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.
