International Journal of Molecular Medical Science, 2025, Vol.15, No.4, 155-164 http://medscipublisher.com/index.php/ijmms 159 decrease in cortisol. However, the differences between the two groups were sometimes not large enough to reach statistical significance. This indicates that larger environmental or institutional factors may also be at play (Figure 2) (Pelin and Sert, 2025). Figure 2 Pre-test and post-test cortisol levels, melatonin levels in the intervention and the control groups (Adopted from Pelin and Sert, 2025) These hormonal changes are crucial because they are related to better sleep, less anxiety, and a lower risk of mental confusion or surgical problems. More melatonin and less cortisol mean a more stable biological clock, deeper and more helpful sleep, as well as better mental and behavioral states-these benefits are particularly important for the elderly and dementia patients (Guo et al., 2016; Pelin and Sert, 2025). 5.3 Possible mechanisms The helpful effects of nursing sleep care on melatonin and cortisol may work through restoring the body’s circadian rhythms. Care plans that match activities to the natural light-dark cycle and reduce night interruptions can reset the body’s own timing for releasing melatonin and cortisol, leading to steadier sleep-wake patterns . This timing balance is important for keeping hormones stable and easing brain-related symptoms in at-risk patients (Guo et al., 2016; Pelin and Sert, 2025). Better sleep care may also support the hypothalamic-pituitary-adrenal (HPA) axis, lowering stress-driven cortisol rises and protecting overall hormone health By calming the HPA axis and boosting melatonin, such care may reduce brain inflammation and oxidative stress, which could help slow brain decline and raise life quality for elderly dementia patients (Guo et al., 2016). 6 Research Limitations and Challenges 6.1 The sample size is small and there are significant differences in research designs Current research on sleep care, especially those targeting patients with Alzheimer's disease, shares a common problem: many trials have very few participants. Many sleep care studies are preliminary or feasibility studies with a small number of participants, resulting in insufficient statistical power and limiting the generalization of conclusions to larger populations (Daniel et al., 2024; Gale et al., 2025). Small sample sizes also increase the risk of result bias, making it more difficult to detect those minor but meaningful changes in melatonin and cortisol.
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