Non-pharmacological interventions for sleep disturbances in people with dementia.

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Authors: 

Wilfling D, Calo S, Dichter MN, Meyer G, Möhler R, Köpke S

What are sleep problems in people with dementia?

People with dementia frequently have sleep problems including an increase in the length and number of awakenings and an increased amount of light sleep. These cause a number of problems for the affected person, their relatives, and carers, possibly leading to carer distress and the admission of people with dementia to nursing homes or long-term care homes.

Can non-medicine interventions help?

As we do not know if medicines can help improve sleep in people with dementia, non-medicine interventions are frequently recommended. These include light therapy, social and physical activities, changes of the environment (such as reducing noise and light at night), or avoiding daytime sleep. Also, intervention programmes consisting of more than one of these components are available (so-called 'multimodal interventions'; e.g. combining light therapy and activities for people with dementia).

What did we want to find out?

We searched for clinical trials that tested the effects of non-medicine interventions for people with dementia and sleep problems. We wanted to find out if these interventions or programmes can promote sleep and avoid side effects for people with dementia and their carers.

What did we do?

We searched for randomised controlled trials (a design of study that usually gives the most reliable evidence about the effects of a treatment) evaluating any non-medicine intervention to improve sleep in people with dementia. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and numbers of participants.

What did we find?

We identified 19 studies, including 1335 participants. The studies included 13 to 193 participants with sleep problems and dementia. All studies applied one or more non-medicine intervention (i.e. light therapy, physical and social activities, carer interventions, daytime sleep restriction, slow-stroke back massage, or transcranial electrostimulation (a method that delivers a low electric current to the scalp that changes brain function)). Seven studies assessed multimodal interventions. Studies assessed sleep in different ways, but most used actigraphy, which is a wristband to measure night-time sleep.

Main results

– Physical activity interventions, social activities, carer interventions, and multimodal interventions may slightly or modestly improve night-time sleep in people with dementia.

– We found no evidence that light therapy, slow-stroke back massage, or transcranial electrostimulation reduce sleep problems in people with dementia.

What are the limitations of the evidence?

Although we were able to include 19 studies with 1335 participants evaluating non-medicine interventions to avoid sleep disturbances in people with dementia, we were unable to draw firm conclusions mostly due to important differences between interventions and lack of methodological quality. Therefore, the results of this review must be interpreted with caution and high-quality studies are urgently needed.

How up to date is this evidence?

The evidence is up to date to 13 January 2022.