A brief behavioral sleep intervention for family caregivers of persons with cancer

Behavioral interventions that support caregivers' restful sleep may delay the onset or decrease the severity of debilitating depressive symptoms. This, in turn, may increase caregivers' physical and psychological health and wellbeing. A repeated-measures experimental design was used to test the feasibility and effectiveness of a brief behavioral sleep intervention for family caregivers of persons with advanced stage cancer. The CAregiver Sleep Intervention (CASI) includes stimulus control, relaxation, cognitive therapy, and sleep hygiene elements. CASI is individualized and delivered to accommodate caregiver burden. Thirty adult caregivers participated. The Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiological Studies-Depression scale (CES-D), and Caregiver Quality of Life-Cancer scale (CQOLC) were used to measure self-reported sleep quality, depressive symptoms, and quality of life. Actigraphs measured latency, duration, efficiency, and wake after sleep onset (WASO) scores. Data were collected at baseline, 3 and 5 weeks, 2, 3, and 4 months post baseline. Improvement was seen across groups; however, intervention caregivers showed more improvement in PSQI and CES-D scores than control caregivers. The CASI appears to be effective in improving sleep quality and depressive symptoms in caregivers of persons with cancer. Improvements in quality of life scores were similar across groups. Sample size and homogeneity limit generalizability.     

Personality and coping: predictors of depression and sleep problems among caregivers of individuals who have cancer

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.     

Sleep and depression in cancer caregivers

A cross-sectional, correlational design was used to describe and explore the relation between caregiver sleep and depression. For the study, 51 caregivers were recruited from two sites in southern California. Caregivers were primarily white (84%), female (80%), spouses (61%), or adult children (29%), who had provided care for a mean of 16 hours per day for an average of 2 years. The Center for Epidemiological Studies-Depression (CES-D)and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiver depression and sleep, respectively. Most of the caregivers (95%) expressed severe sleep problems, and more than half of them were experiencing depressive symptoms at a level that would suggest risk for clinical depression. Correlations were strongest between caregiver depression and the sleep subscales of overall quality (r = 0.70; p < 0.001), habitual sleep efficiency (r = 0.54; p < 0.001), and daytime dysfunction (r = 0.59; p < 0.001). The final regression model, which included these subscales, predicted 63.6% of the variance in depression scores (F = 27.32; p < 0.001). These findings, which are consistent with results from other studies, suggest that caregivers of persons with terminal illness are at risk for clinical depression. It is critical for nurses to be cognizant of the relation between sleep problems and depression, and to explore interventions that would allow the caregivers to obtain needed sleep without diminishing their ability to function in their role as caregiver.     

认知行为疗法对乳腺癌术后化疗患者睡眠质量的影响

目的探讨认知行为疗法（渐进性放松训练联合刺激控制疗法）对改善乳腺癌术后患者睡眠质量的效果。方法采用随机对照研究,将56例乳腺癌术后化疗患者随机分为干预组和对照组各28例。对照组接受乳腺癌术后化疗患者的常规护理;干预组在此基础上,接受为期18周的认知行为治疗。干预前和干预结束后分别用匹兹堡睡眠质量指数问卷（Pittsburgh sleep quality index,PSQI）对两组患者进行评定。结果干预前两组患者PSQI各项得分和总分比较差异无统计学意义（P〉0．05）;干预后干预组患者PSQI量表总分及睡眠质量、入睡潜伏期、睡眠时问、睡眠效率、睡眠障碍、催眠药物、日间功能障碍因子分均低于对照组,差异有统计学意义（P〈0．01）。结论认知行为疗法能有效改善乳腺癌术后化疗患者的心理健康状况,提高患者睡眠质量。     

'Appears to have slept well': assessing sleep in an acute care setting

Sleep disturbance is a common occurrence in the hospital environment where the patients' perceptions of their own sleep are rarely considered in the planning of care. This study aims to determine the difference between subjective (Verran/Snyder-Halpern Sleep Scale), objective (Patient's Sleep Behaviour Observational Tool) and physiological (Actigraph) assessments of a patients' single sleep event within an acute care setting by examining the variables Total Sleep, Midsleep Awakening and Sleep Latency. Results indicate no statistically significant difference between instruments for the assessment of total sleep. Midsleep awakening was of questionable value when assessed in the clinical environment. Sleep latency could be useful following further attention to defining the length and time of onset of the nurse observation period.     

Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease

BACKGROUND: Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. METHODS: The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study - Short Form 36. FINDINGS: The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. CONCLUSION: This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients.     

Music improves sleep quality in older adults

AIM: The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan. BACKGROUND: Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults. METHOD: A randomized controlled trial was used with a two-group repeated measures design. Sixty people aged 60-83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality. RESULTS: Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction (P = 0.04-0.001). Sleep improved weekly, indicating a cumulative dose effect. CONCLUSION: The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.     

Sleep problems,anxıety,depressıon and fatıgue on famıly members of adult intensıve care unıt patıents

The purpose of this study was to determine the levels of sleep problems, anxiety, depression and fatigue in family members of intensive care patients in Turkey and factors affecting these complaints. This cross‐sectional study was carried out with 350 first‐degree relatives of intensive care patients at a university and state hospital. Data were collected between 5 January and 30 May 2014 using a personal information form, the Visual Analogue Scale for Fatigue, the Hospital Anxiety and Depression Scale and the modified Post Sleep Inventory. Of the 350 family members, 76% reported moderate or more serious problems. Anxiety was reported by 81.4% of the family members, and depression by 94.2%. Family members in the study had fatigue, with average scores of 79.42. There were significant correlations between the Visual Analogue Scale for Fatigue and anxiety, depression and scores on the Modified Post‐Sleep Inventory (P < 0.05). Family members of intensive care patients experienced symptoms of fatigue, anxiety, depression and sleep problems. The prevalence of symptoms of sleep problems, anxiety and depression and complaints of fatigue was significantly higher in the family members of intensive care patients in Turkey than reported in the literature.     

癌症患者睡眠质量与心理健康状况调查分析

目的 了解癌症患者睡眠质量及心理状况.方法 采用匹兹堡睡眠质量指数（PSQI）、临床症状自评量表（SCL-90）测试96例癌症患者.结果 有癌痛的患者PSQI总均分高于无癌痛组（P〈0.05）.10.2%癌症患者存在心理问题;87.5%的癌症患者存在睡眠问题,9.38%的患者睡眠质量较差,女性睡眠质量较差者的发生率明显高于男性（P〈0.05）.癌症患者的SCL-90得分除人际关系敏感、偏执和精神病性3个因子外,其余6个因子平均分均明显高于常模（P〈0.05）.SCL-90总分与PSQI各成分除睡眠时间、催眠药外,相关系数均在0.32以上,且有显著性意义（P〈0.05）.结论 癌症患者的睡眠问题影响其心理健康.     

晚期肺癌姑息患者主要照护者的睡眠质量

目的调查晚期肺癌姑息患者主要照护者的睡眠质量并分析其影响因素。方法 2016年2-11月,采用便利抽样法选取在宁波市第二医院经诊断为晚期肺癌进行姑息治疗的患者及其主要照护者各102名为研究对象,采用匹兹堡睡眠质量指数量表(Pittsburgh quality sleep index,PSQI)评定其睡眠质量。结果晚期肺癌姑息患者主要照护者的睡眠障碍发生率为66.7%,PSQI得分(8.02±2.9)明显高于国内常模(P0.001)。照护者性别、患者病程、并发症、家庭人均月收入、主要照护者自身健康状况、参与照护人数是影响主要照护者睡眠质量的因素。结论晚期肺癌姑息患者主要照护者的睡眠质量低,应重视照护者睡眠质量的影响,将对其的评估纳入疾病管理方案中。     

Music improves sleep quality in older adults

Aim.  The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan.
Background.  Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults.
Method.  A randomized controlled trial was used with a two-group repeated measures design.
Sixty people aged 60–83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality.
Results.  Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction ( P  = 0·04–0·001). Sleep improved weekly, indicating a cumulative dose effect.
Conclusion.  The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.     

