November 29, 2025 • 10 mins
This episode explores how chronic insomnia disrupts cognition—and why repairing the brain’s glymphatic cleaning cycle may be the key to restoring mental clarity. We break down new research showing that low-frequency rTMS not only produces rapid sleep improvements but also triggers slower, durable cognitive gains tied directly to enhanced glymphatic clearance.
We start with the severity of chronic insomnia confirmed by PSQI and ISI scores, then detail the marked impairments on MOCA, processing speed, and executive function. From there, we explain the glymphatic system as the brain’s nighttime waste-removal network and show how DTI-ALPS offers a noninvasive measure of clearance efficiency.
You’ll learn the specifics of the two-week LF-rTMS protocol, the brain regions targeted, and why stimulation at low frequency may enhance deep-sleep architecture. The outcomes reveal a striking two-phase pattern: immediate sleep gains within days, followed by delayed cognitive repair that continues to improve as glymphatic flow strengthens. Strong correlations between ALPS improvements and cognitive scores point to a mechanism-focused path for future treatments.
The episode concludes with the broader implications for early intervention, personalized protocols, and a new era in insomnia care that targets the source—not just the symptoms.
High-volume keywords used: insomnia, glymphatic system, rTMS therapy, cognitive impairment, deep sleep, DTI-ALPS, brain fog, sleep restoration
Listener Takeaways
- How severe insomnia damages cognition and executive function
- Why the glymphatic system is central to nighttime brain repair
- How DTI-ALPS quantifies clearance efficiency in humans
- The LF-rTMS protocol that rapidly improves sleep and gradually restores cognition
- Why mechanism-focused treatments may transform insomnia care
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
If you've ever dealt with chronic insomnia, you know
that feeling.
Yeah.
It's it's not just about beingtired.
It's like your brain is juststuck in mud.
SPEAKER_01 (00:06):
Right.
It's a thief.
It steals your focus, yourmemory.
It's this deep, persistent fog.
SPEAKER_00 (00:12):
Exactly.
Yeah.
And it feels like your wholeneurological system just failed
to hit the reset button.
SPEAKER_01 (00:18):
Aaron Powell This is a perfect way to put it.
And we're learn it's not just afeeling, it's a uh a real
measurable neurological problem.
It damages these very basicprocesses that we need for
thinking.
SPEAKER_00 (00:30):
And that is exactly what we are getting into today.
We're gonna dive deep into oneof those fundamental processes,
the brain's own cleaning cycle.
SPEAKER_01 (00:39):
Otherwise known as gymphatic clearance.
And we're gonna look at a reallypromising non-invasive therapy
that seems to kickstart it.
Low frequency repetitivetranscranial magnetic
stimulation.
SPEAKER_00 (00:50):
Aaron Powell Or uh LFRTMS for short.
SPEAKER_01 (00:53):
Yes, much easier.
And our guide for this is afascinating study published in
the journal Sleep.
It's from Zhang and their team,just out in 2025.
SPEAKER_00 (01:00):
What's so exciting about this particular study?
SPEAKER_01 (01:02):
Well, they went beyond just asking, can we help
people sleep?
They asked, can we actually fixthe machine?
Can we improve cognition byfixing this uh this lymphatic
cleaning function?
SPEAKER_00 (01:13):
Aaron Powell Okay, so let's unpack that.
To really get the impact, wehave to start at the beginning,
before any treatment, just howbad was the situation for these
patients?
SPEAKER_01 (01:21):
Aaron Powell It was severe.
This wasn't just a few badnights.
The researchers were very clearabout that.
They took 32 patients withdiagnosed chronic insomnia and
compared them to 40 healthycontrols.
The differences were um stark.
SPEAKER_00 (01:34):
Aaron Powell So let's start with the basics the
sleep scores.
SPEAKER_01 (01:37):
Right.
They used the standard tools,you know, the Pittsburgh Sleep
Quality Index, the PSQI, theInsomnia Severity Index, the
ISI.
SPEAKER_00 (01:44):
And the patient group scores.
SPEAKER_01 (01:45):
They were just dramatically worse.
It wasn't even close.
