First-of-its-kind intervention improves sleep for those living with dementia

The trial, published in The Lancet Healthy Longevity, compared the sleep outcomes of 377 people living at home with dementia receiving usual NHS care with those assigned to the DREAMS START (Dementia Related Manual for Sleep; Strategies for Relatives) intervention.

Sleep disturbances are a common and distressing issue for people with dementia and their families. These disturbances can exacerbate the symptoms of dementia and significantly impact the quality of life for both patients and their carers, often resulting in care at home breaking down.

Pharmacological treatments often come with harmful side effects and are ineffective, making non-pharmacological interventions a preferred first-line treatment. However, until now, there has been no definitive evidence supporting the effectiveness of such interventions.

This study was a phase 3 trial involving 377 dyads of people with dementia and their family carers, recruited from community NHS memory services and older adult mental health services in England. Participants were randomly assigned to receive either the DREAMS START intervention plus usual care or to usual care alone.

DREAMS START is a six-session psychological intervention, developed in consultation with and people living with dementia, and delivered by trained, non-clinically qualified psychology graduates.

The intervention comprises components such as psychoeducation, strengthening routine, light therapy, increased activity, exercise, and carer support. It is tailored to the needs of people with dementia and their relatives.

The researchers found improved sleep after four and eight months in those receiving the DREAMS START intervention compared to those receiving usual care, with significantly lower Sleep Disorders Inventory (SDI) scores. The effect exceeded the minimum clinically important difference on the SDI, suggesting it is clinically important and meaningful. 

The study also found that the intervention led to significant improvements in family carer sleep and anxiety levels after eight months.

Lead author, Professor Penny Rapaport (UCL Division of Psychiatry), said: “Many people living with dementia have disturbed sleep, so DREAMS START is a positive step forward for people with dementia and their families.

“It is the first multicomponent intervention to improve the sleep of people living at home with dementia more than usual clinical care. Importantly, because it is delivered either face-to-face or remotely by non-clinically trained graduates, there is potential for it to be delivered at scale.

This project is funded by the National Institute for Health and Care Research Health Technology Assessment.

Links

• Research paper: Clinical effectiveness of DREAMS START versus usual care for people with dementia and their carers: a single-masked, phase 3, parallel-arm, superiority randomised controlled trial
• Professor Penny Rapapor's academic profile
• UCL Division of Psychiatry

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