Testing Cognitive Behavioral Therapy for Insomnia (CBT-I) on Dyadic Sleep in Dementia: A Randomized Control Trial

About This Grant

Project Summary Sleep disturbances are prevalent among persons living with cognitive impairment, including Alzheimer’s disease and related dementias (PLwD), affecting up to 71% of this population. These disturbances—such as difficulty falling or staying asleep—often lead to nocturnal wakefulness, increasing the likelihood of PLwD leaving their beds at night. Consequently, caregivers must remain alert to provide supervision and assistance. Combined with other caregiving responsibilities, this results in frequent sleep disruptions, fragmented rest, and persistent insomnia-like symptoms. Poor sleep is associated with numerous negative health outcomes, including depressive symptoms, cognitive decline, and a greater risk of earlier residential care placement for PLwD. Despite the widespread impact of sleep disturbances on both PLwD and caregivers, few interventions specifically address both parties, and none fully engage them together in all sessions. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard treatment for sleep disturbances, with efficacy comparable to medication. Partnered CBT-I, where partners reinforce strategies like consistent sleep schedules and stimulus control, has shown promise. Guided by the Modified Spielman 3P Model of Insomnia and the Theory of Dyadic Illness Management, we piloted a CBT-I intervention (REPAIR Sleep) delivered via videoconferencing to dyads of PLwD and their caregivers. The intervention was feasible and acceptable, with participation resulting in reduced insomnia symptoms for both PLwD and caregivers. We now plan to conduct a randomized controlled trial with 120 dyads to test the efficacy of REPAIR Sleep (a 5-week, 60-minute CBT-I intervention) compared to an attention control intervention, Healthy Living. The study will: 1) evaluate the immediate and 6-month efficacy of REPAIR Sleep versus Healthy Living on sleep outcomes for each individual in the dyad using the Insomnia Severity Index, actigraphy, and sleep diaries; 2) assess the immediate and 6- month efficacy of REPAIR Sleep versus Healthy Living on psychological outcomes for each individual in the dyad; and 3) examine whether adherence to CBT-I and interpersonal support between PLwD and caregivers mediate improvements in sleep and psychological outcomes for each individual in the dyad. This research addresses the critical need for effective sleep interventions among PLwD and their caregivers. The dyadic approach is innovative, empowering both individuals to improve their sleep while supporting each other in behavioral changes. As the number of PLwD and caregivers continues to rise, demonstrating the efficacy of this program is crucial. Successful implementation and broad accessibility of REPAIR Sleep could significantly improve sleep outcomes and mitigate the adverse effects of sleep disturbances in this population. Additionally, the findings have important public health implications, offering a scalable solution to enhance sleep and well- being among PLwD-caregiver dyads.