Efficacy of Non-Drug Protocols to Aid Sleep in Demetia

Boston College, Chestnut Hill MA

Investigators

Abstract

Disturbances in sleep are prominent and disabling secondary symptoms in Alzheimer's Disease (AD). Sleep disturbances in nursing home residents are associated with a variety of environmental and behavioral factors. An intervention that addresses environmental and resident- centered strategies can potentially improve sleep and ease daytime agitation in those with AD. The research question guiding this investigation is "Can a sleep protocol utilizing non-pharmacological sleep enhancing strategies such as calming music and a noise-light abatement program improve the quality and quantity of sleep and relieve daytime agitation in nursing home (NH) residents with AD and sleep disorders?" This study is a controlled clinical intervention utilizing 60 NH residents with AD. During Phase I of the project, a resident centered intervention consisting of 30 minutes of calming music at bedtime will be tested. During Phase II, an environmental intervention consisting of a staff-directed noise/light abatement intervention will be developed and implemented and its effect on the quality and quantity of sleep and daytime agitation will be assessed. Finally, calming music at bedtime will be delivered in the noise/light abated environment. Measurements will be collected at four points in time and will consist of: baseline, music, noise/light abatement and music in a noise/light abated environment. Data collected will consist of one week (24 hrs/day X 7 days) of Actigraph monitoring, environmental light and noise measurement, a tally of the number and type of routine and "as needed" (PRN) sedative/hypnotic medications, and scores on the Cohen- Mansfield Agitation Inventory, MiniMental Status Examination and Activities of Daily Living Scale. Data will be analyzed by Repeated Measures Multivariate Analysis of Variance (R-ANOVA) or Covariance (R-ANCOVA). It is hypothesized that when exposed to the Combined Music + Noise/Light Abatement conditions, subjects will have significantly better sleep quantity and quality and significantly less daytime verbal and motor agitation than under any of the other conditions. It is further hypothesized that subjects under both the Music Alone and the Noise/Light Abatement conditions will have significantly better sleep quantity and quality and significantly less daytime verbal and motor agitation than under Baseline conditions.