DREAMS-START (Dementia RElated Manual for Sleep - STrAtegies for RelaTives)
Health Problem : Cognitive disorders ; Sleep disorders
Designation
DREAMS‑START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives)
Abbreviation
DREAMS-START
Category
Psychosocial
Main Indication
The DREAMS‑START program primarily aims to reduce sleep disorders in people living with dementia.
How does it work?
In people with dementia, sleep is often disrupted, which can lead to risks of premature death. These disturbances are often accompanied by difficulties in reasoning and behavior, making the burden heavier for caregivers. This Non-Pharmacological Intervention (NPI) helps improve sleep quality by limiting nighttime awakenings and moments of anxiety during the night. It thus provides better rest for the patient and relief for the caregiver.
Other Benefits
- Reduction of daytime sleepiness
- Better functioning in daily activities.
- Alleviation of physical and mental fatigue of caregivers
- Reduction in the use of sedative medications, often associated with significant side effects and an increased risk of complications.
- This NPI represents a cost-effective solution compared to its effectiveness.
Direct Risks
- This intervention has few serious side effects. Falls, dizziness, headaches, or minor digestive issues.
- Monitoring activity during sleep (called actigraphy) is generally well tolerated, even though some people find it a little inconvenient; its use therefore remains optional.
- Light therapy can, in some sensitive individuals, cause slight eye discomfort, headaches, or restlessness.
- It requires the involvement of caregivers.
- It can represent a certain burden, but studies show that caregivers accept it well and engage with it.
Risks of interaction
None known to date. Some people seem convinced that without medication, there is nothing to be done, whereas this is not the case, particularly in elderly people where non-pharmacological interventions exist.
Contraindications
- Adult with a sleep disorder prior to dementia: for example, sleep apnea syndrome or excessive alcohol consumption.
- Residents in an institution where the environment (collective schedules, lighting, staff) does not allow for individualized care.
- Adult with another serious health problem, an unstable psychiatric disorder (active psychosis, severe uncontrolled agitation), or poorly treated pain.
- Person with unrealistic expectations (for example, seeking immediate effect).
- Residents in an institution where the environment (collective schedules, lighting, staff) does not allow for individualized care.
- Adult with another serious health problem, an unstable psychiatric disorder (active psychosis, severe uncontrolled agitation), or poorly treated pain.
- Person with unrealistic expectations (for example, seeking immediate effect).
Duration
6 weeks
Sessions per week
1 session of about 1 hour per week.
Precautions
- The practitioners delivering this program must be trained and supervised at least once every 2 months.
- A preliminary assessment must be conducted to look for a clinically significant sleep disorder and to identify primary sleep disorders to exclude (e.g., sleep apnea).
- Informed consent must be obtained from the caregiver and, if possible, from the patient.
- A nighttime caregiver or a caregiver capable of applying the strategies must be present.
- Defer the intervention if the person lives alone without nighttime support.
- Tools (manual, light box, relaxation recordings) will be provided and explained, detailing the duration and safety of use (e.g., 30 minutes of morning light exposure).
- Actively monitor for adverse events (falls, headaches, gastrointestinal symptoms) and changes in psychotropic prescriptions during follow-up.
- The arrangements must be adapted (home, clinic, remote) according to logistical constraints and the preference of the caregiver or healthcare provider, while maintaining the structure of the NPI.
- The confidentiality and dignity of the patient are preserved through the presence of the caregiver during the sessions when appropriate.
Regulatory provisions
On medical prescription.
This NPI is designed to be administered by practitioners with degrees in psychology and supervised.
This NPI must be practiced in a healthcare facility, even if some sessions of the program are conducted at home or remotely.
This NPI is designed to be administered by practitioners with degrees in psychology and supervised.
This NPI must be practiced in a healthcare facility, even if some sessions of the program are conducted at home or remotely.
Main Initiator
The DREAMS‑START program was designed by the research team led by Professor Gill Livingston at University College London (UCL) with Julie A. Barber, Kirsi M. Kinnunen, Lucy Webster, Simon D. Kyle, Claudia Cooper and Colin A. Espie, Brendan Hallam, Rossana Horsley, James Pickett and Penny Rapaport.
Author(s) of the Sheet
NPIS (comité scientifique)
Creation Date : 13/03/2026
Revision Date : 15/04/2026
Version : V
Revision Date : 15/04/2026
Version : V
Download the sheet in PDF format
Designation
DREAMS‑START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives)
Abbreviation
DREAMS-START
Category
Psychosocial
Main Health benefit
The DREAMS‑START program primarily aims to reduce sleep disorders in people living with dementia (Kinnunen 2018; Rapaport 2024).
