Assessing Sleep Architecture in Dementia Caregivers at Home Using an Ambulatory Polysomnographic System

Findings from previous research assessing sleep quality in caregivers are inconsistent due to differences in sleep assessment methods. This study evaluated sleep in dementia caregivers using a comprehensive sleep assessment utilizing an ambulatory polysomnography (PSG) device. A total of 20 caregivers and 20 noncaregivers rated their perceived sleep quality, stress, and depressive symptoms; provided samples of cortisol and inflammatory biomarkers; and completed an objective sleep assessment using a portable PSG device. Caregivers reported greater perceived stress than noncaregivers. Next, the groups had different sleep architecture: caregivers spent less proportion of their sleep in restorative sleep stages compared to noncaregivers. Further, levels of C-reactive protein and awakening salivary cortisol were greater in caregivers than in noncaregivers, and these measures were related to sleep quality. Our findings indicate that sleep disruption is a significant concomitant of caregiving and may affect caregiver’s health. Sleep quality of caregivers might be a useful target for a clinical intervention.

[1]  D. Kaufer,et al.  Comparison between informant-observed and actigraphic assessments of sleep-wake rhythm disturbances in demented residents of homes for the elderly. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[2]  B. Oken,et al.  Salivary Cortisol Awakening Response in Mild Alzheimer Disease, Caregivers, and Noncaregivers , 2008, Alzheimer disease and associated disorders.

[3]  M. Vitiello,et al.  Sleep disturbances in caregivers of persons with dementia: contributing factors and treatment implications. , 2007, Sleep medicine reviews.

[4]  L. Fredman,et al.  Sleep Problems in Elderly Women Caregivers Depend on the Level of Depressive Symptoms: Results of the Caregiver–Study of Osteoporotic Fractures , 2007, Journal of the American Geriatrics Society.

[5]  P. Cowen,et al.  Evaluation of first night effect using ambulatory monitoring and automatic sleep stage analysis. , 1988, Sleep.

[6]  A. Chesson,et al.  The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications , 2007 .

[7]  Ståle Pallesen,et al.  A comparison of actigraphy and polysomnography in older adults treated for chronic primary insomnia. , 2006, Sleep.

[8]  M. Vitiello,et al.  Insomnia In Caregivers Of Persons With Dementia: Who Is At Risk And What Can Be Done About It? , 2009, Sleep medicine clinics.

[9]  M. Coleman,et al.  Stress in carers of individuals with dementia and Community Mental Health Teams: an uncontrolled evaluation study. , 2005, Journal of advanced nursing.

[10]  J. Ware.  SF-36 health survey: Manual and interpretation guide , 2003 .

[11]  B. Mausbach,et al.  Effect of Alzheimer caregiving stress and age on frailty markers interleukin-6, C-reactive protein, and D-dimer. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  Jelle Jolles,et al.  Subjective sleep problems in later life as predictors of cognitive decline. Report from the Maastricht Ageing Study (MAAS) , 2002, International journal of geriatric psychiatry.

[13]  J. Breitner,et al.  Detection of dementia in the elderly using telephone screening of cognitive status , 1993 .

[14]  Kathryn A. Lee,et al.  Sleep Patterns and Sleep-Related Factors Between Caregiving and Non-Caregiving Women , 2009, Behavioral sleep medicine.

[15]  Jing Cheng,et al.  Sleep pattern differences between older adult dementia caregivers and older adult noncaregivers using objective and subjective measures. , 2008, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[16]  E. Aguglia,et al.  Stress in the caregivers of Alzheimer's patients: An experimental investigation in ltaly , 2004, American journal of Alzheimer's disease and other dementias.

[17]  C. Depp,et al.  The Relationship Between Objectively Measured Sleep Disturbance and Dementia Family Caregiver Distress and Burden , 2008, Journal of geriatric psychiatry and neurology.

[18]  E. Simonsick,et al.  The Impact of Insomnia on Cognitive Functioning in Older Adults , 2001, Journal of the American Geriatrics Society.

[19]  J. Wilson,et al.  Is Sleep the New Vital Sign? , 2005, Annals of Internal Medicine.

[20]  K. Spiegel,et al.  Impact of sleep debt on metabolic and endocrine function , 1999, The Lancet.

[21]  D L Patrick,et al.  Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). , 1994, American journal of preventive medicine.

[22]  C. Teel,et al.  Fatigue among Elders in Caregiving and Noncaregiving Roles , 1999, Western journal of nursing research.

[23]  Cathy Alessi,et al.  Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. , 2007, Sleep.

[24]  B. Mausbach,et al.  Effects of gender and dementia severity on Alzheimer’s disease caregivers’ sleep and biomarkers of coagulation and inflammation , 2009, Brain, Behavior, and Immunity.

[25]  B. Oken,et al.  Pilot controlled trial of mindfulness meditation and education for dementia caregivers. , 2010, Journal of alternative and complementary medicine.

[26]  John Trinder,et al.  Sick and tired: does sleep have a vital role in the immune system? , 2004, Nature Reviews Immunology.

[27]  A. King,et al.  Sleep complaints in older women who are family caregivers. , 1999, The journals of gerontology. Series B, Psychological sciences and social sciences.

[28]  P. Truax,et al.  Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. , 1992, Psychology and aging.

[29]  Martin Pinquart,et al.  Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. , 2003, Psychology and aging.

[30]  F. Grodstein,et al.  Does Caregiving Stress Affect Cognitive Function in Older Women? , 2004, The Journal of nervous and mental disease.

[31]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[32]  B. Mausbach,et al.  Sleep and Biomarkers of Atherosclerosis in Elderly Alzheimer Caregivers and Controls , 2009, Gerontology.

[33]  Roger M. Ellingson,et al.  Second generation complementary and alternative medicine physiologic data collection and monitoring research platform , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[34]  A. Peters,et al.  Reproducibility in serial C-reactive protein and interleukin-6 measurements in post-myocardial infarction patients: results from the AIRGENE study. , 2010, Clinical chemistry.

[35]  T. Patterson,et al.  Sleep in spousal caregivers of people with Alzheimer's disease. , 2005, Sleep.

[36]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[37]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.