A Dyadic Approach to Improve Sleep and Well-Being Among Persons with Alzheimer's Disease and Their Caregivers

Project Summary/Abstract Poor sleep is very common in persons with Alzheimer’s disease and related dementias (ADRD) and their caregivers. It is significantly associated with adverse mental and physical health outcomes and well-being in both members of the group. Unmanaged poor sleep will further impact the quality of care that the caregivers provide for the patients. This suggests a critical need of sleep management in this vulnerable population. Unfortunately, an intervention addressing sleep problems of both members of the dyad simultaneously is lacking, particularly using the behavioral strategies that have been effective in other groups. Effects of sleep intervention programs in different delivery modalities are also unknown in this group. The current proposal aims to examine the efficacy of a dyadic sleep intervention program for ADRD patients and their caregivers, that is built upon PI’s prior work. We propose a 3-arm randomized controlled trial design (Stage II), including both in-person (n=70 dyads) and telehealth (n=70 dyads) delivery of the intervention, compared to in-person sleep education control (n=70 dyads). The dyadic intervention is a 5-week, manual-based program, which incorporates key components of cognitive behavioral therapy for insomnia, daily light exposure and walking, and a problem-solving approach for ADRD-related problematic nighttime behaviors and other caregiving challenges. All intervention sessions will be delivered by a sleep educator. Primary outcomes include subjective and objective sleep quality of the dyads. Secondary outcomes include the patients’ dementia-related behaviors and quality of life, and the caregivers’ burden, depression, and perceived health. We will also explore effects of the dyadic sleep program on inflammatory markers among caregivers. All outcomes will be measured at baseline, post-intervention (i.e., immediately after the last session of the intervention), and 6-month after the last session. Both superior (both in-person and telehealth interventions versus control) and non-inferior effects (in-person versus telehealth intervention) will be tested. A unique aspect of the proposed work is that the program is tailored to address sleep problems of both patients and caregivers, and includes inflammatory biomarkers to evaluate a key mechanism of intervention benefits that can be further explored in future research. The knowledge gained from this study has the potential to improve the lives of ADRD patients and their caregivers. Our dyadic sleep intervention can be disseminated to multiple communities serving ADRD patients and/or caregivers, including those that lack access to traditional in-person sleep treatment. The intervention manual can also be used to train health professionals and staff in various types of community programs.