Explanation
Sleep is often disrupted in cases of dementia, with risks of premature death (Beydoun 2024; Lucey 2025). The patient experiences reasoning and behavioral disorders that cause an increased burden on caregivers. This NPI improves the patient's sleep quality by reducing the frequency of awakenings and nighttime distress (Livingston 2019; Rapaport 2024; Amador 2025). It consequently relieves the caregiver (Rapaport 2024).
Routine Test
The routine test used to assess the main health marker before and after is the score reported by the caregiver Sleep Disorder Inventory or SDI (Tractenberg 2003).
Threshold
The scores measure 3 dimensions:
- Frequency (rare frequency with occasional disruptive behaviors often linked to contextual factors such as pain, environment, or stress; moderate frequency with regular disturbances; high frequency with almost daily disturbances),
- Severity (low severity with minimally disruptive behaviors; moderate severity with clear disturbances; high severity with highly disruptive behaviors such as nighttime wandering, marked agitation, or screaming),
- Caregiver burden (low caregiver distress; moderate distress with fatigue, stress, and occasional need for caregiver support; high distress with signs of caregiver exhaustion).
- Frequency (rare frequency with occasional disruptive behaviors often linked to contextual factors such as pain, environment, or stress; moderate frequency with regular disturbances; high frequency with almost daily disturbances),
- Severity (low severity with minimally disruptive behaviors; moderate severity with clear disturbances; high severity with highly disruptive behaviors such as nighttime wandering, marked agitation, or screaming),
- Caregiver burden (low caregiver distress; moderate distress with fatigue, stress, and occasional need for caregiver support; high distress with signs of caregiver exhaustion).
Minimal Clinically Important Change
The lower the score on the 3 dimensions of the SDI, the better the quality of sleep. A 4-point decrease in the SDI score is a positive sign (Webster 2020).
Secondary benefits
- Improvement in quality of life (Rapaport 2024).
- Reduction of daytime sleepiness (Livingston 2019; Amador 2025).
- Improvement in daily life functioning (Livingston 2019).
- Reduction of physical and mental burden on caregivers (Rapaport 2024).
- Reduction in the use of sedative medications with numerous adverse effects, including increased risk of morbidity and mortality (Livingston 2019; Rapaport 2024).
- Cost-effective NPI(Gonzalez 2025).
- Reduction of daytime sleepiness (Livingston 2019; Amador 2025).
- Improvement in daily life functioning (Livingston 2019).
- Reduction of physical and mental burden on caregivers (Rapaport 2024).
- Reduction in the use of sedative medications with numerous adverse effects, including increased risk of morbidity and mortality (Livingston 2019; Rapaport 2024).
- Cost-effective NPI(Gonzalez 2025).
Direct Risks
Few serious adverse effects attributable to the intervention itself (Livingston 2019). Falls, dizziness, headaches, gastrointestinal symptoms.
Average acceptability of actigraphy during sleep making its use optional (Livingston 2019).
Phototherapy can occasionally cause eye discomfort, headaches, or agitation in sensitive individuals (Livingston 2019).
The intervention delivered to caregivers requires their commitment and may generate a burden; however, studies show good acceptability and satisfactory adherence (Livingston 2019).
Average acceptability of actigraphy during sleep making its use optional (Livingston 2019).
Phototherapy can occasionally cause eye discomfort, headaches, or agitation in sensitive individuals (Livingston 2019).
The intervention delivered to caregivers requires their commitment and may generate a burden; however, studies show good acceptability and satisfactory adherence (Livingston 2019).
Risks of interaction
None known to date. Some people seem convinced that without medication, there is nothing to be done, whereas this is not the case, particularly in elderly people where non-pharmacological interventions exist (Mack 2025).
Biological and Psychosocial Mechanisms
Realignment of circadian rhythms: the degeneration of structures regulating the circadian rhythm (e.g., suprachiasmatic nucleus) contributes to sleep disturbances in dementia (Jones 2025). The use of morning light, regularity of rising, going to bed, and meals, and if necessary phototherapy, reinforce the biological clock. They stabilize the sleep-wake cycle (Rapaport 2024; Mukherjee 2024). This NPI integrates light and routines as a main lever to reset sleep timing.
Reduction of nighttime awakenings through stimulus-control and deactivation strategies: establishing a sleep-conducive environment (comfort, silence, appropriate temperature, reduction of nighttime stimuli), bedtime routines, relaxation techniques, and plans to manage awakening episodes (structured reassurance, safety) reduce nighttime anxiety and waking behaviors (Livingston 2019).
