Quimba: Wow, that is fascinating. And these tangles that you mentioned, are those things that accumulate just over the course of our regular day to day lives?

Carleara Weiss: Yeah, so those tangles and those proteins, right? Amyloid beta, p-tau proteins, those proteins really accumulate in the brain. So, think about if we are working in the office, for example, and we have, like, some drafts that we need to throw in the trash, and we keep accumulating that trash can during the day. And what happens when we sleep? We come up to that trash can and we empty that. So if we're not able to sleep with the right duration, deep sleep and good quality, that trash can can never go to the bottom. So we always have a little left for the next day, and we can keep accumulating that over the years, right? And that increases the risk for dementia in the future.

Cheryl Quimba: And sleep clears out that trash can.

Carleara Weiss: Yes. Yes, exactly.

Cheryl Quimba: Okay, let's talk about sleep and aging in general. What are some changes we can anticipate as we grow older? How do we know what's normal and what's a warning sign?

Carleara Weiss: This is a very good question, because it's one of the things that I see on a daily basis—people thinking that because they are getting older, the sleep quality or the sleep duration needs to be impacted, and it's normal. And, unfortunately, it's not normal to have those changes.

So, what we consider normal aging, as far as brain health and sleep, is a difference in how the sleep architecture works. So, sleep architecture is the amount of time we spend in light sleep, deep sleep, and REM sleep—that is when we have the dreams, right? So as we get older, the amount of time we spend on those sleep stages can change, especially we spend less time on REM sleep. But the quality of sleep should not be changing with that, right? It's normal to see older adults have more light sleep and be easily awakened for noise outside or other things that may affect their sleep environment. But again, the quality of sleep should not change.

So what I usually say when I'm talking to members of our community is that it's okay to wake up to use the restroom. This is part of normal aging. But it's not normal if you cannot fall back asleep within 30 minutes. So understanding those differences and being aware of those, bringing that to your primary care provider or to a sleep specialist, can help people advocate for themselves and find ways to sleep better as they get older.

Cheryl Quimba: Good to know. That's very good to know. And what's on the horizon for your research?

Carleara Weiss: I'm very excited about this research with helping people sleep better, and with that seeing the impact that it has on their brain health, on the cognitive function. And I'm very excited to expand this research to a larger group of people.

The other part of my research that I'm very excited about is working with the community. So, because of my experience as a family caregiver, I'm starting to work with the family caregivers in our community as well. And helping them navigate this process of taking care of the family members, but also maintaining their own health while they do that. So along with having these studies for people who are 65 to 85 years old and have sleep problems and want to delay the progression of the neurodegeneration, I'm also working in our community to help the family caregivers, increase their health literacy, increase ways that they can find the right resources for their loved ones, but also helping them identify early on if they have some symptoms that need to be checked.

So those two things, I think they're equally important, because having a clinical trial like I have now, it takes years until we have this type of research being available to the public. But while we're doing that important work, we need to help people who are in the trenches right now.

Cheryl Quimba: So you have a wet lab here at UB and a sleep lab?

Carleara Weiss: Yes.

Cheryl Quimba: Could you talk a little bit about that?

Carleara Weiss: Yes, of course. And I think that is also something very interesting, because it's not common for nurses to have a wet lab or a sleep research lab, and my lab is the first one in the School of Nursing. This is something that really distinguishes the work that I do from other researchers, because I can do, with my background in nursing, I can do everything from recruiting the participants to having their analysis done at the lab. But also, the more I become involved with the community for recruitment for this type of studies, the more I'm aware of the need for increased health, literacy and education in our community.

So those two things happen at the same time, and I’m receiving very good feedback from our community as well. It's very common, for example, that I recruit one person for the study, and they bring their spouse, they bring their sisters, they bring their neighbors, and we start building this snowball effect of more people wanting to see why they're not sleeping well, what may be happening in their brain, what can be done now to prevent dementia in the future. And also, going to family caregiver groups around our area here and giving a talk about sleep and brain health and how they can navigate those systems. Those two things happen in a very good parallel, and I'm very fortunate for that.

Cheryl Quimba: Wow, that sounds like very important work, very necessary work. Well, thank you so much for speaking with us today. I've learned so much, and I'm going to think about this when I go to bed tonight.

Carleara Weiss: Thank you so much for having me. It's always a pleasure to try to break down a little bit of the research and bring that, and also share my passion for it that started with my grandmother. And I, every time that I do this, I hope that somebody's grandmother gets better health by listening to it too. So, thanks again.