For Caregiver Sleep: Not All Stressors are Created Equal

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Background: Disturbing behavioral symptoms of dementia, including delusions, hallucinations, nighttime behavior, and so forth, are reported by caregivers as some of the most difficult aspects of providing care. Caregivers also report interrupted and inadequate sleep. This may be, in part, due to the particular stress experienced when managing difficult behavioral symptoms in the relative with dementia. This study examines whether caregiver sleep may be affected by these behavioral problems in terms of the total number of behaviors, the severity of the behaviors and the distress the caregiver perceives.

Methods: In a controlled clinical trial 47 dementia caregivers were followed for five months; 23 caregivers received a night monitoring system (NMS) intervention to awaken the caregiver when the person with dementia left the bed. Sleep was measured for 7-day intervals at five points in time using (1) Actigraphy, an objective, noninvasive method of monitoring sleep/wake cycles and, (2) a sleep diary. Hierarchical linear modeling statistical techniques were used to examine the relationship between behavioral problems [the Neuropsychiatric Inventory Questionnaire (NPI-Q)] and caregiver sleep [total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO)]. System effects will be explored with further analyses to determine between-group differences in caregiver sleep based on the NMS intervention.

Conclusions: Caregivers who spend more time awake after sleep onset reported more behavioral symptoms of dementia than their counterparts. This study's findings suggest that having to manage high numbers of behaviors results in a high stress burden and the difficulty of remaining asleep through the night, but not total burden scores. This lends credence to the theory that not all stressors are created equal, and certain stressors, such as a high number of behavioral symptoms, have a large impact on caregivers.

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Alzheimer's & Dementia, v. 8, issue 4, p. P380