Sleep association between spousal caregiver and person with dementia having REM sleep behavior disorder: a case study using wearable technology

Abstract

AbstractBackgroundRapid eye movement sleep behavior disorder (RBD) is manifested by dreams associated with recurrent abnormal behaviors during sleep including punching, running, jumping out of bed with potential injuries to partners and more often found in persons with dementia (PWD). This is significantly associated with increased caregiver’s sleep disturbances, stress, and health problems that has not been measured objectively. The purpose of this case study was to identify sleep characteristics of a spouse caregiver and dyadic sleep diary for both PWD and caregiver. Furthermore, using Wearable Internet of Things (WIOT) technology (smartring and smartphone) for the caregiver, we examined sleep parameters (e.g., resting heart rate, heart rate variability (HRV), sleep efficiency, deep sleep, REM sleep, and awake time at night) for 4 weeks.MethodsThis case study used mixed methods. A spouse caregiver (wife) and a PWD with RBD (both aged in 70s) living together were recruited. The caregiver wore the smartring 24/7 for 4 weeks. Additionally, the caregiver reported sleep diaries for herself and PWD for 4 weeks including nap time, feeling on wakening, and descriptions of their sleep experiences. At the end, the caregiver was interviewed to understand the perceived sleep experience in relation to PWD’s sleep. T‐tests were used to compare means of sleep parameters–continuous longitudinal data collected by WIOT device.ResultsSleep efficiency, HRV, and awake time of the caregiver were significantly better in the nights when PWD did not have disruptive sleep behaviors compared to those nights with them (all Ps<0.05). The subjective Pittsburg‐sleep‐quality‐index(PSQI) score for the caregiver was 4 at both baseline and 4 weeks. Caregiver’s sleep diary notes showed PWD’s disruptive sleep behaviors for 8/28 days (28.6%), including bed soiling, multiple awakenings, excessive movement during sleep, aggressive behaviors – throwing out things while dreaming. In the exit interview, the caregiver expressed that RBD symptoms interrupted her sleep, however she wanted to care for PWD during the night by sleeping together.ConclusionThis case report using WIOT objective measures found PWD’s disruptive behaviors caused the caregiver to have less sleep efficiency and greater awakenings. Subjectively using PSQI the caregiver did not acknowledge her disruption.