What’s Keeping You Up at Night? Breaking the Cycle of Sleeplessness

What’s Keeping You Up at Night? Breaking the Cycle of Sleeplessness

A good night’s sleep is undeniably refreshing and revitalizing and is also essential to overall health and well-being. Sleep experts continue to emphasize that healthy sleep is just as important as proper nutrition and regular exercise. Consistently poor sleep has been linked to an increased risk of type 2 diabetes, high blood pressure, cardiovascular disease, depression, anxiety, and weakened immune function. Sleep also plays an important role in memory, concentration, mood regulation, and long-term brain health.

While the sleepless nights and drowsy days experienced during the pandemic reached historic highs, sleep difficulties remain widespread in 2026. According to recently released national data, nearly one in three U.S. adults still report getting fewer than the recommended seven hours of sleep per night, and sleep difficulties continue to affect millions of Americans. Approximately one in six adults reports trouble falling asleep, while one in five struggles to stay asleep through the night. Women are more likely than men to experience sleep disruptions and wake feeling unrested. These findings reflect national sleep survey data current through 2025-2026.

Sleep disturbance is closely intertwined with mental health concerns such as anxiety and depression, with each condition capable of influencing and worsening the others. Because of this relationship, it is not always possible to determine which issue began first. Chronic insomnia can contribute to feelings of being overwhelmed, difficulty concentrating, irritability, nervousness, restlessness, and heightened worry or a sense of impending doom. Sleep disorders are also highly prevalent among individuals with mood disorders. Research continues to show that insomnia is one of the most common symptoms of depression, with a substantial majority of people diagnosed with depression reporting persistent sleep difficulties. Obstructive sleep apnea, a condition in which breathing repeatedly pauses during sleep, may also coexist with depression and anxiety, further affecting energy, cognition, and emotional well-being.

Similarly, anxiety can make it more difficult for the body and mind to relax enough to fall asleep. It may also disrupt rapid eye movement (REM) sleep, increasing the likelihood of vivid or disturbing dreams that interrupt rest. Completing the cycle is sleep anxiety, apprehension or fear about going to sleep, which is commonly seen in individuals with insomnia, narcolepsy, sleep apnea, or restless legs syndrome. Recognizing and addressing sleep concerns early is important, as effective treatment can significantly improve both physical and mental health. Although insomnia may feel like a never-ending cycle, effective strategies can help improve sleep and restore restful nights.

Support can include:

  • Cognitive behavioral therapy for insomnia (CBT-I) remains the first-line treatment for chronic insomnia. This evidence-based approach helps individuals identify and change thoughts and behaviors that interfere with sleep, while building healthier sleep habits and routines. CBT-I may include strategies such as stimulus control, sleep scheduling, relaxation techniques, and reducing sleep-related anxiety. Results often take several weeks, but research shows benefits are long-lasting and frequently more effective than medication alone.
  • Prescription sleep medications may be appropriate in select situations, particularly for short- term use or when insomnia significantly affects daily functioning. Medications such as zolpidem (Ambien) or eszopiclone (Lunesta), as well as certain low-dose antidepressants or newer sleep agents, may be considered alongside CBT-I. Because sleep medications can carry risks such as daytime drowsiness, dependence, tolerance, falls in older adults, or next-day impairment, close medical supervision is important.
  • Light therapy and circadian rhythm support can be especially helpful for individuals whose internal body clock is out of sync with their schedule. Strategic exposure to bright light in the morning, limiting evening light exposure (particularly from screens), and maintaining consistent sleep and wake times may help reset circadian rhythms and improve sleep quality, particularly for night owls, shift workers, or those adjusting to schedule changes.

If restless or wakeful nights are becoming more frequent, please let us know. Persistent trouble falling asleep, staying asleep, waking too early, or feeling unrefreshed during the day may signal an underlying sleep issue that deserves attention. Keeping a sleep diary for several weeks can help identify patterns and habits that may be affecting your ability to get restorative rest, including bedtime routines, caffeine or alcohol intake, screen time, exercise, stress, and sleep consistency. In some cases, additional evaluation may be recommended, including a sleep study (polysomnography) or home sleep apnea testing, depending on your symptoms. These studies assess factors such as breathing patterns, oxygen levels, heart rate and rhythm, body movement, sleep stages, and snoring to help identify conditions such as insomnia, obstructive sleep apnea, restless legs syndrome, or other sleep disorders.

