Cecily O'Connor
RedwoodAge.com

It's not uncommon for caregivers to wrestle with money issues or feel down about their lack of free time.  But those stresses can also rob a caregiver of a good night's sleep.  

(Source: ADAM/NIH)

The sleep patterns of older adults who provide care during the night for dementia sufferers are much worse than other older adults, according to a study in the Journal of Clinical Sleep Medicine that documented sleep patterns of caregivers and non-caregivers for up to a week.

Alzheimer's disease is the most common form of dementia, which is a general term to describe loss of memory and intellectual abilities that disrupt daily living.

"There is a lot of stress to this condition, so it doesn't surprise me at all that caregivers would have a harder time with sleep habits and sleep patterns," said Bill Fisher, chief executive officer at the Alzheimer's Association of Northern California and Northern Nevada.  

Fisher hadn't seen the study, but noted that, in general, poor sleep is often the result of a caregiver's inability to cope with growing and ever-changing responsibilities. 

For example, he said many caregivers say to themselves, "If Mom or Dad is waking up in the middle of the night, then I have to sleep lightly."

6.5 Hours
Researchers found that when sleep was measured objectively - and after adjusting for depressive symptoms, age, health condition and education - dementia caregivers slept for an average of 6.5 hours per night, or about 33 minutes less than non-caregivers. And they took about 10 minutes longer to fall asleep, struggling to doze due to concern about their loved one's memory decline.

In addition, caregivers' sleep was more variable, based on lower subjective sleep quality, higher scores of daytime sleepiness and 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 Meredith Rowe, primary researcher and 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.” 

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. However, both caregivers and non-caregivers had an average of more than 40 minutes of time awake during the night after initially falling asleep.

Still, dementia caregivers face certain unique issues in that they are tending to someone who is losing their ability to make decisions, Fisher said. Spouses and adult children are tackling tough issues related to legal matters, finances and healthcare.

Awakenings
Sleep patterns were measured by actigraphy, a method of measuring human rest and activity cycles, 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.

Meanwhile, seven nights of data were collected for 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. The ages ranged from 60 to 89 years for non-caregivers and 60 to 86 years for caregivers.

Other measurement tools used in the study included daily sleep diaries, the Epworth Sleepiness Scale, which is used to determine daytime sleepiness and the Fatigue Severity Scale, which evaluates the impact of fatigue upon individuals. Participants also were assessed for depressive symptoms.

The journal is a publication of the American Academy of Sleep Medicine, which has multiple resources on its website, including information about sleep disorders and possible treatments. The Alzheimer's Association website also has resources for finding local support groups, as well as information on how to better manage caregiver stress and learn about ways to cope with daily problems.

The caregiver study was supported by grants from the National Institute of Nursing Research.