Effectiveness of dyadic sleep intervention and pumpkin seed balls on sleep quality among patients with Alzheimer’s disease in selected Alzheimer’s care centres at Coimbatore, India
Dr. Sampoornam. W*
Professor, Department of Mental Health Nursing,
Annai JKK Sampoorani Ammal College of Nursing, Komarapalayam, India.
*Corresponding Author E-mail: sampoornamwebster@yahoo.in
ABSTRACT:
Context: Studies consistently show the negative health impact of sleep problems in both Alzheimer's disease (AD) patients and their caregivers. Pumpkin seeds provide natural source of tryptophan, an amino acid that promotes sleep. Methods: The research design used for the present study was true experimental design. The total sample size was 60 subjects, out of which 30 in experimental group and 30 in control group. Study subjects was assigned randomly to either experimental group (n=30) or control group (n=30). Pretest was conducted by using demographic variables and Pittsburgh Sleep Quality Index. Experimental group received dyadic sleep intervention for 30-40 minutes, for the period of 3 months. Pumpkin seed balls were given twice a day, for 3 months. Control group received standard methods of care. Posttest was conducted at the end of 1st month, 2nd month and 3rd month by using the same assessment tool in experimental and control group. Results: Paired ‘t’ test, and repeated measures ANOVA showed statistical significance in improving the sleep quality in experimental group comparatively to the control group among patients with Alzheimer’s disease.
KEYWORDS: Dyadic sleep intervention, Pumpkin seed balls, Sleep quality, Alzheimer’s disease.
INTRODUCTION:
Alzheimer’s disease (AD) is a form of dementia that gradually gets worsens over time. It affects various cognitive domains including memory, thinking and behavior. In the early stages of dementia, brain image scans may be normal. In later stages, an MRI may show a decrease in the size of different areas of the brain. There has been no definitive prevention or cure for this entity. Early identification and treatment could help slowing down the progression of this disease.
Older adults with Alzheimer disease and related dementias (ADRD) experience severe dysfunctions of their sleep wake and rest activity patterns that clinically present as sun-downing, excessive daytime sleepiness, nocturnal wandering, agitation, irritability, day–night reversal and decreased cognitive functioning (Diem SJ and Blackwell TL et.al., 2016).
Studies consistently show the negative health impact of sleep problems in both Alzheimer's disease (AD) patients and their caregivers. However, only a few sleep interventions have been conducted for AD patients or their caregivers in community settings and none have addressed both members of the dyad concurrently (Yeonsu Song, 2021).
Pumpkin seeds are rich in nutrients such as vitamin A, vitamin E, zinc, omega-3 and omega-6 fatty acids. The zinc found in pumpkin seeds plays an important role in improving memory and brain function. Pumpkin seeds are true brain food containing Omega 3 fatty acids which are known for their role in improving mental health, aiding memory and supporting healthy brain development (Shemi George, 2014).
To fill these gaps, this study aims to develop a sleep intervention program specifically tailored for AD patient/caregiver dyads that both experience sleep difficulties. Pumpkin seeds provide natural source of tryptophan, an amino acid that promotes sleep.
METHODS:
Prior to the collection of data, permission was obtained from the concerned authority in selected Alzheimer’s care centres at Coimbatore. After obtaining written informed assent and consent, patients with Alzheimer’s disease who fulfill the inclusion criteria was recruited and enrolled in this study. The research design used for the present study was true experimental design. The total sample size was 60 subjects, out of which 30 in experimental group and 30 in control group. Study subjects was assigned randomly to either experimental group (n=30) or control group (n=30).
Pretest was conducted by using demographic variables and Pittsburgh Sleep Quality Index. Experimental group received dyadic sleep intervention for 30-40 minutes, for the period of 3 months. Dyadic sleep intervention was intervened for both the subjects and caregivers. It consists of the components such as sleep schedule, sleep compression, stimulus control and daily walking. Pumpkin seeds were purchased commercially and powdered. 40 grams of powdered pumpkin seeds was prepared as balls by mixing with water. These balls were given twice a day, for 3 months. Control group received standard methods of care. Posttest was conducted at the end of 1st month, 2nd month and 3rd month by using the same assessment tool in experimental and control group.
