Sleep Apnea and Alzheimer's (Medical Doctors Wanted)

This concerns my dad. First off, I want to preface this by saying that I’m not here asking for medical advice in lieu of actually paying a visit to a doctor–he’s been to a doctor; he’s been to a few doctors, in fact. But so far I’m not satisfied that any correct diagnosis has been given. I’m only hoping that someone here may have some suggestions on what the problem may be.

First off, we know he has sleep apnea–a rather severe case of sleep apnea, in fact. He uses a machine (either a BPAP or CPAP, I’m not sure which offhand), but has never adjusted well to it, and generally takes it off in his sleep shortly after falling asleep. In fact, he never seems to get good sleep–it’s not uncommon for him to get up in the morning, get the paper and sit down to read it, then fall back asleep in the chair shortly afterwards. He spends the majority of the day drifting in and out of sleep.

The primary concern, however, is that for a few years now his memory (and his general ability to function in day to day tasks) has been declining.

My first thought was that he is in the earl/mid stages of Alzheimer’s disease, and that may in fact be the case. I’ve read there is a correlation between sleep apnea and Alzheimer’s–though from what I’ve read, no one seems to understand the correlation and whether or not it’s a causal relationship. I’m not absolutely convinced that’s the case, however. For one thing, he was given an EEG (about a year ago, I believe) which apparently showed no indication of Alzheimer’s (though I must admit I’m completely ignorant of what sort of indications an EEG may give of Alzheimer’s–how accurate is such a test for Alzheimer’s?). About a month ago, he was given a psychiatric exam. I’m afraid I don’t know the name or specific type of exam he was given–I will mention what I know, and that’s that some of it involved drawing pictures, as well as being asked to put variously shaped objects into their correspondingly variously shaped holes while blindfolded. Anyway, apparently the results of that test were that, while he does show some cognitive disfunction, it was no more than is typically expected at that age (he’s 70), and was not severe enough to suggest Alzheimer’s.

Some of the symptoms he’s been showing: He gets confused often, particularly when he wakes up (which, as I mentioned before, happens frequently in a single day). It often seems very much like what we all probably have experienced from time to time–You wake up from a very realistic dream, other people are around you, and you insist that whatever you were dreaming was actually happening. Only with him it’s not an occasional thing–it happens several times a day. A common example might be, he wakes up, immediately gets up and starts searching for something; when you ask him what he’s doing, he might say, “You told me to find the (…random item…) for you.” Or he might wake up, head outside, saying something about needing to “turn the lanterns off”.

It goes beyond that, however. A couple of the most striking things I’ve noticed are problems with his visual perception. This past summer I was driving while he was in the car. There was a hill about a half mile in the distance, with a few trees on the ridge. My dad asked, “Are those buzzards up there on the hill?” I told him, “No, dad, I think they’re trees. If they’re buzzards, they’d have to be 50 foot tall buzzards”.

Another time, my mom noticed him staring out the window. She asked him what he was looking at, and he said he was “watching all the lizards in the yard”. My mom told him there weren’t any lizards, so he goes out to prove there are. When he gets out there, he realizes the lizards were just leaves.

Are these visual perception problems a common symptom of Alzheimer’s?

He’s gotten worse in the past few weeks as well. Sometimes when he wakes up he can’t remember where the bathroom is–this is in a house he has lived in for 40 years.

I should also mention that his mother had many of the same problems late in her life (inability to stay awake, poor short term memory).

Anyway, to get to a point, I’m not convinced one way or the other that this is Alzheimer’s. I sometimes wonder whether this could all be caused by a major sleep disorder. One thought that occured to me today is that a lot of his behavior seems to indicate he’s in a dream like state even when he’s awake. This brings me to one specific question (on top of everything else).

No doubt sleep deprivation can lead to hallucinations. I vaguely remember reading about a sleep study (which may be a complete urban legend, which is why I bring it up–to find out if there is any truth to it) in which the subject was allowed to sleep, but once he entered the “dream state” (I’m not sure of the correct term offhand) of sleep he was always awakened. In other words, the subject was allowed to sleep, but not to dream (or even enter the appropriate stage of sleep for dreaming). After a period of time, the subject began to have hallucinations (or some other cognitive disfunction).

