Posted 03.16.2015 | by AMRA
About half of adults aged 55 and over report some difficulty falling and/or staying asleep. Moderate sleep disturbances are often accompanied by daytime fatigue and disturbances in mood, and may be precursors to clinical insomnia. Current treatments for sleep disturbances include medications which can have residual daytime effects and lead to dependency, and cognitive and behavioral treatments which can be costly and require access to skilled therapists. There is an ongoing need for novel treatments that are safe, effective, low cost, and accessible in the broader community.
In a randomized, controlled study, Black et al. [JAMA Internal Medicine] evaluated the Mindfulness Awareness Practices for Daily Living (MAPs) program as a treatment for moderate sleep disturbance in older adults. Prospective participants aged 55 and above were recruited through advertising and screened for the presence of moderate sleep disturbance and the absence of other diagnoses that could aversely affect sleep (e.g., sleep apnea, restless leg syndrome). Forty-nine predominantly Caucasian (84%), female (67%) participants (average age=66) were randomly assigned to either MAPS or to Sleep Hygiene Education (SHE), a widely accepted sleep intervention designed to match MAPS in format, participant involvement, and participant expectations for benefit.
The programs were delivered in six two-hour group sessions that included home practice or study. MAPs participants practiced sitting, walking, movement, eating, and loving-kindness meditations. SHE participants were instructed in sleep education and sleep self-monitoring, relaxation techniques, and sleep hygiene strategies. Pittsburgh Sleep Quality Index scores served as the primary outcome measure. Self-report measures of depression, anxiety, stress, fatigue, and mindfulness (the Five Factor Mindfulness Questionnaire, or FFMQ) were also included, as well as a blood drawn measure of NF-κB, a protein complex that plays a key role in inflammation and increases as a consequence of sleep disruption.
MAPs participants showed a significant increase in mindfulness compared to SHE participants (large effect size, Cohen’s d = 0.76). Sleep quality improved significantly more for MAPs participants (large effect size, Cohen’s d = 0.89), and the MAPs participants’ improvements were correlated with their non-reactivity change scores on the FFMQ (r = -0.46). MAPs participants also reported significantly less severe daytime fatigue (large effect size, Cohen’s d = 1.5)) and depression (medium effect size, Cohen’s d = .68) compared to SHE participants. Both groups showed reduced NF-κB levels, but the difference between treatments did not reach statistical significance.
This is the first randomized, controlled study of a mindfulness-based intervention targeting sleep disturbance in an older adult population. Improvement in the mindfulness condition was large, clinically meaningful, and on a par with the typical effect sizes for both sleep medications and cognitive behavioral therapy. Future research can help determine whether this improvement is long lasting, and whether mindfulness-based interventions are also effective treatments for full-blown clinical insomnia.
Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial. JAMA Internal Medicine.