Project Summary/Abstract This randomized controlled trial aims to evaluate the ability of validated, curriculum based, mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I) vs. Sleep Seminar (SS), an active education control, to treat insomnia in older adult Alzheimer Disease (AD) spousal caregivers with insomnia (N=150) over one-year follow-up. This study also aims to identify whether treatment of insomnia reverses the adverse trajectories of mechanisms of disease risk indicators, namely inflammation and cellular aging. Over 5 million Americans provide informal AD caregiving, which negatively impacts health and is associated with a 63% greater risk of mortality as compared to non-caregiving controls. Insomnia occurs in over 60% of AD caregivers and has independent negative influences on caregiver health and mechanisms of disease risk. Finally, insomnia is a modifiable risk factor, yet no prior study has targeted insomnia in AD caregivers. We have found that MAP-I improves sleep complaints in older adults. Further, we have shown that mindfulness based treatment of insomnia reduces cellular and genomic markers of inflammation and slows cellular aging as indexed by telomere erosion over a one year period. Inflammation and cellular aging in late life predict morbidity and mortality, making these biological mechanisms valuable markers of disease risk in AD caregivers. The specific aims of the study are to 1) determine the effects of MAP-I vs. SS on subjective and objective dimensions of insomnia; 2) evaluate the effects of MAP-I vs. SS on cellular and genomic markers of inflammation; 3) evaluate the effects of MAP-I vs. SS on markers of cellular aging. We will explore moderating effects of caregiver stress on insomnia outcomes, and also the effects of MAP-I vs. SS on outcomes of caregiver stress, health functioning, chronic medical morbidity and related medication use at follow-up. If successful, this research will identify whether treatment of a modifiable risk factor, insomnia, influences sleep and two mechanisms of disease risk, namely, inflammation and cellular aging, which has implications for improving overall health-span of AD caregivers as well as older adults.

Relevance to Public Health 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. This research has real world implications to prioritize screening for sleep disturbance in AD caregivers; to develop, implement, and disseminate a self- care intervention using integrated behavioral health or collaborative primary care models; and to optimize medical management of AD caregivers and treatment of insomnia with the potential to reduce perceived stress burden, improve health functioning, and reduce medical morbidity.