The purpose of this four-group repeated measures randomized clinical trial is to test the effects of three sleep-related behavioral interventions on sleep-activity disruption and related variables in Alzheimer's disease (AD) patients and their primary caregivers. Disturbances in sleep-activity rhythm are prominent and disabling secondary symptoms in AD. Pharmacologic treatment of sleep-activity rhythm disruptions is only minimally effective and is associated with numerous and serious side effects. Behavioral interventions that take into account endogenous circadian factors may prove to be effective in strengthening circadian function, thereby minimizing associated patient and caregiver difficulties. The following interventions, believed to strengthen circadian function, are proposed for this study: sleep hygiene program (SHP), SHP plus prescribed afternoon nap (PAN), and SHP plus daytime sleep restriction (DSR). This research will provide baseline and comparative data on the effect of these interventions on AD subjects and their caregivers. The interventions are both low-cost and low-tech, making them easily accessible to AD patients and their families. It is hypothesized that in AD subjects the three interventions will: 1) strengthen the sleep-activity rhythm as evidenced by increased amplitude and decreased wake time after sleep onset, and 2) decrease secondary symptoms (behavioral/mood problems, sundowning). The effect of the SHP alone is expected to be of smaller magnitude than the effects of PAN and DSR. It is also hypothesized that in the caregiver the interventions will: 1) decrease burden, 2) increase well-being, 3) decrease depression, and 4) improve nighttime sleep pattern. Again, the effect of SHP alone is hypothesized to be less than PAN and DSR. AD patients and their caregivers will participate in the study for six weeks. During week 1 there will be two home visits to obtain informed consent, collect baseline assessment data, and instruct caregivers on intervention protocols. The four week intervention phase follows (weeks 2-5), and post-intervention data will be obtained at two home visits during week 6. One-way repeated measures ANOVAS will be used to test for the main effects of groups (SHP, PAN, DSR, control) and time baseline, post-intervention), and the interaction of group and time on the dependent variables.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR002968-03
Application #
2257087
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Project Start
1991-09-30
Project End
1996-08-31
Budget Start
1993-09-01
Budget End
1996-08-31
Support Year
3
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
073133571
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Dowling, Glenna A; Burr, Robert L; Van Someren, Eus J W et al. (2008) Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. J Am Geriatr Soc 56:239-46
Dowling, Glenna A; Graf, Carla L; Hubbard, Erin M et al. (2007) Light treatment for neuropsychiatric behaviors in Alzheimer's disease. West J Nurs Res 29:961-75
Dowling, Glenna A; Hubbard, Erin M; Mastick, Judy et al. (2005) Effect of morning bright light treatment for rest-activity disruption in institutionalized patients with severe Alzheimer's disease. Int Psychogeriatr 17:221-36
Dowling, Glenna A; Mastick, Judy; Hubbard, Erin M et al. (2005) Effect of timed bright light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. Int J Geriatr Psychiatry 20:738-43
Dowling, G A; Wiener, C L (1997) Roadblocks encountered in recruiting patients for a study of sleep disruption in Alzheimer's disease. Image J Nurs Sch 29:59-64
Dowling, G A (1996) Behavioral intervention strategies for sleep-activity disruption. Int Psychogeriatr 8 Suppl 1:77-86