Finally, remember that sleep needs vary from person to person. While most adults are encouraged to aim for at least seven hours of sleep nightly, quality matters as much as quantity. A helpful measure is how you feel during the day: if you wake feeling rested, remain alert, and function well throughout daily activities, your sleep needs are likely being met.

The foundation begins with basics:

  • Turn off TV, tablets and phones at least 30 minutes before bed.
  • Limit large meals, caffeine and alcohol close to bedtime.
  • Keep a consistent wake-up time seven days a week.
  • Reserve your bedroom for sleep by keeping it dark, cool and quiet; turn around your clock so
    you can’t see the time if you’re tossing and turning in the middle of the night.
  • Seek support for persistent sleep difficulties lasting three months or longer.

Sources: American Academy of Sleep Medicine; National Institutes of Health

Celebrate the Power of Colorful Produce

Celebrate the Power of Colorful Produce

Fill your plate with a vibrant, colorful array of fruits and vegetables for a naturally delicious way to meet your daily requirement of vitamins, minerals, and nutrients. Plant foods contain natural compounds called phytonutrients, which may have anti-inflammatory benefits that can help reduce the risk of chronic diseases.

The US Department of Agriculture 2025–2030 Dietary Guidelines for Americans emphasizes prioritizing whole, healthy, and nutritious foods. Vegetables and fruits remain a cornerstone of that guidance.  Research continues to show that a diet rich in produce can lower blood pressure, reduce the risk of heart disease and stroke, prevent some types of cancer, and have a positive effect on blood sugar.

  1. Keep fruit where you can see it. Place several ready-to-eat washed whole fruits in a bowl or store chopped colorful fruits in a glass bowl in the refrigerator to tempt a sweet tooth.
  2. Explore your local farmer’s market and choose something new. Variety and color are key to a healthy diet. On most days, try to get at least one serving from each of the following categories: dark green leafy vegetables; yellow or orange fruits and vegetables; red fruits and vegetables; legumes (beans) and peas; and citrus fruits.
  3. Skip potatoes as your main vegetable. Choose other vegetables that are packed with different nutrients and more slowly digested carbohydrates.
  4. Make it a meal. Try new recipes that include more vegetables.

Every color has a contribution to make, aim for a few different ones each day and enjoy the entire spectrum.

Red and pink: These fruits and vegetables are an abundant source of the carotenoid lycopene, which may help balance free radical activity in the body, offering protection against prostate cancer and heart and lung disease. Research suggests that increased consumption of tomato-based products and other lycopene-containing foods may reduce the occurrence of prostate cancer, with cooked tomato products potentially offering enhanced benefits.

beet, cherry, cranberry, pink grapefruit, pomegranate, radicchio, red radish, red onion, persimmon, pink guava, blood orange, raspberries, red dragon fruit, red apple, red grape, red pepper, red potato, rhubarb, strawberries, tomato, watermelon

Orange and yellow: Enjoy an extra boost of beta-cryptoxanthin, which supports intracellular communication and may help prevent heart disease. Orange and yellow fruits and vegetables also contain vitamin C and carotenoids, including beta-carotene, which is associated with promoting healthy vision and cell growth. The current guidelines recommend eating a variety of colorful produce to ensure a diversity of beneficial plant chemicals.

acorn squash, butternut squash, apricot, cantaloupe, carrot, grapefruit, lemon, mango, nectarine, orange, orange pepper, papaya, peach, pineapple, pumpkin, summer squash, sweet potato, tangerine, yam, yellow apple, yellow pepper, yellow squash, pomelo, turmeric root, star fruit

Green: These are some of the healthiest fruits and vegetables, rich in chemicals like sulforaphane, isothiocyanates, and indoles, which may inhibit the action of carcinogens. Dark green and leafy vegetables have the highest concentration of both antioxidants and fiber. They’re also packed with potassium, lutein, isoflavones, and vitamin K, which can be important for vision, bone, and blood health.

artichoke, asparagus, avocado, bok choy, broccoli, Brussels sprouts, celery, collard greens, cucumber, green bean, green cabbage, green grape, green onion, green pepper, kale, kiwi, leek, lime, mustard green, okra, pear, peas, romaine lettuce, snow peas, spinach, sugar snap peas, watercress, zucchini, seaweed, broccolini, matcha, Swiss chard, arugula, edamame, alfalfa sprouts and green herbs (mint, rosemary, sage, thyme and basil).

