Evaluation of Non-Pharmacological Interventions for Community-Dwelling Individuals With Dementia Experiencing Sleep Disturbances: An Updated Systematic Review
Restricted accessReview articleFirst published online 2025
Evaluation of Non-Pharmacological Interventions for Community-Dwelling Individuals With Dementia Experiencing Sleep Disturbances: An Updated Systematic Review
Sleep disturbances create adverse cognitive and health outcomes for people living with dementia (PLwD). Approximately 19% to 44% of PLwD in the community experience sleep disturbances, but to date, no systematic review has focused primarily on interventions developed for community-dwelling populations (Livingston et al., 2024; Koren et al., 2023; Wong & Lovier, 2023). This systematic review builds on a Cochrane Systematic Review (Wilfling et al., 2023) that evaluated all non-pharmacological interventions to help address poor sleep in PLwD. The current review builds on the Wilfling et al. (2023) review but focuses only on studies published from 2022 through 2024 and only RCT studies for community-dwelling PLwD experiencing sleep disturbances. Six studies met the inclusion criteria. Photo/light interventions and activity-based interventions had mixed outcomes, preventing any firm conclusions about effectiveness. Dyadic-based multi-component interventions may be effective for treating sleep in PLwD in the community.
AlmutairiR.ZauszniewskiJ. (2022). Sleep disturbance in informal caregivers of persons with Dementia: Systematic review. International Journal of Caring Sciences, 15(2), 1533–1544.
AryankhesalA.BlakeJ.WongG.MegsonM.BriscoeS.AllanL.BroomfieldN. M.EastwoodZ.GreeneL.HiltonA.KillettA.LazarA. S.LitherlandR.LivingstonG.MaidmentI.ReeveJ.RookG.ScottS.UmJ.van HorikJ.FoxC. (2024). Sleep disturbance in people with Dementia or mild cognitive impairment: A realist review of general practice. British Journal of General Practice, 74(741), 233–e241. https://doi.org/10.3399/bjgp.2023.0171
4.
BalvertS.SordoG.MildersM. (2024). The efficacy of dyadic interventions for community-dwelling people with dementia and their caregivers: A systematic review and meta-analysis. Ageing Research Reviews, 96.
5.
BeaudreauS.SpiraA.StewartA.KexirianE.LuiL.-Y.EnsrudK.RedlineS.Ancoli-IsraelS.StoneK.Study of Osteoporotic Fractures. (2012). Validation of the Pittsburgh sleep quality index and the epworth sleepiness scale in older black and white women. Sleep Medicine, 13(1), 36–42. https://doi.org/10.1016/j.sleep.2011.04.005
6.
BencaR.HerringW. J.KhandkerR.QureshiZ. (2022). Burden of insomnia and sleep disturbances and the impact of sleep treatments in patients with probable or possible Alzheimer’s disease: A structured literature review. Journal of Alzheimer's Disease: JAD, 86(1), 83–109. https://doi.org/10.3233/JAD-215324
7.
BeydounM.TateR.GeorgescuM.GamaldoA.Maino VieytesC.BeydounH.Noren HootenN.EvansM.ZondermanA. (2024). Poor sleep quality, dementia status and their association with all-cause mortality among older US adults. Aging, 16(17), 12138–12167. https://doi.org/10.18632/aging.206102
8.
BjörkstedtE.VoutilainenA.AuvinenK.HyttinenV.JyrkkäJ.MäntyselkäP.LönnroosE. (2023). The role of functioning in predicting nursing home placement or death among older home care patients. Scandinavian Journal of Primary Health Care, 41(4), 478–485.
9.
BrodatyH.ConnorsM. H.XuJ.WoodwardM.AmexD.PRIME study group. (2014). Predictors of institutionalization in Dementia: A three-year longitudinal study. Journal of Alzheimer's Disease: JAD, 40(1), 221–226. https://doi.org/10.3233/JAD-131850
10.
BrownA.DowlingJ.VermaR.ValentaT.PiestchA.CavuotoM.McCurryS.BeiB.WoodwardM.JacksonM.VarmaP. (2024). Integrating lived experience to develop a tailored sleep intervention for people living with dementia and carepartners. Dementia, 24(4), 697–719. https://doi.org/10.1177/14713012241282769
11.
BuysseD.ReynoldsC.MonkT.BermanS. R.KupferD. J. (1998). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
12.