RESULTS:
Paired ‘t’ test, and repeated measures ANOVA showed statistical significance in improving the sleep quality in experimental group comparatively to the control group among patients with Alzheimer’s disease (Table 1).
DISCUSSION:
The study findings revealed that administration of dyadic sleep intervention and pumpkin seed balls were significant in enhancing the sleep quality. This result is consistent with the study findings of Yeonsu Song et.al, 2019 who reported in their case series study about behavioral sleep intervention program targeting patients with Alzheimer's disease and their caregivers.
Dyadic behavioral sleep program can be tailored to various types of sleep problems among patients with Alzheimer's disease and their family caregivers, with the goal of improving daytime function by reducing sleep disturbances at night.
Caregiver training and participation of both members of the dyad in sleep management may benefit the patients' sleep and other health outcomes, reduce caregiver stress and burden and ultimately delay or prevent institutionalization of Alzheimer's disease patients.
Salami, O., Lyketsos, C., and Rao, V. (2011) conducted a systematic review to define the evidence-based behind treatment options for sleep disturbance in AD. The non-pharmacological approaches involved decreasing the time spent in bed during the day, increased daily sunlight exposure, increased physical activity, structured bedtime routine, and decreased night time noise and light. They concluded that there are limits to the efficacy and safety of the treatment strategies aimed at ameliorating insomnia in patients with AD. Nevertheless, several interventions have shown some modicum of efficacy and the non-pharmacological treatments expose patients to the least amount of risk in comparison to medication therapies.
Pumpkin seeds are rich in nutrients such as vitamin A, vitamin E, zinc, omega-3 and omega-6 fatty acids. The zinc found in pumpkin seeds plays an important role in improving memory and brain function. Pumpkin seeds are true brain food containing amino acid (Shemi George, 2014). Pumpkin seeds provide natural source of tryptophan, an amino acid that promotes sleep.
Table 1 Sleep quality in experimental group and control group with pre and posttest scores
|
Variable |
Experimental group and Control group |
Mean ± SE |
Significance Paired ‘t’ test |
||
|
Experimental group Pre – Post |
Control group Pre – Post |
||||
|
Sleep quality
|
Experimental group– Pretest |
14.3 ± 2.0 |
t = 6.48 P =0.001 Significant |
t = 1.45 P =0.33 NS |
|
|
Experimental group- Posttest |
19.1 ± 3.3 |
||||
|
Control group- Pretest |
15.4± 2.6 |
||||
|
Control group- Posttest |
16.2± 2.8 |
||||
|
Repeated measures ANOVA |
|||||
|
Experimental group-Posttest |
F ratio=4.006 Significant |
||||
|
Control group-Posttest |
F ratio=1.005 NS |
||||
|
N = 60 (n1=30, n2=30) |
|||||
CONCLUSION:
Dyadic sleep intervention and pumpkin seed balls were quite effective for enhancing the sleep quality among patients with Alzheimer’s disease.
REFERENCES:
1. Diem SJ, Blackwell TL, Stone KL, et al. Measures of sleep-wake patterns and risk of mild cognitive impairment or dementia in older women. Am J Geriatr Psychiatry. 2016; 24(3):248–258.
2. Yeonsu Song. A Dyadic sleep Intervention for Alzheimer's Disease Patients and Their Caregivers. Ongoing RCT. 2021.
3. Yeonsu Song, Susan M Mccurry, Diane Lee and Karen R. Josephson. Development of a dyadic sleep intervention for Alzheimer’s disease patients and their caregivers. Disability and Rehabilitation. 2019; 43(2):1-11.
4. Salami, O., Lyketsos, C., and Rao, V. Treatment of sleep disturbance in Alzheimer's dementia. International Journal of Geriatric Psychiatry. 2011; 26(8): 771–782.
5. Shemi George. Supplementary effect of pumpkin seeds on Memory function in animal and human models. Final report of a minor research project submitted to university grants commission. Bangalore. 2014.
Received on 09.11.2022 Modified on 11.12.2022
Accepted on 04.01.2023 ©A&V Publications All right reserved
A and V Pub Int. J. of Nursing and Medical Res. 2023; 2(1):6-8.
DOI: 10.52711/ijnmr.2023.02