Blue and purple: Anthocyanins are powerful antioxidants that may help delay cellular aging, block the formation of blood clots, and boost urinary tract health.

blackberries, blueberries, black currants, dates, eggplant, Concord grapes, plum, prunes, purple fig, raisins, beetroot, purple cabbage, elderberries

White: These foods may not be as brightly hued as the others, but they shine with valuable phytonutrients. These include the potentially anti-tumor properties of allicin and quercetin, found in garlic and onions; the healthy compound sulforaphane in the cruciferous cauliflower; and immune-supporting selenium in mushrooms.

banana, bamboo shoots, cauliflower, fennel, garlic, Jerusalem artichoke, jicama, kohlrabi, leeks, lychees, mushrooms, onion, parsnips, potato, shallots, white beans (cannellini, navy beans, lima beans, soybeans), white peaches and daikon radish.

Sources: dietaryguidelines.gov;  nutritionsource.hsph.harvard.edu

The Food Safety Edge: Why It Matters More After 40

The Food Safety Edge: Why It Matters More After 40

For many, foodborne illness is something we associate with a bad restaurant meal or a short-lived stomach bug. But as we move through middle age and beyond, food safety becomes less about inconvenience and more about protecting our health and resilience. With that in mind, we share how adopting a few consistent habits can help significantly lower your risk.

Why Risk Rises as We Age

As food safety expert Dr. Donald Schaffner explains: “Our immune systems decline in their effectiveness as a natural consequence of aging, making us more susceptible to many illnesses, including foodborne ones.” Dr. Schaffner, Department Chair, Distinguished Professor and Extension Specialist in Food Science at Rutgers University, is known globally for his research on quantitative microbial risk assessment, predictive food microbiology, and notably, for debunking the “five-second rule” in a widely cited study that showed bacteria can transfer from surface to food in less than one second.

Starting in midlife, several age-related changes may occur that impact how your body handles germs. Digestion may slow, which gives bacteria more time to grow; stomach acid may decrease which reduces a natural defense; and the immune system often begins to decline between ages 50 and 60. Additionally, chronic conditions and medications that suppress immunity can add to vulnerability.

“While absolute risk increases with age, people can change their relative risk by making safer choices in the foods they consume, and by being vigilant about the proper steps for food handling,” says Schaffner.

The Germs That Matter Most

Foodborne illness is common in the U.S., with 48 million cases reported annually, most often caused by norovirus, Salmonella, and E.coli. Of particular concern is Listeria, which unlike most bacteria, can continue to grow slowly in the refrigerator.
Dr. Schaffner notes: “A unique thing about this microorganism is that it can grow slowly at 40°F or below, so even properly refrigerated foods can become unsafe over time.”

Protect yourself from these common pathogens

Top risk for adults Typical sources How to prevent
Listeria in refrigerated ready-to-eat foods Deli meats/hot dogs, refrigerated pâtés/spreads, some soft cheeses, smoked seafood For higher-risk adults, avoid deli meats/hot dogs or reheat to 165°F/steaming; respect use-by dates and when in doubt, throw it out.
Undercooked ground meats (STEC E. coli) Burgers, meatballs, meatloaf; cross-contamination Cook ground meats to 160°F; use a thermometer.
Norovirus from hands and surfaces Ready-to-eat foods handled after cooking, shared platters, some produce Wash hands 20 seconds; keep sick food handlers out of the kitchen; clean surfaces.
Raw/undercooked oysters (Vibrio) Raw oyster bars, undercooked shellfish Adults with chronic illness (especially liver disease) should avoid raw oysters; choose cooked shellfish.
Home-canning mistakes (botulism) Improperly canned low-acid vegetables, meats, seafood Use pressure canning for low-acid foods; don’t rely on boiling-water canners.

Beyond Raw Milk: The Bigger Picture

Raw, or unpasteurized milk has received attention in recent headlines, with claims of probiotic benefits and decreased allergenic potential. While there are no controlled human studies to substantiate these claims, the science is clear that unpasteurized milk can carry harmful pathogens such as Listeria, Salmonella and Campylobacter. Pasteurization, used for more than a century, kills these bacteria without reducing milk’s nutritional value, making it the safer choice for adults over 65, people with chronic illness, those on immunosuppressive medications, pregnant women, and young children.

But that’s just one piece of the larger food safety picture. “Risk isn’t limited to a short list of ‘dangerous’ foods,” maintains Dr. Schaffner. “It’s important that older adults realize they are at increased risk of food poisoning from all foods, and so should take special care to follow proven best practices when preparing meals – clean, separate, cook and chill.”

