Treatment Options for Sleep Disturbances in Dementia: A Systematic Review

ObjectiveThis systematic review aims to evaluate recent evidence on interventions for sleep disturbances in dementia, a major clinical concern, with limited pharmacological and non-pharmacological strategies examined in controlled trials.MethodsWe included eight RCTs (N = 666 participants; 2020 - January 2025) in people with dementia and sleep disturbances. Records were identified via MEDLINE, screened using PRISMA-guidelines, and non-randomized or non-intervention studies were excluded. Risk-of-bias was assessed with Cochrane RoB2, and effect sizes (Cohen's d) were calculated in R.ResultsZ-drugs indicated small-large benefits, with eszopiclone significantly improving sleep efficiency and latency. Orexin receptor antagonists indicated mixed evidence, with low-dose lemborexant (2.5 mg) most favorable, meeting benchmarks for nocturnal awakenings. Circadian modulation light therapy was associated with reduced nocturnal awakenings in small trials, while relaxation-based music therapy indicated little to no effect. Social stimulation with PARO indicated increased sleep time and large positive effects on sleep efficiency, despite missing clinical benchmarks.ConclusionsEvidence is limited by sparse reporting and few trials per intervention. Z-drug eszopiclone, low-dose ORA lemborexant, and social stimulation PARO show the most favorable profile across outcomes and benchmarks, but pharmacological options require careful risk-benefit consideration. Non-pharmacological approaches appear safer but under-researched. Future trials should standardize outcomes and tailor strategies to patient needs. No external funding. The review was registered in INPLASY: https://doi.org/10.37766/inplasy2025.1.0097.