Increase in daytime activity: daytime stimulation (activity planning, light exercise, exposure to natural light) increases the homeostatic sleep pressure at night and reduces prolonged naps and daytime sleepiness. This NPI restore a classic wake-sleep architecture (Rapaport 2024).
Strengthening caregiver skills: intervention train caregivers to understand the causes of disturbed sleep, implement individualized plans, and maintain long-term changes (Livingston 2019).
Systemic mechanism: by reducing sleep fragmentation and nighttime awakenings, this NPI can improve daytime alertness, decrease neuropsychiatric symptoms related to sleep deprivation, and potentially limit the impairment of amyloid protein metabolism (Rapaport 2024; Siwecka 2025).
Reduction of nighttime awakenings through stimulus-control and deactivation strategies: establishing a sleep-conducive environment (comfort, silence, appropriate temperature, reduction of nighttime stimuli), bedtime routines, relaxation techniques, and plans to manage awakening episodes (structured reassurance, safety) reduce nighttime anxiety and waking behaviors (Livingston 2019).
Increase in daytime activity: daytime stimulation (activity planning, light exercise, exposure to natural light) increases the homeostatic sleep pressure at night and reduces prolonged naps and daytime sleepiness. This NPI restore a classic wake-sleep architecture (Rapaport 2024).
Strengthening caregiver skills: intervention train caregivers to understand the causes of disturbed sleep, implement individualized plans, and maintain long-term changes (Livingston 2019).
Systemic mechanism: by reducing sleep fragmentation and nighttime awakenings, this NPI can improve daytime alertness, decrease neuropsychiatric symptoms related to sleep deprivation, and potentially limit the impairment of amyloid protein metabolism (Rapaport 2024; Siwecka 2025).
Responding population
Individuals with any type and severity of dementia living at home with a family caregiver and presenting a clinically significant sleep disorder. Caregiver capable of assisting and implementing the strategies.
Nonresponding population
- Adult with a prior primary sleep disorder, for example sleep apnea syndrome or excessive alcohol consumption.
- Residents in a facility where the environment (collective schedules, lighting, staff) is incompatible with individualized care.
- Adult with a serious medical comorbidity, an unstable psychiatric disorder (active psychosis, severe uncontrolled agitation) or poorly managed pain.
- Person with unrealistic expectations (for example seeking immediate effect).
- Residents in a facility where the environment (collective schedules, lighting, staff) is incompatible with individualized care.
- Adult with a serious medical comorbidity, an unstable psychiatric disorder (active psychosis, severe uncontrolled agitation) or poorly managed pain.
- Person with unrealistic expectations (for example seeking immediate effect).
Participants
Individual
Duration
6 weeks
Sessions per week
1 session of about 1 hour per week.
Procedure
The DREAMS‑START intervention is a manualized, multi-component program delivered to the caregiver of a person living with dementia (Kinnunen 2018; Livingston 2019; Rapaport 2024; DREAMS-START 2026). While the sessions are designed to be held with the caregiver alone to encourage open discussion, the person living with dementia can participate if they wish. The program is structured into individual sessions targeting assessment, circadian resynchronization, sleep hygiene, daytime activation, management of nighttime awakenings, and caregiver training (Livingston 2019; DREAMS-START 2026). Six individual sessions following the manual are delivered over 6 weeks (up to 12 weeks if necessary). Written materials are provided to the caregiver, and, if applicable, an actigraphy system to monitor sleep quality.
Session 1: Assessment and Individual Formulation
Main objective: establish a targeted assessment of sleep disorders, routines, medical and environmental factors, and co-construct a behavioral formulation.
Content: sleep assessment using the SDI and sleep diary; review of medications; identification of triggering factors (naps, light, noise); personalized initial plan.
Session 2: Sleep Hygiene and Bedtime Routines
Main objective: reduce nighttime stimuli and establish predictable routines.
Content: hygiene rules (bed for sleeping only, limit screens and stimulating activities), learning bedtime rituals, optimizing comfort, organization, nighttime safety.
Session 3: Circadian training and light exposure
Main objective: resynchronize the biological clock to consolidate nighttime sleep.
Content: Plan for exposure to natural light/morning phototherapy, regular wake-up/bedtime and meal schedules; advice on lamps if indicated. The component of external signals that allow the internal biological clock, called the circadian rhythm, to synchronize with the environment is essential.
Session 4: Daytime activation and nap management
Main objective: increase the homeostatic pressure of nighttime sleep through planned activity.
