A programme designed to improve sleep for people living at home with dementia is more cost-effective than usual care, new research has found.

These findings support rolling out this programme for people with dementia who are experiencing sleep disturbances, as well as their carers.

Sleep problems are a common and distressing issue for people with dementia and their families. They often lead to worsened symptoms, reduced quality of life, and increased healthcare costs. 

The DREAMS START programme

The DREAMS START (Dementia Related Manual for Sleep; Strategies for Relatives) programme was previously shown to be clinically effective. It has now also been evaluated for its economic benefits.

The programme was developed by University College London (UCL) researchers in consultation with people living with dementia. It includes a variety of methods such as using light boxes, increasing daytime activity and building bedtime routines.

The study involved 377 pairs of people with dementia and their family carers across England. 

Participants either received the DREAMS START intervention in addition to their usual care, or continued with usual care alone. 

The intervention involved family carers attending 6 guided sessions with a trained, non-clinical facilitator. These sessions focused on strategies to improve sleep routines, increase daytime activity, manage comfort and reduce napping.

Economic benefits

Those who were given the DREAMS START intervention saw an average reduction of £59 per pair in health and social services costs over 8 months compared to the usual care group. 

When considering wider costs, such as out-of-pocket expenses, the reduction was £116 per pair. These lower costs were mainly due to a reduction in emergency department visits. As well as less reliance on unpaid help from family and friends.

People who completed the programme also had much lower levels of sleep disturbance than those who had usual care only.

“A positive step forward for people with dementia”

Professor Penny Rapaport, University College London, who led the study, said: “Many people living with dementia have disturbed sleep. So these findings are a positive step forward for people with dementia and their families.

“If this intervention was implemented on a larger scale, the cost per person with dementia and their carer would likely decrease further due to economies of scale.

“As both a clinically and cost effective option, we recommend that DREAMS START should become a routine part of care for people with dementia who experience disturbed sleep.”

This research was funded by the National Institute for Health and Care Research (NIHR) and involved volunteers from Join Dementia Research. 

‘Cost–utility analysis of the DREAMS START intervention for people living with dementia and their carers: a within-trial economic evaluation’ was published in The Lancet.

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