Family caregivers' sleep disturbance and its associations with multilevel stressors when caring for patients with dementia

Objective: We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD). Methods: For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD-FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs' neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs' distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale - Short Form, and sleep disturbance by the General Sleep Disturbance Scale. Results: FCGs' most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs' sleep disturbance was predicted by their physical fatigue, their depressive symptoms, and the synergistic effect of physical fatigue and depressive symptoms in the final model, explaining 57.8% of the variance. Conclusions: This study supports the model that development of caregivers' sleep problems may depend on their depression, fatigue, and the synergistic effects of these two variables. These findings suggest that clinicians should educate FCGs' about self-care and offer strategies for dealing with a cluster of symptoms when maintaining sleep hygiene.