The goal of this study is to test a program designed to teach nursing facility staff to improve common sleep- related symptoms among residents with Alzheimer?s disease and related dementia. Sleep disturbances are quite common affecting as many as 69% of residents overall while staff do not fully understand how to improve sleep without using medications. Sleep medications and other sedatives are commonly used as first-line therapy but this is problematic because these medications can lead to greater problems with thinking, more frequent falls, and even worse sleep over time. In addition, poor sleep can lead to depressed mood, behavior symptoms of dementia, greater trouble with thinking and memory, worse pain, and less activity participation. There have been efforts to reduce the use of medications for sleep in nursing homes, yet there is still a need to improve the quality of sleep among residents with Alzheimer?s disease who continue to have difficulties. Because residents with Alzheimer?s disease depend on caregiving staff to meet their basic day-to-day needs, it is essential that staff members participate in sleep improvement efforts. This study will ?mentor? nursing facility staff to improve residents? sleep and related symptoms by using a sleep improvement program called: Improving Sleep Using Mentored Behavioral and Environmental Restructuring for Residents with Dementia (SLUMBER-RD). This program provides mentoring to facility staff from sleep and aging experts to improve the nighttime sleep environment, increase daytime activity levels and light exposure, reduce daytime behaviors that cause sleep disturbances at night, and to help individual residents who are having difficulty with sleep. The study will take place in one dementia unit per facility within two nursing facilities in random order. In addition to mentoring staff on strategies to improve sleep, this study will use technology to assist facility staff. This includes decibel meters to record noise levels and wrist actigraphs to measure residents? sleep quality, activity levels and light exposure. Facility staff will also be given a list of targeted strategies to be used with residents having difficulty with sleep. Staff will be able to record episodes of sleep disturbance and to see a visual display of these data to support their work. This study will test whether the SLUMBER intervention improves nighttime sleep quality, resident reported symptoms of poor sleep, depressed mood, anxiety and pain, and whether the intervention improves cognitive and activity levels. This study will also measure whether staff have created a better sleep environment with decreased nighttime noise, increased daylight exposure and greater use of strategies to promote better sleep.
Sleep disturbances are common in Alzheimer?s disease and related dementia (ADRD) skilled nursing facilit y (SNF) units and are associated with the highly prevalent symptoms of behavioral disturbances, depressed mood and anxiety, and the functional challenges of cognitive and physical impairments. The Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER) for Residents with Dementia (SLUMBER-RD) intervention trial, a comprehensive sleep improvement program using behavioral and environmental modifications, will be adapted from SLUMBER for use in SNF dementia units to test whether efforts to improve sleep in these units will lead to meaningful improvements in related symptoms an d function. If successful, this approach could benefit thousands of SNF residents with dementia who suffer from poor sleep and related adverse outcomes.
