Relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia in Thailand


sleep quality

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Sanprakhon, P., Chaimongkol, N., & Hengudomsub, P. . (2022). Relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia in Thailand. Belitung Nursing Journal, 8(3), 229–234.
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Accepted for publication: 2022-05-16
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Background: Providing care for older people with memory loss is a significantly stressful task. The caregiver experienced deterioration of the care recipients regarding their cognitive and functioning abilities, often resulting in the caregiver’s feelings of distress, stress, and unsatisfactory sleep quality. 

Objective: This cross-sectional study aimed to examine the relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia. 

Methods: A simple random sampling method was used to recruit participants of seventy-two family caregivers who received care from a community long-term care facility at two primary hospitals in Thailand. Research instruments included the Relative Stress Scale and the Pittsburgh Sleep Quality Index. The data were analyzed using descriptive statistics, means, standard deviation, and simple linear regression.

Results: The study revealed that caregivers had a high level of caregiving stress (M = 49.68, SD = 4.71), and poor sleep quality (M = 12.44, SD = 3.60). Caregiving stress was positively correlated with poor sleep quality (r = 0.54, p < 0.01) with a large relationship.

Conclusion: Thai family caregivers of people with dementia reported high stress level and had poor sleep quality. The findings suggest that nurses in primary health care should focus on assessing stress levels and sleep quality as well as improving sleep quality for family caregivers by developing interventions.

Supporting Agencies

National Research Council of Thailand (Grant # 960944, 2021)


Copyright (c) 2022 Panawat Sanprakhon, Nujjaree Chaimongkol, Pornpat Hengudomsub

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declare that there is no conflict of interest.


The authors would like to thank all participants who greatly contributed to this study, and the staff in Songphinong district, Suphun Buri, Thailand, for assisting with the recruitment process and data collection. Additionally, Dr. Panawat Sanprakhon wishes to acknowledge “The Increase of Nurse Production Scholarship” for his PhD program at Suan Dusit University, Thailand.

Authors’ Contributions

All authors contributed equally insubstantial contributions to the conception and design, acquisition of data, and analysis and interpretation of data. In addition, all authors participated in drafting the manuscript or revising it critically for important intellectual content, and given final approval of the version to be submitted and any revision version as well as agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Data Availability

The dataset generated during and/or analyzed during the current study is available from the corresponding author on reasonable request.


Adegbohun, A., Uwakwe, R., Adeosun, I., & Ojini, F. (2017). The quality of sleep, burden of care and psychological distress in caregivers of patients with stroke. International Journal of Mental Health & Psychiatry, 2017(3), 4.

Al-Daken, L. I., & Ahmad, M. M. (2018). Predictors of burden and quality of sleep among family caregivers of patients with cancer. Supportive Care in Cancer, 26(11), 3967-3973.

Bachmann, P. (2020). Caregivers’ experience of caring for a family member with Alzheimer’s disease: A content analysis of longitudinal social media communication. International Journal of Environmental Research and Public Health, 17(12), 4412.

Boostaneh, M., Zirak, M., & Fallah, R. (2021). Burden of care and its relationship with sleep quality of cancer patients’ caregivers. Research Square.

Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-cultural Psychology, 1(3), 185-216.

Bursch, H. C., & Butcher, H. K. (2012). Caregivers’ deepest feelings in living with Alzheimer’s disease: A Ricoeurian interpretation of family caregivers’ journals. Research in Gerontological Nursing, 5(3), 207-215.

Buysse, D. J., Reynolds Iii, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.

Byun, E., Lerdal, A., Gay, C. L., & Lee, K. A. (2016). How adult caregiving impacts sleep: A systematic review. Current Sleep Medicine Reports, 2(4), 191-205.

Chen, Y., Wang, J.-Y., Liu, X.-Y., Meng, F.-X., Li, A.-P., & Peng, G.-P. (2019). Sleep quality of spousal caregivers is associated with neuropsychiatric symptoms and living ability of patients with Alzheimer disease. Chinese Medical Journal, 132(12), 1490-1493.

Cheng, S.-T. (2017). Dementia caregiver burden: A research update and critical analysis. Current Psychiatry Reports, 19(9), 1-8.

Chuakhamfoo, N. N., Phanthunane, P., Chansirikarn, S., & Pannarunothai, S. (2020). Health and long-term care of the elderly with dementia in rural Thailand: A cross-sectional survey through their caregivers. BMJ Open, 10(3), e032637.

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. London: Routledge.

Fonareva, I., & Oken, B. S. (2014). Physiological and functional consequences of caregiving for relatives with dementia. International Psychogeriatrics, 26(5), 725-747.

Gao, C., Chapagain, N. Y., & Scullin, M. K. (2019). Sleep duration and sleep quality in caregivers of patients with dementia: A systematic review and meta-analysis. JAMA Network Open, 2(8), e199891-e199891.

