McCurry 2012.

Study characteristics
Methods	Study design: RCT Follow‐up: 1 month
Participants	Country: USA Setting: 37 long‐term care facilities Inclusion criteria: probable or possible Alzheimer's disease diagnosis ≥ 2 sleep problems on the Sleep Disorders Inventory sleep problems occurring ≥ 3 times per week living in an adult family home with owner/operator and staff willing to participate Exclusion criteria: pre‐existing diagnosis of a primary sleep disorder (sleep apnoea, restless legs syndrome, REM behaviour disorder) major medical illness that awakens residents at night (severe pain, emphysema, uncontrolled incontinence) dementia caused by alcohol abuse or Parkinson's disease history of severe psychiatric disease (schizophrenia, bipolar disease) medical status considered fragile by staff Number of participants completing the study: 47 (IG 31, CG 16) Baseline characteristics: Residents: age (years, mean): 86.6 (SD 7.2) gender (female): 60% MMSE (mean): 8.1 (SD 7.6) Carers: age (years, mean): 48.2 (SD 9.7) gender (female): 90% Group differences: not reported
Interventions	Intervention: 4 sessions of sleep education programme for carer‐staff (in 1 month). Consisted of 1. 30‐minute in‐service education on general sleep issues and the intervention; 2. verbal and visual feedback (noise levels recorded in nursing home were presented and verbal feedback about noise levels and sources of noise given); 3. noise abatement: implementation of procedures to reduce noise (e.g. turn off unwatched televisions); 4. individualised incontinence care: research staff provided incontinence care during hourly rounds when residents were awake. Otherwise, frequency of waking residents up for incontinence care was based on residents' risk for skin problems. During incontinence care, staff attempted to reduce noise and light exposure. Control: usual care
Outcomes	Night‐time total sleep, hour/minutes (actigraphy) Night‐time total wake, hour/minutes (actigraphy) Sleep efficiency (actigraphy) Daytime sleep, hours/minutes (actigraphy)
Funding	Sponsorship source: Alzheimer's Association National Institute of Mental Health University of Washington
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Sequence generation	Unclear risk	Quote: "Residents were randomly assigned after the baseline assessment […] according to a 2:1 simple allocation ratio …"
Allocation concealment	Unclear risk	Not reported.
Blinding of participants and personnel All outcomes	Unclear risk	Unknown.
Blinding of participants and personnel Subjective sleep quality (carer ratings)	Unclear risk	Unknown.
Blinding of participants and personnel Objective sleep measures	Unclear risk	Unknown.
Blinding of outcome assessors Objective outcome measures	Low risk	Assessors blinded to treatment assignment.
Blinding of outcome assessors Subjective sleep quality (carer ratings)	Unclear risk	No information available.
Incomplete outcome data All outcomes	Low risk	3 (6%) residents lost to follow‐up after 1 month.
Selective outcome reporting	Low risk	Analysis followed published study protocol.
Other sources of bias	Low risk	No adjustment for cluster effects as none were detected. Quote: "Twenty‐seven AFHs [adult family homes] (73%) had only one resident study participant, and 10 AFHs had two resident participants. Analysis of variance components indicated that including site effects did not enhance the explanatory power of models."