A significant difference in the sleep disturbances among Alzheimer patients, caregivers

A study published in the May 1 issue of the journal SLEEP finds that sleep disturbances among Alzheimer patients vary significantly from those of their family caregivers, and that, surprisingly, poor sleep in either the patient or caregiver is not necessarily linked to disturbed sleep in the other.

Susan M. McCurry, PhD, of the University of Washington, and colleagues studied 44 community-dwelling older adults, between 63-93 years of age, with probable or possible Alzheimer disease and their co-residing family caregivers. The subjects had dementia for an average of 5.7 years. Caregivers were adult family members, between 21-87 years of age, who lived with the patient and could monitor nightly sleep and implement treatment recommendations.

One week of sleep-wake activity was measured for all patients and their caregivers using an Actillume wrist-movement recorder. Sleep variables included total minutes of nighttime sleep, the percentage of time spent asleep, the number of awakenings, the duration of time awake at night, total daytime sleep, and circadian rest-activity variables. The subjects were evaluated for patient and caregiver mood, physical function, medication use, caregiver behavior management style, and patient cognitive status.

According to the results, the sleep variables that showed the greatest night-to-night stability and variability differed between patients and caregivers. The greatest stability for patients was observed for the time of night when they went to bed. For caregivers, the greatest stability was total wake time at night. The least stable patient sleep variable was total hours of sleep per night. Time in bed was the least stable variance for caregivers.

When participants were classified into “good” or “bad” sleepers based upon the percent of sleep time at night, there was a sizable number (between 25-41 percent) of patient-caregiver duos on any given night where one person was sleeping well and the other was sleeping poorly; in some cases, the poor sleeper being the caregiver. Instances where both caregiver and patient were sleeping poorly over a seven-night sampling period were more likely to be in those in which patients had a lower level of physical function, were more severely demented, and used more sleep medications.

"Factors that we might expect would explain much of the relationship between patient and caregiver sleep, such as sharing a room at night, were not significant predictors of outcome,” said Dr. McCurry. “Understanding the complex inter-relationship of sleep in Alzheimer disease patients and caregivers is an important first step towards the development of individualized and effective treatment strategies."

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls and use more over-the-counter or prescription sleep aids. In addition, recent studies associate lack of sleep with serious health problems such as an increased risk of obesity, cardiovascular disease and diabetes.