主观睡眠质量与抑郁症患者自杀的关系

INTRODUCTIONPatientswithdepressionfrequentlyreportdisturbedsleep，includingdifficultieswithsleeponset，sleepmaintenance，andearlymorningawakening，sometimeshypersomnia．Itwassuggestedthatinsomniacouldbeanearlysymptomof，oramarkerofvulnerabilitytode－pression．Ithasbeenreportedthatdifferentkindsofdisturbedsleepmayaffectsuicidalityinbothdepressivepatientsandnormalpopu－lation犤１－２犦．Thepurposeofthisstudywastoexaminetheassociationbetweensleepqualityandsuicidalityinmajordepressivepatients…     

A comparison of disrupted sleep patterns in women with cancer-related fatigue and postmenopausal women without cancer

Purpose

Fatigue and disrupted sleep often coexist and both are prominent clinical problems in cancer affecting quality of life. Disrupted sleep patterns are likely related to cancer-related fatigue. The relationship needs further investigation. This study aimed to characterize and compare disrupted sleep patterns in fatigued breast cancer patients receiving chemotherapy with postmenopausal women without a history of cancer. Anxiety levels were also examined.

Methods

Data for this secondary analysis came from two studies. Global sleep quality and state anxiety were self-reported by 30 fatigued female breast cancer chemotherapy outpatients and 32 non-cancer postmenopausal women using Pittsburgh Sleep Quality Index (PSQI) and State-Trait Anxiety Inventory, respectively.

Results

Fatigued breast cancer patients showed significant sleep difficulties, characterized by prolonged sleep onset latency (M = 54.3, SD = 49.2 min) and frequent nighttime awakenings, despite 40% of the patients using sleep medications three or more times a week. Compared to the non-cancer comparison group, fatigued patients reported significantly longer sleep latency (p = 0.041), more use of sleep medications (p = 0.006), and higher total PSQI scores (p = 0.005). State anxiety levels did not differ between the two groups (p = 0.88).

Conclusions

Sleep is disrupted in fatigued breast cancer women undergoing chemotherapy. Nearly all fatigued patients (97%) had trouble sleeping (global PSQI scores > 5), indicating significant difficulties in overall sleep quality among those patients. Knowledge of the nature of sleep disruption among cancer patients may contribute to CRF symptom management leading to tailored interventions designed to improve sleep quality in cancer patients thereby managing fatigue and improving quality of life.     

Social problem-solving partnerships with family caregivers.

The goal of this pilot study was to compare the effectiveness of home and telephone social problem-solving partnerships on primary family caregiver outcomes and to determine whether certain caregiver and stroke survivor characteristics influenced these outcomes. Thirty primary family caregivers were assigned to either a home visit, telephone contact, or control group. A registered nurse trained caregivers in the intervention groups in a series of seven telephone calls or home visits during a 12-week period to use social problem-solving skills in managing caregiving problems. Primary family caregiver outcomes were compared before the intervention, during the intervention (at 2 and 5 weeks after discharge), and after the intervention (at 13 weeks after discharge). Compared to the home and control groups, the telephone group had a significant reduction in depression, more positive problem-solving skills, and greater caregiver preparedness during the intervention, and improved, but nonsignificant depression, problem-solving, and caregiver preparedness scores postintervention. Race, age, and education were significant for selected outcomes.     

Impact of Alzheimer disease patients' sleep disturbances on their caregivers

Sleep disturbance symptoms are common in persons living with Alzheimer disease (AD). However little is known about the impact of sleep disturbance symptoms in patients living with AD on caregiver burden and quality of life (QOL). The aims of this study were to determine the prevalence of symptoms of disturbed sleep in patients with AD, identify the care-recipient sleep disturbance symptoms that predict caregiver burden and QoL, and determine how care-recipient sleep disturbance symptoms compare to other caregiver and patient characteristics when predicting caregiver QoL. Caregiver burden was assessed using the Screen for Caregiver Burden. Sixty percent of the care-recipients had at least one sleep symptom. In 130 caregiver/patient dyads, nocturnal awakenings, nocturnal wandering, and snoring predicted caregiver burden. Multivariate modeling demonstrated that caregiver burden, caregiver physical and mental health, and caregiver depression were predictors of overall caregiver QoL. Treating disturbed sleep in care-recipients and caregiver mental health symptoms could have important public health impact by improving the lives of the caregiving dyad.     

