Listening to voices across cultures: non-pharmacological approaches to coping with sleep problems in dementia among ethnically diverse older adults in the UK.

BACKGROUND: Sleep disturbances are a common yet often overlooked challenge for people living with dementia and their caregivers, significantly affecting daily functioning and well-being. Existing interventions frequently prioritise pharmacological treatments, which may not align with the cultural values and preferences of ethnically diverse communities. This study explored how older adults with mild dementia and their caregivers from white British, Caribbean, Chinese, and South Asian backgrounds in the UK understand and manage sleep difficulties using culturally meaningful, non-pharmacological strategies. METHODS: A qualitative, cross-cultural design was adopted using focus group discussions with 12 dementia dyads (older adults and their caregivers) recruited from community organisations in a city in Southern England. Four focus groups were conducted using a topic guide to elicit participants' lived experiences and culturally informed coping practices. Transcripts were analysed using reflexive thematic analysis with NVivo 14, generating four overarching themes that captured shared and culturally specific perspectives. RESULTS: Analysis revealed four key themes: (i) Sleep as a holistic and relational experience, (ii) The importance of routine, ritual, and physical engagement, (iii) Emotional calm and non-drug coping with night-time worry, and (iv) Cultural fit and practical accessibility shape participation. Participants viewed sleep through a holistic lens, closely linked to emotional, spiritual, and relational harmony. Gentle, non-invasive approaches such as calming evening rituals, light physical activity, spiritual reflection, and mindfulness-like practices were described as culturally rooted and preferable to medication. Participants valued familiar routines, trusted facilitators, and flexible, community-based delivery. Practical barriers, such as time constraints and caregiving demands, were highlighted alongside a strong desire for co-designed, culturally adaptive interventions. CONCLUSIONS: This study underscores the potential of culturally grounded, mind-body approaches to address sleep disturbances in dementia care. By aligning interventions with communities' daily routines, spiritual beliefs, and emotional needs, non-pharmacological strategies can improve acceptability and relevance. Critically, these findings show that ethnicity and cultural background should not be overlooked in research and intervention design, as they shape how people experience and manage sleep. Community-embedded, participatory models can foster trust, sustain engagement, and ultimately support better sleep and well-being for people living with dementia and their caregivers.