Posted: 09.19.2014 | by AMRA
Insomnia affects up to 20% of the U.S. population, and sufferers present with difficulties in both falling asleep and staying asleep. Drugs used to treat insomnia often have undesirable side effects including substance dependency and memory impairment. Cognitive-behavioral therapy (CBT) can help, but less than half of all insomnia sufferers treated with CBT achieve full remission.
Ong et al. [Sleep] tailored a mindfulness-based therapy for insomnia (MBTI) modeled on MBSR. The program targets psychophysiological hyperarousal and includes behavioral strategies often used in CBT when applied to insomnia. Fifty-four patients meeting diagnostic criteria for chronic insomnia and reporting elevated pre-sleep arousal were randomly assigned to one of two mindfulness-based interventions (MBSR or MBTI) or an 8-week self-monitoring (SM) control.
All participants kept a sleep diary and rated the severity of their insomnia and pre-sleep arousal. Objective measures of sleep quality were also obtained through polysomnography (laboratory monitoring of brain rhythm, eye movement, and muscle tone) and wrist actigraphy (a measure of nighttime movement using a watch-like device worn on the wrist).
Both the MBSR and MBTI groups showed significant reductions in total self-reported awake time when compared with the control group. The combined meditation groups reduced self-reported time awake by 44 minutes per night, while the control group reported a reduction of only 1 minute per night. The combined groups also showed significantly greater reductions in self-rated pre-sleep arousal and significantly greater improvement in self-rated insomnia severity than the controls. Effect sizes were moderate to large.
Treatment response rates — as defined by at least a 7-point decline in self-rated insomnia severity — were 60% (MBTI), 39%(MBSR) and 0% (SM), respectively. MBTI response rates continued to improve up to six-month follow-up, whereas MBSR treatment response remained constant over time. Study groups did not differ from each other on the objective measures.
This study is in line with prior research showing a greater effect of mindfulness practice on self-report measures than on objective measures of sleep. While the discrepancy between self-report and objective measurement of sleep needs further examination, it is the subjective perception of insomnia that drives patients to seek treatment, and thus self-report is an important measure of clinical improvement.
Ong, J. C., Manber, R., Segal, Z., Xia, Y., Shapiro, S., & Wyatt, J. K. (2014). A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep, 37(9), 1553-63.