Content: program of adapted daily activities (light exercise, social engagement), limitation and scheduling of naps, techniques to stimulate the day. Rationale: daytime activation is associated with better nighttime consolidation in pilot studies.
Session 5: Management of Nighttime Awakenings and Safety
Main Objective: reduce the frequency and impact of nighttime awakenings and ensure safety.
Content: stimulus-control strategies, reassurance scripts, plans for managing nighttime wandering, environmental adaptations (night lighting, barriers), coordination with medical services if necessary.
Session 6: Caregiver Training, Relapse Prevention, and Follow-up
Main Objective: strengthen caregiver skills, plan for maintaining changes, and anticipate relapses.
Content: review of the personalized plan, monitoring tools with the SDI test and a journal, coping strategies in case of worsening, support contacts and follow-up plan (Livingston 2019).
Session 1: Assessment and Individual Formulation
Main objective: establish a targeted assessment of sleep disorders, routines, medical and environmental factors, and co-construct a behavioral formulation.
Content: sleep assessment using the SDI and sleep diary; review of medications; identification of triggering factors (naps, light, noise); personalized initial plan.
Session 2: Sleep Hygiene and Bedtime Routines
Main objective: reduce nighttime stimuli and establish predictable routines.
Content: hygiene rules (bed for sleeping only, limit screens and stimulating activities), learning bedtime rituals, optimizing comfort, organization, nighttime safety.
Session 3: Circadian training and light exposure
Main objective: resynchronize the biological clock to consolidate nighttime sleep.
Content: Plan for exposure to natural light/morning phototherapy, regular wake-up/bedtime and meal schedules; advice on lamps if indicated. The component of external signals that allow the internal biological clock, called the circadian rhythm, to synchronize with the environment is essential.
Session 4: Daytime activation and nap management
Main objective: increase the homeostatic pressure of nighttime sleep through planned activity.
Content: program of adapted daily activities (light exercise, social engagement), limitation and scheduling of naps, techniques to stimulate the day. Rationale: daytime activation is associated with better nighttime consolidation in pilot studies.
Session 5: Management of Nighttime Awakenings and Safety
Main Objective: reduce the frequency and impact of nighttime awakenings and ensure safety.
Content: stimulus-control strategies, reassurance scripts, plans for managing nighttime wandering, environmental adaptations (night lighting, barriers), coordination with medical services if necessary.
Session 6: Caregiver Training, Relapse Prevention, and Follow-up
Main Objective: strengthen caregiver skills, plan for maintaining changes, and anticipate relapses.
Content: review of the personalized plan, monitoring tools with the SDI test and a journal, coping strategies in case of worsening, support contacts and follow-up plan (Livingston 2019).
Components
A session lasts about 60 minutes. It is sequenced and individualized. It is addressed to both the caregiver and the patient to co-construct and implement strategies aimed at improving the sleep of the person living with dementia (Livingston 2019).
Session Objectives
- Assess the current state of sleep and routines (review of the sleep diary / actigraphy).
- Explain the link between dementia and sleep (Livingston 2019).
- Build or adjust the personalized plan (light, routines, daytime activity, management of awakenings).
Welcome and Recap (5–10 min)
Review of the previous session and checking the actions carried out (if this is not the first session).
Review of Data and Formulation (10–15 min)
SDI test and sleep diary and, if available, actigraphy data to identify priority problems (e.g., nighttime awakenings, prolonged naps).
Targeted psychoeducation (10–15 min)
Simple explanation of mechanisms (circadian rhythm, effects of naps, role of light) and the reasons why certain strategies are proposed.
Co-design of the personalized action plan (15–20 min)
Regular wake-up/bedtime and meal times; exposure to natural light or use of a morning light box if indicated.
Sleep hygiene and stimulus control: bedtime routines, reduction of nighttime stimulation, arrangement of the sleeping area.
Daytime activation: plan of suitable activities and exercises (or seated exercise video) to reduce naps and increase nighttime sleep pressure.
Management of awakenings: reassurance scripts, strategies for nighttime wandering, and safety measures.
Practical training and tools (5–10 min)
Demonstration of relaxation exercises, provision of the personalized manual, setup of the lamp if provided, and explanation of follow-up (journal, emergency contacts).
Closure and follow-up plan (2–5 min) Summary of actions to be taken before the next session and date/format of the next meeting (in-person, video, or phone)
Session Objectives
- Assess the current state of sleep and routines (review of the sleep diary / actigraphy).
- Explain the link between dementia and sleep (Livingston 2019).
- Build or adjust the personalized plan (light, routines, daytime activity, management of awakenings).
