About the project

Sleep difficulties in dementia are common and varied, including reduced sleep at night, night-time awakenings and wandering, and excessive daytime sleepiness. Family carers are often woken by their relatives' sleep difficulties and night-time care costs to continue caring at home can be unaffordable.

DREAMS:START (Dementia Related Manual for Sleep; Strategies for Relatives) is a psychological intervention, developed in consultation with current and former carers and people living with dementia. This randomised controlled trial will test the clinical and cost effectiveness of the manualised intervention. The intervention - consisting of six sessions - is tailored to the particular sleep difficulties of each person with dementia and delivered to their caregiver.

Why is this important?

Many people living with dementia have disturbed sleep, including reduced night-time sleep, night-time wandering and daytime sleepiness. They often wake family members, who may become exhausted, stressed and unhappy. Night-time care is often unaffordable and so care at home may break down.

What do we already know?

There are currently no proven effective and safe treatments for sleep disorders in people with dementia, possibly because even the same person may have many causes of sleep disturbance, such as dementia, anxiety and pain. Our team of experts in sleep, dementia interventions, and people whose lives have been affected by dementia, developed DREAMS:START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a six-session intervention, to improve sleep for people living with dementia. We used the best available evidence and what people told us was important to them. It uses several different strategies, such as increasing light, activity, comfort, routine and relaxation. These are adapted to suit each person seen, based on an individual’s needs. The idea is to use only relevant parts for each person.  A clinical psychologist trains and supervises health workers with a degree to deliver DREAMS:START.  They deliver DREAMS:START individually to family carers (people with dementia can also join sessions), and together they work out and try relevant strategies to improve their relative’s sleep.

We completed a small randomised study to see if DREAMS:START was feasible (whether people agreed to take part) and acceptable (whether people completed and liked it). We compared people with dementia who received it with those who had no additional treatment. Most people we approached were from memory services. About two-thirds of people approached agreed to participate (62), and nearly 90% completed the therapy. It was therefore feasible and acceptable. It appeared promising in improving sleep. Study participants made a few suggestions for future improvements.

What do we want to find out?

We want to know if DREAMS:START works: our primary question is “Do people with dementia living at home sleep better 6 months after receiving the intervention compared to people who did not receive it?”. We also want to know if it continues to work at 9 months, if it improves quality of life, if it is good value and if it works, how it works. We will recruit 370 people.

If DREAMS:START works, it will mean services can offer an effective treatment to improve the lives of people living with dementia and their families.  We will work with people affected by dementia and sleep disturbances, and service providers, throughout the project to ensure potential benefits can be widely rolled out.

Funding and Awards

This project is funded by the National Institute for Health Research (NIHR) HTA Reference Number: NIHR128761

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