Abstract
Background
Providing informal care for a relative or friend with medical or mental needs can extol a physical burden on the caregiver, including impaired aspects of sleep quality such as suboptimal sleep duration, lengthened sleep latency, frequent awakenings, daytime sleepiness, and poor self-rated sleep quality. Diminished sleep quality can worsen the health in the caregiver, including dysregulation of hypothalamic-pituitary-adrenal axis (HPA) activity. Few studies have attempted to describe sleep in young adults who provide regular informal care. This study examines subjective and objective indicators of sleep quality and diurnal cortisol rhythms among young adult caregivers relative to non-caregiving peers. We expect that caregivers will exhibit poorer objective and subjective sleep quality and greater dysregulation in diurnal cortisol indices, than demographically similar non-caregivers, and that caregivers with poorer sleep will exhibit pronounced cortisol dysregulation.
Methods
Participant self-reported sleep quality over the prior month via the Pittsburgh Sleep Quality Index and objective sleep quality was observed via wrist actigraph for three consecutive days. Diurnal salivary cortisol was also measured across the three days of actigraph monitoring.
Results
Informal caregivers exhibited more self-reported sleep disturbance and greater sleep latency than non-caregivers, as well as more objectively measured sleep fragmentation. Caregivers with a shorter sleep duration were observed to have flatter diurnal cortisol slopes than caregivers with a relatively longer sleep duration.
Conclusions
Young adult caregivers appear to be at risk for impairment in sleep quality, which in turn might impact health through HPA axis dysregulation. Longitudinal research is needed to identify these relationships across time.
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References
Carney S, Koetters T, Cho M, West C, Paul SM, Dunn L, et al. Differences in sleep disturbance parameters between oncology outpatients and their family caregivers. J Clin Oncol. 2011;29:1001–6.
Christakis NA, Allison PD. Mortality after the hospitalization of a spouse. New Engl J Med. 2012;354:719–30.
Dhruva A, Lee K, Paul SM, West C, Dunn L, Dodd M, et al. Sleep-wake circadian activity rhythms and fatigue in family caregivers of oncology patients. Cancer Nurs. 2012;35:70–81.
Happe S, Berger K. FAQT study investigators. The association between caregiver burden and sleep disturbances in partners of patients with Parkinson’s disease. Age Ageing. 2002;31:349–54.
Lee KC, Yiin JJ, Lin PC, Lu SH. Sleep disturbances and related factors among family caregivers of patients with advanced cancer. Psycho-Oncol. 2015;24:1632–8.
Morris BA, Thorndike FP, Ritterband LM, Glozier N, Dunn J, Chambers SK. Sleep disturbance in cancer patients and caregivers who contact telephone-based help services. Support Care Cancer. 2015;23:1113–20.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation of chronic insomnia in adults. J Sleep Med. 2008;15:487–504.
Pawl JD, Lee SY, Clark PC, Sherwood PR. Sleep loss and its effects on health of family caregivers of individuals with primary malignant brain tumors. Res Nurs Health. 2013;36:386–99.
Carter PA, Chang BL. Sleep and depression in cancer caregivers. Cancer Nurs. 2000;23:410–5.
Schwarz KA. A study of the relationship of caregiving appraisal to depressive symptomatology and home care utilization. J Commun Health Nurs. 1999;16:95–108.
Yates ME, Tenstedt S, Chang BH. Contributors to and mediators of psychological well-being for informal caregivers. J Gerontol Series B Psychol Sci Soc Sci. 1999;54:P12–22.
Carter PA. Bereaved caregivers’ descriptions of sleep: impact on daily life and the bereavement process. Oncol Nurs Forum. 2003;32:741.
Crowley S, Van Reen E, LeBourgeois MK, et al. A longitudinal assessment of sleep timing, circadian phase, and phase angle of entrainment across human adolescence. PLoS One. 2014;9:e112199.
Hagenauer MH, Perryman JI, Lee TM, Carskadon MA. Adolescent changes in the homeostatic and circadian regulation of sleep. Dev Neurosci. 2009;31(4):276–84.
Levine C, Gibson Hunt G, Halper D, Hart AY, Lautz J, Gould DA. Young adult caregivers: a first look at an unstudied population. Amer J Pub Health Assn. 2005;95:2071–5.
Balbo M, Leproult R, Van Cauter E. Impact of sleep and its disturbances on hypothalamo-pituitary-adrenal axis activity. Int J Endocrinol. 2010;2010:759234.
Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C. HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology. 2004;29:83e98.
Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA. 1992;267:1244e52.
Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25:1e35.
Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002;53:865e71.
Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: a systematic review and meta-analysis. Psychoneuroendocrinology. 2017;83:25–41.
Allen AP, Curran EA, Duggan A, Cryan JF, Chorcoráin AN, Dinan TG, et al. A systematic review of the psychobiological burden of informal caregiving for patients with dementia: focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev. 2017;73:123–64.
