It is estimated that 7% to 20% of older adults have mild cognitive impairment (MCI) and 60% of people with MCI have some sleep disturbances. Insomnia is the most common sleep disturbance in older adults and is characterized by difficulty initiating or maintaining sleep, awakening too early, and next day consequences such as difficulty concentrating. The proposed project seeks to address a major gap in the literature and clinical practice, lack of effective nonpharmacological treatments for insomnia in older adults with mild cognitive impairment. We propose conducting a randomized pilot study testing a brief (4 week), tablet-based, personalized, multicomponent behavioral sleep intervention for insomnia (MBSI-I) that will target known etiological risk factors and perpetuators of insomnia among older adults with mild cognitive impairment, compared to a sleep education control. Key components of the intervention include stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (one month) and sustained efficacy (3 months) of MBSI-I compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which MBSI-I affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. Real-time monitoring of intervention adherence, using mobile device technology with real time data transmission, represents a fundamental change in the insomnia treatment paradigm and will be most beneficial given that this group has memory impairments. Upon completion, this proposal will provide foundational knowledge for large scale intervention trials and address limitations in current insomnia treatments in patients with mild cognitive impairment. This research closely aligns with the strategic mission of the National Institute of Nursing Research because it proposes strategies to personalize care and use real time health information to improve symptoms of insomnia in older adults with mild cognitive impairment and to build evidence toward successful symptom management in this vulnerable population. Furthermore, the interdisciplinary training plan and goals developed for this proposal will fill a critical void in my current skillset and provide me the expertise necessary to initiate a successful and independent program of research related to improve sleep and health-related quality of life in at-risk older adults. By expanding my knowledge of 1) mobile device technology, 2) measurement of cognitive health related outcomes, 3) clinical trials of behavioral interventions and translational research, 4) biomarker assessment, and 5) scientific writing, oral presentations, manuscript development and peer review, I will be able to conduct research to evaluate more effective nonpharmacological treatments for sleep problems in older adults. To facilitate the achievement of my career development goals, I will follow an intensive training plan that incorporates coursework, laboratory training, mentoring and seminars, workshops, and other structured activities; participation in research studies, data analysis, and manuscript preparation; professional development activities; and close mentorship. Overall, the research and training activities in this proposal will build a strong foundation for my career as an independent investigator.
Insomnia symptoms in older adults with mild cognitive impairment represent a significant public health burden in terms of impaired quality of life, risks from untreated insomnia, and risks from pharmaceutical insomnia treatment. To address the limitations in the most effective non-pharmacological treatments for insomnia in older adults with mild cognitive impairment, a randomized pilot study will be conducted to test a brief (4 week), tablet-based, personalized, multicomponent behavioral sleep intervention for insomnia, compared to a sleep education control, in this at-risk group. The findings of the proposed project will inform future, larger scale clinical trials and may provide a novel and innovative way for older adults with mild cognitive impairment to achieve better sleep and health-related quality of life outcomes.
