Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial

Objectives: To evaluate whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE‐AD)) could improve sleep in dementia patients living at home with their family caregivers. Design: A randomized, controlled trial. Participants: Thirty‐six community‐dwelling patients with Alzheimer's disease (AD) and their family caregivers. Intervention: All participants received written materials describing age‐ and dementia‐related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=17) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills. Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box. Control subjects (n=19) received general dementia education and caregiver support. Measurements: Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep‐wake activity measured at baseline, posttest (2 months), and 6‐month follow‐up using an Actillume wrist‐movement recorder. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, and the Revised Memory and Behavior Problem Checklist. Caregiver self‐reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale. Results: Patients participating in NITE‐AD showed significantly greater (P