S and full research articles published in SLEEP, the official journal of the APSS. Sleep and sleep disorder scientific findings.

S and full research articles published in SLEEP, the official journal of the APSS. Sleep and sleep disorder scientific findings.

Objectives: This study compared subjective (questionnaire) and objective (actigraphy) sleep assessments, and examined agreement between these methods, in vulnerable older adults participating in a Veterans Administration Adult Day Health Care (ADHC) program. Methods: 59 ADHC participants (95% male, mean age = 78 years) completed sleep questionnaires and 72 continuous hours of wrist actigraphy. Linear regression was used to examine agreement between methods and explore discrepancies in subjective/objective measures. Results: Disturbed sleep was common, yet there was no agreement between subjective and objective sleep assessment methods. Compared with objective measures, one-half of participants reported worse sleep efficiency (SE) on questionnaires while one-quarter over-estimated SE. Participants reporting worse pain had a greater discrepancy between subjective and objective SE. Conclusions: Vulnerable older adults demonstrated unique patterns of reporting sleep quality when comparing subjective and objective methods. Additional research is needed to better understand how vulnerable older adults evaluate sleep problems. Clinical Implications: Objective and subjective sleep measures may represent unique and equally important constructs in this population. Clinicians should consider utilizing both objective and subjective sleep measures to identify individuals who may benefit from behavioral sleep treatments, and future research is needed to develop and validate appropriate sleep assessments for vulnerable older adults.

Objectives: To test a new cognitive behavioral therapy for insomnia ( CBT ‐I) program designed for use by nonclinicians. Design: Randomized controlled trial. Setting: Department of Veterans Affairs healthcare system. Participants: Community‐dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159). Intervention: Nonclinician “sleep coaches” delivered a five‐session manual‐based CBT ‐I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education. Measurements: Primary outcomes, including self‐reported (7‐day sleep diary) sleep onset latency ( SOL ‐D), wake after sleep onset ( WASO ‐D), total wake time ( TWT ‐D), and sleep efficiency ( SE ‐D); Pittsburgh Sleep Quality Index ( PSQI ); and objective sleep efficiency (7‐day wrist actigraphy, SE ‐A) were measured at baseline, at the posttreatment assessment, and at 6‐ and 12‐month follow‐up. Additional measures included the Insomnia Severity Index ( ISI ), depressive symptoms (Patient Health Questionnaire‐9 ( PHQ ‐9)), and quality of life (Medical Outcomes Study 12‐item Short‐form Survey version 2 ( SF ‐12v2)). Results: Intervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6‐month assessments, and the baseline and 12‐month assessments in SOL ‐D (−23.4, −15.8, and −17.3 minutes, respectively), TWT ‐D (−68.4, −37.0, and −30.9 minutes, respectively), SE ‐D (10.5%, 6.7%, and 5.4%, respectively), PSQI (−3.4, −2.4, and −2.1 in total score, respectively), and ISI (−4.5, −3.9, and −2.8 in total score, respectively) (all P < .05). There were no significant differences in SE ‐A, PHQ ‐9, or SF ‐12v2. Conclusion: Manual‐based CBT ‐I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.

The number of informal caregivers providing assistance to adults is increasing commensurate with our aging society. Sleep disturbances are prevalent in caregivers and associated with negative physical, medical, and functional outcomes. Here, we describe the predisposing, precipitating, and perpetuating factors contributing to the development of sleep problems in caregivers, and discuss three understudied caregiving populations that have clinical importance and unique circumstances influencing sleep quality and health. There is clear evidence supporting the interaction between sleep loss, caregiving stress, and vulnerability to chronic disease. Telehealth and telemedicine sleep interventions for caregivers combined with assistive technologies targeting care-receivers have potential to be more individualized, affordable, and widely accessible than traditional in-person insomnia treatment approaches. Limited data exist describing the etiology and treatment of sleep problems in caregivers of veterans, medical patients newly discharged from the hospital, and developmentally disabled adults. There is a growing literature describing the general determinants of sleep disturbances in caregivers, the health consequences of these disturbances, and intervention strategies for treating them. Identifying effective sleep treatments suited to more specialized caregiving situations and increasing intervention access will help caregivers continue to provide quality care while protecting their own health and well-being.