In a study published in the journal Cancer Nursing (Vol. 23, No. 6), researchers looked at 51 caregivers in southern California and found 95% reported severe sleep problems and more than half were having symptoms that suggest a risk for clinical depression.

The study showed a strong relationship between caregivers? sleep problems and their levels of depression. The strongest relations were seen in overall sleep quality, habitual sleep efficiency (number of hours slept versus number of hours in bed), and daytime dysfunction (sleepiness during the day). Caregivers who reported these three problems were most likely to report higher levels of depression.

Lead researcher Pat Carter, PhD, assistant professor of nursing, University of Texas at Austin School of Nursing, believes health care professionals should talk to caregivers about the sleep they are getting. "As caregivers, they need to realize how much sleep or lack of sleep is affecting their role," she says.

Terri Ades, RN, MS, AOCN, director of the health content and nursing staff at the American Cancer Society, points out that caregivers are in the difficult position of caring for loved ones who require intensive care for long periods of time. "It isn?t really surprising that they would be having depressive symptoms associated with sleep problems," Ades says. "They are under a lot of stress, work hard, often have no support for themselves, and are fatigued."

Carter is currently working on a new study, funded by the National Institutes of Health, to further explore the relationship between sleep and depression in caregivers. She is examining changes in sleep and depression over a 10-week period. "Although data is preliminary," she says, "it appears to be that the lack of sleep is causing depression."

So far in the new study, it seems that periods of poor sleep quality are followed by periods of depression. If caregivers are sleeping well, their depression levels seem to decrease, Carter says.

Managing sleep problems for caregivers can be difficult. Drugs often are prescribed for better sleep, but caregivers may not want to take them for fear they will interfere with the ability to take care of their loved one properly. Carter believes health care professionals should know that sleeping pills do not always work in these situations and should help find other options.

Caregivers may sleep better if they set and follow rules for regular sleep and make sure to get enough exercise, Carter says. They also can take other steps including journal writing, progressive relaxation techniques, making the bed and room comfortable, and not drinking before bedtime. "If we can keep depression levels within a manageable level before they become clinical, caregivers can continue to provide care," she says.