Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 53; no. 5; pp. 793 - 802
• Main Authors: McCurry, Susan M., Gibbons, Laura E., Logsdon, Rebecca G., Vitiello, Michael V., Teri, Linda
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Inc 01.05.2005; Blackwell; Wiley Subscription Services, Inc
• Subjects: actigraphy; Adult; Aged; Aged, 80 and over; Alzheimer Disease - complications; Alzheimer Disease - therapy; Alzheimer's disease; Behaviour modification; Biological and medical sciences; caregivers; Caregivers - education; Carers; Clinical trials; Community living; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Educational programmes; Elderly people; Families; Female; General aspects; Humans; Insomnia; Male; Medical sciences; Medical treatment; Middle Aged; Nervous system (semeiology, syndromes); Neurology; nocturnal disturbances; Randomized controlled trials; sleep; Sleep Initiation and Maintenance Disorders - etiology; Sleep Initiation and Maintenance Disorders - psychology; Sleep Initiation and Maintenance Disorders - therapy; Treatment; Treatment Outcome; USA; Human; Nervous system diseases; Alzheimer disease; Caregiver; Sleep disorder; Cerebral disorder; caregivers; Gerontology; Randomization; Sleep; Treatment; Education; Insomnia; nocturnal disturbances; Central nervous system disease; Clinical trial; Degenerative disease; actigraphy; Sleep wake cycle; Neurological disorder; Elderly; Alzheimer's disease; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2005.53252.x

Objectives: To evaluate whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE‐AD)) could improve sleep in dementia patients living at home with their family caregivers. Design: A randomized, controlled trial. Participants: Thirty‐six community‐dwelling patients with Alzheimer's disease (AD) and their family caregivers. Intervention: All participants received written materials describing age‐ and dementia‐related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=17) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills. Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box. Control subjects (n=19) received general dementia education and caregiver support. Measurements: Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep‐wake activity measured at baseline, posttest (2 months), and 6‐month follow‐up using an Actillume wrist‐movement recorder. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, and the Revised Memory and Behavior Problem Checklist. Caregiver self‐reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale. Results: Patients participating in NITE‐AD showed significantly greater (P<.05) posttest reductions in number of nighttime awakenings, total time awake at night, and depression, and increases in weekly exercise days than control subjects. At 6‐month follow‐up, treatment gains were maintained, and additional significant improvements in duration of night awakenings emerged. When cognitive level was controlled, NITE‐AD patients had lower longitudinal ratings of daytime sleepiness than controls. There was a trend for control subjects to spend more time in bed at 6 months than NITE‐AD patients. Conclusion: This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques (specifically, sleep hygiene education, daily walking, and increased light exposure) that are known to improve sleep in nondemented, institutionalized older adults.