Beyond “Sleep Problems”: Conceptual Disentangling of Nighttime Disturbances in Dementia
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Nighttime disturbances, including nocturnal neuropsychiatric symptoms, circadian rhythm disruptions, and sleep-wake disorders, are closely intertwined and commonly occur in people with dementia (PwD). Despite their specificity, they are frequently described using broad and nonspecific terms such as “sleep problems”. However, such conceptual ambiguity may hinder precise clinical reasoning, contribute to heterogeneity in research populations, and obscure treatment selection and care planning when these symptoms may require different management approaches. In this paper, we address the lack of specificity in the conceptualization of nighttime disturbances in dementia by synthesizing descriptive accounts from the existing literature. Systematic database searches of Web of Science, PubMed, ProQuest Psychology, and CINAHL were conducted using a predefined search strategy combining terms for nighttime disturbances and dementia. These searches yielded 6,338 records. At least one outcome had to include a description of nighttime disturbances (either sleep-related or wakefulness-related). In total, 18 studies were included. We provide a framework highlighting potentially distinct underlying mechanisms of three interrelated phenomena, including nocturnal wakefulness behaviors, sleep-related behaviors, and disruptions in circadian rhythm. By clarifying phenomenological boundaries and potentially different mechanisms, this framework aims to support more precise assessment and communication in institutional and home care settings. A clear differentiation of nighttime phenomena is crucial for more targeted and mechanism-informed treatment approaches to improve continuity of care and support decision-making regarding long-term care. Through this integrative framework, we aim to contribute to a more systematic and nuanced understanding of nighttime disturbances in dementia, moving beyond broad descriptive labels toward clinically meaningful differentiation.
