REDUCING STRESS AND SLEEP DISTURBANCES IN CAREGIVERS OF ALZHEIMER'S PATIENTS

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The stress of caregiving is associated with a number of adverse health outcomes including psychiatric morbidity, immune system dysregulation, increased susceptibility to illness and disease, and increased risk for mortality. Sleep complaints are common among caregivers, and stress-related sleep disruptions may signal vulnerability to, or play a causal role in, the adverse health consequences of caregiving. The general aim of this revised study is to test the efficacy of an intervention designed to reduce stress and improve sleep in a sample of spousal careqivers of patients with Alzheimer Disease (AD). The intervention will be compared to an attention-only control condition. Specific aims of this study are: 1. To characterize stress-related sleep disruptions in spousal caregivers of AD patients. 2. To test the short-term efficacy of a stress management+healthy sleep practices (SM+HSP) intervention for improving sleep and health outcomes in AD caregivers. 3. To test the durability of SM+HSP in AD caregivers. The study will include 60 spousal caregivers of AD patients who will be randomly assigned to one of two treatment conditions. The SM+HSP intervention will consist of eight weekly in-home sessions that will focus on information support, skills training, affective self-management, and healthy sleep practices. Individually, these components have been shown to be efficacious for reducing stress or improving subjective sleep complaints in AD caregivers. The control condition will include eight weekly in-home sessions which will focus on diet and food intake. Treatment integrity will be monitored by audiotape recordings. The program project measures battery (Agebat) and additional measures specific to caregiving will be administered at four time points: prior to randomization, immediately post-intervention, and at 6- and 12-month follow-up visits. Project -specific data will be used to evaluate treatment efficacy and relationships among caregiver stress and sleep. Relationships among stress, sleep, and health will be more fully evaluated using program-wide data collected in Project 1-5. Our program-wide aim is: to characterize the impact of stress-related sleep disruptions on health in older adults, including AD caregivers, recent widows/widowers, patients with insomnia in primary care settings, and healthy elders above the age of 75 years. The main hypotheses to be tested within the individual project are that the stress of caregiving has a detrimental effect on sleep and that stress-related sleep disruptions, in turn, negatively impact health and well-being. It is hypothesized that, relative to the attention-only control condition, the active intervention (SM+HSP) will result in improvements in sleep and subsequent improvements in health and well-being.