Psychoeducation Group (McCurry)

Name of Intervention: CBT for insomnia in dementia caregivers

Principal Investigator (s): Susan M. McCurry, Ph.D.

Institutional Affiliation: University of Washington

PI contact information: Susan M. McCurry, Ph.D., School of Nursing, University of Washington, 9709 3rd Ave NE, Suite 507, Seattle WA 98115-2053, smccurry@u.washington.edu

Caregiver Intervention Description - Successful behavioral treatment for reported sleep problems in elderly caregivers of dementia patients: A controlled study

1. Summary of Intervention

The intervention was a combination cognitive-behavioral treatment for insomnia designed for use with caregivers of persons with dementia. The treatment included education about good sleep practices (“sleep hygiene” and “stimulus control” recommendations), as well as training in stress management/relaxation techniques and behavioral management skills for reducing dementia-related behavior problems. Caregivers were also placed on a sleep compression schedule to reduce total time in bed at night. The treatment was initially implemented as a 6-week, group intervention then, based upon feedback from caregivers, modified to be a 4-week, individual treatment.

The intervention followed a standardized treatment manual. However, the type of sleep problems caregivers experience vary, so specific sleep hygiene, stimulus control, and sleep restriction recommendations were individualized for each person.

Caregivers in active treatment showed significant improvements in self-reported sleep quality at post-treatment and 3-month follow up, compared to no-treatment control subjects.

Key search terms:

Sleep, insomnia, Alzheimer’s disease, dementia, cognitive-behavioral therapy, empirically based treatments

2. Intervention Materials

A treatment manual was followed. Caregivers kept a daily sleep log. They received handouts with standard sleep hygiene/stimulus control recommendations, forms to assist in problem-solving dementia-related behavioral disturbances, and a copy of the Pleasant Events Schedule for Alzheimer’s disease (PES-AD; Logsdon & Teri, 1995). A copy of the 4-session version of the treatment manual, including a sample sleep log and study handouts, is available from Susan M. McCurry, Ph.D., School of Nursing, University of Washington, 9709 3rd Ave NE, Suite 507, Seattle WA 98115-2053, smccurry@u.washington.edu.

3. Implementing the Intervention

Training qualifications and guidelines for those delivering the intervention:

The published intervention was conducted by a PhD-level psychologist, but could be implemented by MS-level health care professionals. No current training program to implement the intervention is in place.

Estimated costs of implementing the intervention:

Delivery costs: The intervention is 4 sessions over four weeks; each session is one hour in length. It could be done in either group or individual format, in-home or in-facility (group sessions would run 1.5 hours to allow sufficient time for group interaction around the study material). It is designed to be delivered by a professional (not lay leaders). Prior to beginning therapy, caregivers should provide two weeks of baseline sleep diary information, to guide trainers in developing individualized sleep hygiene, stimulus control, and sleep restriction recommendations.

Costs of materials: Reproduction costs are minimal: the treatment manual is 22 pages. Caregiver sleep diaries and self-report sleep outcome measures range up to several pages each. If actigraphy or polysomnography were to be used to measure sleep outcomes instead of self-report, costs would increase substantially for equipment and/or clinical laboratory time and interpretation costs.

Caveats/ limitations on the implementation of this intervention:

Outcomes reported in the paper are based only upon caregiver self-report, and the follow-up period was brief (3 months). Younger caregivers and persons who had better compliance with treatment recommendations had better treatment outcomes.

4. For more information

SM McCurry, RG Logsdon, L Teri (1996) Behavioral treatment of sleep disturbance in elderly dementia caregivers. Clinical Gerontologist, 17(2), 35-50.

SM McCurry, RG Logsdon, L Teri, MV Vitiello (2007) Sleep disturbances in caregivers of persons with dementia: Contributing factors and treatment implications. Sleep Medicine Reviews, 11, 143-153.

SM McCurry, RG Logsdon, L Teri, MV Vitiello (2007) Evidence-based psychological treatments for insomnia in older adults. Psychology and Aging, 22(1), 18-27