NiteCAPP: Web-based Interventions for Insomnia in Rural Dementia Caregivers

BEHAVIORAL

NiteCAPP CARES

Web-based intervention that will include 4 weekly sessions and 4 bimonthly boosters. Each session is to be completed individually by CG (with PWD to extent able) in a single sitting (less than 45 mins). Each session should be completed in 7 days with next session released only after prior one completed. Session 1 focuses on sleep education, sleep hygiene, and stimulus control. Session 2 focuses on sleep compression, relaxation, and problem solving. Session 3 focuses on coping and stress management and cognitive therapy. Session 4 focuses on a review of skills and plan for maintenance of behavior change.

BEHAVIORAL

NiteCAPP SHARES

Web-based intervention that will include 4 weekly sessions and 4 bimonthly boosters. Each session is to be completed individually by CG (with PWD to extent able) in a single sitting (less than 45 mins). Each session should be completed in 7 days with next session released only after prior one completed. Session 1 focuses on expanded sleep education and sleep hygiene. Session 2 focuses insomnia education and sleep hygiene support. Session 3 focuses on targeted sleep education and sleep in dementia. Session 4 focuses on a review of skills and plan for maintenance of behavior change. Boosters review skills, encourage practice, and troubleshoot issues.

Completion

Time frame: Single administration at 8 weeks

Percentage of sessions completed out of the 4 sessions/modules included in NiteCAPP and WebSHE.

Adherence

Time frame: Single administration at 8 weeks

Percentage of the intervention instructions followed as indicated on the treatment adherence logs completed each day during treatment.

Internet Intervention Utility Questionnaire

Time frame: Single administration at 8 weeks

Questionnaire with 15 items, including two open-ended questions, that assesses the usability, like-ability, and usefulness of online interventions using a 5-point Likert scale from 1-not at all to 5-very. The two open-ended questions ask the participant to list the most and least helpful parts of the program

Satisfaction Survey

Time frame: Single administration at 8 weeks

Survey that assesses the patient's experience and satisfaction with treatment.

Insomnia Severity Index

Time frame: Single administration at baseline, 8 weeks, 6 month and 12 follow up

Brief self-report measure of current perception of insomnia symptom severity, distress and daytime impairment. Commonly used as an outcome assessment in insomnia treatment research.

Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Completed each morning (\~5 mins) during each assessment period. Electronic daily diaries collecting self-reported information on caregiver sleep onset latency (time to fall asleep), wake after sleep onset (time awake after sleep onset to last awakening), and sleep efficiency (total sleep time divided by time in bed and multiplied by 100). We developed and tested these electronic diaries.

Change in Pain Intensity - Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record pain intensity; range: 0-100 (no pain- most intense)

Change in Pain Unpleasantness - Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record pain unpleasantness; range: 0-100 (none- most unpleasantness)

Change in Wake After Sleep Onset - Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record wake after sleep onset (number of minutes)

Change in Sleep Onset Latency- Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record sleep onset latency (number of minutes)

Change in Sleep Efficiency- Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record sleep efficiency

Change in Fatigue - Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record insomnia severity; range: 0-100 (no insomnia - most severe)

Change in Sleep and Pain Medication - Daily Electronic Sleep Diaries

Time frame: Daily at baseline, 8 weeks, 6 month and 12 follow up

Daily electronic dairies will record daily medication consumption

Change in Perceived Stress Scale

Time frame: Single administration at baseline, 8 weeks, 6 month and 12 follow up

Perceived Stress Scale is a self-report measure of how life situations are perceived as stressful. The scale consists of 15 items corresponding to everyday situation and participants are asked to rate on a Likert scale from 0 (never) to 4 (very often) how

Change in Kingston Caregiver Stress Scale (KCSS)

Time frame: Single administration at baseline, 8 weeks, 6 month and 12 follow up

A 10-item scale that asks caregivers to rate on a scale from 1 (no stress) to 5 (extreme stress) how much stress they experience related to various aspects of caregiving.

Change in Dysfunctional Beliefs About Sleep (DBAS)

Time frame: Single administration at baseline, 8 weeks, 6 month and 12 follow up

A self-report measure of sleep-related arousal. This measure consists of 30 questions intended to measure 5 dimensions: misconceptions about the causes of insomnia, misattributions or amplifications of the consequences, unrealistic expectations, control, and predictability of sleep and faulty beliefs about sleep promoting practices. Although the original scale used a 100 mm VAS, subsequent research with the DBAS has used an 11-point Likert scale (0 = strongly disagree, 10 = strongly agree), and the latter response method will be used.

Change in Peripheral Arousal

Time frame: Single administration at baseline, 8 weeks, 6 month and 12 follow up

Holter monitor assessed 5 min ECG recordings at rest at home (enhancing ecological validity). Variables: RMSDNN (root mean sqrd standard dev. of N-N intervals), pNN50 (percent of N-N intervals less than 50 ms), LF over HF (high frequency divided by low frequency ratio; index of autonomic nervous system regulation).

Change in Inflammation

Time frame: Single blood draw at baseline, 8 weeks, 6 month and 12 follow up

Blood based biomarkers will be examined at each assessment period. Biomarkers include: inflammatory (HS-CRP, IL-6), neurodegenerative ( AβB42, tau levels)

Change in Blood-based Biomarker Interleukin 6 IL-6)

Time frame: Single blood draw at baseline, 8 weeks, 6 month and 12 follow up

Inflammation

Change in Blood-based Biomarker AβB42

Time frame: Single blood draw at baseline, 8 weeks, 6 month and 12 follow up

Neurodegenerative

Change in Blood-based Biomarker Tau

Time frame: Single blood draw at baseline, 8 weeks, 6 month and 12 follow up

Neurodegenerative

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