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

Aidin Aryankhesal, Jessica Blake, Geoff Wong, Molly Megson, Simon Briscoe, Louise Allan, Niall M. Broomfield, Zenahrai Eastwood, Leanne Greene, Andrea Hilton, Anne Killett, Alpar S. Lazar, Rachael Litherland, Gill Livingston, Ian Maidment, Joanne Reeve, George Rook, Sion Scott, Jinpil Um, Jayden van HorikChris Fox

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)e233-e241
JournalBritish Journal of General Practice
Issue number741
Early online date18 Mar 2024
Publication statusPublished - 1 Apr 2024

Bibliographical note

Copyright © The Authors. This article is Open Access: CC BY 4.0 licence (


  • Caregivers/psychology
  • Cognitive Dysfunction/epidemiology
  • Comorbidity
  • Dementia/complications
  • General Practice
  • Humans
  • Sleep Wake Disorders/epidemiology


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