Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice


BACKGROUND: Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. AIM: To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. DESIGN AND SETTING: A realist review of existing literature conducted in 2022. METHOD: Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined. RESULTS: In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep. CONCLUSION: In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.

Publication DOI:
Divisions: College of Health & Life Sciences > Aston Pharmacy School
College of Health & Life Sciences
Funding Information: This study is funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research (grant reference number: NIHR202345). The views expressed are those of the authors and not necessarily those of the NIHR or
Additional Information: Copyright © The Authors. This article is Open Access: CC BY 4.0 licence (
Uncontrolled Keywords: Caregivers/psychology,Cognitive Dysfunction/epidemiology,Comorbidity,Dementia/complications,General Practice,Humans,Sleep Wake Disorders/epidemiology
Publication ISSN: 1478-5242
Last Modified: 21 May 2024 12:51
Date Deposited: 27 Mar 2024 11:55
Full Text Link:
Related URLs: https://bjgp.or ... /BJGP.2023.0171 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2024-04-01
Published Online Date: 2024-03-18
Accepted Date: 2023-10-23
Authors: Aryankhesal, Aidin
Blake, Jessica
Wong, Geoff
Megson, Molly
Briscoe, Simon
Allan, Louise
Broomfield, Niall M.
Eastwood, Zenahrai
Greene, Leanne
Hilton, Andrea
Killett, Anne
Lazar, Alpar S.
Litherland, Rachael
Livingston, Gill
Maidment, Ian (ORCID Profile 0000-0003-4152-9704)
Reeve, Joanne
Rook, George
Scott, Sion
Um, Jinpil
van Horik, Jayden
Fox, Chris



Version: Published Version

License: Creative Commons Attribution

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