Treatment of sleep and nighttime disturbances in Alzheimer's disease: a behavior management approach.
OBJECTIVE
Sleep and nighttime behavioral disturbances are widespread in community-dwelling dementia patients, but little is known about the usefulness of behavioral interventions for treating them. This article presents data from three cases enrolled in an ongoing study of sleep problems in community-dwelling Alzheimer's disease (AD) patients: nighttime insomnia treatment and education for Alzheimer's disease.


METHODS
All subjects received written materials describing age- and dementia-related changes in sleep, and standard principles of good sleep hygiene. Caregivers also received education about dementia, listings of relevant community resources, and general support. Subjects' sleep-wake activity was measured at baseline, post-test (2 months), and 6-month follow-up using an Actillume wrist-movement recorder, which was worn continuously for 1 week.


RESULTS
Post-test actigraphic improvements in sleep quantity and sleep efficiency, number of nighttime awakenings, and amount of daytime sleep, as well as subjective sleep ratings were observed. One subject maintained improvements at 6-month follow-up. Subjects varied widely in the type of sleep problems reported and behavioral strategies implemented by family caregivers, illustrating the complexity that characterizes nighttime behavioral disturbances in AD.


CONCLUSIONS
This paper provides clinical and empirical evidences that behavioral strategies including standard sleep hygiene recommendations can be helpful in treating sleep and nighttime behavioral disturbances in dementia patients.
McCurry
Susan M
SM
Department of Psychosocial and Community Health, University of Washington, 9709 3rd Avenue N.E., Suite 507, Seattle, WA 98115-2053, USA. smccurry@u.washington.edu
Logsdon
Rebecca G
RG
Vitiello
Michael V
MV
Teri
Linda
L
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D001521:Behavior Therapy; D005260:Female; D006801:Humans; D008297:Male; D020447:Parasomnias / Q000209:etiology / Q000628:therapy*; D010353:Patient Education as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000628:therapy*; D012944:Social Support