  1. Clean. Wash hands with soap and water for at least 20 seconds before and after handling food. Clean utensils and surfaces frequently. Rinse fruits and vegetables under running water.
  2. Separate. Keep raw meat, poultry, seafood, and eggs away from ready-to-eat foods. Use separate cutting boards if possible.
  3. Cook. Use a food thermometer, and remember that color is not a reliable guide. Cook poultry and leftovers to 165°F, ground meats to 160°F, and whole cuts to 145°F (with rest time).
  4. Chill. Refrigerate perishable foods within two hours (one hour if it’s above 90°F). Keep your refrigerator at 40°F or below.

When to Call Us

Seek medical advice promptly if you’re in a high-risk group or if your symptoms are severe, such as bloody diarrhea, severe abdominal pain, signs of dehydration or fever with stiff neck or confusion.
A final word: with a thermometer in your drawer, a refrigerator set at the right temperature, and a few mindful habits, you can safely enjoy one of life’s greatest pleasures for decades to come.

Breathing Easier: What’s New in Seasonal Allergy Care

Breathing Easier: What’s New in Seasonal Allergy Care

Seasonal allergies affect about one in four American adults, and if you’re among them, you know the routine: weeks of sneezing, congestion, itchy eyes, sinus pressure, and disrupted sleep. The immune system mistakes harmless pollen for a threat, triggering a cascade of histamine and inflammatory chemicals that can feel relentless.

The good news is that allergy science keeps advancing. The past year has brought meaningful updates, including a first-ever FDA approval for a serious sinus condition, along with clearer guidance on what works best and when to start treatment.

How Common are Seasonal Allergies, and are They Getting Worse?

Roughly 25.7% of American adults have been diagnosed with seasonal allergies, with the highest rates among those in their 40s, 50s, and early 60s (27.9% in the 45–64 age group), according to the American College of Allergy, Asthma and Immunology (ACAAI). All told, an estimated 106 million American adults and children live with allergies or asthma.

Many patients are surprised to develop new symptoms in midlife or to find that allergies they once managed easily are now significantly worse. Pollen seasons are starting earlier and lasting longer in many parts of the country, and the data backs that up.

Neeta Ogden, MD, director of the Allergy, Asthma and Sinus Center, and ACAAI spokesperson, explains why.

In the past we would see a decline in allergy symptoms in parallel with a less reactive immune system that comes with age. But with soaring pollen counts at levels we haven’t seen in prior decades, the immune insult is so extreme that it’s almost as if some reactivity is inevitable. This is leading to new onset allergy symptoms for the first time in your 50s or 60s, or continued allergy later in life even when we would have expected it to dissipate.

If your allergies seem new, or newly intense, you’re not imagining it.

What Works: The Foundation of Good Allergy Care

Nasal corticosteroid sprays remain the gold standard for allergic rhinitis, more effective than antihistamines alone for controlling congestion and postnasal drip. Several are available over the counter:

  • Fluticasone (Flonase)
  • Budesonide (Rhinocort)
  • Triamcinolone (Nasacort)

These work best when used daily and consistently. It typically takes a few days to reach full effectiveness, and the doses in nasal sprays are low enough that they are not associated with the systemic effects of oral steroids.

Antihistamines—cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra)—effectively relieve itching, sneezing, and runny nose, but are less effective for congestion on their own. Combining them with a nasal steroid often works better. Older antihistamines like diphenhydramine (Benadryl) cause significant sedation and are not appropriate for regular daytime use.

Combination nasal sprays that pair a steroid with a nasal antihistamine (such as Dymista or Ryaltris) show better results than either medication alone, so it may be worth considering if standard options aren’t effective.

The Timing Advantage: Why Earlier Is Better

One of the most consistently underutilized strategies is starting allergy medications one to two weeks before your typical symptom season. This matters more than many people realize, and the biology behind it is worth understanding.

“Once the allergic cascade starts and continues to receive input from the daily onslaught of seasonal triggers, it becomes that much harder to control or reverse,” says Dr. Ogden. “This is called allergic priming, a phenomenon where repeated, chronic exposure to an allergen like pollen causes the nasal mucosa to become hyper-responsive, leading to worse symptoms from lower levels of exposure later in the season.”

She continues: “Starting allergy medications one to two weeks before the season provides almost like a shield of armor against pollen. With earlier seasons we can’t predict when that first day of extreme pollen exposure will hit and with daily medicine on board, you can protect yourself against it.”

If you reliably develop symptoms every spring or fall at roughly the same time, discuss a pre-emptive start date with us. You can track local pollen counts at pollen.aaaai.org to time this precisely.

