PATIENT CARE
stress on family caregivers. Conversely, high physical/mental stress occasionally causes sleep disorder.2
Mattress Sleep is considered
as one of the important elements of fatigue and is thought to have a potential of serving as an indicator useful in the evaluation of fatigue. Measurement of sleep during daily life
necessitates a measuring device that can satisfy diverse requirements. Wrist actigraphy (ACT) has been acknowledged as a reliable means of sleep research.3,4 Problems arise, however, from forgetting to attach devices, or the erroneous recording of respiration as bodily movement, the inability to measure bodily movement due to the restriction of arm motions in some postures, and erroneous recording of external vibration as bodily movement.5,6
To eliminate these issues,
many investigators instruct the research subjects to keep a sleep diary or a device attachment record during the study.7,8 However, keeping such records is a
burden for both the subjects and the investigators, possibly making it difficult to continue the routine measurement of sleep. In studies of dementia elderly people living at care facilities, a special wrist band to avoid unintended detachment.9
Sleeping with an ACT
device is not always comfortable, and a more convenient device is desirable. For long-term measurement of sleep,
a non-wearing type device is desirable. Takamasa Kogure et al of Paramount Bed Co. Ltd have developed an NWA sensor named Nemuri SCAN, which is now available commercially in Japan.10
This
sensor, capable of measuring sleep if placed under the mattress, enables measurement of sleep routinely without causing stress. However, there is a need to develop an indicator for evaluation of sleep quality on the basis of the data collected with this kind of device. This study was aimed at developing an indicator of sleep quality of dementia patients and their family caregivers.
Figure 1. Nemuri SCAN positioning under a mattress.
Evaluation methods A Nemuri SCAN sensor was used to collect sleep data (see Fig 1). With this device, sleep status was divided into three stages – leaving the bed, waking, and falling asleep – and can be measured at intervals of one minute. The subjective evaluation of sleep used J-ZBI-8 (Zarit), GDS (Geriatric Depression Scale) and PSQI (Pittsburgh Sleep Quality Index). A ‘care diary’ was prepared and used
to record behavioral and psychological symptoms of dementia patients. Each caregiver entered what they observed during the study period into this diary. Check items for assessment of the patient’s condition and the background of care were set forth, and their data (profile data) were collected from Physician A and family caregivers. The physician at ‘Clinic A’ selected ten patient-caregiver pairs from the patients with dementia (Alzheimer’s). Of these ten pairs, seven pairs gave consent to the
Night’s sleep section 1.0
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
12:00 15:00 18:00 21:00
Nemuri SCAN
study and were enrolled. The study was conducted between October 2014 and January 2015. Sleep was measured for four weeks, with the Nemuri SCAN placed under the mattress of each patient and caregiver. This study was approved in advance by the Ethics Committee of Graduate School of Engineering at the University of Tokyo.
Study results
Falling asleep rate graph The status of sleep varies from day to day even in the same individual. To assess the status of sleep during daily living, it is necessary to summarize the individual trends of sleep. For this reason, using the sleep data collected for 28 days, we calculated the probability of falling asleep (falling asleep rate) during each ten-minute period of the day over 24 hours in each subject (14 subjects of seven pairs). That was followed by graphic representation of the falling asleep rate for each ten-minute period (see Fig 2).
Indicator of sleep during the night sleep section So that individuals can continue ordinary social activity, they are usually expected to sleep at night and to remain awake and active during the daytime. In patients with dementia, the daytime-night relationship is likely to be reversed, and this tendency serves as an obstacle against sleep at night by family caregivers. For this study, the period for sleep at night was defined as the period from 6 pm to 9 am the following day. On the basis of the status of sleep during this period, the following sleep indicators by individual subjects were analysed. l Starting time of the night sleep: the time at which the falling asleep rate exceeded 0.5 for the first time after 6pm.
l Ending time of the night sleep: the time at which the falling asleep rate below 0.5 for the last time before 9 am.
l Night sleep section: period from the starting time of the night sleep to the ending time of the night sleep.
l Night sleeping time: duration of the night sleep section.
l Falling asleep rate: mean of the falling asleep rate during the night sleep section.
Falling asleep rate
l Cumulative sleeping time: night sleeping time x falling asleep rate.
0:00 Time Start of night’s sleep Figure 2. Falling asleep rate. IFHE DIGEST 2021 End of night’s sleep 3:00 6:00 9:00 12:00
The falling asleep rate reflects ‘sleep efficiency’ and the cumulative sleeping time indicates ‘the actually sleeping period at night’. These two parameters were set as important indicators of sleep quality.
Factors improving sleep First, analysis was made of day care. Day care was being received by Patient ID02,
111
Falling asleep rate
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116
