Sleep patterns of older adults who live with and provide direct care during the night for a person with dementia are significantly worse than other older adults.
When sleep was measured objectively, and after adjusting for depressive symptoms, age, health condition and education, adults who take care of a person suffering from dementia took longer to fall sleep and had less total sleep than noncaregivers. Caregivers slept for an average of about 6.5 hours per night, which was about 33 minutes less than noncaregivers, and they took about 10 minutes longer to fall asleep. Caregiver sleep also was more variable from night-to-night, and caregivers reported lower subjective sleep quality, had higher scores of daytime sleepiness on the Epworth Sleepiness Scale and had higher depressive symptom scores.
"On average, caregivers only slept about six -and-a-half hours a night and took almost 23 minutes to fall asleep," said primary investigator Meredith Rowe, PhD, associate professor at the University of Florida. "Using the sleep diary data that subjects kept at the same time, however, depression was the primary determinant of poor sleep with depressed subjects reporting less time asleep and more wake time over the week."
According to Rowe, the most surprising finding of the study was that the caregiver group took a longer time to fall asleep, which is consistent with the greater worry and concern that caregivers may have. The researchers had expected the caregivers' main sleep problem to be more time awake in the middle of the night when the person with dementia needed supervision. The difference between groups was not significant, however, as both caregivers and noncaregivers had an average of more than 40 minutes of time awake during the night after initially falling asleep.
Sleep patterns were measured by actigraphy for three to seven nights for the 31 caregivers in the study, each of whom lived with and provided direct care to a person with dementia who had nighttime awakenings. Seven nights of data were collected by actigraphy for the 102 noncaregivers in a previous study on sleep in older adults who were relatively healthy, living in the community and not diagnosed with sleep disorders other than insomnia. In general, both groups were predominantly female, white and currently married. Ages ranged from 60 to 89 years for noncaregivers and 60 to 86 years for caregivers. The noncaregiver sample had a significantly greater level of education than the caregiver sample.
Other measurement tools used in the study included daily sleep diaries, the Epworth Sleepiness Scale and the Fatigue Severity Scale. Participants were also assessed for depressive symptoms.
The caregiver study was supported by grants from the National Institute of Nursing Research.
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