Insomnia and Sleeping Pills: What is the Decisive Difference that Increases Dementia Risk?

When tossing and turning every night because you cannot fall asleep, two fears assail you. The anxiety that "What if dementia toxins accumulate in my brain because I can't sleep?" and the worry that "Will taking sleeping pills for a long time cause dementia?" According to a video from Uihak Channel Biondwi, the relationship between dementia risk, chronic insomnia, and sleeping pill consumption must be understood by making a clear distinction between them.

Why Chronic Insomnia Interferes with the Brain's 'Cleaning Function'

If a state of not being able to sleep properly persists, it deals a direct blow to brain health. Our brain possesses a cleaning device called the 'Glymphatic System' that washes away waste accumulated during the day. However, if sleep is insufficient or if one wakes up frequently, this system cannot function properly.

In this process, 'beta-amyloid' or 'tau protein,' which are toxic substances that cause Alzheimer's, cannot be washed away and instead accumulate in the brain. Furthermore, if you cannot sleep, abnormalities can occur in the 'Orexin' regulation mechanism, which is the hormone that controls arousal, and chronic neuroinflammation can occur. This leads to vascular endothelial dysfunction, causing damage to the cerebral white matter, and consequently becomes a cause that simultaneously increases the risk of both Alzheimer's dementia and vascular dementia.

According to the results of a meta-analysis published in an international academic journal in 2025, insomnia is associated with increasing the overall risk of dementia by about 36.2% and the risk of Alzheimer's dementia by about 45%. In particular, if one cannot sleep at night and is accompanied by excessive daytime sleepiness, the risk of vascular dementia can rise sharply to about 80–85%. However, it is difficult to conclude whether insomnia is a direct cause of dementia or if insomnia occurs due to early brain changes from dementia because the causal relationship is complex, but it is clear that insomnia is closely related to brain aging.

The 'Buffering Action' of Deep Sleep and the Role of Orexin Hormone

According to a study published in a recent neurology journal, higher levels of Orexin in the cerebrospinal fluid tended to correlate with declining cognitive function. In other words, the stronger the signal that keeps the brain awake, the greater the risk of cognitive decline. However, what should be noted here is the 'quality of sleep.'

Research results showed that among patients at risk of cognitive decline due to high Orexin levels, those with abundant 'slow-wave sleep (deep sleep)' or 'spindle sleep' showed a distinct reduction in the negative effects of Orexin on cognitive function. This suggests that deep and stable sleep acts as a buffer that protects the brain. Therefore, rather than simply increasing the time spent sleeping, it is important to secure the quality of deep sleep that can protect the brain.

Sleeping Pills, Are They Always Dangerous? Principles for Correct Use

It is dangerous to neglect insomnia due to a phobia of sleeping pills. The video emphasizes that sleeping pills are by no means a panacea, nor are they unconditionally bad drugs. The key is 'appropriate use suited to the patient.' The primary recommended treatment for insomnia is not medication, but 'CBT-I.' However, since CBT-I takes time to show effects, medication can be used selectively only in cases where daily life during the day is immediately difficult or when it cannot be controlled by CBT-I alone.

Sleeping pills are largely divided into four types. A representative example is the 'benzodiazepine group,' which acts extensively by lowering overall brain function, providing sedation, muscle relaxation, and memory suppression. On the other hand, drugs such as 'Zolpidem' or 'Eszopiclone' act selectively on GABA receptors to help one fall asleep quickly, but side effects such as sudden abnormal behavior while sleeping or not remembering the next day have been reported. Recently, 'Orexin receptor antagonists' or medications related to 'melatonin' that help maintain the brain's natural sleep flow are also being used.

In conclusion, it is safest to use sleeping pills only when absolutely necessary, in appropriate doses and for short periods. Rather than neglecting insomnia and decreasing the brain's cleaning function, the way to protect brain health is to seek professional help and wisely treat the condition by adjusting the type, dosage, and duration of the medication.