The Effect of Tele-Savvy on Sleep Quality and Insomnia in Caregivers of Persons Living with Dementia.

Introduction: Sleep disturbance is prevalent in caregivers of persons living with dementia (PLwD). Tele-Savvy, a 7-week virtual psychoeducational intervention, enhances caregivers' competence and self-care, and reduces depression. While not explicitly designed to do so, Tele-Savvy can potentially improve caregivers' disturbed sleep. The present study aimed to examine the longitudinal effects of Tele-Savvy on caregivers' sleep quality and insomnia. Methods: This was a secondary data analysis of a 3-arm randomized control trial [Tele-Savvy (active treatment), Healthy Living (attention control), and usual care (waitlist control)]. Multilevel mixed modeling with intent-to-treat principles tested for group, time, and group-by-time effects. Effect sizes were estimated for all changes from baseline to the initial 6-month post-intervention point. Following completion of the 6-month post-randomization delay, we examined combined outcomes for Tele-Savvy. Results: Participants (n=137; mean age 64.7 years) were predominantly female (68.6%) and White (68.6%). We found no initial group-by-time effects for the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). For the combined Tele-Savvy group, there was a statistically significant improvement in ISI scores across time (p=0.050). The combined Tele-Savvy effect size for PSQI was d=0.126 and ISI was d=0.310. Discussion: Tele-Savvy resulted in a significant long-term reduction in insomnia symptoms in this sample of caregivers of PLwD and demonstrated a positive trend for improvement in their sleep quality. Since sleep disturbance is so prevalent among caregivers of PLwD, the inclusion of sleep health education into psychoeducation caregiver interventions may yield even better outcomes for caregivers.

Association of Sleep and Physical Activity Among Older Adults and the Moderation of Chronotype.

This study aimed to examine the associations of both subjectively and objectively measured sleep with physical activity among older adults and to explore the possible moderating role of chronotype in these associations. We included baseline data of 116 community-dwelling older adults without dementia from three prior studies. Pittsburgh Sleep Quality Index and Actigraphy were used as subjective and objective sleep measures, respectively. Physical activity was assessed by the Physical Activity Scale for the Elderly. The Morningness-Eveningness Questionnaire was used to measure chronotype, which was further dichotomized into morning type and non-morning type. Multiple linear regressions were performed to examine the associations, controlling for demographic and health characteristics. We found that better subjective sleep quality, shorter actigraphy sleep duration, and higher actigraphy sleep efficiency were uniquely associated with greater physical activity. Being a morning type might alleviate the adverse association between poor subjective sleep quality and physical activity among older adults.

Effects of music interventions on sleep in older adults: A systematic review.

Sleep disruption is common among older adults. Non-pharmacological interventions involving music has emerged as a promising approach to address sleep disruption. The purpose of this systematic review was to examine the effects of music interventions on sleep outcomes among older adults (age ≥ 50). We searched five databases through May 2020 and found 16 eligible studies focused on two types of music interventions: music listening (n = 11) and multi-component (n = 5). We found mixed evidence in the efficacy of music interventions to improve sleep outcomes in older adults, which included sleep quality, objective and subjective sleep characteristics. Music listening interventions contained relaxing music with research teams personalizing music choice based on participants' preferences. Multi-component interventions included listening to music in addition to one other approach, such as massage, tai chi, and nature scenes. Future higher-quality studies should provide a detailed description of music interventions and tailor music selections to older adults' preferences.

Sleep disruption and quality of life in persons with dementia: A state-of-the-art review.

Sleep disruption in persons with dementia is pervasive and contributes to negative health outcomes and decreased quality of life. Using Lawton's framework for quality of life in persons with dementia, the aim of this state-of-the-art review was to synthesize current knowledge on the association between sleep disruption and quality of life in persons with dementia in four domains: physical, social/behavioral, emotional well-being, and cognitive. Based on the final sample of six studies, sleep disruption was negatively associated with all four quality of life domains in persons with dementia. Given the variations in research design, measurement and sample size, conclusions could not be generated on the magnitude of the effects by domain. We do, however, provide recommendations for future research and clinical practice.