Behavior Approach Helps Alzheimer's Patients Sleep

NEW YORK (Reuters Health) - Behavioral techniques that are known to improve sleep in non-demented institutionalized older adults may benefit patients with Alzheimer's disease who have nighttime insomnia, according to the findings of a small study published in the Journal of the American Geriatrics Society.

Dr. Susan M. McCurry and colleagues from the University of Washington, Seattle, examined whether a comprehensive sleep education program -- dubbed Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE-AD) -- could improve sleep in Alzheimer's disease patients living at home with family caregivers. A total of 36 patients and their caregivers were included in the study.

All subjects received handouts describing age- and dementia-related changes in sleep and principles of good sleep hygiene.

Seventeen caregivers in the NITE-AD intervention group were given recommendations about developing a sleep hygiene program for Alzheimer's disease patients. They also received training in behavior management skills. The patients in this group were instructed to walk daily for 30 minutes -- in practice, usually accompanied by a caregiver -- and to increase daily light exposure by 1 hour using a light box.

The 19 subjects assigned to the other group just received general dementia education and caregiver support.

A wrist-movement recorder was used to measure levels of sleep-awake activity before the intervention, and again two months and six months after the intervention. Secondary outcomes included measures of sleepiness, depression, memory and behavior.

Patients in the NITE-AD group spent an average of 36 minutes less time awake at night -- a 32-percent reduction from the start of the study -- and had 5.3 fewer nightly awakenings -- also a 32-percent reduction from the start of the study -- than control subjects, McCurry's team reports.

Depression levels were also significantly lower in NITE-AD patients and they had lower ratings of daytime sleepiness than control subjects after accounting for level of mental functioning.

Treatment gains were maintained at six months.

"Whether all components of the NITE-AD intervention are necessary to achieve treatment effects and whether the timing of walking and light therapy sessions are important to treatment outcome need to be evaluated, and strategies to enhance long-term treatment adherence should be identified," the investigators note.

SOURCE: Journal of the American Geriatric Society, May 2005.