This data showed thatobjectively they were really
struggling to get restorativesleep, and subjectively, it was
causing them huge distress.
SPEAKER_00 (01:55):
Aaron Powell But the real nightmare of insomnia isn't
just the night, it's the nextday.
It's what it does to yourability to just think.
SPEAKER_01 (02:03):
Precisely.
We throw around words like brainfog, but this study put hard
numbers to it.
The insomnia group performedsignificantly worse on a whole
battery of cognitive tests.
SPEAKER_00 (02:14):
Aaron Powell Can you give us a couple of examples?
What kinds of functions werefailing?
SPEAKER_01 (02:18):
Sure.
So they used the MOCA, theMontreal cognitive assessment.
It's a broad measure of overallcognitive health, you know,
attention, language, memory.
SPEAKER_00 (02:28):
And the insomnia group.
SPEAKER_01 (02:30):
Scored significantly lower.
It's a clear sign that the wholesystem is just running slower.
SPEAKER_00 (02:34):
Okay, so the MOCA's the big picture.
What about the nitty-grittyday-to-day stuff that makes you
feel like you can't function?
SPEAKER_01 (02:41):
Well, think about processing speed, the ability to
just think on your feet.
They used the digit symbolsubstitution test.
The patients were much slower atthat.
And they also struggled withexecutive functions.
SPEAKER_00 (02:51):
Which is what exactly?
Planning.
SPEAKER_01 (02:53):
Planning, prioritizing, switching between
tasks, things measured by thecolor trail test.
This is why people with insomniafeel so overwhelmed.
Their brain literally can'tshift gears as efficiently.
SPEAKER_00 (03:04):
So we have people who can't sleep and their brains
are struggling.
Now let's bring in the mechanismyou mentioned earlier, the
lymphatic clearance function.
This seems to be the key thatlinks everything together.
SPEAKER_01 (03:15):
It is.
This is the central concept, andit's worth taking a second on
this.
SPEAKER_00 (03:19):
Please do.
What is the glymphatic system?
SPEAKER_01 (03:21):
The best analogy is to think of your brain as a
bustling city.
All day, it's working, creatingmetabolic waste, you know, trash
is piling up on the streets.
Right.
The lymphatic system is thesanitation crew that only comes
out at night.
When you're in deep sleep,cerebrospinal fluid washes
through your brain tissue andclears out all that junk.
SPEAKER_00 (03:41):
And if you have chronic insomnia, the sanitation
crew never gets to do a fullshift.
SPEAKER_01 (03:47):
Never.
The waste just builds up.
And that buildup is toxic, itcauses inflammation, and it
contributes directly to thatbrain fog and cognitive decline
we were just talking about.
Your brain is literally swimmingin its own metabolic byproducts.
SPEAKER_00 (04:01):
Aaron Powell And what makes this study so
powerful is that they didn'tjust guess this was happening.
They could actually see it, theycould measure it.
SPEAKER_01 (04:07):
They could.
Using some really advancedneuroimaging, they use something
called the DTI ALPS index.
SPEAKER_00 (04:13):
DTI ALPS.
SPEAKER_01 (04:14):
Yeah, the name is a mouthful diffusion tensor
imaging along the paravascularspace.
But what it does is simple.
Think of it as a sensor thatmeasures how wet the fluid is
flowing through the brain'spipes.
SPEAKER_00 (04:24):
So a lower DTI-ALPS score means the plumbing is
clogged.
SPEAKER_01 (04:28):
Precisely.
And that was a core findingright at the start.
The chronic insomnia patientshad a significantly lower
DTI-ALPS index than the healthycontrols.
Their cleaning system wasmeasurably broken before they
even started the treatment.
SPEAKER_00 (04:41):
That sets the stage perfectly.
A complete system failure,sleep, thinking, and the
physical plumbing of the brain.
SPEAKER_01 (04:48):
Yeah.
SPEAKER_00 (04:48):
So what was the proposed solution?
SPEAKER_01 (04:51):
The solution was LFRTMS.
SPEAKER_00 (04:54):
Low frequency repetitive transcranial magnetic
stimulation.
Seems like a leap, right?
How can magnets on your scalpaffect fluid flow deep inside
your brain?
