Nighttime insomnia treatment and education for Alzheimer's disease: a randomized, controlled trial.
OBJECTIVE
To evaluate whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE-AD)) could improve sleep in dementia patients living at home with their family caregivers.


METHODS
A randomized, controlled trial.


METHODS
Thirty-six community-dwelling patients with Alzheimer's disease (AD) and their family caregivers.


METHODS
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=17) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills. Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box. Control subjects (n=19) received general dementia education and caregiver support.


METHODS
Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep-wake activity measured at baseline, posttest (2 months), and 6-month follow-up using an Actillume wrist-movement recorder. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, and the Revised Memory and Behavior Problem Checklist. Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale.


RESULTS
Patients participating in NITE-AD showed significantly greater (P<.05) posttest reductions in number of nighttime awakenings, total time awake at night, and depression, and increases in weekly exercise days than control subjects. At 6-month follow-up, treatment gains were maintained, and additional significant improvements in duration of night awakenings emerged. When cognitive level was controlled, NITE-AD patients had lower longitudinal ratings of daytime sleepiness than controls. There was a trend for control subjects to spend more time in bed at 6 months than NITE-AD patients.


CONCLUSIONS
This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques (specifically, sleep hygiene education, daily walking, and increased light exposure) that are known to improve sleep in nondemented, institutionalized older adults.
McCurry
Susan M
SM
Department of Psychosocial and Community Health, University of Washington, Seattle, Washington 98115, USA. smccurry@u.washington.edu
Gibbons
Laura E
LE
Logsdon
Rebecca G
RG
Vitiello
Michael V
MV
Teri
Linda
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000628:therapy*; D017028:Caregivers / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome