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In the United States half of the 15 million informal caregivers of persons with Alzheimer's disease or a related dementia (PWDs) do not live with the PWD. This paper compares the sleep quality and health of 59 community-dwelling caregivers living with the PWD and 21 living apart from the PWD. Variables of interest were caregiving experience (hours caregiving, problematic behaviors of the PWD, caregivers' perception of dementia severity), sleep quality, and health (perceived health, stress, and depressive symptoms). Parametric unpaired t tests were used to calculate the differences between key variables. Multiple regression models were constructed, controlling for age, gender, behavior index, and dementia severity to examine the variance explained by living arrangements on sleep quality and health. Caregivers living apart from the PWD experienced the same level of poor sleep quality as did caregivers living with the PWD. The living arrangements of the caregiver did not make a unique contribution to sleep quality or health variables except for reports of unhealthy days. Given the importance of good quality sleep for health, the findings highlight the importance of evaluating caregivers living apart from the PWD for sleep problems with the same level of concern as one would have for those living with the PWD., (© The Author(s) 2014.)

Dementia caregiving is stressful and can result in negative health outcomes. Understanding the intermediate dynamic changes in caregiving may help nurses target interventions. The purposes of this study were to measure short-term changes in sleep, mastery, and stress in dementia caregivers and to explore their impacts on caregiver depression and health. Seventy-four caregivers were measured at baseline, 4, and 8 weeks for changes in global mastery, caregiver mastery, sleep quality, perceived stress, depression, and health. Over the 8 weeks, changes were observed in sleep, mastery, stress, and health measures, indicating support for the dynamic and complex nature of dementia caregiving. Sleep and perceived stress made unique contributions to depression, but the contributions to health varied. Clinical implications for nurses are to assess caregivers frequently and reinforce successful interventions periodically as caregiving evolves., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Aims and Objectives: To examine caregiver sleep quality, especially in relation to the daytime and night-time behaviours and psychological symptoms exhibited by persons with dementias., Background: Caregivers of persons with dementias experience poorer sleep in comparison with noncaregivers, and poor sleep is related to negative health outcomes. The reasons for caregivers' poor sleep are complex, and it is known that the night-time behaviours of the persons with dementia contribute to caregiver sleep disruption. However, the frequency of behavioural and psychological symptoms of dementia has hitherto not been sufficiently explored as a contributing factor to poor caregiver sleep., Design: A nonexperimental cross-sectional design., Methods: Eighty caregivers completed questionnaires on the frequency of behavioural and psychological symptoms of the persons with dementia, the Dementia Severity Rating Scale, the Pittsburgh Sleep Quality Index and the Center for Epidemiologic Studies Depression Scale., Results: Poor sleep was reported with awakenings by the persons with dementia occurring for more than half of the caregivers. The frequency of behaviours and symptoms did not make a unique contribution to the variance of caregivers' global sleep. The frequency of behaviours, and specifically of agitation and apathy, contributed to the variance in subjective sleep quality, as defined by the caregivers' appraisal of their sleep., Conclusions: The findings demonstrate the relationship between (1) daytime and night-time behaviours of persons with dementias and (2) their caregivers' sleep quality and emphasise the complexity of the factors that contribute to caregiver sleep quality., Relevance to Clinical Practice: These findings suggest that nurses should be cognizant of the relationship between daytime behaviours of the persons with dementia and the caregivers' appraisal of their sleep, realising that appraising one's sleep as poor can be a contributing factor to perpetuating sleep problems. Interventions aimed at helping the caregiver manage the persons with dementia's agitation or the caregiver's emotional response to persons with dementia apathy may improve caregivers' perception of their sleep., (© 2013 Blackwell Publishing Ltd.)

Purpose/objectives: To describe caregiver sleep and depression using caregiver narratives. To compare qualitative descriptions with quantitative scores., Design: Descriptive, one-time, open-ended interview followed by structured sleep and depression questions., Setting: Interview conducted in person or via telephone at caregiver's preference., Sample: 47 caregivers of patients with advanced stage cancer. Caregivers had a mean age of 54 years, and most were female (81%), Caucasian (82%), and spouses (61%). They provided care for a mean of 24 months. Patients' diagnoses were lung cancer (36%), colorectal cancer (13%), or recurrences (51%)., Methods: Two cancer care sites in southern California provided participants. After consent, the researcher conducted interviews. The Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiological Studies-Depression (CES-D) instruments were administered following interviews., Main Research Variables: Sleep pattern changes and depression levels over time as defined by caregivers., Findings: Caregivers described severe fluctuations in sleep patterns over time and how these changes affected caregiver depressive symptoms. PSQI and CES-D scores matched narrative comments., Conclusions: Caregivers' narratives suggest they suffer progressive sleep deprivation that affects their emotions and ability to continue as caregivers., Implications for Nursing: Nurses must recognize the severe sleep problems experienced by caregivers and respond with interventions to increase sleep quality and decrease depression.

Discrepancies between subjective and objective sleep measures have been reported for some time; however, it is critical to consider the implications of inaccurate or incomplete sleep assessment for frail older adults who are struggling to maintain independence. To compare sleep assessment methods, we collected objective sleep measurements, subjective measures via self-report sleep surveys, and qualitative data through semi-structured audio-recorded interviews, from five older adults who self-reported sleep problems while living in a retirement community in the southwestern US. Participants' objective sleep and qualitative narratives were congruent, but self-report measures failed to capture several unique sleep problems identified in the sample. A sleep assessment tool specifically designed to measure older people's sleep experiences could provide more accurate and sensitive data. [ABSTRACT FROM AUTHOR]

• Insomnia in older adults is under recognized and undertreated, and not a result of normal aging. • Insomnia has significant negative effects on quality of life and daily functioning, and leads to increased stress and social isolation. • Qualitative methods reveal negative outcomes from insomnia not captured in traditional sleep assessments. Insomnia in older adults has been linked to increased incidence of falls, depression and anxiety, cognitive impairment, institutionalization, and mortality, but traditional sleep assessment instruments, designed for the general adult population, fail to capture many of the experiences and causes that are unique to older adults. This mixed methods study elicited open narratives from 18 older adults (6 men,12 women, mean age 84, SD= 7.62, range 67–96) who reported chronic insomnia or disrupted sleep to learn how poor sleep affected their quality of life and daily functioning. The interviews were supplemented with three widely used self-report sleep instruments to provide baseline sleep quality and hygiene scores. Content analysis of the participants' narratives revealed the overriding theme of Insomnia Is Exhausting , which exemplifies the physical and emotional strain this chronic condition creates, and four categories : A Bad Night, Self-Management, Stoicism and Consequences. The narratives revealed severe, negative effects on quality of life, including reduced functional capacity and increased stress, anxiety, and social isolation. The results of this study can be used as a foundation for interventions to enhance sleep quality for this population. [ABSTRACT FROM AUTHOR]

Objective: Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy.Methods: Women 21 to 65 years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated.Results: Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = -0.37 to -0.49, Ps < .00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance.Conclusions: Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research. [ABSTRACT FROM AUTHOR]

Nurses practicing in long-term care or rehabilitation settings face unique challenges from prolonged or repeated exposure to stressors, given their extended time with patients. This puts them at risk for compassion fatigue, burnout, and secondary traumatic stress, which can lead to decreased resilience and sleep problems. The aim of this study was to examine relationships among resilience, professional quality of life, sleep, and demographics in nurses working in long-term care or rehabilitation settings, and to investigate whether demographics, professional quality of life, and sleep quality are significant predictors of nurses' resilience. In this cross-sectional study, we used the following measures: demographics, the Connor-Davidson Resilience Questionnaire, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Scale (ProQOL). Data were analyzed with SPSS v25. Data analysis consisted of descriptive statistics, bivariate correlations, and multiple regression. Participants (N = 120) were mostly female (85%) and registered nurses (90%). Mean scores were 52.13 for resilience and 7.53 for sleep quality. Mean ProQOL subscale scores were 41.78 for compassion satisfaction, 22.28 for compassion fatigue, and 23.92 for secondary traumatic stress. Multiple regression models showed that compassion satisfaction, burnout, and secondary traumatic stress significantly predicted resilience (β = 0.69, β = −0.61, and β = −0.34, respectively, all p <.05). Resilience is important in nurses' personal and professional lives because it helps to protect nurses from the negative consequences of stressors. Strategies, resources, and workplace support can promote self-care and resilience. • Nurses working in rehabilitation/long-term care are at risk of compassion fatigue. • Higher secondary traumatic stress and burnout link to lower resilience. • Self-care strategies and healthy sleep improve resilience. • Nurses with higher compassion satisfaction show greater resilience. • Early recognition of stressors and actions are critical in promoting resilience. [ABSTRACT FROM AUTHOR]