Immunotherapy: The Only Treatment That Changes the Underlying Response

Allergy shots (subcutaneous immunotherapy) remain the only therapy that can actually modify the underlying allergic response rather than just managing symptoms. The process involves regular injections of gradually increasing allergen doses over three to five years. Many patients achieve lasting relief that continues well after completing the course.

For patients in their 50s and 60s wondering whether immunotherapy is still worth pursuing, Dr. Ogden advises: “Immunotherapy remains a great option at those ages and may sometimes be better in older patients who may not do well taking medications like antihistamines. However, you have to proceed with caution in older patients who might have a more complicated medical history and make sure there are no contraindications.”

Practical considerations include the time commitment for regular injections and a small risk of anaphylaxis, which requires post-injection observation in the office. Sublingual immunotherapy (dissolving tablets placed under the tongue) is FDA-approved for certain pollen allergies as a needle-free alternative, but note that it is not approved for patients over 65.

Simple, Underrated and Very Effective: Saline Nasal Irrigation

Rinsing the nasal passages with a saline solution, using a Neti pot, squeeze bottle, or syringe, physically removes pollen, allergens, and irritants from the nose. It reduces postnasal drip and congestion, and it prepares the nasal lining so that medicated sprays absorb better. Used with sterile or distilled water once or twice daily, it has virtually no side effects and is widely recommended by allergy specialists.

First Drug Approved for Fungal Sinus Disease

Allergic fungal rhinosinusitis (AFRS) is a chronic sinus condition caused by an allergic immune reaction to naturally occurring fungi. It produces thick, sticky mucus that can fill and expand the sinuses and erode surrounding bone. The same type 2 inflammatory pathway implicated in eczema, asthma, and nasal polyps are involved, and it has a high recurrence rate even after surgery.

However, in a promising development this February, the FDA gave a green light to the first drug ever approved for this condition. Dupilumab (Dupixent) is a biologic that works by blocking specific inflammatory signals (IL-4 receptor alpha) rather than broadly suppressing the immune system. It is already approved for eczema, asthma, nasal polyps, COPD, and chronic hives. In Phase III trials, patients receiving dupilumab showed 50% improvement in clogged sinuses (opacification) after one year, and significant reductions in polyp size, congestion, and bone erosion.

“This is an exciting approval and shows the continued diversity of applications for dupilumab, especially in the setting of rhinosinusitis,” says Dr. Ogden. “For those patients it offers very significant relief for a serious condition with a 92% reduction in need for further sinus surgery or systemic corticosteroids compared to placebo, and an 81% reduction in nasal congestion. It’s pretty groundbreaking and life-changing for patients managing what can be a debilitating disease.”

If You Have Both Allergies and Asthma

Allergies and asthma frequently overlap. High pollen counts can worsen asthma symptoms and increase flare risk. Drugs such as Singulair can help manage both conditions simultaneously, though they carry a small risk of mood-related side effects in some patients.

A Word About Online Allergy Information

Be aware that although social media is filled with posts purporting new cures, it’s often inaccurate. In fact a 2026 study published in the Journal of Allergy and Clinical Immunology found that the most engaging content was often the least informed. Natural remedy claims were the most common theme, followed by promotion of IgG food panel testing, and fears about allergy medications.

A persistent example: although not supported by evidence, many believe that eating local honey can desensitize you to local pollens. The reality is that most wind-borne pollens causing hay fever are not the same pollens bees carry into hives, and the amount in honey is far too low to produce a therapeutic immune response.

Acting on misinformation can delay effective treatment, so please check with our office before spending time and money on unproven approaches.

When to See an Allergist

We can manage many straightforward seasonal allergies at our office, but will refer you to an allergist if:

  • Your symptoms are not adequately controlled despite standard medications
  • You want to identify your specific allergens through skin or blood testing
  • You’re considering immunotherapy to reduce long-term medication dependence
  • You have recurrent sinus infections, nasal polyps, or symptoms suggestive of fungal sinus disease
  • You experience symptoms year-round
  • You have coexisting asthma

Seasonal allergies are common, but prolonged suffering doesn’t have to be. With the right timing, evidence-based treatment, targeted new therapies for severe disease, and careful evaluation of your options, most patients can achieve meaningful relief. If you have questions about anything described here, please don’t hesitate to bring them to your next visit.

Our goal: to help you breathe easier, literally.


Allergy-Proofing Your Home

Reducing indoor allergen exposure can meaningfully improve symptom control alongside medication.

