Effectiveness of non-pharmacological interventions for sleep disturbances in people living with dementia: A systematic review and meta-analysis

Dementia is characterized by global cognitive dysfunction, which can cause difficulties in performing Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), with the most common type of dementia being Alzheimer's disease (AD).1,2 Up to 70% of people living with dementia(PlwD) suffer from sleep disturbances.3 Sleep disturbances are any disruption to the sleep process, including difficulty falling or staying asleep, short sleep duration, waking up during the night, early morning waking, and excessive daytime sleepiness.4,5

Sleep disturbances can lead to agitation, aggression, irritability,6, 7, 8 decreased social engagement,9 and reduced attention and motivation, all of which can impact cognitive performance.10 Furthermore, sleep disruption may contribute to amyloid deposition, increased Tau, and inflammation, all of which lead to neurodegeneration and, as a result, cause or worsen cognitive impairment.11

Facing these challenges, doctors use pharmacotherapy in clinical work to improve sleep symptoms in PlwD.5,12 Common pharmacological treatments include sedative-hypnotics, atypical antipsychotics, antidepressants, melatonin, and receptor agonists.12 Since the source of the sleep problems may be changed in the brain caused by dementia, it is not clear whether usual sleeping tablets are effective for PlwD. There are worries that the medicines could cause significant side effects.5

Non-pharmacological therapies are recommended as the most appropriate initiation strategy in PlwD.13 Because these may help avoid medication side effects, drug interactions, and limited efficacy. However, current research on non-pharmacological interventions in sleep management in PlwD is extremely limited, and our systematic review and meta-analysis focused on the following two key questions. (1) Which non-pharmacological interventions can alleviate sleep disorders in PlwD? (2) What aspects of sleep disorder symptoms can be improved by these non-pharmacological interventions in PlwD? Addressing these questions will help us provide empirically-based recommendations for PlwD with sleep disturbances and explore future research directions.

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