CebollaA.GalianaL.CamposD.OliverA.SolerJ.DemarzoM.BañosR.Feliu-SolerA.García-Campayo (2018). How does mindfulness work? Exploring a theoretical model using samples of meditators and non-meditators. Mindfulness, 9(3), 860–870. https://doi.org/10.1007/s12671-017-0826-7
13.
*ChanA.YuD.ChoiK. C.LeeD.SitJ.ChanH. (2016). Tai chi qigong as a means to improve nighttime sleep quality among older adults with cognitive impairment: A pilot randomized controlled trial. Clinical Interventions in Aging, 11, 1277–1286. https://doi.org/10.2147/CIA.S111927
14.
ChaputJ.DutilC.FeatherstoneR.RossR.GiangregorioL.SaundersT.JanssenI.PoitrasV.KhoM.Ross-WhiteA.ZankarS.CarrierJ. (2020). Sleep timing, sleep consistency, and health in adults: A systematic review. NRC Research Press.
15.
ChengS.-T.LiK.-K.OrP. P. L.LosadaA. (2022). Do caregiver interventions improve outcomes in relatives with Dementia and mild cognitive impairment? A comprehensive systematic review and meta-analysis. Psychology and Aging, 37(8), 929–953. https://doi.org/10.1037/pag0000696
16.
CiprianiG.LucettiC.DantiS.NutiA. (2015). Sleep disturbances and Dementia. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 15(1), 65–74. https://doi.org/10.1111/psyg.12069
17.
CremascoliR.SparasciD.GiustiG.CattaldoS.PrinaE.RovetaF.BrunoF.GhezziC.CerriS.PicasciaM.BerniniS.SinforianiE.TerzaghiM.PrianoL.MauroA.MannieR. (2022). Effects of circadian phase tailored light therapy on sleep, mood, and cognition in Alzheimer’s disease: Preliminary findings in a pivotal study. Frontiers in Physiology, 12, 1–11. https://doi.org/10.3389/fphys.2021.755322
18.
De PasqualeC.KazziM.SutherlandK.ShrianeA.VincentG.CistulliP.BinY. (2024). Sleep hygiene – What do we mean? A bibliographic review. Sleep Medicine Reviews, 75.
19.
EskaK.GraesselE.DonathC.SchwarzkopfL.LauterbergJ.HolleR. (2013). Predictors of institutionalization of dementia patients in mild and moderate stages: A 4-year prospective analysis. Dementia and Geriatric Cognitive Disorders Extra, 3(1), 426–445. https://doi.org/10.1159/000355079
20.
GibsonR.GanderH.JonesL. (2014). Understanding the sleep problems of people with Dementia and their family caregivers. Dementia, 13(3), 350–365. https://doi.org/10.1177/1471301212473884
21.
GibsonR.GanderP. (2020). Factors associated with the sleep of carers: A survey of New Zealanders supporting a family member with cognitive impairment or dementia. Dementia, 20(3), 919–935. https://doi.org/10.1177/1471301220915071
22.
GibsonR.HelmA.RossI.GanderP.BrehenyM. (2023). “I think I could have coped if I was sleeping better”: Sleep across the trajectory of caring for a family member with Dementia. Dementia, 22(5), 1038–1056. https://doi.org/10.1177/14713012231166744
23.
HigginsJ.ThomasJ.ChandlerJ.CumpstonM.LiT.MatthewP.VivianW. (2024). Cochrane handbook for systematic reviews of interventions 6.5 edition. Cochrane.org. https://training.cochrane.org/handbook/current
24.
HirtJ.VetschJ.HeinrichS. (2024) (In press). Nurse-led physical activity interventions for people with dementia in nursing homes: A systematic review on intervention characteristics and implementation facilitators/barriers.International Journal of Nursing Studies.
25.
HjetlandG.NordhusH.PallesenS.CummingsJ.TractenbergR.ThunE.KolbergE.FloE. (2020). An actigraphy-based validation study of the sleep disorder inventory in the nursing home. Frontiers in Psychiatry, 11, 173. https://doi.org/10.3389/fpsyt.2020.00173
26.
HuongT.NguyenH.NguyenA. (2024). Effectiveness of non-pharmacological interventions for Dementia among elderly: A randomized controlled trial. Geriatrics, 9(2).
27.
JingW.WillisR.FengZ. (2016). Factors influencing quality of life of elderly people with dementia and care implications: A systematic review. Archives of Gerontology and Geriatrics, 66, 23–41. https://doi.org/10.1016/j.archger.2016.04.009
28.
JohnM. (1991). A new method for measuring daytime sleepiness. The Epworth Sleepiness Scale.Sleep, 14.
29.
