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

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. 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. 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. 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. ISRCTN50844606, registered on 9 September 2024. To evaluate whether a structured, team-delivered intervention based on Cognitive Behavioural Therapy for Insomnia can improve sleep and related outcomes of nursing home residents. The intervention did not result in significant between-group differences in sleep outcomes. However, it was associated with reductions in behavioural and psychological symptoms of dementia in residents with cognitive impairments. Although this trial did not demonstrate significant between-group improvements in sleep outcomes, the findings suggest a potential influence on behavioural and psychological symptoms of dementia, underscoring the relevance of a team-based sleep intervention as a non-pharmacological approach in dementia care.