JMIR Publications

ABSTRACT

Chronic insomnia affects up to 63% of family dementia caregivers. Research suggests chronic insomnia prompts changes in central stress processing that have downstream negative effects on health, mood, cognitive, inflammatory, and neurodegenerative functioning. We hypothesize cognitive behavioral treatment for insomnia (CBT-I) will reverse those downstream effects by improving insomnia and restoring healthy central stress processing. Rural caregivers are particularly vulnerable, but have limited access to CBT-I so we developed an accessible digital version using community input (NiteCAPPSM CARES). This trial will evaluate NiteCAPPSM CARES’ acceptability, feasibility, and short-term and long-term effects on the sleep and stress mechanisms underlying poor caregiver health and functioning. Knowledge obtained will address not only what outcomes improve, but also how/why they improve and for how long which will help us to modify NiteCAPPSM CARES to optimize treatment potency and support future pragmatic testing and dissemination. Dyads (N =100) consisting of caregivers with chronic insomnia and their co-residing persons with dementia will be recruited from Columbia Missouri and surrounding areas. Participant dyads will be randomized to 4 weeks (plus 4 bimonthly booster sessions) of NiteCAPPSM CARES or a web-based sleep hygiene control (NiteCAPPSM SHARES). Participants will be assessed at baseline, post-treatment, 6- and 12-month follow-ups. The following assessments will be completed by caregivers: 1 week of actigraphy and daily diaries measuring sleep, insomnia severity index, arousal (heart rate variability), inflammation (blood derived biomarkers: IL-6, CRP), neurodegeneration (blood derived biomarkers: Aβ40/42, ptotal tau, ptau181, ptau217), cognition (joggle battery, NIH toolbox, Cognitive Failures Questionnaire), stress/burden, health, and mood (depression, anxiety). Persons with dementia will complete 1 week of actigraphy at each timepoint.