JohnsM. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14(6), 540–545. https://doi.org/10.1093/sleep/14.6.540
30.
KitamuraK.WatanabeY.NakamuraK.TakanoC.HayashiN.SatoH.SomeyaT. (2021). Short daytime napping reduces the risk of cognitive decline in community-dwelling older adults: A 5-year longitudinal study. BMC Geriatrics, 21(474), 474. https://doi.org/10.1186/s12877-021-02418-0
31.
KorenT.FisherE.WebsterL.LivingstonG.RapaportP. (2023). Prevalence of sleep disturbances in people with dementia living in the community: A systematic review and meta-analysis. Ageing Research Reviews, 83, 101782.
32.
LachH.HarrisonB.PhongphanngamS. (2017). Falls and fall prevention in older adults with early-stage Dementia. Research in Gerontological Nursing, 10(3), 139–148. https://doi.org/10.3928/19404921-20160908-01
33.
LiangY.WangL.ZhuJ. (2018). Factor structure and psychometric properties of Chinese version of Beck Anxiety Inventory in Chinese doctors. Journal of Health Psychology, 23(5), 657–666. https://doi.org/10.1177/1359105316658971
34.
*LinC.TsengS.ChuangY.KuoC.ChenN. (2022). Grounding the body improves sleep quality in patients with mild Alzheimer’s disease: A pilot study. Healthcare, 10(3), 581. https://doi.org/10.3390/healthcare10030581
35.
LiuK.LeggettA.KimK.PolenickC.McCurryS.ZaritS. (2022). Daily sleep, well-being, and adult day services use among dementia care dyads. Aging & Mental Health, 26(12), 2472–2480. https://doi.org/10.1080/13607863.2021.1998354
36.
LivingstonG.HuntleyJ.LiuK.CostafredaS.SelbackG.AlladiS.AmesD.BanerjeeS.BurnsA.BrayneC.FoxN.FerriC.GitlinL.HowardR.KalesH.KivimakiM.LarsonE.NakasujjaN.RockwoodK.MukadamN. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet (London, England), 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
37.
LuppaM.LuckT.BrählerE.KönigH. H.Riedel-HellerS. G. (2008). Prediction of institutionalization in Dementia. A systematic review. Dement Geriatr Cogn Disord, 26(1), 65–78.
38.
MaoJ.YamakawaM.HuX.ChikamaH.SwaT.TakeyaY. (2025). Negative consequences of sleep deprivation experienced by informal caregivers of people with dementia on caregivers and care recipients: A scoping review. International Journal of Nursing Practice, 31(2). https://doi.org/10.1111/ijn.70010
39.
McAlpineT.MullanB.ClarkeP. (2024). Reconsidering the role of sleep hygiene behaviors in sleep: Associations between sleep hygiene, perceptions, and sleep. International Journal of Behavioral Medicine, 31(5), 705–717. https://doi.org/10.1007/s12529-023-10212-y
40.
*McCurryS.GibbonsL.LogsdonR.VitielloM.&TeriL. (2005). Nighttime insomnia treatment and education for Alzheimer’s disease: A randomized controlled trial. Journal of the American Geriatrics Society, 53(5), 793–802. https://doi.org/10.1111/j.1532-5415.2005.53252.x
41.
*McCurryS.PikeK.VitielloM.LogsdonR.LarsonE.TeriL. (2011). Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer’s disease: Results of a randomized controlled trial. Journal of the American Geriatrics Society, 59(8), 1393–1402. https://doi.org/10.1111/j.1532-5415.2011.03519.x
42.
MitoloM.TononC.La MorgiaC.TestaC.CarelliV.LodiR. (2019). Effects of light treatment on sleep, cognition, mood, and behavior in Alzheimer’s disease: A systematic review. Dementia and Geriatric Cognitive Disorders, 46(5-6), 371–384. https://doi.org/10.1159/000494921
43.
Munthe-KaasH.HøklebyH.LewinS.GlentonC. (2020). The TRANSFER approach for assessing the transferability of systematic review findings. BMC Medical Research Methodology, 20(11).
44.
NikmatA. W.HawthorneG.Al-MashoorS. H. (2015). The comparison of quality of life among people with mild Dementia in nursing home and home care--a preliminary report. Dementia (London, England), 14(1), 114–125. https://doi.org/10.1177/1471301213494509
45.
Nora de SouzaL.Torres VilarinoG.AndradeA. (2024). What do we know about the effects of physical exercise on Dementia, without Alzheimer’s? Systematic review of international clinical trials. Retos: Nuevas Perspectivas de Educación Físíca, Deporte y Recreación, 51, 1001–1013.