Sleep–wake activity rhythm and health‐related quality of life among patients with coronary artery disease and in a population‐based sample—An actigraphy and questionnaire study

The aim of this study was to explore whether there are gender differences in sleep and health‐related quality of life in patients with coronary artery disease (CAD) and a matched population‐based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty‐seven patients with stable CAD and 47 participants from a population‐based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF‐36. Actigraphy recordings and a sleep diary were performed for seven 24‐h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF‐36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non‐pharmacological, self‐care programme supported and led by nurses.     

认知行为疗法对肾移植受者术后负性情绪和睡眠质量的效果研究

目的验证认知行为疗法对肾移植受者术后负性情绪、睡眠质量的效果。方法便利抽样选择2015年5月至2016年1月福州市某三级甲等综合医院58名肾移植受者,分为干预组28名和对照组30名。对干预组进行为期3周的认知行为疗法干预,而对照组则采用常规护理。使用基本资料调查表、非精神科住院患者心理评定量表和匹兹堡睡眠指数量表评价其效果。结果干预组患者在抑郁、愤怒维度的得分显著低于对照组患者的得分,PSQI总分和睡眠质量、睡眠时间、入睡时间、睡眠效率维度等五个方面亦低于对照组(均P0.05)。结论认知行为疗法能够有效降低肾移植受者术后抑郁、愤怒情绪,同时对改善肾移植受者术后睡眠质量有较好的效果。     

Short-term changes in sleep,mastery & stress: Impacts on depression and health in dementia caregivers

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.     

医科大学男护生睡眠质量及心理健康状况研究

目的探讨医科大学男护生睡眠质量及其与心理健康的关系。方法采用症状自评量表(SCL-90)和匹兹堡睡眠质量指数(PSQI)量表对某医科大学2005-2008级105名男护生及同期的105名女护生进行测评。结果(1)以PSQI总分≥8分作为判断睡眠质量问题的界限,19.8%的男护生有睡眠质量问题,睡眠不佳主要体现在日间功能障碍(43.6%)、睡眠质量差(17.8%)和入睡时间长(17.8%)。本、专科男护生和男女护生在PSQI总分上差异均无统计学意义,但本科男护生的日间功能得分显著高于专科生(t=2.066,P0.05),男护生入睡时间得分显著低于同期调查的女护生(t=-2.965,P0.01)。(2)男护生与普通大学男生、医科大学男生的PSQI总分差异均无统计学意义(P0.05),但睡眠时间及睡眠障碍的得分显著高于普通大学男生,入睡时间和睡眠时间的得分显著低于医科大学男生。(3)不同睡眠质量状况的男护生SCL-90均分及各因子得分(除敌意因子外)差异均有统计学意义。(4)男护生SCL-90均分及各因子得分与PSQI总分呈正相关(0.265≤r≤0.513),与PSQI各项目得分中的睡眠效率、睡眠障碍、日间功能等均呈正相关(0.229≤r≤0.482)。结论学校应重视男护生的睡眠质量问题,促进男护生心理健康。     

养老院老年人睡眠质量及其与抑郁情绪的关系

目的 调查养老院老年人的睡眠质量与抑郁状况,为护理干预提供依据.方法 采用匹茨堡睡眠质量指数量表和老年抑郁量表,对北京市某社会福利院107名入住时间≥6个月的老年人进行问卷调查.结果 35名(32.71％)老年人存在睡眠问题;19名(17.76％)老年人存在抑郁情绪;睡眠质量与抑郁相互影响,抑郁能解释睡眠质量总变异的16.4％,睡眠质量中的白天功能紊乱、习惯性睡眠效率两个因子能解释抑郁得分总变异的43.3％.结论 部分养老院老年人存在睡眠问题和抑郁情绪,二者相互影响.养老院护理人员应采取措施提高老年人的睡眠质量,以减少老年人抑郁情绪的发生.