Sleep in Spousal Alzheimer Caregivers: A Longitudinal Study with a Focus on the Effects of Major Patient Transitions on Sleep

Study Objectives: Findings on sleep disturbances in family dementia caregivers are conflicting. We studied the longitudinal effects of dementia caregiving and major transitions in the caregiving situation on caregivers' sleep and the effect of moderating variables. Design and Setting: Community-based longitudinal study with assessments about once a year for up to three years. Participants: A sample of 109 elderly spousal Alzheimer caregivers and 48 non-caregiving age-and gender-matched controls. Measurements and Results: Random regression models with fixed and time-variant effects for covariates known to affect sleep were used to evaluate changes in the Pittsburgh Sleep Quality Index (PSQI) and in four actigraphy measures over time in relation to caregiving status and transitions (i.e., nursing home placement or death of the Alzheimer disease spouse). Multivariate-adjusted sleep characteristics did not significantly differ between caregivers and non-caregivers over time. Spousal death increased caregivers' nighttime wake after sleep onset (WASO) by 23 min (P = 0.002) and daytime total sleep time (TST) by 29 min (P = 0.003), while nighttime sleep percent decreased by 3.2% (P = 0.009) and nighttime TST did not change. Placement of the spouse had no significant effect on caregivers' sleep. Older age, male gender, role overload, depressive symptoms, and proinflammatory cytokines variously emerged as significant moderators of the relationships between caregiving and transitions with poor subjective and objective sleep. Conclusions: Alzheimer caregivers and non-caregiving controls had similar trajectories of sleep. However, there may be subgroups of caregivers who are vulnerable to develop sleep disturbances, including those whose spouses have died.