*RapaportP.AmadorS.AdelekeM.BarberJ.BanerjeeS.CharlesworthG.ClarkeC.EspieC.GonzalezL.HorsleyR.HunterR.KyleS.ManelaM.RaczekM.WalkerZ.WebsterL.YuanH.LivingstonG. (2024). Clinical effectiveness of DREAMS START (Dementia related manual for sleep; strategies for relatives) versus usual care for people with Dementia and their carers: A single-masked, phase 3, parallel-arm, superiority randomized controlled trial. Lancet.
SidaniS.FoxM.ButlerJ.MaimetsI. (2022). Development of a multicomponent intervention to promote sleep in older persons with Dementia transitioning from hospital to home. International Journal of Older People Nursing, 17(5), 1–12. https://doi.org/10.1111/opn.12463
50.
*SloaneP.FigueiroM.GargS.CohenL.ReedD.WilliamsC.PreisserJ.ZimmermanS. (2015). Effect of home-based light treatment on persons with Dementia and their caregivers. Lighting Research & Technology (London, England: 2001), 47(2), 161–176. https://doi.org/10.1177/1477153513517255
51.
SpiraA.BeaudreauS.StoneK.KezirianE.LuiL.RedlineS.Ancoli-IsraelA.EnsrudeK.StewartA.Osteoporotic Fractures in Men Study. (2011). Reliability and validity of the Pittsburgh sleep quality index and the Epworth sleepiness scale in older men. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 67(4), 433–439. https://doi.org/10.1093/gerona/glr172
52.
StewartR.ChamblessD.Wiltsey-StirmanS. (2018). Decision making and the use of evidence-based practice: Is the three-legged stool balanced?Practice Innovations, 3(1), 56–67. https://doi.org/10.1037/pri0000063
53.
TractenbergR.SingerC.CummingsJ.ThalL. J. (2003). The Sleep Disorder Inventory (SDI): An instrument for studies of sleep disturbance in persons with Alzheimer’s disease. Journal of Sleep Research, 12(4), 331–337. https://doi.org/10.1046/j.0962-1105.2003.00374.x
54.
TriccoA.CardosoR.ThomasS.MotiwalaS.SullivanS.KealeyM.BrendaM.OuimetM.HillmerM.PerrierL.ShepperdS.StrausS. (2016). Barriers and facilitators to uptake of systematic reviews by policy makers and health care managers: A scoping review. Implementation Science: IS, 11(4), 4. https://doi.org/10.1186/s13012-016-0370-1
55.
TsaiP.WangS.WangM., et al. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSCQI) in primary insomnia and control subjects. Quality of Life Research, 14(8).
56.
WangX.WangY.XinT. (2020). The psychometric properties of the Chinese version of the Beck Depression Inventory-II with middle school teachers. Frontiers in Psychology, 11, 548965. https://doi.org/10.3389/fpsyg.2020.548965
57.
WennbergA. M. V.WuM. N.RosenbergP. B.SpiraA. P. (2017). Sleep disturbance, cognitive decline, and dementia: A review. Seminars in Neurology, 37(4), 395–406. https://doi.org/10.1055/s-0037-1604351
58.
WilflingD.CaloS.DichterM. N.MeyerG.MöhlerR.KöpkeS. (2023). Non-pharmacological interventions for sleep disturbances in people with Dementia. The Cochrane Database of Systematic Reviews, 1. https://doi.org/10.1002/14651858.CD011881.pub2
59.
WongR.LovierM. (2023). Sleep disturbances and dementia risk in older adults: Findings from 10 years of national U.S. prospective data. American Journal of Preventive Medicine, 64(6), 781–787. https://doi.org/10.1016/j.amepre.2023.01.008
60.
YamaguchiY.GreinerC.NakamuraM.KabayaS. (2024). Caregiver burden and psychological status and their associations with sleep quality among family caregivers living with older people with Dementia: A mixed method study. Geriatric Nursing, 60, 504–510. https://doi.org/10.1016/j.gerinurse.2024.10.016
61.
ZangL.LiuX.LiY.LiuJ.LuQ.ZhangY.MengQ. (2023). The effect of light therapy on sleep disorders and psychobehavioral symptoms in patients with Alzheimer’s disease: A meta-analysis. PLoS ONE, 18(12), 1–21. https://doi.org/10.1371/journal.pone.0293977
62.
ZaritS.ReeverK.Bach-PetersonJ. (1980). Relatives of impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