SPEAKER_01 (05:03):
It sounds a bit like science fiction, I know, but
it's non-invasive.
They place an electromagneticcoil on the scalp and it
generates these very gentlemagnetic pulses.
Totally painless.
And these pulses create tinyelectrical currents in a
targeted part of the brain'scortex.
The theory is that thesecurrents help modulate neural
activity.
(05:23):
They encourage the brain toproduce the low frequency brain
waves that are uh characteristicof deep sleep.
SPEAKER_00 (05:30):
Ah, I see.
So it's not pushing the fluiddirectly, it's creating the
conditions for the client tohappen by encouraging deep
sleep.
SPEAKER_01 (05:38):
That's the idea.
It's nudging the brain to enterits optimal cleaning state.
SPEAKER_00 (05:42):
And what was the treatment protocol?
This wasn't a one-time thing.
SPEAKER_01 (05:45):
No, not at all.
Consistency was reallyimportant.
Twenty-two of the patients wentthrough with it.
They received 10 sessions intotal.
SPEAKER_00 (05:53):
Over how long?
SPEAKER_01 (05:54):
Over two consecutive weeks.
So it was pretty intensive.
Five days on, weekend off, fivemore days on, a focused two-week
block.
SPEAKER_00 (06:01):
Aaron Powell Which is pretty achievable, clinically
speaking.
And they tracked the resultsover time, right?
They didn't just look at the endof week two.
SPEAKER_01 (06:06):
Aaron Powell Right.
They were very careful about thefollow-up.
The sleep scores, the PSQI andISI, they measured those
frequently.
Right after the two weeks, thenat one month, two months, and
three months out.
SPEAKER_00 (06:16):
Aaron Powell They wanted to see if the sleep
improvement would stick.
SPEAKER_01 (06:18):
Exactly.
But for the, let's say, theheavy machinery, the cognitive
tests, and that DTI ALPS index,they focused on the longer term.
They measure it at week two, buttheir main interest was the
three-month mark.
SPEAKER_00 (06:31):
Aaron Ross Powell To see if there was a real lasting
physical change in the brain.
SPEAKER_01 (06:35):
Aaron Powell Yes.
They wanted to be sure it wasn'tjust a temporary effect.
SPEAKER_00 (06:38):
Aaron Powell Okay, this is where it gets really
good.
Let's talk about the results.
Did it work?
And how quickly?
SPEAKER_01 (06:44):
It did work.
And what's so fascinating isthat the recovery happened in
two very clear phases.
Phase one.
Was rapid sleep improvement.
The PSQI and ISI scores droppedsignificantly, which means
better sleep startingimmediately at week two.
The moment the treatment ended,the patients started reporting
that they were sleeping better.
SPEAKER_00 (07:04):
That's a huge win right there.
An immediate quality of lifeimprovement.
SPEAKER_01 (07:08):
A massive win.
But what about the deeper stuff?
That's phase two.
SPEAKER_00 (07:11):
The cognitive repair.
SPEAKER_01 (07:12):
Right.
The deep functional repair.
That took more time.
While patients felt betterquickly, their brains needed
time to sort of consolidate thegains.
SPEAKER_00 (07:21):
So when did they see those changes?
SPEAKER_01 (07:23):
By the three-month follow-up.
This is the crucial part.
At month three, the DTI ALPSindex or plumbing measure showed
significant improvement.
The brain's cleaning system wasmeasurably more efficient.
SPEAKER_00 (07:36):
Wow.
So the treatment gives the braina window of good sleep.
Yes.
And then the brain uses thatwindow over the next few months
to physically start repairingits own cleaning system.
SPEAKER_01 (07:47):
You've nailed it.
And that physical repairtranslated directly to cognitive
improvement.
By month three, the mocha scoreswere up, processing speed on the
DSST was better, working memorywas better, the thinking had
improved.
SPEAKER_00 (08:01):
Okay, so this brings us to the final most important
question.
What does it all mean?
It's one thing to say sleep gotbetter, and then later cognition
got better.
It's another thing to provethey're connected.
SPEAKER_01 (08:11):
And that is the absolute power of this study.
