Non-pharmacological interventions for sleep improvement in Alzheimer's disease: A systematic review and meta-analysis

BackgroundSleep disturbances are common in Alzheimer's disease (AD) and may worsen neuropsychiatric symptoms, caregiver burden, quality of life, and disease progression. Non-pharmacological strategies are increasingly used because long-term hypnotic or antipsychotic treatment may be limited by safety concerns, but their effects on subjective and objective sleep outcomes remain uncertain.ObjectiveTo evaluate the efficacy of non-pharmacological interventions for improving sleep in patients with AD.MethodsFollowing PRISMA guidelines, we searched PubMed, Embase, the Cochrane Library, Web of Science, and CINAHL through June 6, 2025, for randomized controlled trials of non-pharmacological interventions in AD. The primary outcome was the Pittsburgh Sleep Quality Index (PSQI); secondary outcomes were actigraphy-derived sleep efficiency, total sleep time, wake after sleep onset, number of awakenings, and time in bed. Standardized mean differences were pooled using fixed- or random-effects models. Subgroup, sensitivity, publication-bias, and meta-regression analyses were performed where appropriate.ResultsFourteen randomized controlled trials comprising 937 participants were included. Non-pharmacological interventions significantly reduced PSQI scores (SMD = -0.46, 95% CI -0.70 to -0.21). Neuromodulation-based interventions showed potentially favorable effects on PSQI, and caregiver-delivered programs such as NITE-AD modestly reduced nocturnal awakenings. No significant effects were observed for sleep efficiency, total sleep time, wake after sleep onset, or time in bed.ConclusionsNon-pharmacological interventions may modestly improve subjective sleep quality in AD, but objective sleep benefits remain limited. Larger, multicenter trials with standardized protocols, longer follow-up, harmonized subjective and objective outcomes, and AD-related biomarker assessment are needed.