Training caregivers to change the sleep hygiene practices of patients with dementia: The NITE-AD project

OBJECTIVES: To examine the feasibility of training caregivers to implement sleep hygiene recommendations in dementia patients. DESIGN: A randomized, controlled trial. SETTING: Community. PARTICIPANTS: Twenty-two community-dwelling patients with Alzheimer's disease (AD) and their family caregivers. INTERVENTIONS: 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 = 10) also received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient. Control subjects (n = 12) received general dementia education and caregiver support. MEASUREMENTS: Success implementing sleep hygiene recommendations was measured using daily log reports to calculate the percentage of days that caregivers reported that patients met individualized sleep scheduling, daytime-napping, and walking goals. RESULTS: Caregivers in active treatment were more successful in setting goals related to sleep scheduling and increasing daytime activity than control caregivers who received written materials only. Among patients who were candidates for sleep hygiene changes, active treatment subjects were also significantly (P < .01) more likely than controls to maintain a consistent bedtime (83% vs 38% of days attempted) and a consistent rising time (96% vs 59%), to nap less during the day (70% vs 28%), and to walk daily (86% vs 7%). CONCLUSION: This study provides evidence that sleep hygiene interventions are feasible with community-dwelling AD patients. Caregivers were able to help patients change sleep scheduling, napping, and walking routines, but clinicians who recommend sleep hygiene changes for their dementia patients should be aware that many caregivers need active assistance setting up and implementing a sleep hygiene program. Simply providing caregivers with education is often insufficient.