Is there any truth to this? I’m wondering if my dad may have a sleep disorder of this nature. Are there any case histories of such a sleeping disorder with similar symptoms?

Anyway, sorry for this being so long; thanks for reading. Any advice/suggestions/speculation would be welcome.

IANAD. This is an educated guess to attempt to answer, and incidentally to bump this one in hopes of better-educated postings.

My mother had Alzheimer’s, and I researched it to the best of my powers. Your instinct that it could be something else is a very sound one. Effects of the following conditions have been attributed to Alzheimer’s: disrupted sleep, medication effects, mini-strokes, nutrition issues, other illnesses, and substance abuse.

There is a San Francisco hospital (Mt. Zion) that does an Alzheimer’s evaluation that, among other things, looks at these other possible diagnoses. There may be such an evaluation available near where you live.

Or if multiple attempts at diagnosis begin to seem like floundering, you and your father might pursue the sleep apnea seriously, pushing his doctor to come up with something that really works. Whether or not he has Alzheimer’s, he has unresolved sleep issues.

Oh, and whatever stage of the big A a person may have, the symptoms get clearly worsened by anything like tiredness, distraction, worry, illness, depression, stress, too much excitement, etc. IMHO, you can get that effect with no Alz’s whatsoever.

This is common. Many people can not tolerate the CPAP mask. I doubt I could. It is loud and uncomfortable. A shame, though, since it clearly is an effective treatment.

Yes, there is an association and it is becoming more and more appreciated. For a taste of the literature, go to and search using the following “apnea AND (cognitive OR dementia)” - but leave out the quotation marks.

It’s not part of the standard diagnostic testing. Usually EEG results are too non-specific. Alzheimer’s is a diagnosis of exclusion usually made on clinical grounds when other possibilities have been ruled out on the basis of CT scan and various blood tests.

Clearly encouraging. Still, I assume your dad was (is) a pretty bright man. If he’s starting from a high level of intelligence and education, cognitive impairment may be masked to some degree.

Yes. But they are also common with other disorders.

I think it is possible given that you KNOW he has sleep apnea and given that sleep apnea can lead to cognitive impairment.

IIRC, yes. This formed some of the basis for the understanding that sleep apnea, which is associated with loss of REM sleep, leads to so-called hypnogogic hallucinations.

IMHO, if possible, you may wish to have your dad seen at a place where there’s interest in both sleep disordered breathing and dementing processes. Your best bet is the nearest medical school although that’s clearly no guarantee. Where abouts does he live?

Thanks to both of you for your responses.

He lives in southwest Virginia, about 2-2.5 hours from Charlottesville, so the UVA medical school is an option. I live in Raleigh, so Duke would be a reasonable option as well. Plus, my brother and his family live in Baltimore, so Johns Hopkins is there. My dad hasn’t been driving any lately, and my mom isn’t crazy about driving in the interstate traffic for any extended period; but I come up to visit frequently and don’t mind driving at all, so I could probably easily arrange to drive him to any medical school in the mid-Atlantic. Anyone know of a particular medical school in this area which would be best suited for this?

He’s been retired for quite a few years now, but had a long career as a chemical engineer. After he was given the psychiatric exam, we were told that it showed some cognitive impairment–not enough to imply Alzheimer’s, but more than would be expected in someone of his engineering background (apparently the results of the test corresponded to an IQ of about 114, whatever that really means).

The link on hypnogogic hallucinations is definitely interesting–it seems to correspond quite closely to his behavior, though he doesn’t seem to be aware that he’s hallucinating. I remember that as much as 20 or 25 years ago he had a tendency to drift asleep while sitting around (though not nearly to the extent he does now). Close to 10 years ago is when I first remember how he would sometimes drift off to asleep, then partially wake up and jerk around and call out, like he was trying to act out a dream (though again, not nearly to the extent now).

Is it possible to be so sleep deprived that hypnogogic hallucinations occur during a large part of your waking hours? I’ve got this idea that since he has sleep apnea his sleep is already restless, and maybe once he enters a dream, the dream startles him into (partial) wakefulness, disrupting his sleep. It’s been going on so long it seems like it’s led him to a near permanent state of hypnogogia.