Sleep study for people with dementia shows ongoing benefit after two years

Written by Professor Georgina Charlesworth

27th April 2026

TWO YEAR FOLLOW UP DATA FOR DREAM START STUDY SHOWS SLEEP BENEFITS FOR PEOPLE WITH DEMENTIA LIVING AT HOME ARE SUSTAINED

The DREAM START study was a randomised controlled trial of a multi-component intervention to address sleep disturbance in people with dementia. The study was carried out across 12 NHS sites across England, including NELFT. All participants with dementia were people whose sleep disturbance had developed since the onset of dementia. Difficulties identified by family carers on the ‘Sleep Disorders Inventory’ SDI included: difficulty falling asleep; getting up during the night; wandering, pacing or getting involved in inappropriate activities at night; waking the carer during the night; waking at night, dressing and planning to go out, thinking that it is morning and time to start the day; waking too early in the morning (earlier than is their habit); and sleeping excessively during the day.

In total, 377 dyads of people with dementia and family carers were enrolled into the study. The mean age of participants was 79 years, 55% were women and 25% non-white (e.g. Asian, Black, Arab). All participants received treatment as usual and 188 randomly allocated, offered the DREAM START intervention which is a six session, manualised, personalised approach involving psychoeducation, routine light therapy, distress management, activity, relaxation, and caregiver support. The DREAM START intervention was delivered weekly or fortnightly by trained graduate psychologist either online, over the phone or in person. Overall, participants liked the intervention and carers were able to find time for it; 83% of those offered DREAM START received 4 or more sessions and 75% completed all six sessions. 

Follow-up at 8 months and 2 years

At the 8-month follow-up, people with dementia who had received DREAM START were compared to those who had not. People in both arms of the trial improved, but the improvement was greater in people who received DREAM START. By the time of the 2-year follow up, 177 (46.9%) participants with dementia were still living at home. Those who had received the DREAM START intervention were continuing to show benefit from the intervention with lower sleep disturbance scores than those who received treatment as usual alone. The improvements in carer outcomes that had been indicated at 8 months were not sustained for 2 years, and there were no differences between the groups in the numbers of people who moved into care homes or who died. 

Why is this important?

Sleep difficulties are common in dementia and associated with adverse outcomes for the physical and mental health of both the person with dementia and family carers. Sleep medication can have adverse effects, including increased mortality. Having an effective non-pharmacological option for people with dementia is, therefore, important for both people with dementia and their families.

DREAM START into practice

The DREAM START intervention is designed to work alongside routine care. In NELFT, the intervention was delivered during the trial by Assistant Psychologists (APs) in Memory Services, trained and supervised by the UCL research team. AP training included how to introduce acti-watches and light boxes to families and how to personalise the intervention. The DREAM START intervention cost £574 per dyad, including AP time, training and supervision, light boxes and watches. Taking costs into account, the intervention saves £59 per dyad from the perspective of health and social care, and £116 per dyad from a societal perspective.

References

Rapaport, P., Adeleke, M. O., Barber, J. A., Gonzalez, L., Hunter, R., Manela, M., ... & Livingston, G. (2026). The DREAMS START intervention for sleep in dementia: Long‐term follow‐up of a randomized controlled trial. Alzheimer's & Dementia, 22(3), e71274. https://doi.org/10.1002/alz.71274 

Tractenberg, R. E., Singer, C. M., Cummings, J. L., & Thal, L. J. (2003). The Sleep Disorders Inventory: an instrument for studies of sleep disturbance in persons with Alzheimer's disease. Journal of Sleep Research, 12(4), 331-337. DOI: 10.1046/j.0962-1105.2003.00374.x

Rapaport, P., Amador, S., Adeleke, M. O., Barber, J. A., Banerjee, S., Charlesworth, G., ... & Livingston, G. (2024). 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. The Lancet Healthy Longevity, 5(10). DOI: 10.1016/j.lanhl.2024.08.004

Rapaport, P., Amador, S., Adeleke, M. O., Barber, J. A., Banerjee, S., Charlesworth, G., ... & Livingston, G. (2024). 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. The Lancet Healthy Longevity, 5(10). DOI: 10.1016/j.lanhl.2024.08.004