Timed Activity Routines for People with Memory Issues Improve Subjective Sleep

Nancy Hodgson, PhD, RN, FAAN

Credit: Penn Nursing, University of Pennsylvania

For people with memory issues, completing timed activities around the same time every day, such as reminiscing in the morning, exercising in the afternoon, and sensory activities in the evening, can improve subjective sleep and quality of life (QOL), according to a new study.

Timed activities offer a way for individuals with cognitive impairment to have improved QOL and sleep quality—without using drugs.

“The results from this study provide fundamental new knowledge regarding the effects of timing activity participation and can lead to structured, replicable treatment protocols to address sleep disturbances,” investigators wrote, led by Nancy Hodgson, PhD, RN, FAAN, a leadership professor in nursing and chair of the department of biobehavioral health services at the University of Pennsylvania School of Nursing. “Overall, the Healthy Patterns Program resulted in improved QOL compared to an attention-control group.”

More than 60% of people with cognitive impairment experience sleep issues with symptoms of irregular sleep-wake rhythm, daytime hypersomnia, frequent nighttime awakenings, and poor sleep efficiency. Individuals with cognitive impairment with sleep issues may have a poor QOL.

For people with sleep disturbances, structuring photic stimuli activity at specific times throughout the day can help regulate circadian rhythms, such as bright light therapy or artificial indoor light, but often these treatments do not work for people with cognitive impairment.

Investigators leveraged data from a randomized, double-blind control trial called “The Healthy Patterns Sleep Study,” conducted from May 2016 – June 2022. The team assessed to see if the Healthy Patterns Sleep Program improved sleep quality and QOL for people with cognitive impairment. They also assessed to see if the program would help people who had depressive symptoms and poor observed sleep at baseline.

Hodgson and colleagues randomized 209 pairs—a pair with cognitive impairment and a care partner—to either the Healthy Patterns Sleep Program which included 1-hour activity sessions administered weekly in the morning, afternoon, or evening over 4 weeks, or the control group consisting of sleep hygiene training and education on home safety and health promotion.

For participants with cognitive impairment, the mean age was 73.6, and 66.5% were female. The sample included 64.1% of Black participants, 16.3% of White participants, and 18.7% of Hispanic/Latino. Participants were eligible if they were ≥ 60 years old, English or Spanish speaking, able to tolerate a wrist actigraphy, faced sleep disturbances, presence of cognitive impairment based on the Clinical Dementia Rating Scale, and had a care partner who could attend all study visits.

The Healthy Patterns Sleep Program evaluated an individual’s health and functional status, as well as preferences and interests, educated care partners on ways to create routine activity and sleep schedules based on the environment, and trained care partners in using timed activities aligning with circadian rhythms throughout the day.

In both groups, the team assessed for QOL, objective and subjective sleep quality, and neuropsychiatric symptoms at baseline and 4 weeks later.

The analysis demonstrated participants in the Healthy Patterns Sleep Program had a significantly improved QOL. The mean change score of the Quality in Life in Alzheimer’s Disease Scale (QOL-AD) from baseline to 4 weeks later was 0.91 ± 4.0, demonstrating the score, on average, was almost 1 point greater by the end of the study. The QOL-AD score was 1.93 points greater than the control group by the end of the study (95% CI, 0.0000 – 3.0000; P = .491).

Although the analysis did not show significant effects on objective (F(4,173) = 0.97, P = .425) or subjective sleep or neuropsychiatric symptoms (F(3,147) = 0.67, P = .56), a subgroup analysis revealed subjective sleep—measured by the Patient Reported Outcomes Measurement Information System Sleep-Related Impairment Survey—significantly improved with the program for individuals with depression symptoms (P = .015) or poor sleep at baseline (P = .005).

The investigators highlighted several limitations, including using a fixed interval for actigraphy data despite individuals with cognitive impairment prone to taking naps or staying relatively inactive, the type of way to measure PSQI remains controversial, home and environmental factors could have confounded the program’s outcome, and the trial had a short duration.

“The lack of any significant findings on objective sleep data suggests that a longer intervention period may be required to influence actigraphically measured sleep quality,” investigators wrote.

^References

1. ^{Hodgson NA, McPhillips MV, Petrovsky DV, et al. Timed Activity to Minimize Sleep Disturbance in People With Cognitive Impairment. Innov Aging. 2023;8(1):igad132. Published 2023 Dec 8. doi:10.1093/geroni/igad132}
2. ^{Improving Quality of Life and Sleep in People With Memory Problems Without Using Drugs. EurekAlert! February 6, 2024. https://www.eurekalert.org/news-releases/1033656. Accessed February 16, 2024.}