Bedding & Bedroom

  • Encase mattresses and pillows in allergen-barrier covers
  • Wash bedding weekly in hot water (at least 130°F) or dry on high heat
  • Minimize rugs, heavy curtains, and hard-to-clean decor that collect dust

Air Quality

  • Keep windows closed during high-pollen days; use air conditioning
  • Replace HVAC filters regularly; HEPA filters trap the finest particles
  • Vacuum weekly with a HEPA-filter vacuum (standard vacuums can disperse fine particles back into the air)

Pollen Control

  • Shower before bed to rinse pollen from hair and skin
  • Change clothes after spending time outdoors on high-pollen days
  • Wear sunglasses outside to reduce eye exposure

Mold & Moisture

  • Keep indoor humidity below 50%; use a dehumidifier if needed
  • Check under sinks and around appliances regularly for moisture or leaks

Pets

  • Keep pets out of bedrooms if dander is a trigger
  • Bathe dogs weekly to reduce dander (bathing cats is generally less helpful for reducing human symptoms)

A Quick Guide to Alternative Methods

Saline Nasal Irrigation

Evidence: Strong. Widely recommended as an adjunct to standard treatment. Physically removes allergens and improves medication absorption.

Acupuncture

Evidence: Modest. Some randomized trials suggest small symptom improvement but it is not a substitute for evidence-based treatment.

Butterbur

Evidence: Preliminary. Some antihistamine-like effects in small studies, but raw butterbur contains compounds toxic to the liver. Only PA-free certified products should be considered.

Quercetin and Other Supplements

Evidence: Insufficient. Lab studies are promising, but human clinical trial evidence remains limited and inconsistent.

Probiotics

Evidence: Emerging. Certain strains may modestly reduce symptoms by influencing gut-immune interactions. An active area of research, but not yet standard practice.

Dietary Changes

Anti-inflammatory diets (fruits, vegetables, omega-3 fatty acids) support overall immune health, but medical treatment may still be needed.

Note: Always consult with us before starting supplements or alternative therapies. “Natural” does not automatically mean safe, and some supplements interact with prescription medications.

A New, Hopeful Era for Brain Health

A New, Hopeful Era for Brain Health

From prevention to precision care, a new wave of research is reshaping what it means to protect your memory and thinking

For generations, a diagnosis of dementia or Alzheimer’s disease signaled a one-way journey of irreversible decline that slowly eroded memory, independence, and identity. Over the last decade, though, scientific understanding has expanded dramatically. Today, a combination of lifestyle interventions, biomarker testing, and targeted therapies has radically injected hope into the diagnosis and treatment of cognitive disorders in older adults. Perhaps most remarkable: research now suggests that up to 45% of dementia cases may be preventable. “Dementia is not an inevitable part of aging,” says Amy Sanders, MD, a highly respected dementia neurology expert now at Sunday Health, a preventive cognitive neurology practice.

A similar evolution occurred in cardiology decades ago. As with heart disease, which was once considered unavoidable, and oncology, where one-size-fits-all treatments have given way to precision medicine, scientific discovery is reframing what’s possible in dementia care. “This field, once static, is now full of energy and promise,” says Maria Thomas, co- founder and CEO of Sunday Health. “By focusing on prevention, early detection, and individually tailored treatments, we are moving toward a future where cognitive decline can be delayed, managed, and increasingly, prevented.”

Prevention Takes Center Stage

New drugs and diagnostics often make the news, but clinicians consistently note that managing modifiable risk factors is central to good health. For older adults, this includes new approaches to delay and/or prevent dementia. A robust body of evidence, anchored internationally by the landmark FINGER study and its counterpart, the U.S. POINTER study, shows that targeted lifestyle changes can significantly reduce cognitive decline.

The original FINGER trial, published in The Lancet in 2015, demonstrated that a multimodal program combining diet, exercise, cognitive training, and cardiovascular risk management helped preserve memory and executive function in older adults at risk for cognitive decline. Its global expansion, the World-Wide FINGERS Network, now spans more than 60 countries. The U.S. POINTER study produced similarly compelling results. Participants who received structured lifestyle support, including personal coaching, nutrition guidance, and regular social engagement, showed greater cognitive stability and improved emotional well-being.

These findings and others have led experts to reconsider the long-held belief that dementia simply happens with age. Instead, they highlight the extraordinary adaptability of the brain. Thomas notes that prevention must start earlier than most people realize. “We’ve long understood how to protect our heart health, but attention to brain health has lagged. Today, we know the same evidence-based behaviors that support cardiovascular health also contribute directly to maintaining cognitive health,” says Thomas.

