Relevance to clinical practice
The clinical implications of the present study suggest that
nurses should be cognizant of the relationship between daytime
behaviours of the PWD and caregivers’ appraisal of
their sleep; the appraisal of one’s sleep as poor can be a
contributing factor to the perpetuation of sleep problems.
Assessment of a caregiver’s sleep should include discussion
about the PWD’s behaviours, with reference to their number,
type, frequency and emotional impact, as well as to
current management techniques used by the caregiver and
the effectiveness of those techniques. Cognitive behavioural
therapies are known strategies to improve caregiver sleep
and improve health outcomes such as depression (Carter
2006). Current research in health promotion activities and
specific interventions to improve caregiver sleep have demonstrated
the benefit of multicomponent interventions as
well as interventions that expand on or diverge from traditional
cognitive behavioural therapy techniques (Rose et al.
2008, Elliot et al. 2010, Rowe et al. 2010). Instructions to
caregivers about sleep (sleep hygiene strategies) must also
include guidance and instruction about managing or minimising
dementia behaviours as well as the impact of those
behaviours on the caregivers’ emotional and psychological
well-being, in order to reduce the risk of worry and rumination.
Psychoeducational interventions that include components
of active participation (e.g. role playing) have
demonstrated the best outcomes in caregivers’ feelings of
burden, depression and well-being (Pinquart & So¨ rensen
2006). These approaches could benefit caregivers’ sleep.
Improving caregivers’ sleep can benefit health outcomes for
the caregiver and potentially reduce the cost to the family
by preventing early institutionalisation of the PWD.