Posted 06.25.2020 | by AMRA

The diagnosis and treatment of breast cancer is a major stressor, and many breast cancer survivors (24-46%) suffer from insomnia with persistent difficulty in falling and staying asleep. Mindfulness training may help insomnia by promoting relaxation and by enhancing present-moment focusing, which can reduce sleep-interfering thoughts and emotions.

Mindfulness-Based Therapy for Insomnia (MBTI) is an integrated therapeutic intervention that offers mindfulness training along with cognitive-behavioral strategies for stress management and sleep hygiene. Zhao et al. [European Journal of Cancer Care] tested the effectiveness of MBTI compared to a wait-list control for improving sleep quality in a large sample of breast cancer survivors.

The researchers randomly assigned 136 Chinese women (average age = 53 years) diagnosed with breast cancer who had completed surgery, adjuvant chemotherapy and radiotherapy, and who met the American Academy of Sleep Medicine criteria for insomnia to an MBTI program or a wait-list control.

The six-week MBTI program was delivered in weekly, 90-minute group sessions, with instructions for 20-40 minutes of daily home mindfulness practice. Seventy percent of group session time was devoted to meditation practice using the body scan, yoga, sitting and walking meditations. The remainder of the time involved didactic material on stress management, sleep hygiene, and cognitive strategies to change one’s thinking.

Participants kept sleep diaries and meditation practice logs and were assessed at baseline, post intervention, and at 3- and 6-month follow-up on self-report measures of insomnia and mindfulness using the Five Facet Mindfulness Questionnaire.

They also donned wrist-worn actigraphs for three consecutive nights during each of the four assessment periods to measure their nighttime movement activity. Actigraphic data yielded measures of sleep latency, sleep awakenings, total time asleep, and sleep efficiency (the percentage of time in bed someone is actually asleep).

The results showed that the MBTI group significantly decreased their self-reported insomnia symptoms compared to controls (d=-1.32). Significant improvements were maintained from post-intervention through 6-month follow up.

The percentage of MBTI participants reporting moderate-to-severe insomnia decreased from 69% to 9.5% over the six months, whereas the percentage of participants reporting either no insomnia or subclinical insomnia increased from 31% to 91%.

Actigraphic data also showed significant improvement for MBTI participants over controls with regards to sleep onset latency (d=-0.10), waking after falling asleep onset (d=-1.82), total sleep time (d=0.56) and sleep efficiency (d=1.44). The improvements in latency of waking after sleeping, total sleep time, and sleep efficiency persisted through 6-month follow-up.

MBTI participants also showed a significant improvement in mindfulness disposition scores compared to controls (d=1.03) that persisted through 6-month follow-up.

The study shows that a mindfulness-based intervention adapted for insomnia improves self-reported sleep quality as well as objectively measured sleep maintenance, total sleep time, and sleep efficiency compared to a wait-list control. Effect sizes were large and maintained through 6-month follow-up. Study limitations include the lack of an active control comparator or information on any sedative medications participants may have used during the study.

Reference:

Zhao, Y., Liu, J. E., Lewis, F. M., Nie, Z. H., Qiu, H., Han, J., Su, Y. L. & Yang, S. S. (2020). Effects of mindfulness-based cognitive therapy on breast cancer survivors with insomnia: A randomised controlled trial. European Journal of Cancer Care, e13259.

[Link to study]