Dr. Sanders underscores this lifespan approach: “It’s never too early to think about brain health, optimally beginning in your mid-30s when cognitive aging starts. But it’s never too late either.” She points to findings from the Rush Memory and Aging Project, which showed that adults well into their 70s and 80s experienced slower cognitive decline simply by adopting new activities.

The 14 Modifiable Risk Factors for Dementia Prevention

  1. Hearing loss
  2. Traumatic brain injury
  3. High blood pressure
  4. Excessive alcohol use
  5. Obesity
  6. Smoking
  7. Depression
  8. Social isolation
  9. Physical inactivity
  10. Diabetes
  11. Air pollution
  12. Untreated vision loss*
  13. High LDL cholesterol*
  14. Low education levels

*Newly added to the 2024 per Lancet Commission report.

Brain Health Through the Lifespan

Sources: Sunday Health, Lancet

 

Why Lifestyle Matters: Connecting the Dots

Why do lifestyle interventions make such a difference? Today’s research paints a clear biological picture.

  • Physical activity increases blood flow, reduces inflammation, and promotes the growth of new neural connections.
  • A nutrient-rich diet helps counteract oxidative stress and supports metabolic health.
  • Social interaction and cognitive engagement strengthen neural networks and build cognitive reserve, defined as the brain’s capacity to withstand age-related change.

Advances in Early Detection

For decades, investigating a diagnosis of Alzheimer’s disease required invasive spinal taps or costly imaging. But recent advances, especially in biomarker testing, have changed the landscape. In May 2025, the FDA approved the Lumipulse G pTau217/β-Amyloid 1-42 Plasma Ratio, the first-ever blood test that can identify Alzheimer’s-related proteins well before symptoms appear.

Dr. Sanders cautions that its purpose is specific: “The Lumipulse test is intended for people age 55 or older who are already showing symptoms. An abnormal ratio does NOT mean someone definitely has Alzheimer’s, and a normal result doesn’t guarantee they don’t.”

Instead, the test is one tool in a broader diagnostic picture, akin to A1C (blood glucose) tests for diabetes or measuring cholesterol levels for heart disease. “There is no single test that makes a definitive diagnosis of Alzheimer’s disease,” she emphasizes.

Ideally, brain health baselines that include cognitive testing and biomarker measurements will become a standard part of preventive care. “Just as you periodically get a colonoscopy or mammogram, establishing a brain health baseline can help detect any changes early,” says Thomas.

For those with risk factors such as a family history or genetic vulnerability (e.g. the APOE gene), baselines can be particularly informative. “APOE is a risk gene, not a destiny gene,” Dr. Sanders reminds. “It’s even more reason to work on modifiable risk factors if you know you’re at increased genetic risk.”

New Therapies: A Turning Point in Treatment

Two FDA-approved monoclonal antibodies—lecanemab (Leqembi) and donanemab (Kisunla)—have demonstrated that it’s possible to slow disease progression in the earliest stages of Alzheimer’s disease. In clinical trials, these patients experienced a 25–35% reduction in cognitive decline.

“These are the first ever disease-modifying medications for Alzheimer’s,” Dr. Sanders notes.

The Lancet cautions that trial results range from modestly positive to neutral, and the real- world impact is still unfolding. Currently they are appropriate only for early-stage Alzheimer’s patients who have confirmed amyloid buildup and are not on blood thinners. But for many families, even a modest slowing of decline can translate into months or years of meaningful function.

What’s Coming Next

The treatment pipeline is expanding rapidly. New therapies target multiple mechanisms:

  • Tau-targeting treatments to prevent the spread of tau tangles.
  • Anti-inflammatory drugs to address the role of neuroinflammation.
  • Neuroprotective compounds to preserve neurons and synapses.
  • GLP-1 receptor agonists (commonly used for diabetes and weight loss) are now being studied for neuroprotective effects.

Another accelerating frontier: artificial intelligence. Machine-learning tools can analyze health records, cognitive patterns, and even voice changes to detect decline earlier than human clinicians can. These technologies promise increasingly personalized, predictive brain care.

As scientific understanding deepens, one theme has become clear: brain health, like heart health, requires consistent habits, early detection, and lifelong attention. With more accessible biomarkers, evolving therapeutics, and stronger evidence for prevention than ever before, the next decade promises major breakthroughs. Or as Thomas says: “The future of brain health isn’t just hopeful, it’s actionable.”

 

Sources: Alzheimer’s Association, Finnish Geriatric Intervention Study, Mayo Clinic.

