Sleep problems in elderly women caregivers depend on the level of depressive symptoms: Results of the caregiver-study of osteoporotic fractures

OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women. DESIGN: Cross-sectional study conducted in four communities in 1999 to 2001. SETTING: Home-based interviewer-administered questionnaires. PARTICIPANTS: Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures. MEASUREMENTS: Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item. RESULTS: In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES- D >= 16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems ( adjusted odds ratios ranging from 2.5, 95% confidence interval (CI) = 1.2-5.2 for trouble falling asleep to 4.0, 95% CI = 2.0-7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations ( e. g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems. CONCLUSION: Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems.