Carter, P.A. (2006). A brief behavioral sleep intervention for family caregivers of persons with cancer. Cancer Nursing, 29(2), 95–103.

To test the feasibility and effectiveness of a brief behavioral sleep intervention for family caregivers of persons with advanced stage cancer

Each caregiver received an Actigraph on the wrist of the dominant hand and was asked to wear it for the next three days. During this time, the caregiver completed a sleep log to illustrate times out of bed, time to bed, awakening and out of bed, and times of disturbance. At week two, intervention group caregivers (n = 15) received the CASI (author developed sleep intervention), and the attention control group caregivers received body mechanics information and training. All caregivers completed the Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiological Studies—Depression Scale (CES-D), and Caregiver Quality of Life Index—Cancer (CQOLC) at week three and provided sleep log and Actigraph data. A booster CASI session was delivered to the intervention group at week four, and the attention group received a booster of the body mechanics material. The intervention incorporated stimulus control, relaxation therapy, cognitive therapy, and sleep hygiene. Participants were educated on sleep promotion techniques within the context of caregiving. Measurements of all study variables from both groups occurred in week five and two, three, and four months post-baseline.

• The sample included 30 participants.
• The mean age of the sample of 30 family caregivers was 53 years (age range 21–85 years).
• Females: 63% (both intervention and control groups) (n = 19)
• Males: 27% (both intervention and control groups) (n = 11)
• Participants had multiple cancer diagnoses, were at end of life, and were not in a hospice program.
• Inclusion criteria required caregivers to be at least 21 years of age; identify themselves as family caregivers; have reported difficulty in beginning and maintaining sleep or non-restorative sleep for at least one month; and live with patients whose caregivers assessed them as having advanced stage cancer diagnoses.
• Most caregivers were spouses (57%) or adult children (30%) and provided care for a mean length of 17 hours per day.
• Eighty-seven percent of caregivers were Caucasian, and 13% were Hispanic.

• Multi-site
• Home
• Central Texas USA

A repeated measures experimental design was used.

• Pittsburgh Sleep Quality Index (PSQI) (used to measure caregiver sleep quality)
• Actigraph sleep watch (used to measure sleep patterns [latency, duration, efficiency, and wake after sleep onset])
• Sleep logs
• Center for Epidemiological Studies—Depression Scale (CES-D) (used to measure caregiver depression symptoms)
• Caregiver Quality of Life Index—Cancer (CQOLC) (used to measure caregiver quality of life)

Pearson product correlations reported on how sleep duration and efficiency were “strongly negatively associated” with caregiver depression and quality of life over time; however, actual statistical results were not provided in this report. Overall sleep quality (PSQI) and sleep latency were strongly and consistently correlated with caregiver depression and quality-of-life scores over time. Quality-of-life scores were strongly and consistently positively correlated with depressive symptoms over time, according to the author. Caregiver quality of life and self-reported sleep quality improved for both groups over the duration of the study. Intervention caregivers showed greater improvements in PSQI total scores than did control caregivers at each time measurement. The difference between groups in PSQI score was only statistically significant at month four in the study (p = 0.03), in favor of the intervention group.

Delivery of a home-based caregiver sleep intervention may be helpful for caregivers who report sleep disturbances that dramatically influence their personal quality of life and ability to provide care to a family member with cancer. This intervention appears to be feasible and can be tailored to the caregiver.

• The sample had less than 100 participants.
• The limited ethnic representation in sample limits generalizability of findings.
• The limited sample size also affects the use of more powerful statistical analysis that would support efficacy of the intervention. 
• It is unclear whether randomization occurred for the caregiver group assignment.
• The author states a number of significant results; however, the actual data and statistics for these are not all provided.

Findings suggest that an intervention to improve caregiver sleep quality may be helpful and that poor sleep quality is associated with lower quality of life and depressive symptoms.