Reconstructing Sleep and Stress Management Programs for People with Dementia

In people with dementia, sleep disturbances and circadian rhythm disruption, as well as heightened stress responses and behavioral and psychological symptoms of dementia (BPSD), constitute major drivers of nighttime agitation, delirium, falls, infections, emergency visits, hospitalization, and institutionalization, thereby sharply increasing caregiving burden and healthcare and long-term care costs. At the same time, conventional sleep hygiene and BPSD management approaches tend to rely on complex self-management models that presuppose “correct instruction,” which are prone to implementation failure in dementia due to impairments in executive function, attention, and memory. The purpose of this paper is not to present new efficacy data, but rather to reorganize existing evidence on sleep and stress/BPSD management from the perspective of “core active ingredients,” and to propose a reconfigured intervention framework that can realistically function in dementia care settings: the Dementia-adapted Sleep & Stress Management (D-SSM) framework. The proposed program retains three minimal core elements: (1) anchoring daily rhythms (fixed wake time and morning light exposure); (2) proactive removal of triggers for nighttime agitation and delirium (e.g., pain, constipation, dehydration, sleep deprivation); and (3) consistent, reassurance-oriented communication and standardized responses based on the DICE approach. This design suppresses reliance on complex self-judgment and multi-stage behavior change tasks. Future evaluation should prioritize implementation-focused outcomes that are directly linked to costs—such as nighttime caregiving frequency, incidence of delirium and BPSD, psychotropic medication use, and emergency visits—rather than focusing exclusively on falls or cognitive indices.