This paper reports 48 hours of descriptive baseline actigraphy data obtained from persons with dementia (n=47) in four nursing facilities. The study was part of a larger study of the effects of massage on sleep. Data on minutes of nighttime sleep, sleep latency, sleep efficiency, wake after sleep onset, daytime sleep and day/night sleep ratio were collected and analyzed for all participants and stratified by Mini Mental Status Examination (MMSE) scores into three subgroups: mild dementia (MMSE > 15, n=11); moderate dementia (MMSE 5-15, n=23); and severe dementia (MMSE < 5, n=13). Overall, participants slept 56% of the night and napped 17% of the daytime. Longer sleep latency and wake after sleep onset were attributed to early bed times and rise times with long intervals (10.4 hours) spent in bed. The sample was representative of a population with chronic medical illnesses, painful conditions, and agitated behaviors often treated with psychotropic medications, and these could have accounted in part for poor sleep patterns. Poor sleep hygiene practices and environmental factors were cited as possible contributors to interrupted sleep. Recommendations for nursing practice include recognition of poor sleep patterns and the use of non-pharmacological interventions to promote sleep in persons with dementia in the nursing home.
In spite of the wide-spread use of sedative hypnotic medications, disturbed sleep is a common problem in persons with dementia in the nursing home. Studies report marginal benefits and numerous side effects associated with pharmacological interventions for sleep in persons with dementia.
Although evidence for its effectiveness is sparse, slow-stroke back massage is a non-pharmacological intervention that has been used since the time of Florence Nightingale to relieve physiological and psychological stressors and promote restorative sleep.
This pilot randomized controlled trial examined the effects of a 3-minute SSBM on minutes of nighttime sleep in persons with dementia (n = 40) in the nursing home.
The hypothesis was: participants receiving slow-stroke back massage will have increased minutes of nighttime sleep compared to participants receiving a usual care/control condition.
The primary aim of this study was to compare the effects of slow-stroke back massage to a usual care/control condition on minutes of nighttime sleep. Secondary aims were to explore the effects of slow-stroke back massage compared to a usual care/control condition on minutes of nighttime sleep latency, sleep efficiency, wake after sleep onset, daytime sleep, and the day/night sleep ratio.
Participants were randomized to an intervention group (n = 20) who received the 3-minute SSBM intervention or a control group (n = 20) who received usual bedtime care. Actigraphy was used to record data on sleep variables at baseline and post intervention. Descriptive statistics showed a 36 minute increase on minutes of nighttime sleep in the SSBM intervention group (46.1 minutes) compared with the control group (10.32 minutes). ANCOVA did not reveal any statistically significant differences between the intervention and control groups on minutes of nighttime sleep [F(1, 37) = 1.90, p = 0.18, effect = 0.05)] or on exploratory sleep variables. Long hours in bed, poor sleep hygiene practices and environmental factors contributed to poor sleep patterns. Findings from this pilot study suggest that SSBM may be an effective nursing intervention to promote sleep in persons with dementia in the nursing home, but further testing is needed to provide definitive results.
|Advisor:||Beverly, Claudia J.|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 70/04, Dissertation Abstracts International|
|Keywords:||Complementary therapy, Dementia, Massage, Nursing homes, Sleep, Slow-stroke back massage|
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