They didn't just stop there,they ran the statistical
analysis to prove that theimprovement in the physical
mechanism was directly linked tothe clinical benefits.
In other words, the more yourplumbing improved, the more your
thinking improved, the betteryour brain worked.
SPEAKER_00 (08:26):
Let's see the numbers.
How strong was that link?
SPEAKER_01 (08:29):
It was incredibly strong.
The strongest link was betweenthe DTI ALPS index and that
overall cognitive score, theMOCA.
They found a correlationcoefficient of R equals 0.836.
SPEAKER_00 (08:42):
Aaron Powell Okay, for anyone who doesn't live and
breathe statistics, an R valueof 0.836 is that's almost a
one-to-one relationship.
It's huge.
SPEAKER_01 (08:51):
It's a massive finding.
It means that something like 83%of the improvement in their
thinking ability could beexplained by the improvement in
their brain's waist clearance.
SPEAKER_00 (09:00):
So fixing the plumbing really does seem to fix
the thinking.
It's not just a side effect.
SPEAKER_01 (09:04):
It suggests it might be the key intermediate step,
the real target of the therapy.
SPEAKER_00 (09:09):
And it wasn't just linked to overall cognition, was
it?
SPEAKER_01 (09:11):
No, it was across the board.
They found strong correlationswith working memory, with
executive function.
And importantly, the better theclearance got, the better the
patients felt their sleep was.
The physical change was linkedto the subjective improvement.
SPEAKER_00 (09:23):
So to put it all together, 10 sessions of LFRTMS
helps the brain achieve ahealthier sleep state.
That state allows the lymphaticsystem to finally do its job,
clearing out months or years ofwaste.
And that physical cleaningprocess is directly,
statistically linked to patientsthinking more clearly and
sleeping better three monthslater.
SPEAKER_01 (09:43):
That's the story the data tells.
It's a shift from just treatinga symptom, I can't sleep, to
fixing a mechanical problem, mybrain can't clean itself.
And it seems LFR TMS helps fixthe machine.
SPEAKER_00 (09:54):
So just to sum it all up one last time, this is
really promising evidence thatLFR TMS can help with chronic
insomnia, not just by improvingsleep, but by an enhancing
cognitive function through thisdirect link to the brain's
cleaning cycle.
SPEAKER_01 (10:07):
It's a tangible mechanism we can now target and
study further.
It's really exciting.
SPEAKER_00 (10:11):
It really is.
Now, this study gives us thispowerful preliminary evidence,
but it also raises a reallyimportant question, one for you
to think about as you go aboutyour day.
Since we now see this strongcorrelation, what comes next?
What kind of research is neededto prove this is truly cause and
effect?
And maybe more importantly, ifthis brain cleaning cycle is so
critical, should therapies likeLFR TMS be used much earlier in
(10:35):
treating insomnia to preventthat long term cognitive damage
before it ever gets this bad?
SPEAKER_01 (10:40):
A fascinating and critical question for the future
of sleep medicine.
If you've ever dealt with chronic insomnia, you know
that feeling.
Yeah.
It's it's not just about beingtired.
It's like your brain is juststuck in mud.
SPEAKER_01 (00:06):
Right.
It's a thief.
It steals your focus, yourmemory.
It's this deep, persistent fog.
SPEAKER_00 (00:12):
Exactly.
Yeah.
And it feels like your wholeneurological system just failed
to hit the reset button.
SPEAKER_01 (00:18):
Aaron Powell This is a perfect way to put it.
And we're learn it's not just afeeling, it's a uh a real
measurable neurological problem.
It damages these very basicprocesses that we need for
thinking.
SPEAKER_00 (00:30):
And that is exactly what we are getting into today.
We're gonna dive deep into oneof those fundamental processes,
the brain's own cleaning cycle.
SPEAKER_01 (00:39):
Otherwise known as gymphatic clearance.
And we're gonna look at a reallypromising non-invasive therapy
that seems to kickstart it.
Low frequency repetitivetranscranial magnetic
stimulation.
SPEAKER_00 (00:50):
Aaron Powell Or uh LFRTMS for short.
SPEAKER_01 (00:53):
Yes, much easier.
And our guide for this is afascinating study published in
the journal Sleep.