Greaney, M. L., Kunicki, Z. J., Drohan, M. M., Nash, C. C., & Cohen, S. A. (2022). Sleep quality among informal caregivers during the COVID-19 pandemic: A cross-sectional study. Gerontology and Geriatric Medicine, 8, 23337214211057387.

Greene, J. G., Smith, R., Gardiner, M., & Timbury, G. C. (1982). Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: A factor analytic study. Age and Ageing, 11(2), 121-126.

Hinton, L., Tran, D., Nguyen, T.-N., Ho, J., & Gitlin, L. (2019). Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: A scoping review. BMJ Global Health, 4(6), e001830.

Jirapramukpitak, T., & Tanchaiswad, W. (1997). Sleep disturbances among nurses of Songklanagarind Hospital. Journal of the Psychiatrist Association of Thailand, 42(3), 123-132.

Lee, D., Heo, S. H., Yoon, S.-S., Chang, D.-I., Lee, S., Rhee, H.-Y., Ku, B. D., & Park, K.-C. (2014). Sleep disturbances and predictive factors in caregivers of patients with mild cognitive impairment and dementia. Journal of Clinical Neurology, 10(4), 304-313.

Lindeza, P., Rodrigues, M., Costa, J., Guerreiro, M., & Rosa, M. M. (2020). Impact of dementia on informal care: A systematic review of family caregivers’ perceptions. BMJ Supportive & Palliative Care.

Liu, S., Li, C., Shi, Z., Wang, X., Zhou, Y., Liu, S., Liu, J., Yu, T., & Ji, Y. (2017). Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. Journal of Clinical Nursing, 26(9-10), 1291-1300.

Lohr, L. S. (2010). Sampling: Design and analysis. Tempe: Arizona State University.

Mills, P. J., Ancoli-Israel, S., von Känel, R., Mausbach, B. T., Aschbacher, K., Patterson, T. L., Ziegler, M. G., Dimsdale, J. E., & Grant, I. (2009). Effects of gender and dementia severity on Alzheimer’s disease caregivers’ sleep and biomarkers of coagulation and inflammation. Brain, Behavior, and Immunity, 23(5), 605-610.

Morris, J. C. (1997). Clinical dementia rating: A reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9(S1), 173-176.

Okuda, S., Tetsuka, J., Takahashi, K., Toda, Y., Kubo, T., & Tokita, S. (2019). Association between sleep disturbance in Alzheimer’s disease patients and burden on and health status of their caregivers. Journal of Neurology, 266(6), 1490-1500.

Ornstein, K., & Gaugler, J. E. (2012). The problem with “problem behaviors”: A systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient–caregiver dyad. International Psychogeriatrics, 24(10), 1536-1552.

Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583-594.

Peng, H. L., & Chang, Y. P. (2013). Sleep disturbance in family caregivers of individuals with dementia: A review of the literature. Perspectives in Psychiatric Care.

Shakiba Zahed, M. E., Eslami, A. A., Barekatain, M., Hassanzadeh, A., & Zamani-Alavijeh, F. (2020). Stress as a challenge in promoting mental health among dementia caregivers. Journal of Education and Health Promotion, 9, 65.

Simón, M. A., Bueno, A. M., Blanco, V., Otero, P., & Vázquez, F. L. (2022). Prevalence and associated factors with poor sleep quality in non-professional caregivers. Journal of Clinical Medicine, 11(3), 719.

Simón, M. A., Bueno, A. M., Otero, P., Blanco, V., & Vázquez, F. L. (2019). Caregiver burden and sleep quality in dependent people’s family caregivers. Journal of Clinical Medicine, 8(7), 1072.

Smyth, A., Whitehead, L., Quigley, E., Vafeas, C., & Emery, L. (2020). Disrupted sleep and associated factors in Australian dementia caregivers: A cross-sectional study. BMC Geriatrics, 20(1), 1-7.

Song, M. J., & Kim, J. H. (2021). Family caregivers of people with dementia have poor sleep quality: A nationwide population-based study. International Journal of Environmental Research and Public Health, 18(24), 13079.

Ulstein, I., Wyller, T. B., & Engedal, K. (2007). High score on the Relative Stress Scale, a marker of possible psychiatric disorder in family carers of patients with dementia. International Journal of Geriatric Psychiatry, 22(3), 195-202.

von Känel, R., Mausbach, B. T., Ancoli-Israel, S., Dimsdale, J. E., Mills, P. J., Patterson, T. L., Ziegler, M. G., Roepke, S. K., Chattillion, E. A., & Allison, M. (2012). Sleep in spousal Alzheimer caregivers: A longitudinal study with a focus on the effects of major patient transitions on sleep. Sleep, 35(2), 247-255.

Wang, Z., Ma, C., Han, H., He, R., Zhou, L., Liang, R., & Yu, H. (2018). Caregiver burden in Alzheimer's disease: Moderation effects of social support and mediation effects of positive aspects of caregiving. International Journal of Geriatric Psychiatry, 33(9), 1198-1206.

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