Poorer sleep quality and worse sleep impairment in persons living with cognitive impairment were significantly associated with more caregiver depression, worse caregiver mastery, and greater caregiver burden, highlighting 'a critical need to address the effects of PLWCI sleep disruption on caregivers in dementia care services.'
Key Findings
Results
Poorer sleep quality in persons living with cognitive impairment (PLWCI) was significantly associated with more caregiver depression after controlling for PLWCI cognition, age, and gender.
β = 0.387, p = 0.029
Caregiver depression was measured using the Center for Epidemiological Studies Depression Scale (CES-D)
Sleep quality was assessed subjectively via the Pittsburgh Sleep Quality Index (PSQI), filled out by the caregiver describing the PLWCI's sleep
Sample size was n = 209 from secondary analysis of Healthy Patterns baseline data
Results
Worse sleep-related impairment in PLWCI was significantly associated with worse caregiver mastery.
β = 0.104, p = 0.004
Caregiver mastery was measured using the Caregiver Mastery Scale
Sleep-related impairment was assessed using the PROMIS Sleep Related Impairment scale, completed by caregivers describing the PLWCI's sleep
Results
Poor PLWCI sleep quality was associated with lower caregiver mastery, with the effect being larger for female caregivers than male caregivers.
This moderation by caregiver gender was noted after controlling for PLWCI cognition, age, and gender
Caregivers in the sample were primarily female (81%) and family caregivers (67%), with a mean age of 56.6 ± 14.7 years
The specific interaction effect size or p-value for the gender moderation was not reported in the abstract
Results
PLWCI having worse sleep impairment was significantly associated with greater caregiver burden.
β = -0.163, p = 0.039
Caregiver burden was measured using the Zarit Burden Interview
The negative beta coefficient indicates that worse sleep impairment (higher PROMIS scores) was associated with more caregiver burden
Results
PLWCI being less sleepy during the day was associated with more caregiver burden, approaching statistical significance.
β = 0.104, p = 0.055
Daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS), completed by caregivers describing the PLWCI
This finding suggests that PLWCI who are more alert and active during the day may place greater demands on caregivers
Methods
Objective sleep measures (total sleep time and sleep efficiency from actigraphy) were included but subjective caregiver-reported sleep measures showed the significant associations with caregiver outcomes.
Objective sleep variables were derived from 3 nights of actigraphy worn by PLWCI
Subjective measures included the PROMIS Sleep Related Impairment, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale
PLWCI were primarily female (66.5%) and Black (64%), with a mean age of 73.6 ± 8.6 years
The abstract does not report significant associations for objective actigraphy-derived variables with caregiver outcomes
What This Means
This research suggests that when people with dementia or other forms of cognitive impairment sleep poorly, their caregivers pay a significant price. Analyzing data from 209 caregiver-patient pairs, the study found that caregivers who reported that their care recipients had poor sleep quality were more likely to experience depression and feel less in control of their caregiving role. Caregivers were also more likely to feel burdened when the person they cared for was less sleepy during the day—possibly because a more wakeful person with cognitive impairment requires more active supervision and engagement. Notably, these effects were strongest for female caregivers when it came to the sense of mastery over caregiving.
The study is noteworthy because it used both objective measurements (wrist-worn activity monitors worn for three nights to track actual sleep) and subjective caregiver reports of how well the person with cognitive impairment slept. The significant findings came primarily from the caregivers' own perceptions of the care recipient's sleep, rather than from the objective actigraphy data, which may reflect the importance of how caregivers perceive and interpret disrupted sleep during the night. The sample was drawn from a population that was predominantly Black (64%) and female, which adds diversity to a research area often underrepresenting these groups.
This research suggests that sleep disruption in people with cognitive impairment is not just a problem for the individual—it reverberates through the caregiving relationship, affecting the mental health, sense of competence, and overall burden experienced by those providing care. These findings point to the potential value of dementia care programs that address sleep issues in care recipients as a way to also support caregiver well-being.
McPhillips M, Donnelly E, Dong F, Petrovsky D, Sefcik J, Brewster G, et al.. (2026). Caregiver outcomes related to sleep disturbances in persons living with cognitive impairment.. Geriatric nursing (New York, N.Y.). https://doi.org/10.1016/j.gerinurse.2026.103869