Nonpharmacological intervention reduces sleep disturbances in people with dementia

DREAMS START*, a nonpharmacological intervention, reduces sleep disturbances in people living with dementia at home, according to a recent study presented at AAIC 2024.

“Sleep disturbance is common in people living with dementia … with a reported prevalence of approximately 26 percent … [It is well known that] medication is not recommended as a first-line treatment because often it can be harmful [and does not have a great deal] of evidence for effectiveness,” said lead author Dr Penny Rapaport from the Division of Psychiatry at University College London in London, UK.

On the other hand, nonpharmacological therapies are recommended as the most appropriate initiation strategy for people with dementia, as they may help avoid medication side effects, drug interactions, and limited efficacy. [Geriatr Nurs 2023;51:76-83]

Rapaport and her team developed and delivered DREAMS START, a multimodal nonpharmacological intervention, demonstrating its feasibility and acceptability in treating sleep problems among people with dementia living in their own homes. [BMJ Open 2024;doi:10.1136/bmjopen-2023-075273]

Researchers conducted a phase III, multicentre, parallel arm, superiority trial that involved 377 participant dyads (persons with dementia [mean age 79.4 years, 54.6 percent female] and sleep disturbance, and their caregivers). Participants were randomized 1:1 to either the DREAMS START intervention (n=188) or to the usual National Health Service treatment (n=189). Six sessions of DREAMS START (1 hour/session), manualized and personalized, were delivered by supervised, nonclinically trained graduates every 1–2 weeks.

The Sleep Disorders Inventory (SDI) measures sleep disturbance and describes the frequency and severity of sleep-disturbed behaviours. [BMJ Open 2024;doi:10.1136/bmjopen-2023-075273]

At 8 months, participants in the DREAMS START intervention arm achieved significantly lower SDI scores, as a higher SDI score indicates a worse outcome, compared with those in the usual treatment arm (mean SDI score, 15.6 vs 20.34; adjusted mean difference, -4.70 points; p=0.002), which was sustained from month 4 (adjusted mean difference, -4.40 points; p=0.003). [Rapaport et al, AAIC 2024]

As a result, the family carers in the intervention group experienced significantly improved sleep and less anxiety than those in the usual treatment group at 8 months (mean differences, 0.57 and -0.86, respectively).

Rapaport noted that a high fidelity rate of 95.4 percent was achieved, indicating that the DREAMS START intervention was acceptable.

“To our knowledge, this is the first and largest fully powered RCT of a multicomponent nonpharmacological intervention that improves sleep in people living at home with dementia and their caregivers, with sustained effectiveness beyond delivery,” said Rapaport.

“DREAMS START is a step forward for people with dementia and their families experiencing sleep problems,” she added.