Mindfulness Meditation and Insomnia in Alzheimer Disease Caregivers

Study Overview
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Brief Summary
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Treatment of insomnia in caregivers is needed given that 60% of Alzheimer disease caregivers report sleep complaints, and insomnia may add to the burden of AD caregiving and contribute to morbidity and mortality risk. This is the first intervention trial in AD caregivers to target insomnia and also evaluate two mechanisms of chronic disease risk, inflammation and cellular aging

Detailed Description
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This randomized controlled trial aims to evaluate the non-inferiority of Mindful Awareness Practices for Insomnia (MAP-I ) vs. Cognitive Behavioral Therapy for Insomnia (CBT-I) on outcomes of insomnia, cellular and genomic markers of inflammation, and cellular aging in older adult AD spousal caregivers with insomnia (N=150) over one-year follow-up. The specific aims of this project are: Primary Aim 1: Determine the effects of MAP-I vs. CBT-I on subjective and objective dimensions of insomnia. Secondary Aim 1: Evaluate the effects of MAP-I vs. CBT-I on cellular and genomic markers of inflammation. Secondary Aim 2: Evaluate the effects of MAP-I vs. CBT-I on markers of cellular aging. Exploratory Aim 1: Explore moderating effects of caregiver stress (Stress and Adversity Inventory, STRAIN, number & experienced intensity of stress exposure) on insomnia outcomes, and effects of MAP-I vs. CBT-I on caregiver stress, health functioning, chronic medical morbidity and related medication use at follow-up.

Official Title
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Mindfulness Meditation and Insomnia in Alzheimer Disease Caregivers: Inflammatory and Biological Aging Mechanisms

Conditions
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Insomnia Chronic

Intervention / Treatment
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* Behavioral: CBT-I
* Behavioral: MAP-I


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Alzheimer or other dementia caregivers Older than 45 years of age Self-identified as the principal person taking care of the patient with Alzheimer or other dementia Diagnostic and Statistical Manual Criteria - 5 for Insomnia Exclusion Criteria: Psychiatric disorders including current major depressive disorder or other current DSM-5 psychiatric disorder (e.g. substance dependence) with the exception of anxiety disorder; Psychotic symptoms; Acute suicidal or violent behavior or history of suicide attempt within the last year Other sleep disorders including current or lifetime history of sleep apnea, nocturnal myoclonus, phase-shift disorder as identified by SCID-5 and Duke Structured Interview for Sleep Disorders (DSISD) Medical conditions such as acute or uncontrolled medical illness (e.g., major surgery, metastatic cancer, Class III heart failure, inflammatory disorder) Chronic infections Obesity with body mass index (BMI) >35 Use of hormone containing medications including steroids or immune modifying drugs Daily use of analgesics such as opioids; Daily us of sedative hypnotic medications Cognitive impairment as evidenced by DSM-5 interview and/or Mini-Mental Status Exam (MMSE < 26) Actively practicing a mind body intervention.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 95 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized, non-inferiority design
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: CBT-I<br>Cognitive behavioral therapy for insomnia (CBT-I), considered the treatment of choice by the American Academy of Sleep Medicine, combines cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation to improve sleep outcomes, with demonstrated efficacy in adult and older adult populations | Behavioral: CBT-I<br>* CBT-I is a behavioral treatment for insomnia<br>|
| Experimental: MAP-I<br>The Mindful Awareness Practices (MAPs) is a validated and curriculum-based meditation similar to Mindfulness Based Stress Reduction, with the exception that MAPs does not include a day-long retreat or yoga and hence takes a more practical and accessible approach that focuses specifically on the practice of mindfulness and its application in everyday life. (http://marc.ucla.edu) MAP for Insomnia (MAP-I) is a modified version of MAPs that incorporates practice prior to bed, use of practice in the bed during night-time awakenings, and daily body scan. | Behavioral: MAP-I<br>* MAP-I is a mindfulness meditation treatment for insomnia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Insomnia clinical response | Change in severity of insomnia as measured by the Insomnia Severity Index | One-year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Insomnia clinical response | Change in severity of insomnia as measured by clinical diagnosis | One year | 
| Daytime dysfunction | Change in depressed mood as measured by the Inventory of Depressive Symptoms | One year | 
| Inflammation | Change in markers of systemic inflammation as measured by C-reactive protein | One year | 
| Cellular aging | Change in markers of cellular aging as measured by transcriptional profiles of the senescent secretory associated phenotype (SASP) | One year |