Effect of institutional respite care on the sleep of people with dementia and their primary caregivers

Study Aim/Purpose: This study sought to evaluate the impact of two weeks of institutional respite care provided in four community hospital units in East Midlands, United Kingdom on sleep patterns of patients with dementia who normally live at home. 

Summary of Methods: The authors describe their study design as “prospective case series.” Baseline measurements of sleep outcomes for 33 dyads of caregivers and patients were taken for 2 weeks prior to receipt of the institutional care, during 2 weeks of respite, and two weeks at follow-up using the Actiwatch system. Caregivers were also provided questionnaires at baseline, daily sleep diaries, and completed weekly Epworth Sleepiness Scale ratings throughout the six continuous weeks of the study. 

Summary of Results: At baseline, caregivers and dementia patients showed evidence of clinically significant sleep disturbance. For caregivers, total sleep time per night increased significantly, subjective sleep quality improved, and total time in bed per night increased during respite care. Comparing caregivers who shared a bedroom with the patient to those who did not, the former group showed less change in total sleep. For patients, respite was associated with increased sleep onset latency, reductions in total sleep time per night, and weakening of circadian activity rhythm compared to baseline. All outcomes were not sustained, shifting in the direction of baseline levels at follow up. 

Study Limitations (as cited by authors): The authors note that the absence of serial measures of caregiver mood and the short (2 week) follow-up period in this study limit the inferences that can be drawn from the data. Further, they suggest that “while the present findings offer a valuable, pragmatic and adequately powered design, a randomized controlled trial could provide a more rigorous test of respite care effect.” 

Authors’ Discussion/Conclusions: “As one of several services supporting caregivers and patients in the community, institutional respite offers the potential to improve quality of sleep and quality of life for dementia caregivers…. Future research could usefully focus on strategies that optimize the sleep quality of patients in respite care and broaden and maintain these demonstrated benefits in spousal and nonspousal caregivers. Such research should also recognize the multidimensional nature of caregiver burden and explore the relative contribution of sleep quality to the demands and satisfactions of providing care.”