Welcome and Recap (5–10 min)
Review of the previous session and checking the actions carried out (if this is not the first session).
Review of Data and Formulation (10–15 min)
SDI test and sleep diary and, if available, actigraphy data to identify priority problems (e.g., nighttime awakenings, prolonged naps).
Targeted psychoeducation (10–15 min)
Simple explanation of mechanisms (circadian rhythm, effects of naps, role of light) and the reasons why certain strategies are proposed.
Co-design of the personalized action plan (15–20 min)
Regular wake-up/bedtime and meal times; exposure to natural light or use of a morning light box if indicated.
Sleep hygiene and stimulus control: bedtime routines, reduction of nighttime stimulation, arrangement of the sleeping area.
Daytime activation: plan of suitable activities and exercises (or seated exercise video) to reduce naps and increase nighttime sleep pressure.
Management of awakenings: reassurance scripts, strategies for nighttime wandering, and safety measures.
Practical training and tools (5–10 min)
Demonstration of relaxation exercises, provision of the personalized manual, setup of the lamp if provided, and explanation of follow-up (journal, emergency contacts).
Closure and follow-up plan (2–5 min) Summary of actions to be taken before the next session and date/format of the next meeting (in-person, video, or phone)
Equipment
- Printed DREAMS‑START manual for the caregiver containing the modules, practical sheets, and personalized plan.
- If applicable, a light therapy lamp for a scheduled morning exposure to resynchronize the circadian rhythm.
- Sleep activity watch for 24-hour movement recording.
- Daily sleep diary.
- Sleep Disorders Inventory (SDI) questionnaire.
- Audio recordings for relaxation and exercise materials.
- Personalized action sheets and activity plans.
- Safety and risk assessment tools such as nighttime safety checklists, emergency contacts, and risk management procedures.
- Consent forms.
- If applicable, a light therapy lamp for a scheduled morning exposure to resynchronize the circadian rhythm.
- Sleep activity watch for 24-hour movement recording.
- Daily sleep diary.
- Sleep Disorders Inventory (SDI) questionnaire.
- Audio recordings for relaxation and exercise materials.
- Personalized action sheets and activity plans.
- Safety and risk assessment tools such as nighttime safety checklists, emergency contacts, and risk management procedures.
- Consent forms.
Location
Mainly at home. The sessions can exceptionally take place in a specialized service for people with dementia or remotely according to preferences and constraints.
Best implementation practices
- Systematically assess sleep and contributing factors (SDI, sleep diary, medication review, actigraphy if possible) before developing the plan (Livingston 2019; Wilfling 2025).
- Formulate an individualized hypothesis based on the interview with the caregiver and, if possible, actigraphy data (Livingston 2019).
- Provide the caregiver with the DREAMS‑START manual and practical materials, that is, the sheets and relaxation recordings (Livingston 2019).
- Give a light box and explain its use (regular morning exposure, timer) when circadian resynchronization is indicated (Livingston 2019).
- Structure the one-hour sessions with a summary, a review of actions taken, new content, and a weekly action plan (Livingston 2019).
- Adapt the recommendations to the patient’s cognitive and physical level (e.g., seated exercises, alternatives if mobility is limited) (Livingston 2019).
- Teach sleep hygiene and stimulus-control techniques (bedtime routines, reduction of nighttime stimulation) (Livingston 2019).
- Plan daytime activation (pleasant activities, appropriate exercise) to reduce naps and increase nighttime sleep pressure (Livingston 2019).
- Co-construct scripts for managing nighttime awakenings (reassurance, safety, standardized responses) with the caregiver (Livingston 2019).
- Measure intervention fidelity (random recording of a session, checklist evaluation) and adjust if necessary (Livingston 2019).
- Monitor adverse events and the use of psychotropic medications (Livingston 2019).
- Document falls, headaches, and medication changes (Livingston 2019).
- Involve caregivers in decision-making and encourage their self-care (modules on caregiver sleep and stress management) (Livingston 2019).
- Customize the frequency and location of the sessions (home should be preferred even though it is possible to conduct sessions at a health center or remotely as needed) (Livingston 2019).
- Document a final "What works?" plan summarizing the effective strategies and the long-term follow-up plan (Livingston 2019).
Best practices for sustainability
- Train the practitioner, psychologist, or equivalent, through a specific session with a standardized manual.
- Supervise the practitioner through an expert referent to ensure safety, quality of the intervention, and risk management.
- Rely on the standard manual, practical sheets, relaxation recordings, and personalized action plans given to caregivers.
- Measure adherence (number of sessions attended).
- Record any adverse events and adjust care.