It's from Zhang and their team,just out in 2025.
SPEAKER_00 (01:00):
What's so exciting about this particular study?
SPEAKER_01 (01:02):
Well, they went beyond just asking, can we help
people sleep?
They asked, can we actually fixthe machine?
Can we improve cognition byfixing this uh this lymphatic
cleaning function?
SPEAKER_00 (01:13):
Aaron Powell Okay, so let's unpack that.
To really get the impact, wehave to start at the beginning,
before any treatment, just howbad was the situation for these
patients?
SPEAKER_01 (01:21):
Aaron Powell It was severe.
This wasn't just a few badnights.
The researchers were very clearabout that.
They took 32 patients withdiagnosed chronic insomnia and
compared them to 40 healthycontrols.
The differences were um stark.
SPEAKER_00 (01:34):
Aaron Powell So let's start with the basics the
sleep scores.
SPEAKER_01 (01:37):
Right.
They used the standard tools,you know, the Pittsburgh Sleep
Quality Index, the PSQI, theInsomnia Severity Index, the
ISI.
SPEAKER_00 (01:44):
And the patient group scores.
SPEAKER_01 (01:45):
They were just dramatically worse.
It wasn't even close.
This data showed thatobjectively they were really
struggling to get restorativesleep, and subjectively, it was
causing them huge distress.
SPEAKER_00 (01:55):
Aaron Powell But the real nightmare of insomnia isn't
just the night, it's the nextday.
It's what it does to yourability to just think.
SPEAKER_01 (02:03):
Precisely.
We throw around words like brainfog, but this study put hard
numbers to it.
The insomnia group performedsignificantly worse on a whole
battery of cognitive tests.
SPEAKER_00 (02:14):
Aaron Powell Can you give us a couple of examples?
What kinds of functions werefailing?
SPEAKER_01 (02:18):
Sure.
So they used the MOCA, theMontreal cognitive assessment.
It's a broad measure of overallcognitive health, you know,
attention, language, memory.
SPEAKER_00 (02:28):
And the insomnia group.
SPEAKER_01 (02:30):
Scored significantly lower.
It's a clear sign that the wholesystem is just running slower.
SPEAKER_00 (02:34):
Okay, so the MOCA's the big picture.
What about the nitty-grittyday-to-day stuff that makes you
feel like you can't function?
SPEAKER_01 (02:41):
Well, think about processing speed, the ability to
just think on your feet.
They used the digit symbolsubstitution test.
The patients were much slower atthat.
And they also struggled withexecutive functions.
SPEAKER_00 (02:51):
Which is what exactly?
Planning.
SPEAKER_01 (02:53):
Planning, prioritizing, switching between
tasks, things measured by thecolor trail test.
This is why people with insomniafeel so overwhelmed.
Their brain literally can'tshift gears as efficiently.
SPEAKER_00 (03:04):
So we have people who can't sleep and their brains
are struggling.
Now let's bring in the mechanismyou mentioned earlier, the
lymphatic clearance function.
This seems to be the key thatlinks everything together.
SPEAKER_01 (03:15):
It is.
This is the central concept, andit's worth taking a second on
this.
SPEAKER_00 (03:19):
Please do.
What is the glymphatic system?
SPEAKER_01 (03:21):
The best analogy is to think of your brain as a
bustling city.
All day, it's working, creatingmetabolic waste, you know, trash
is piling up on the streets.
Right.
The lymphatic system is thesanitation crew that only comes
out at night.
When you're in deep sleep,cerebrospinal fluid washes
through your brain tissue andclears out all that junk.
SPEAKER_00 (03:41):
And if you have chronic insomnia, the sanitation
crew never gets to do a fullshift.
SPEAKER_01 (03:47):
Never.
The waste just builds up.
And that buildup is toxic, itcauses inflammation, and it
contributes directly to thatbrain fog and cognitive decline
we were just talking about.
Your brain is literally swimmingin its own metabolic byproducts.
SPEAKER_00 (04:01):
Aaron Powell And what makes this study so
powerful is that they didn'tjust guess this was happening.
They could actually see it, theycould measure it.
SPEAKER_01 (04:07):
They could.