This cross-sectional study described personality and coping and examined their relationships with depression and sleep in 51 adult caregivers of individuals who have cancer. Findings are compared with dementia caregiver literature. Fifty-two percent of caregivers reported Center for Epidemiological Studies-Depression (CES-D) scores greater than 16, and 95% reported Pittsburgh Sleep Quality Index (PSQI) scores greater than 5, indicating risk for clinical depression and severe sleep problems. Less functional coping, optimism, mastery, neuroticism, and sleep predicted 66.4% of the variance in depression. Less functional coping, mastery, neuroticism, and depression predicted 41% of the variance in sleep. Neuroticism and mastery predicted 45.3% of the variance in less functional coping strategies. Caregiver optimism and mastery levels were consistent with levels found in dementia studies. Neuroticism scores were higher than in studies of caregivers of individuals with dementia. Mastery and neuroticism were related to depression, as in other caregiver studies. Findings suggest there are far more similarities than differences between caregivers of individuals who have cancer and caregivers of those who have dementia. Caregiver personality and coping strategies appear to be related to caregiver outcomes similarly in the cancer and dementia populations. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe how sleep and bereavement may be related in family caregivers. Design: Descriptive and qualitative. Selling: Participants' homes. Sample: 9 adults with no previous diagnoses of clinical depression or sleep disorders who had been providing care to family members who died in the previous six months. Methods: Participants provided narrative accounts of sleep quality, bereavement, and daily functioning since the death of their family members Participants' sleep quality and depressive symptoms also were measured with the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiological Studies-Depression Scale (CES-D). Main Research Variables: Sleep quality, depressive symptoms, bereavement, and daily functioning. Findings: Narratives revealed five themes: nightmares, wake after sleep onset, scheduling, daily life, and bereavement. Participants scored high on the PSQI and CES-D. Conclusions; Sleep quality appears to affect bereavement and daily functioning. Participants reported severe levels of sleep disturbance and depressive symptoms. implications for Nursing: Studies are needed to explore sleep quality in bereaved caregivers and to examine the relationship between sleep quality and an individual's ability to accomplish the tasks of bereavement. [ABSTRACT FROM AUTHOR]

Taiwanese mothers have identified insufficient sleep as a major manifestation of postpartum depression. Few studies have thoroughly examined the relationship between sleep and depression during the early postpartum period, however. The objectives of this study were to compare the characteristics of both the postpartum sleep and daytime sleepiness of depressed first-time mothers and of their non-depressed counterparts, and to determine the factors that significantly increased mothers' risks of being depressed. A non-probability sample of 163 first-time mothers completed a questionnaire between the 13th and 20th days of the postpartum period. The Center of Epidemiological Studies- Depression and Pittsburgh Sleep Quality Index were used to measure mothers' experiences of depression symptoms and sleep. Daytime sleepiness was estimated in four ways, derived from the Roy Adaptation Model. The results indicated that the depressed mothers had poorer sleep quality than the non-depressed mothers, slept less efficiently, reported more sleep disturbances, and exhibited more daytime dysfunctions. Mothers who frequently perceived their daytime sleepiness to be affected by infant-care performance were more likely to be depressed. The study's findings support the view that there is a connection between depression and poor sleep among postpartum mothers in Taiwan, and indicate that depressed mothers' experiences of poor sleep are multi-faceted, and not simply a matter of insufficient sleep. [ABSTRACT FROM AUTHOR]

Hospice nurses are chronically bereaved. They experience and help others through the grief of loosing a loved daily. Chronic stress, such as that experienced by hospice nurses, has been linked to complaints of insomnia. While hospice nurses are specially trained to assist others in their bereavement process, they often neglect their own needs, leaving themselves vulnerable to burnout. Burnout of these highly trained nurses negatively affects both the nurse and the patients and families. This study explored the effectiveness of a behavioral sleep intervention to improve sleep quality and depressive symptoms. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were measured with the Center for Epidemiologi-cal Studies Depression (CESD) scale. Specific questions were: 1. Will a behavioral sleep intervention improve nurse sleep quality as measured by the sleep variables of latency, duration, and efficiency? 2. Will nurses express improvement in depressive symptoms from baseline to post sleep intervention? Stress process theory guided this study. Chronic stress increases risk for negative outcomes (insomnia & depression). A 5-week repeated measures design was used to explore the effectiveness of a behavioral sleep intervention to improve sleep quality and depressive symptoms in hospice nurses. The intervention was delivered in two 1-hour sessions and included stimulus control, sleep hygiene, relaxation, and cognitive behavioral education. Goal setting and monitoring was used to individualize the intervention. Sessions were group format and delivered on-site at the hospice facility. Self-report sleep (PSQI) and depression (CESD) were measured at baseline, three and 5 weeks. Descriptive statistics were used. 13 nurses participated in the study. Nurses' average age was 52 years. Average years in practice were 19, with an average of 5 years in hospice. Mean PSQI was 10(sd5), CESD was 17(sd12). Sleep variable averages were: latency =30 minutes, duration = 6 hours, efficiency = 75%. There were minor improvements in sleep and depressive symptoms over time; however, sample size precluded significance testing. Hospice nurses are at high risk for chronic bereavement. Insomnia and depression are common problems. Behavioral therapies appear to improve insomnia in this population. If insomnia is successfully treated, depression and burnout may be less likely. Funding Sources: The Cain Excellence Fund at The University of Texas at Austin [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. Data Sources: Published articles, books and book chapters, conference proceedings, and MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature®, PsycINFO, and the Cochrane Library computerized databases. Data Synthesis: Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. Conclusions: Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. Implications for Nursing: All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority. [ABSTRACT FROM AUTHOR]