- Adapt the modality to the place of intervention and the content to the patient's physical/cognitive abilities and home constraints.
- Include paid caregivers if necessary.
- Integrate the DREAMS‑START program into memory pathways and caregiver support services.
- Regularly audit indicators such as adherence rate, fidelity, and SDI outcomes to correct identified obstacles.
- Communicate the results to clinicians, caregivers, and decision-makers.
- Engage caregivers and clinical teams in co-production to promote ownership.
Precautions
- Train and supervise the practitioners (initial training, biweekly clinical supervision, fidelity checklist) (Livingston 2019).
- Systematically assess clinical eligibility before initiating the intervention, by looking for a clinically significant sleep disorder (SDI ≥ 4) and identifying primary sleep disorders to exclude (e.g., sleep apnea).
- Obtain informed consent from the caregiver and, if possible, from the patient.
- Check for the presence of a nighttime caregiver or a caregiver capable of implementing the strategies.
- Postpone the intervention if the person lives alone without nighttime support.
- Clinically supervise the delivery through regular supervision meetings with a referring physician for high-risk cases.
- Standardize the delivery using the fidelity checklist and by randomly recording sessions for quality control.
- Customize the action plan based on the collected data (SDI, sleep diary, actigraphy if available) and adapt the recommendations to the patient’s cognitive and physical level.
- Provide and explain the use of tools (manual, light box, relaxation recordings), detailing the duration and safety of use (e.g., 30 minutes of morning light exposure).
- Actively monitor adverse events (falls, headaches, gastrointestinal symptoms) and changes in psychotropic prescriptions during follow-up.
- Measure adherence and impact with validated tools such as the SDI.
- Adapt the modality (home, clinic, remote) according to logistical constraints and the dyad’s preference, while maintaining the structure of the NPI.
- Protect the patient’s confidentiality and dignity by prioritizing sessions with the caregiver alone when appropriate.
Regulatory specification
On medical prescription.
This NPI is designed to be administered by practitioners with degrees in psychology and supervised.
This NPI must be practiced in a healthcare facility, even if some sessions of the program are conducted at home or remotely.
This NPI is designed to be administered by practitioners with degrees in psychology and supervised.
This NPI must be practiced in a healthcare facility, even if some sessions of the program are conducted at home or remotely.
Main Initiator
The DREAMS‑START program was designed by the research team led by Professor Gill Livingston at University College London (UCL) with Julie A. Barber, Kirsi M. Kinnunen, Lucy Webster, Simon D. Kyle, Claudia Cooper and Colin A. Espie, Brendan Hallam, Rossana Horsley, James Pickett and Penny Rapaport.
Qualification required
Psychologist or equivalent trained at the NPI.
References
Prototype study
Kinnunen KM et al. A manual-based intervention for carers of people with dementia and sleep disturbances: an acceptability and feasibility RCT. Health Technol Assess. 2018 Dec;22(71):1-408. https://doi.org/10.3310/hta22710
Mechanistic study
Mukherjee U et al. Mechanisms, consequences and role of interventions for sleep deprivation: Focus on mild cognitive impairment and Alzheimer's disease in elderly. Ageing Res Rev. 2024 Sep;100:102457. https://doi.org/10.1016/j.arr.2024.102457
Interventional studies
Livingston G et al. DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people with dementia and sleep disturbances: a single-blind feasibility and acceptability randomized controlled trial. Int Psychogeriatr. 2019 Feb;31(2):251-265. https://doi.org/10.1017/S1041610218000753
Rapaport P et al. Clinical effectiveness of DREAMS START (Dementia Related Manual for Sleep; Strategies for Relatives) versus usual care for people with dementia and their carers: a single-masked, phase 3, parallel-arm, superiority randomised controlled trial. Lancet Healthy Longev. 2024 Oct;5(10):100635. https://doi.org/10.1016/j.lanhl.2024.08.004
Risk assessment studies
Sidani S et al. Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home. Int J Older People Nurs. 2022 Sep;17(5):e12463. https://doi.org/10.1111/opn.12463
