To sleep, perchance to dream—ay, there’s the rub:

For in that sleep of death what dreams may come…

Hamlet by William Shakespeare

By Dr. Jim Ferguson
My grandchildren are out of school for the summer, and despite Covid they passed all their studies. Actually, there was never a doubt. Unlike me, my grandchildren like school.

I’m sure I have forgotten many of the good times in my early education – like recess. Instead, I remember having to sit at a desk and pay attention. I was interested in sports and later girls during grades one through twelve. I do remember my favorite day of the school year. It was the last day before summer break, though the joy was often tempered by my irrational worries that the final report card would not allow me to pass to the next grade level. My underachieving years were eventually replaced with focus in college and, of course, medical school.

With school out for the summer grandparents have more shepherding responsibilities and occasionally we get to add some words of wisdom along the way. I told my grandchildren that they may be out of school this summer, but schooling is never over. My years of formal education may be over, but my informal education is not. I may be retired from medical practice, but not from the school of life and lifelong educational pursuits.

Actually, I love teaching myself about the things that interest me. I no longer do assignments from others or study to pass a test. I derive joy from reading and studying about things that intrigue me. And I am blessed with the time, tools and support that enable my curiosity to roam and my creativity to flourish in these columns.

I read fewer medical journals these days, but a recent article about sleep in the Journal of American Medical Association (JAMA) caught my eye. Perhaps I was intrigued because I’m reading a book which discusses the difference between the brain and the mind. The human brain is an organ composed of 100 billion interconnected nerve cells. When these neurons exchange electro-chemical information, we think. Humans think more deeply than any other known species. But, “Where do those thoughts go when we go to sleep?”

We are unconscious when we sleep, though brain systems that control, for instance, respiration still function. My argument is that the thinking, conscious mind is apart from the brain when we sleep. This essay will disappear if I turn off my computer and my thoughts are not “saved.” And yet, I can be awakened from sleep and my conscious mind returns. Perhaps my brain is able to constantly save the thoughts of my conscious mind.

Humans spend one third of their life asleep and unconscious, with our mind elsewhere. Science does not know why we sleep. Yet we know that sleep is necessary and sleep deprived persons become dysfunctional and often sick. When our ancestors slept, they were more vulnerable to predators. Even today, we are more subject to enemies when asleep.

Perhaps sleep is needed to rest the brain and the body. The brain uses 20% of the body’s energy. Though brain energy utilization decreases when we are asleep, it does not stop because many areas of the brain are still active. Sigmund Freud thought our dreams during sleep were where we dealt with negative thoughts of the subconscious. Science has shown that sleep helps “consolidate memories and learning” perhaps by pruning some neuron connections and strengthening others. As a gardener I know it is often necessary to prune a tomato plant or a fruit tree.

Recent scientific studies suggest that sleep is an important “waste management” mechanism for the brain. Given the high metabolic rate of brain cells, there are a lot of waste products produced including amyloid-beta (AB) and tau proteins which are associated with Alzheimer’s disease. The JAMA article describes a recently discovered “glymphatic drainage system” in the brain which is important for removing accumulated waste.

Interestingly, “the flow of fluid through the glymphatic system is greatest during sleep, particularly during non-rapid eye movement sleep.” Researchers have found that the drainage system’s function is reduced with aging, shift work, traumatic brain injury, sleep apnea, and a host of other medical conditions including chronic insomnia. The bottom line is that a good night’s sleep is necessary for waste removal and a healthy brain.

Along the same line is the recent approval of a new drug to treat Alzheimer’s disease (AD). Though studies have shown less than robust results, the drug is the first new treatment for AD in almost 20 years of research. Biogen’s drug, aducanumab, is a monoclonal antibody (truly a designer drug) which binds to amyloid, aiding in this waste product’s removal.

I have no stock in Biogen. Nor am I a researcher or an “expert” like the tarnished Fauci. But in defense of the new drug, please consider the following: We still do not have a clear picture of what causes Alzheimer’s disease. However, the accuracy of the diagnosis has improved in recent years with new tests like PET scans and spinal fluid analysis for amyloid and tau proteins. And sometimes you have to go with the best that you’ve got.

You should realize that the Covid vaccines were approved on an emergency basis. Anyone who has taken one of these vaccines is part of the greatest clinical research trial in the history of mankind. After weighing the risks and the benefits for myself and my wife, we thanked President Trump and took the “experimental” vaccine. If I had Alzheimer’s disease and a pet scan showed amyloid deposits in my brain, and the MRI showed brain shrinkage consistent with Alzheimer’s disease and my spinal fluid analysis showed amyloid waste products, I would probably take the new monoclonal antibody infusion and hope for the best.

Maybe Ole Joe should read this essay and avoid his Chinese “friends in low places” and slip on down to his Delaware “oasis” for a nap and a monoclonal antibody infusion.