5h • General discussion
Patient came in convinced he had Alzheimer's. Brain scan was clean. Turns out: sleep apnea. Completely reversible.
A 62-year-old engineer came to my clinic terrified.
Six months of worsening memory. Forgetting meetings. Losing his car in parking lots.
"My father had Alzheimer's at 65," he told me. "This is it."
His wife confirmed everything. Progressive decline. Personality changes. More irritable than usual.
I ordered the standard workup.
Cognitive testing: impaired attention and working memory. Executive function problems.
MRI: normal for age. No focal atrophy.
Blood work: normal.
But then I asked about sleep.
"I snore," he said. "My wife makes me sleep in the guest room."
His wife jumped in: "He gasps and makes noises. I can't sleep in the same room."
Sleep study confirmed severe obstructive sleep apnea.
Oxygen saturation dropping to 78% (normal is 95%+). Waking up 47 times per hour without knowing it.
Brain getting starved of oxygen all night. Every night. For years.
We started CPAP therapy.
Three months later, he was back.
Different person.
"I can think again," he said. "It's like someone turned the lights back on."
Repeat cognitive testing: completely normal.
Memory fixed. Attention restored. Back to his baseline.
Not Alzheimer's. Never was.
Sleep apnea mimics dementia perfectly.
Attention problems. Memory impairment. Executive dysfunction. Mood changes.
Affects 1 billion people worldwide. Most don't know they have it.
The clues I look for:
- Loud snoring. Witnessed apneas. Excessive daytime sleepiness.
- Morning headaches. Difficult-to-control hypertension.
- Cognitive complaints that seem too fast (months, not years).
- Normal brain imaging.
The good news:
Sleep apnea is treatable.
CPAP. Oral appliances. Weight loss. Sometimes surgery.
And when you treat it, cognition often improves.
Not always completely. Chronic severe apnea can cause permanent damage.
But many patients, like this engineer, recover fully.
The lesson:
Not all memory loss is dementia.
Before diagnosing Alzheimer's, rule out reversible causes.
Sleep disorders. B12 deficiency. Thyroid problems. Medication side effects. Depression.
Together, these aren't rare. They're common.
And they're fixable.
My patient's wife asked: "How many people get diagnosed with dementia when it's really sleep apnea?"
I told her the truth: too many.
💬 Do you know someone with untreated sleep apnea and memory complaints?
P.S. Happy Holidays Everyone!
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Patient came in convinced he had Alzheimer's. Brain scan was clean. Turns out: sleep apnea. Completely reversible.
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