Timed Activity to Minimize Sleep Disturbance in People With Cognitive Impairment

Nancy A Hodgson; Miranda V McPhillips; Darina V Petrovsky; Adriana Perez; Sonia Talwar; Nalaka Gooneratne; Barbara Riegel; Subhash Aryal; Laura N Gitlin

doi:10.1093/geroni/igad132

Timed Activity to Minimize Sleep Disturbance in People With Cognitive Impairment

Innov Aging. 2023 Dec 8;8(1):igad132. doi: 10.1093/geroni/igad132. eCollection 2024.

Authors

Nancy A Hodgson¹, Miranda V McPhillips¹, Darina V Petrovsky², Adriana Perez¹, Sonia Talwar¹, Nalaka Gooneratne³, Barbara Riegel¹, Subhash Aryal¹, Laura N Gitlin⁴

Affiliations

¹ School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² School of Nursing, Rutgers University, New Brunswick, New Jersey, USA.
³ Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.

Abstract

Background and objectives: Sleep disturbances occur in >60% of persons living with cognitive impairment, affecting their quality of life (QOL). Regulating the sleep-wake cycle through engaging cognitive, physical, and sensory-based activities delivered at strategic times may reduce sleep disturbances and be a feasible nonpharmacological treatment for sleep problems. The objective of this trial was to test the efficacy of a timed-activity intervention in improving QOL and sleep disturbances in persons living with cognitive impairment.

Research design and method: Randomized 2-group parallel design involving 209 dyads of community-residing persons living with cognitive impairment and care partners. Dyads were randomly assigned (1:1) to 1-hr home activity sessions administered weekly in the morning, afternoon, or evening over 4 weeks (the Healthy Patterns Sleep Program), or to an attention-control condition consisting of sleep hygiene training plus education on home safety and health promotion. QOL, objective and subjective sleep quality, and neuropsychiatric symptoms were assessed at baseline and 4 weeks later.

Results: QOL was significantly improved in the intervention group compared to control (p = .0491). There were no significant effects on objective or subjective sleep or neuropsychiatric symptoms. In a subgroup analysis, subjective sleep as measured by the PROMIS (Patient Reported Outcomes Measurement Information System) Sleep-Related Impairment survey was significantly improved in the intervention group compared to the control group for individuals with symptoms of depression (p = .015) or poor observed sleep at baseline (p = .005).

Discussion and implications: The Healthy Patterns Intervention may benefit QOL for persons living with cognitive impairment and those with poor subjective sleep. A longer dose may be necessary to elicit improvement in actigraphically measured sleep-wake activity.

Clinical trial registration number: NCT0368218 5.

Keywords: Cognitive impairment; Dementia family caregiving; Nonpharmacological strategies; Quality of life; Sleep disturbances.