Over 11 million individuals in the United States served as caregivers of persons with dementia, providing an estimated 16 billion hours of unpaid care in 2021.1 The need for instrumental assistance in the community is indispensable for persons with dementia who require various types and levels of care at different stages of the illness trajectory. Caregivers of persons with dementia are a high-risk, high-need group and would benefit from sleep evaluation and interventions, especially that they experience high levels of role overload and may be vulnerable to nighttime awakenings of the person with dementia.2,3 Caregivers of persons with dementia report poor sleep health outcomes, with 50 to 70 percent of caregivers experiencing sleep disturbance, which includes difficulty initiating or maintaining sleep.4 Additionally, caregivers of persons with dementia are found to have poorer sleep quality and lower sleep duration compared to age-matched non-caregiver controls.5 More importantly, based on the findings of a recent meta-analysis,5 caregivers of persons with dementia have significantly less hours of sleep than the minimum sleep duration for adults (i.e., 7 hours per night) as recommended by the National Sleep Foundation.6 This has profound health implications given that sleep disturbance and short sleep duration (defined as habitual sleep duration of less than 6 hours7) are associated with an increase in markers of inflammation8 and risk for cardiometabolic disease.9,10

Caring for persons with dementia is a complex role often shared with other family members and characterized by high levels of role overload.11 Role overload is the subjective experience of caregiving stressors where the demands exceed the caregiver's personal resources.12 Role overload is associated with sleep disturbance among caregivers in general,13 and caregivers of persons with dementia in particular.14 Caregivers of persons with dementia generally report higher levels of overload over longer periods of time, compared to caregivers of persons with other health conditions.11 Therefore, it is important to evaluate modifiable factors to mitigate the influence of role overload on disturbed sleep and subsequently improve caregiving experiences and sleep health among caregivers of persons with dementia.

Psychological resilience is the process of successfully adapting and recovering in the face of stress and adversity and is associated with positive health outcomes.15,16 In the context of dementia caregiving, resilience has been positively associated with subjective well-being and quality of life.17,18 Additionally, resilient characteristics such as personal mastery were found to attenuate the detrimental effect of negative life events on cardiovascular risk among spousal caregivers of persons with dementia.19 However, research on the effect of resilience on caregivers’ physical health, notably sleep health is limited. According to the care partner resilience behavioral framework, there are four behavioral domains related to resilience among dementia care partners: problem-response, self-growth, help-related, and learning-related behaviors.20 Self-growth behaviors encompass self-care and other strategies that caregivers use to maintain their overall health and well-being.20 Therefore, a cargiver's level of resilience can affect their ability to engage in self-care behaviors, such as sleep health maintenance, despite caregiving challenges.

Resilience is positively associated with sleep quality (as measured by the Pittsburgh Sleep Quality Index) among a representative sample of adults in the United States21 and has been established as a moderator for the association between stressful life events and sleep quality among college students.22 Despite caregivers of persons with dementia experiencing different stressful situations as compared to college students, we anticipate that resilience may moderate the relationship between caregiver role overload and sleep disturbance among caregivers of persons with dementia. Caring for a person with dementia is associated with a host of challenges and adverse health implications for the caregiver and other family members.11 Therefore, resilience may buffer the impact of caregivers’ role overload on sleep disturbance by enabling better coping strategies with caregiving challenges, resulting in protective health benefits.

The purpose of this study was to assess the moderating role of resilience on the relationship between role overload and sleep disturbance among caregivers of persons with dementia. We hypothesized that resilience would buffer against the effect of role overload on sleep disturbance. The findings highlight resilience as a psychological resource that can be targeted in sleep health interventions to attenuate the stress of caregivers and improve their sleep health outcomes.