Kinnunen KM et al. The management of sleep disorders in dementia: an update. Curr Opin Psychiatry. 2017 Nov;30(6):491-497. https://doi.org/10.1097/YCO.0000000000000370
Implementation study
Wilfling D et al. Process evaluation of an intervention to reduce sleep problems in people living with dementia in nursing homes: a mixed-methods study. Age Ageing. 2025 Mar 3;54(3):afaf051. https://doi.org/10.1093/ageing/afaf051
Other publications
Amador S et al. Process evaluation in a randomised controlled trial of DREAMS-START (dementia related manual for sleep; strategies for relatives) for sleep disturbance in people with dementia and their carers. Age Ageing. 2025 Mar 3;54(3):afaf053. https://doi.org/10.1093/ageing/afaf053
Beydoun MA et al. Poor sleep quality, dementia status and their association with all-cause mortality among older US adults. Aging (Albany NY). 2024 Sep 4;16(17):12138-12167. https://doi.org/10.18632/aging.206102
DREAMS-START. Dementia Related Manual for Sleep; Strategies for Relatives is a psychological intervention. UCL, London, 2026. https://www.ucl.ac.uk/brain-sciences/psychiatry/research/mental-health-older-people/projects/dreams-start?utm_source=copilot.com
Gonzalez L et al. Cost-utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation. Lancet Healthy Longev. 2025 May;6(5):100708. https://doi.org/10.1016/j.lanhl.2025.100708
Jones A et al. Potentially Modifiable Risk Factors for Dementia and Mild Cognitive Impairment: An Umbrella Review and Meta-Analysis. Dement Geriatr Cogn Disord. 2024;53(2):91-106. https://doi.org/10.1159/000536643
Livingston G et al. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess. 2014 Jun;18(39):1-226, v-vi. https://doi.org/10.3310/hta18390
Lucey BP. Sleep Alterations and Cognitive Decline. Semin Neurol. 2025 May;45(3):333-347. https://doi.org/10.1055/a-2557-8422 Mack KM. When no medication is best practice: Transforming geriatric care with nurse-led non-pharmacological interventions and care. Geriatr Nurs. 2025 Jul-Aug;64:103442. https://doi.org/10.1016/j.gerinurse.2025.103442
Rapaport P et al. An intervention to improve sleep for people living with dementia: Reflections on the development and co-production of DREAMS:START (Dementia RElAted Manual for Sleep: STrAtegies for RelaTives). Dementia (London). 2018 Nov;17(8):976-989. https://doi.org/10.1177/1471301218789559
Rapaport P et al. Clinical and cost-effectiveness of DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people living with dementia and their carers: a study protocol for a parallel multicentre randomised controlled trial. BMJ Open. 2024 Feb 1;14(2):e075273. https://doi.org/10.1136/bmjopen-2023-075273
Rapaport P et al. Sleep Disturbances and Dementia in the UK South Asian Community: A Qualitative Study to Inform Future Adaptation of the DREAMS-START Intervention. Geriatrics (Basel). 2025a Sep 8;10(5):121. https://doi.org/10.3390/geriatrics10050121
Rapaport P et al. Long-term health conditions and their impact on people with sleep disturbances and dementia. BMC Geriatr. 2025b May 26;25(1):376. https://doi.org/10.1186/s12877-025-06045-x
Siwecka N et al. Sleep Disorders in Neurodegenerative Diseases with Dementia: A Comprehensive Review. J Clin Med. 2025 Oct 9;14(19):7119. https://doi.org/10.3390/jcm14197119
Tractenberg RE et al. The Sleep Disorders Inventory: an instrument for studies of sleep disturbance in persons with Alzheimer's disease. J Sleep Res. 2003 Dec;12(4):331-7. https://doi.org/10.1046/j.0962-1105.2003.00374.x
Webster L et al. The minimum clinically important difference on the sleep disorders inventory for people with dementia. Int J Geriatr Psychiatry. 2020 Nov;35(11):1418-1423. https://doi.org/10.1002/gps.5384
Kinnunen KM et al. A manual-based intervention for carers of people with dementia and sleep disturbances: an acceptability and feasibility RCT. Health Technol Assess. 2018 Dec;22(71):1-408. https://doi.org/10.3310/hta22710
Mechanistic study
Mukherjee U et al. Mechanisms, consequences and role of interventions for sleep deprivation: Focus on mild cognitive impairment and Alzheimer's disease in elderly. Ageing Res Rev. 2024 Sep;100:102457. https://doi.org/10.1016/j.arr.2024.102457
Interventional studies
Livingston G et al. DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people with dementia and sleep disturbances: a single-blind feasibility and acceptability randomized controlled trial. Int Psychogeriatr. 2019 Feb;31(2):251-265. https://doi.org/10.1017/S1041610218000753