Spirituality in Medicine: Rediscovering an Ancient Dimension of Healing

Spirituality in Medicine: Rediscovering an Ancient Dimension of Healing

Modern medicine excels at treating disease, yet true healing can go beyond correcting an abnormal lab value or repairing an injury. It involves restoring wholeness of body, mind, and spirit. Increasingly, we recognize that spirituality is a powerful dimension of health, shaping how people find hope, strength, and meaning in moments of challenge.

What Is Spirituality?

Spirituality is broader than religion, though faith may be part of it. At its core, it involves:

  • A search for meaning and purpose.
  • A sense of connection with oneself, others, nature, or a higher power.
  • Transcendence, growing beyond one’s limitations.

The American Academy of Family Physicians describes spirituality as “the way you find meaning, hope, comfort, and inner peace in your life.” People express it through prayer, meditation, nature, music, art, or personal values. While religion offers structure and community, spirituality is personal, more of an inner compass guiding how you live and how you heal. Deepening this connection often brings peace, resilience, and clarity.

How Spirituality Differs from Religion

Religion Spirituality
Shared beliefs and organized practices Individual search for meaning and purpose
Rituals or worship Expression through reflection, art, nature, or quiet contemplation
Community-oriented Personal, self-directed

Research increasingly supports the link between spiritual well-being and physical health. People who describe themselves as spiritual often report lower stress, healthier behaviors, and greater life satisfaction. Regular practices such as meditation, prayer, or mindfulness have been associated with lower blood pressure, improved immunity, and better mood.

Harvard cardiologist Dr. Herbert Benson termed this the relaxation response — the body’s built-in healing mechanism triggered by calm, focused awareness. Even 10–20 minutes of quiet reflection daily can slow the heart rate, ease anxiety, and reduce pain.

Recent studies show:

“Man is not destroyed by suffering; he is destroyed by suffering without meaning.”
— Viktor Frankl

Spirituality helps people adapt to hardship, forgive more readily, and find strength in situations that cannot be changed. When illness or loss occurs, questions naturally arise: Why is this happening? What matters most? Will my loved ones be okay? Facing these questions is not a sign of weakness but of courage and self-awareness.

Tools for Exploring Your Spiritual Life

Two simple frameworks used in healthcare can help you reflect on what brings meaning, comfort, and clarity.

The HOPE Reflection:

H — Hope: What gives you strength or peace?
O — Organized beliefs: Do you participate in a faith or spiritual community?
P — Personal spirituality: What practices nourish your spirit?
E — Effects on care: How do your beliefs guide decisions?

The FICA Reflection:

F — Faith, Belief, Meaning: What gives your life purpose?
I — Importance and Influence: How do your beliefs help you cope?
C — Community: Who offers belonging and support?
A — Action: What habits help you live your values?

Cultivating Spiritual Health

Spiritual growth is lifelong and doesn’t require a specific belief system, only openness and intention.

Try:

  • Quiet reflection or prayer
  • Noticing small moments of beauty
  • Practicing forgiveness (see ho’oponopono, below)
  • Staying connected with uplifting people
  • Celebrating simple joys

Ask yourself:

  • Who are the most important people in my life?
  • How have they affected me?
  • With whom do I feel most comfortable?
  • What is my ideal job? What if the money didn’t matter?
  • Where would I like to be in 10 years?
  • What are some goals for this year?
  • How can I avoid a stagnant life?
  • Do things happen for a reason?
  • What are my beliefs on life’s purpose?
  • What specific experiences have shaped my spiritual beliefs?
  • Am I a good person?

And remember: At any given moment, you have the power to say this is not how the story is going to end.

Adapted from a presentation by Uday Jani, MD, Shore View Medical Care

The Four Things That Matter Most

The ancient Hawaiian practice of ho’oponopono — “to make right” — offers a simple yet profound way to restore balance and resolve conflict. While this tradition has been taught for generations, many people were introduced to it more recently through mentions in popular culture, including a storyline in medical drama “The Pitt.” Its appearance there reflects a growing public curiosity about approaches that support emotional healing and connection. Modern teachers such as Dr. Ihaleakalā Hew Len and palliative care expert Dr. Ira Byock have helped bring ho’oponopono into therapeutic care.

Using these healing words in daily life can help people release burdens, improve emotional well-being and resolve interpersonal difficulties with integrity and grace:

I am sorry. Acknowledging hurt without guilt or shame.
Forgive me. Letting go of regret and emotional burdens.
Thank you. Gratitude for both challenges and blessings.
I love you. Extending unconditional love to yourself and others.