Holland JM, Thompson LW, Cucciare MA, et al. Cortisol outcomes among Caucasian and Latina/Hispanic women caring for a family member with dementia: a preliminary examination of psychosocial predictors and effects of a psychoeducational intervention. J of Intl Soc Investig Stress. 2011;27:334–46.
de Vugt ME, Jolles J, van Osch L, Stevens F, Aalten P, Lousberg R, et al. Cognitive functioning in spousal caregivers of dementia patients: findings from the prospective MAASBED study. Age Ageing. 2006;35:160–6.
Fonareva I, Amen AM, Zajdel DP, Ellingson RM, Oken BS. Assessing sleep architecture in dementia caregivers at home using an ambulatory polysomnographic system. J Geriatr Psychiatry Neurol. 2011;24:50–9.
Mortensen J, Dich N, Clark AJ, et al. Informal caregiving and diurnal patterns of salivary cortisol: results from the Whitehall II cohort study. Pychoneuroendocrinology. 2019;100:41–7.
Buckley TM, Schatzberg AF. On the interactions of the hypothalamicpituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab. 2005;90:3106e14.
Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev. 2008;12:197e210.
Hoyt MA, Bower JE, Irwin MR, Weierich MR, Stanton AL. Sleep quality and depressive symptoms after prostate cancer: the mechanistic role of cortisol. Behav Neurosci. 2016;130:351–6.
Chang WP, Lin CC. Relationships of salivary cortisol and melatonin rhythms to sleep quality, emotion, and fatigue levels in patients with newly diagnosed lung cancer. Euro J Oncol Nurs. 2017;29:79–84.
Matthews KA, Hall MH, Cousins J, Lee L. Getting a good night’s sleep in adolescence: do strategies for coping matter? Behav Sleep Med. 2016;14:367–77.
Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003;26:342–92.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.
National Alliance for Caregiving. e-Connected family caregiver: bringing caregiving into the 21st century. Bethesda: United Healthcare; 2011.
Zigmond AS, Snaith RP. Hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012;35:287–302.
Ambulatory Monitoring, Inc. Action-W user’s guide. Ardsley: Ambulatory Monitoring, Inc.; 1999.
Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time dependent change. Psychoneuroendocrinology. 2003;28:916–31.
Chida Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol. 2009;80:265–78.
Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park: Sage Publications; 1991.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. 2nd ed. New York: Guilford Press; 2018.
Arnett JJ. Emerging adulthood: a theory of development from the late teens through the twenties. Am Psychol. 2000;55:469–80.
Besedovsky L, Lange T, Born J. Sleep and immune function. Eur J Phys. 2012;463:121–37.
Leggett AN, Liu Y, Klein LC, Zarit SH. Sleep duration and the cortisol awakening response in dementia caregivers utilizing adult day services. Health Psychol. 2016;35:465–73.
van Dalfsen JH, Markus CR. The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: a systematic review. Sleep Med Rev. 2018;39:187–94.
Buckhalt JA, El-Sheikh M, Keller P. Children’s sleep and cognitive function: race and socioeconomic status as moderators of effects. Child Dev. 2007;78:213–31.
Gallo LC. The reserve capacity model as a framework for understanding psychosocial factors in health disparities. Appl Psychol: Health Well-Being. 2009;1:62–72.
Knutson KL, Rathouz PJ, Yan LL, Liu K, Lauderdale DS. Sleep. 2007;30:793–6.
Gibbins J, McCoubrie R, Kendrick AH, Senior-Smith G, Davies AN, Hanks GW. Sleep-wake disturbances in patients with advanced cancer and their family carers. J Pain Symptom Manag. 2009;38:860–70.
Schwartz S, Anderson WM, Cole SR, Cornoni-Huntley J, Hays JC, Blazer D. Insomnia and heart disease: a review of epidemiologic studies. J Psychosom Res. 1999;47(4):313e33.
Guo X, Zheng L, Wang J, Zhang X, Zhang X, Li J, et al. Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med. 2013;14:324e32.
Krystal AD. Sleep and psychiatric disorders: future directions. Psychiatr Clin North Am. 2006;29:1115e30.
Shaffer KM, Applebaum AJ, DuHamel KN, Garland S, Gerhman P, Mao JJ. Cancer survivors’ beliefs about the causes of their insomnia: associations of causal attributions with survivor characteristics. Beh Sleep Med. 2018; in press.
Shaffer KM, Carter P, Garland SN, Applebaum AJ. Cognitive behavioral therapy for insomnia for cancer caregivers. In: Applebaum A, editor. Cancer caregivers. New York: Oxford University Press; 2019.
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Funding was provided by the National Cancer Institute (SC1 CA187494).
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As stated in the manuscript, all study procedures were approved by the Institutional Review Board of the primary author’s institution and informed consent was obtained from all individual participants included in the study.
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Hoyt, M.A., Mazza, M.C., Ahmad, Z. et al. Sleep Quality in Young Adult Informal Caregivers: Understanding Psychological and Biological Processes. Int.J. Behav. Med. 28, 6–13 (2021). https://doi.org/10.1007/s12529-019-09842-y
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DOI: https://doi.org/10.1007/s12529-019-09842-y