International Journal of Molecular Medical Science, 2025, Vol.15, No.4, 155-164 http://medscipublisher.com/index.php/ijmms 158 The best effect will be achieved by integrating these environmental changes into daily life and routine care. Research shows that integrating these changes with employee training and a clear step-by-step approach can reduce sleep disturbances and make nights more peaceful (Ashghab et al., 2024). Even so, the results may vary from person to person and are also related to how well the plan is executed, so continuous checks and minor adjustments are needed (Ritmala-Castren et al., 2021; Bellon et al., 2022; Mendonça et al., 2024) 4.2 Adjustments to activities and schedules Ensuring that patients with dementia have something to do during the day and a regular life is the key point for nurses to carry out sleep care. Fixing bedtime and wake-up times, encouraging daytime exercise and social interaction, and teaching simple sleep hygiene can help calibrate the biological clock and improve sleep (Alfonsi et al., 2021; Mendonça et al., 2024). Gentle exercise or group activities can also reduce daytime naps and promote better sleep at night (Wilfling et al., 2025). Practical advice for patients and caregivers includes: reducing caffeine and alcohol intake, maintaining consistent bedtime habits, and engaging in quiet and relaxing activities before sleep. The best results are achieved when these practices are in line with personal preferences and abilities and are continuously followed up and encouraged by nurses (Alfonsi et al., 2021; Mendonça et al., 2024). The coordination of day shifts and night shifts helps maintain these patterns and brings long-term benefits (Wilfling et al., 2025). 4.3 Relaxation methods and personalized care Non-pharmaceutical soothing methods-such as listening to music, smelling scents or gentle touching - are increasingly being used by Alzheimer's patients to help them sleep better. These methods can reduce anxiety, making people more relaxed and easier to fall asleep. Studies have also found that both total sleep duration and sleep quality have improved (Bellon et al., 2022; Al-Hammouri and Rababah, 2024; Asharhab et al., 2024). Music and aromatherapy are simple and easy to perform, and patients are often willing to accept them. Better results can be achieved by formulating personalized care plans based on each person's sleep habits, preferences and needs. The plan can adjust the schedule, choose the relaxation method preferred by the patient, or invite family members to participate and support (Alfonsi et al., 2021). The key to success lies in regular assessment, close collaboration with patients and caregivers, and flexible adjustment as circumstances change (Rintala-Castren et al., 2021; Mendonça et al., 2024; Wilfling et al., 2025). 5 The Effects of Nursing Sleep Management on Melatonin and Cortisol Levels 5.1 Current research status at home and abroad and differences in intervention models Recent work in China and other countries has paid closer attention to how nurse-led sleep care affects hormones such as melatonin and cortisol. Studies have tested several care models, including body-clock-focused nursing, multi-part non-drug programs, and targeted environmental or behavior changes. Although many projects were carried out in hospitals and intensive care units, more research is now aimed at older adults and people with dementia, who often have marked sleep problems (Guo et al., 2016; Pelin and Sert, 2025). Intervention plans vary across studies. Some focus on improving the environment and keeping the body clock on track, while others combine behavior changes, education, and relaxation methods. Research abroad often uses multi-component programs that blend supportive nursing, fixed daily schedules, and changes to the surroundings. Local work may prefer single-focus or routine-based care. These differences often reflect the health system, cultural habits, and available resources in each place (Guo et al., 2016; Pelin and Sert, 2025). 5.2 Main results and significance of changes in melatonin and cortisol Some studies suggest that nurse-led sleep care may have a positive effect on melatonin and cortisol, but the results may vary among different populations and with different approaches. Studies have found that comprehensive non-pharmaceutical care for the elderly can increase nocturnal melatonin and reduce cortisol, thereby improving sleep, reducing confusion and making recovery more stable (Guo et al., 2016). In the biological clock-focused care, both the group receiving care and the group not receiving care experienced an increase in melatonin and a
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