Mindful Cure for Insomnia
By John M. de Castro, Ph.D.
“By taking this mindful attitude, sleep is facilitated by simply being aware of the moment-to-moment experience of relaxing into the bed, without judging or being critical of that experience, so that the mind can gently slip into sleep.” – John Cline
Modern society has become more around-the-clock and more complex producing considerable pressure and stress on the individual. The advent of the internet and smart phones has exacerbated the problem. The resultant stress can impair sleep. Indeed, it is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. Yet over 70 million Americans suffer from disorders of sleep and about half of these have a chronic disorder. These disorders include insomnia, sleep apnea, narcolepsy, and restless leg syndrome. It has been estimated that 30 to 35% of adults have brief symptoms of insomnia, 15 to 20% have a short-term insomnia disorder, and 10% have chronic insomnia
Sleep problems are more than just an irritant. Sleep deprivation is associated with decreased alertness and a consequent reduction in performance of even simple tasks, increased difficulties with memory and problem solving, decreased quality of life, increased likelihood of accidental injury including automobile accidents, and increased risk of dementia and Alzheimer’s disease. It also places stress on relationships, affecting the sleep of the older individuals sleep partner. Finally, insomnia can lead to anxiety about sleep itself. This is stressful and can produce even more anxiety about being able to sleep. This can become a vicious cycle, where not being able to sleep induces anxiety and stress about going to sleep which in turn makes it harder to go to sleep which reinforces the anxiety and on and on.
Obviously, people in modern society need to get more and better quality sleep. About 4% of Americans revert to sleeping pills. But, these do not always produce high quality sleep and can have problematic side effects. So, there is a need to find better methods to improve sleep even in the face of modern stressors. Contemplative practices have been reported to improve sleep amount and quality and help with insomnia. The importance of insomnia underscores the need to further investigate safe and effective alternatives to drugs.
In today’s Research News article “Mindfulness Meditation and CBT for Insomnia: A Naturalistic 12-Month Follow-up”
Or see below, or for full text see
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766838/
Ong and colleagues treated a group of adults with insomnia with combination of mindfulness training with Cognitive Behavioral Therapy for Insomnia (CBT-I) treatment. The mindfulness training consisted of body scan, sitting and walking meditation. CBT-I consisted of identifying and changing the thoughts and the behaviors that affect the ability to sleep or sleep well. The intervention was conducted in 2-hour weekly sessions over a 6-week period.
They found that after the treatment there were significant improvements in sleep quality, daytime tiredness pre-sleep arousal, effort to go to sleep, and insomnia severity. In addition, they found that the higher the level of mindfulness the lower the levels of daytime sleepiness and daytime tiredness. Importantly, these improvements were maintained 6 and 12-month after the end of treatment.
These findings are exciting and demonstrate that insomnia can be effectively treated without drugs and the treatment can have lasting effects. But, since there wasn’t a control group or condition, caution must be exercised in reaching firm conclusions. In addition, since there wasn’t a comparison with Cognitive Behavioral Therapy for Insomnia (CBT-I) alone without the added mindfulness training, it is impossible to reach a conclusion regarding the efficacy of either component by themselves. It is unclear whether it was the CBT-I or the mindfulness training, or both, or some form of confound such as a placebo effect or simply the passage of time that were responsible for the effects. Further more tightly controlled research is needed to clarify these important points.
Regardless, the study by Ong and colleagues reinforces the findings of previous research that mindfulness may be a safe and effective treatment for insomnia with long-term effectivenes.
“Exploring the practice of mindfulness requires no religious affiliation or philosophical belief. It’s a gentle, simple, practical method of paying attention — one that may deliver profound benefits for our waking and sleeping lives.” – Michael J. Breus
CMCS – Center for Mindfulness and Contemplative Studies
Study Summary
Ong, J. C., Shapiro, S. L., & Manber, R. (2009). Mindfulness Meditation and CBT for Insomnia: A Naturalistic 12-Month Follow-up. Explore (New York, N.Y.), 5(1), 30–36. http://doi.org/10.1016/j.explore.2008.10.004
Abstract
A unique intervention combining mindfulness meditation with cognitive behavioral therapy for insomnia (CBT-I) has been shown to have acute benefits at post-treatment in an open label study. The aim of the present study was to examine the long-term effects of this integrated intervention on measures of sleep and sleep-related distress in an attempt to characterize the natural course of insomnia following this treatment and to identify predictors of poor long-term outcome. Analyses were conducted on 21 participants who provided follow-up data at 6 and 12 months post treatment. At each time point, participants completed one week of sleep and meditation diaries and questionnaires related to mindfulness, sleep, and sleep-related distress, including the Pre-Sleep Arousal Scale (PSAS), Glasgow Sleep Effort Scale (GSES), Kentucky Inventory of Mindfulness Skills (KIMS), and the Insomnia Episode Questionnaire. Analyses examining the pattern of change across time (baseline, end-of-treatment, 6 month, and 12 month) revealed that several sleep-related benefits were maintained during the 12-month follow-up period. Participants who reported at least one insomnia episode (≥ 1 month) during the follow-up period had higher scores on the PSAS (p < .05) and GSES (p < .05) at end-of-treatment compared to those with no insomnia episodes. Correlations between mindfulness skills and insomnia symptoms revealed significant negative correlations (p < .05) between mindfulness skills and daytime sleepiness at each of the three time points but not with nocturnal symptoms of insomnia. These results suggest that most sleep-related benefits of an intervention combining CBT-I and mindfulness meditation were maintained during the 12-month follow-up period with indications that higher pre-sleep arousal and sleep effort at end-of-treatment constitute a risk for occurrence of insomnia during the 12 months following treatment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766838/