Researchers from Baylor University analyzed combined data from previous studies to identify sleep disturbances in caregivers of dementia patients and determined behavioral interventions that can improve their sleep.
The number of adults with dementia is increasing every year causing a respective increase in the number of caregivers of dementia patients. It is estimated that there are more than 16 million adult caregivers of dementia patients and more than two-thirds of them experience some form of sleep disturbance. Research shows that caregivers of dementia patients sleep for shorter duration and have a more disturbed sleeping pattern compared with other adults of the same age. An accumulated loss of sleep leads to the diminished ability of caregivers to function efficiently and also compromises the quality of caregiving to the patients.
Major contributors of sleep disturbance of caregivers of dementia patients
The treatment of a caregiver’s sleep problems starts with an understanding of the main contributing factors of the sleep disturbance. Researchers have recognized three main contributors of sleep disturbance: disrupted sleep routine of the caregiver, burden, and depression associated with caregiving, and the physical health problems arising due to caregiving.
Dementia caregiving is associated with negative health effects
Sleep disturbances associated with caregiving lead to mental, physical, and cognitive health problems in caregivers of dementia patients. Some studies have shown a reduced performance of memory and attention in adult caregivers compared with non-caregivers. The researchers also suggest that sleep disturbances cause a decline in the cognitive ability of caregivers. Furthermore, emotional stress associated with dementia caregiving may lead to the development of dementia in caregivers.
Can caregivers of dementia patients benefit from treatment interventions?
It is important to recognize and address the poor sleep quality in caregivers of dementia patients in order to help them improve their quality of life. The researchers from Baylor University conducted an analysis of 35 studies that included data from 3,268 caregivers of dementia patients and 696 non-caregiving controls. The study was recently published in the JAMA Network Open, a publication of the American Medical Association.
The researchers performed meta-analyses to evaluate sleep duration, sleep quality, and sleep interventions in caregivers of dementia patients. The quality of sleep was assessed using standardized instruments. Total sleep time was measured by diagnostic tools such as polysomnography, actigraphy, and self-reported measures.
The results showed that due to difficulty in falling asleep and staying asleep through the night, caregivers had lower sleep duration amounting to 2.5 to 3.5 hours each week compared with age-matched non-caregivers. The quality of sleep was also significantly lower in caregivers compared with non-caregivers.
Interestingly, the caregivers who received simple sleep interventions such as exercise during the day, avoiding tea or coffee past late afternoon, not drinking alcohol at night, and getting more sunlight had a better sleep quality than caregivers who did not receive interventions.
The significance of sleep interventions in caregivers of dementia patients
The results of this study are consistent with the recommendation of the Global Council on Brain Health that suggests that all adults can change their behaviors in order to improve their sleep. This study highlights that sleep interventions in caregivers of dementia patients are associated with better sleep quality. The poor sleep quality of caregivers is a result of the caregiver’s response to the stressful environment. The researchers suggest that if the caregivers can alter their response to the stress, better sleep quality, and eventually better cardiovascular and brain health can be achieved.
The study showed that behavioral interventions were more effective than pharmacological interventions. Sleep hygiene education helped to improve the caregiver’s nighttime routine. Light chronotherapy treatment, a technique that involves intentionally delaying bedtime 2-3 hours every night till one can sleep at the desired time, helped train the caregiver’s circadian rhythms. In addition, the researchers showed that day time exercise helped lower the sense of burden and fatigue and stress management techniques decreased symptoms of depression in the caregivers of dementia patients.
Clinicians should consider sleep interventions for both dementia patients and their caregivers
With the number of people being diagnosed with dementia increasing every year, there is a rising need for caregivers of dementia patients worldwide. This meta-analysis indicates that caregivers of dementia patients have shorter and poor-quality sleep compared to the non-caregivers of the same age group. However, noninvasive behavioral interventions helped reduce the sleep disturbance and resulted in better quality sleep in caregivers of dementia patients.
Taking into consideration the health consequences of poor-quality sleep over a prolonged period of time, it is important that the clinicians consider sleep interventions not only for the dementia patients but also for the caregivers of dementia patients.
Written by Preeti Paul
Reference: Chenlu Gao et al. Sleep Duration and Sleep Quality in Caregivers of Patients with Dementia. JAMA Netw Open. 2019;2(8);e199891. Doi:10.1001/jamanetworkopen.2019.9891
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