Informal caregivers provide the majority of care for chronically ill adults, including persons with dementia. While these individuals provide a great benefit to the chronically ill relative, being a caregiver is associated with deleterious health consequences, including premature mortality and higher rates of coronary heart disease (CHD). Another common complaint among dementia caregivers is poor sleep, which has been connected to premature mortality and higher rates of CHD in noncaregiving adults. Currently no sleep therapies are empirically validated as effective for caregivers of persons with dementia (PWD), and since PWD often arise at night, improving caregiver sleep could be potentially hazardous as a sleeping caregiver cannot provide supervision during night awakenings. Our primary purpose is thus to determine whether a combined intervention is effective in improving sleep in caregivers of PWD who arise at night. The intervention consists of a night home monitoring system that provides reliable alerts to caregivers when PWD leave the bed and move through the house. While this system improved home safety for PWD, it did not affect caregiver sleep, so a more traditional sleep therapy will be added-cognitive-behavioral therapy for insomnia (CBTi). In the proposed study, experimental participants will receive the night home monitoring system + CBTi;control participants will receive only the night home monitoring system. Participants will remain in the study for 24 weeks, with 4 data collection points. We hypothesize experimental participants will have less time awake after going to bed, and improved sleep efficiency (percent time asleep while in bed). Sleep data will be collected for multiple nights using actigraphy and sleep diary. Our secondary research questions focus on the relationship between poor sleep and CHD. Both in adults and in dementia caregivers, there appears to be a link between poor sleep and abnormal levels on coronary heart disease biomarkers, and likely an increase in CHD with poor sleep.
We aim to further explore this relationship as well as determine whether levels of biomarkers improve with improved sleep from the intervention. We propose to draw blood samples at 3 data collection points and measure a set of biomarkers indicative of CHD. Our primary expected outcome is an effective, easy-to-use treatment that can improve sleep in dementia CGs with sleep problems. We will continue to build the science on the relationship between sleep and CHD, and to understand mechanisms that may underlie deleterious changes in CG health. Obtaining evidence of the relationship between sleep and CHD biomarkers, supported by preliminary data that improving sleep reverses changes in biomarker levels, would begin to fill a critically important gap in research aiming to reduce the trend of PWD caregiver mortality and CHD as well as PWD placement in nursing homes. A longer study would then be proposed to determine how to deliver effective sleep therapies to sustain normalization of CHD biomarkers, as well as to determine whether the actual disease process was affected.

Public Health Relevance

The aim of the proposed project is to improve the sleep of informal caregivers of persons with dementia. We also will explore whether sleep affects the levels of biomarkers that indicate the presence of heart disease. This study will test the effectiveness of a combined intervention on caregiver sleep;we will use both a new night home monitoring system and cognitive-behavioral therapy for insomnia.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-R (02))
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Nielsen, Lisbeth
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University of South Florida
Schools of Nursing
United States
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