Rapaport P et al. Clinical effectiveness of DREAMS START (Dementia Related Manual for Sleep; Strategies for Relatives) versus usual care for people with dementia and their carers: a single-masked, phase 3, parallel-arm, superiority randomised controlled trial. Lancet Healthy Longev. 2024 Oct;5(10):100635. https://doi.org/10.1016/j.lanhl.2024.08.004
Risk assessment studies
Sidani S et al. Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home. Int J Older People Nurs. 2022 Sep;17(5):e12463. https://doi.org/10.1111/opn.12463
Kinnunen KM et al. The management of sleep disorders in dementia: an update. Curr Opin Psychiatry. 2017 Nov;30(6):491-497. https://doi.org/10.1097/YCO.0000000000000370
Implementation study
Wilfling D et al. Process evaluation of an intervention to reduce sleep problems in people living with dementia in nursing homes: a mixed-methods study. Age Ageing. 2025 Mar 3;54(3):afaf051. https://doi.org/10.1093/ageing/afaf051
Other publications
Amador S et al. Process evaluation in a randomised controlled trial of DREAMS-START (dementia related manual for sleep; strategies for relatives) for sleep disturbance in people with dementia and their carers. Age Ageing. 2025 Mar 3;54(3):afaf053. https://doi.org/10.1093/ageing/afaf053
Beydoun MA et al. Poor sleep quality, dementia status and their association with all-cause mortality among older US adults. Aging (Albany NY). 2024 Sep 4;16(17):12138-12167. https://doi.org/10.18632/aging.206102
DREAMS-START. Dementia Related Manual for Sleep; Strategies for Relatives is a psychological intervention. UCL, London, 2026. https://www.ucl.ac.uk/brain-sciences/psychiatry/research/mental-health-older-people/projects/dreams-start?utm_source=copilot.com
Gonzalez L et al. Cost-utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation. Lancet Healthy Longev. 2025 May;6(5):100708. https://doi.org/10.1016/j.lanhl.2025.100708
Jones A et al. Potentially Modifiable Risk Factors for Dementia and Mild Cognitive Impairment: An Umbrella Review and Meta-Analysis. Dement Geriatr Cogn Disord. 2024;53(2):91-106. https://doi.org/10.1159/000536643
Livingston G et al. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess. 2014 Jun;18(39):1-226, v-vi. https://doi.org/10.3310/hta18390
Lucey BP. Sleep Alterations and Cognitive Decline. Semin Neurol. 2025 May;45(3):333-347. https://doi.org/10.1055/a-2557-8422 Mack KM. When no medication is best practice: Transforming geriatric care with nurse-led non-pharmacological interventions and care. Geriatr Nurs. 2025 Jul-Aug;64:103442. https://doi.org/10.1016/j.gerinurse.2025.103442
Rapaport P et al. An intervention to improve sleep for people living with dementia: Reflections on the development and co-production of DREAMS:START (Dementia RElAted Manual for Sleep: STrAtegies for RelaTives). Dementia (London). 2018 Nov;17(8):976-989. https://doi.org/10.1177/1471301218789559
Rapaport P et al. Clinical and cost-effectiveness of DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people living with dementia and their carers: a study protocol for a parallel multicentre randomised controlled trial. BMJ Open. 2024 Feb 1;14(2):e075273. https://doi.org/10.1136/bmjopen-2023-075273
Rapaport P et al. Sleep Disturbances and Dementia in the UK South Asian Community: A Qualitative Study to Inform Future Adaptation of the DREAMS-START Intervention. Geriatrics (Basel). 2025a Sep 8;10(5):121. https://doi.org/10.3390/geriatrics10050121
Rapaport P et al. Long-term health conditions and their impact on people with sleep disturbances and dementia. BMC Geriatr. 2025b May 26;25(1):376. https://doi.org/10.1186/s12877-025-06045-x
Siwecka N et al. Sleep Disorders in Neurodegenerative Diseases with Dementia: A Comprehensive Review. J Clin Med. 2025 Oct 9;14(19):7119. https://doi.org/10.3390/jcm14197119
Tractenberg RE et al. The Sleep Disorders Inventory: an instrument for studies of sleep disturbance in persons with Alzheimer's disease. J Sleep Res. 2003 Dec;12(4):331-7. https://doi.org/10.1046/j.0962-1105.2003.00374.x
Webster L et al. The minimum clinically important difference on the sleep disorders inventory for people with dementia. Int J Geriatr Psychiatry. 2020 Nov;35(11):1418-1423. https://doi.org/10.1002/gps.5384
Experts who voted for the publication of this sheet
NINOT Grégory , WARNERY Alain , Mathilde MinetAuthor(s) of the Sheet
NPIS (comité scientifique)
Creation Date : 13/03/2026
Revision Date : 15/04/2026
Version : V
Revision Date : 15/04/2026
Version : V
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