The effectiveness of a cognitive behavioural therapy for insomnia based intervention to improve sleep quality in nursing home residents, a cluster randomised controlled trial.

PURPOSE: To evaluate the effectiveness of a structured, team-delivered intervention based on cognitive behavioural therapy for insomnia (CBT-I) on sleep and related outcomes in nursing home residents.

METHODS

A cluster randomised controlled trial with intervention group and control group was conducted in five nursing homes between February 2024 and February 2025. A total of 240 residents were included, with a mean age of 86.8 years and 72.5% being female. Sleep outcomes were assessed using the Pittsburgh Sleep Quality Index (PSQI) for residents who were cognitively intact or mildly impaired, and the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) for residents with significant cognitive or language impairments.

RESULTS

In the PSQI group (n = 124) there was a significant interaction effect between time and group for the total PSQI score (p = 0.031). No significant between-group difference was observed at follow-up. In the NPI-NH group (n = 116), no significant effect was found for sleep and nighttime behaviour disturbances (p = 0.061). However, residents in the intervention group showed significant improvements across several neuropsychiatric domains, including reductions in delusions, agitation/aggression, depression, disinhibition and aberrant motor behaviour.

CONCLUSION

Although the intervention did not result in significant between-group differences in sleep outcomes, these findings suggest that a structured, team-delivered CBT-I-based intervention may contribute to improvements in behavioural and psychological symptoms of dementia (BPSD). This underscores the often-overlooked relationship between sleep and BPSD and supports further investigation of team-based sleep interventions in long-term care settings.

TRIAL REGISTRATION: ISRCTN50844606, registered on 9 September 2024.