Using some really advancedneuroimaging, they use something
called the DTI ALPS index.
SPEAKER_00 (04:13):
DTI ALPS.
SPEAKER_01 (04:14):
Yeah, the name is a mouthful diffusion tensor
imaging along the paravascularspace.
But what it does is simple.
Think of it as a sensor thatmeasures how wet the fluid is
flowing through the brain'spipes.
SPEAKER_00 (04:24):
So a lower DTI-ALPS score means the plumbing is
clogged.
SPEAKER_01 (04:28):
Precisely.
And that was a core findingright at the start.
The chronic insomnia patientshad a significantly lower
DTI-ALPS index than the healthycontrols.
Their cleaning system wasmeasurably broken before they
even started the treatment.
SPEAKER_00 (04:41):
That sets the stage perfectly.
A complete system failure,sleep, thinking, and the
physical plumbing of the brain.
SPEAKER_01 (04:48):
Yeah.
SPEAKER_00 (04:48):
So what was the proposed solution?
SPEAKER_01 (04:51):
The solution was LFRTMS.
SPEAKER_00 (04:54):
Low frequency repetitive transcranial magnetic
stimulation.
Seems like a leap, right?
How can magnets on your scalpaffect fluid flow deep inside
your brain?
SPEAKER_01 (05:03):
It sounds a bit like science fiction, I know, but
it's non-invasive.
They place an electromagneticcoil on the scalp and it
generates these very gentlemagnetic pulses.
Totally painless.
And these pulses create tinyelectrical currents in a
targeted part of the brain'scortex.
The theory is that thesecurrents help modulate neural
activity.
(05:23):
They encourage the brain toproduce the low frequency brain
waves that are uh characteristicof deep sleep.
SPEAKER_00 (05:30):
Ah, I see.
So it's not pushing the fluiddirectly, it's creating the
conditions for the client tohappen by encouraging deep
sleep.
SPEAKER_01 (05:38):
That's the idea.
It's nudging the brain to enterits optimal cleaning state.
SPEAKER_00 (05:42):
And what was the treatment protocol?
This wasn't a one-time thing.
SPEAKER_01 (05:45):
No, not at all.
Consistency was reallyimportant.
Twenty-two of the patients wentthrough with it.
They received 10 sessions intotal.
SPEAKER_00 (05:53):
Over how long?
SPEAKER_01 (05:54):
Over two consecutive weeks.
So it was pretty intensive.
Five days on, weekend off, fivemore days on, a focused two-week
block.
SPEAKER_00 (06:01):
Aaron Powell Which is pretty achievable, clinically
speaking.
And they tracked the resultsover time, right?
They didn't just look at the endof week two.
SPEAKER_01 (06:06):
Aaron Powell Right.
They were very careful about thefollow-up.
The sleep scores, the PSQI andISI, they measured those
frequently.
Right after the two weeks, thenat one month, two months, and
three months out.
SPEAKER_00 (06:16):
Aaron Powell They wanted to see if the sleep
improvement would stick.
SPEAKER_01 (06:18):
Exactly.
But for the, let's say, theheavy machinery, the cognitive
tests, and that DTI ALPS index,they focused on the longer term.
They measure it at week two, buttheir main interest was the
three-month mark.
SPEAKER_00 (06:31):
Aaron Ross Powell To see if there was a real lasting
physical change in the brain.
SPEAKER_01 (06:35):
Aaron Powell Yes.
They wanted to be sure it wasn'tjust a temporary effect.
SPEAKER_00 (06:38):
Aaron Powell Okay, this is where it gets really
good.
Let's talk about the results.
Did it work?
And how quickly?
SPEAKER_01 (06:44):
It did work.
And what's so fascinating isthat the recovery happened in
two very clear phases.
Phase one.
Was rapid sleep improvement.
The PSQI and ISI scores droppedsignificantly, which means
better sleep startingimmediately at week two.
The moment the treatment ended,the patients started reporting
that they were sleeping better.
SPEAKER_00 (07:04):
That's a huge win right there.
An immediate quality of lifeimprovement.
SPEAKER_01 (07:08):
A massive win.
But what about the deeper stuff?
That's phase two.
SPEAKER_00 (07:11):
The cognitive repair.
SPEAKER_01 (07:12):
Right.
The deep functional repair.
That took more time.
While patients felt betterquickly, their brains needed
time to sort of consolidate thegains.
SPEAKER_00 (07:21):
So when did they see those changes?
SPEAKER_01 (07:23):
By the three-month follow-up.
This is the crucial part.
At month three, the DTI ALPSindex or plumbing measure showed
significant improvement.
The brain's cleaning system wasmeasurably more efficient.
SPEAKER_00 (07:36):
Wow.
So the treatment gives the braina window of good sleep.
Yes.
And then the brain uses thatwindow over the next few months
to physically start repairingits own cleaning system.
SPEAKER_01 (07:47):
You've nailed it.
And that physical repairtranslated directly to cognitive
improvement.
By month three, the mocha scoreswere up, processing speed on the
DSST was better, working memorywas better, the thinking had
improved.
SPEAKER_00 (08:01):
Okay, so this brings us to the final most important
question.
What does it all mean?
It's one thing to say sleep gotbetter, and then later cognition
got better.
It's another thing to provethey're connected.
SPEAKER_01 (08:11):
And that is the absolute power of this study.
They didn't just stop there,they ran the statistical
analysis to prove that theimprovement in the physical
mechanism was directly linked tothe clinical benefits.
In other words, the more yourplumbing improved, the more your
thinking improved, the betteryour brain worked.
SPEAKER_00 (08:26):
Let's see the numbers.
How strong was that link?
SPEAKER_01 (08:29):
It was incredibly strong.
The strongest link was betweenthe DTI ALPS index and that
overall cognitive score, theMOCA.
They found a correlationcoefficient of R equals 0.836.
SPEAKER_00 (08:42):
Aaron Powell Okay, for anyone who doesn't live and
breathe statistics, an R valueof 0.836 is that's almost a
one-to-one relationship.
It's huge.
SPEAKER_01 (08:51):
It's a massive finding.
It means that something like 83%of the improvement in their
thinking ability could beexplained by the improvement in
their brain's waist clearance.
SPEAKER_00 (09:00):
So fixing the plumbing really does seem to fix
the thinking.
It's not just a side effect.
SPEAKER_01 (09:04):
It suggests it might be the key intermediate step,
the real target of the therapy.
SPEAKER_00 (09:09):
And it wasn't just linked to overall cognition, was
it?
SPEAKER_01 (09:11):
No, it was across the board.
They found strong correlationswith working memory, with
executive function.
And importantly, the better theclearance got, the better the
patients felt their sleep was.
The physical change was linkedto the subjective improvement.
SPEAKER_00 (09:23):
So to put it all together, 10 sessions of LFRTMS
helps the brain achieve ahealthier sleep state.
That state allows the lymphaticsystem to finally do its job,
clearing out months or years ofwaste.
And that physical cleaningprocess is directly,
statistically linked to patientsthinking more clearly and
sleeping better three monthslater.
SPEAKER_01 (09:43):
That's the story the data tells.
It's a shift from just treatinga symptom, I can't sleep, to
fixing a mechanical problem, mybrain can't clean itself.
And it seems LFR TMS helps fixthe machine.
SPEAKER_00 (09:54):
So just to sum it all up one last time, this is
really promising evidence thatLFR TMS can help with chronic
insomnia, not just by improvingsleep, but by an enhancing
cognitive function through thisdirect link to the brain's
cleaning cycle.
SPEAKER_01 (10:07):
It's a tangible mechanism we can now target and
study further.
It's really exciting.
SPEAKER_00 (10:11):
It really is.
Now, this study gives us thispowerful preliminary evidence,
but it also raises a reallyimportant question, one for you
to think about as you go aboutyour day.
Since we now see this strongcorrelation, what comes next?
What kind of research is neededto prove this is truly cause and
effect?
And maybe more importantly, ifthis brain cleaning cycle is so
critical, should therapies likeLFR TMS be used much earlier in
(10:35):
treating insomnia to preventthat long term cognitive damage
before it ever gets this bad?
SPEAKER_01 (10:40):
A fascinating and critical question for the future
of sleep medicine.
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