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Mindfulness Insomnia Remedy

July 16, 2009 Written by JP       [Font too small?]

Nothing can replace the blissful feeling we get after a good nights sleep. On the other hand, tossing and turning for hours or simply being unable to relax enough to fall asleep makes the following day quite a struggle. Sleeping pills can be helpful for the occasional restless night, but shouldn’t be used on a regular basis. It turns out that the solution to this disturbingly common problem may very well reside inside our heads. A group of scientists from Duke University suggest that simply being mindful of your thoughts and quieting your mental chatter may be enough to induce some much need slumber.

One of the leading causes of insomnia is chronic stress. Many people simply can’t let go of their daily mental anxiety once they hit the sack. A recent presentation at the North American Research Conference on Complementary and Integrative Medicine examined the role of mindfulness-based stress reduction (MBSR) on sleep disorders in a group of 151 men and women. The Pittsburgh Sleep Quality Index was used a way of measuring the effects of an 8 week MBSR training program on various aspect of sleep hygiene. Here’s what the researchers from Duke Integrative Medicine discovered:

  • Participants in the MBSR program demonstrated a 26% improvement in overall sleep quality and fewer symptoms of sleepiness in the daytime (28% reduction).
  • Instances of waking up in the middle of the night were reduced by 16% and sleep medication use dropped by 25%.
  • At the starting point of the trial, 70% of the volunteers met the criteria for “clinically significant sleep disturbances”. After the MBSR instruction, that number dropped to 50%.

According to Dr. Jeff Greeson, a psychologist from Duke, “When people become more mindful they learn to look at life through a new lens. They learn how to accept the presence of thoughts and feelings that may keep them up at night. They begin to understand that they don’t have to react to them. As a result, they experience greater emotional balance and less sleep disturbances.” (1)

A 2008 study in The Journal of Nervous and Mental Disease also found a statistically important reduction in “worry associated sleep disturbances” in 19 patients with anxiety disorder who underwent a similar 8 week MBSR course.(2) These results are in line with previous research conducted in recent years.(3) In fact, it appears that mindfulness meditation is specifically effective in managing the variety of insomnia that involves anxiety and/or worry related issues. Another promising piece of data is that the effects of MBSR seem to be long lasting. For instance, a review published at the beginning of this year found that improvements in sleep status were still present after a 12 month follow up period. (4)

Mindfulness Training Results from the University of Pennsylvania (5)

There are MBSR courses being taught throughout the world. But if you’re interested in experimenting with a very simple form of mindfulness meditation, you can follow these basic steps:

  1. Find a reasonably quite space that is relatively free of sensory stimulation. Dimming the light in a room may be helpful. Allow yourself a few minutes to sit and become accustomed to this peaceful environment.
  2. Sit upright in a position that allows you to feel comfortable, but not overly relaxed. The goal is to provoke a peaceful state, but not sleep.
  3. Close your eyes and gently begin to focus on your breath. Direct your attention to the air that is being inhaled into your nose and exhaled through your mouth. Note the feeling in the body that accompanies the air exchange – the calming effect, the rise and fall of your abdomen.
  4. It’s perfectly natural for thoughts to pop into your mind. When they do, simply be aware of whatever comes to mind. Then, redirect your focus back to your breathing pattern.
  5. The length of the meditative session varies, but can be as short as 5 minutes. A typical allotment of time is between 15-30 minutes. After your time is up, allow yourself to sit peacefully for a few moments and slowly adjust back to your prior state.

This practice tends to be most effective if practiced on a regular basis. Many practitioners find that beginning and ending their days with a meditative moment helps to set a positive tone for the times that follow. It’s important to note that traditional MBSR training often involves a total of 26 hours of instruction and is obviously much more involved than what I’ve described. (6) I can’t promise that you’ll derive the same results without that structure. Still, I do believe that even less intensive and/or streamlined forms of mindfulness can yield a positive outcome with sleep and beyond.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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11 Comments & Updates to “Mindfulness Insomnia Remedy”

  1. Christina Crowe Says:

    Great post!

    I used to have this same issue whenever I would go to bed. My mind would be filled with thoughts of the day’s events, and sleep wouldn’t come for a while. Now though, sleep comes more easily for me. It especially helps if I put the television on the news channel and turn the volume low. The murmur from the television has the same effect as someone who’s reading to you.

  2. JP Says:

    Thanks, Christina. :)

    It’s helpful to have many techniques to choose from. I know some people who use their TV (with the “timer” fuction) to lull them into slumberland too. Thanks for sharing what works for you!

    Be well!

    JP

  3. Ken Shim, RMT Says:

    A good reminder of the importance of sleeping, letting go. Also, there are lots of studies of massage and acupuncture as being effective stress relievers. Acupuncture in particular works well for insomnia. There are a few points I use that do wonders for activating the parasympathetic nervous system and activating the sleep centres

  4. JP Says:

    Thanks, Ken.

    I’m glad that you pointed out the utility of other mind-body approaches in cases of insomnia. If one therapeutic form, such as meditation, isn’t right for an individual … there is likely to be another variety that is more appealing/appropriate.

    Be well!

    JP

  5. Dr. Jeff Greeson Says:

    Dear JP,

    I enjoyed reading your well researched summary on this topic…well done.

    For anyone who may be interested, here is a brief TV interview I did recently in which we discuss the study in a bit more detail.

    http://www.news14.com/Default.aspx?ArID=611728

    Keep up the great work!

    - Dr. Greeson

  6. JP Says:

    Thank you very much, Dr. Greeson! I appreciate your kind words!

    I just viewed your interview and really enjoyed it. Your explanation of the mindfulness practice and the benefits noted in your experiment added to my level of understanding. Thanks for bringing this interview to our attention.

    I’ll look forward to learning more about your continuing research. I’m sure it’ll be fascinating.

    Be well!

    JP

  7. Rod Rayborne Says:

    I’ve had insomnia for decades and nothing seemed to help. Then I noticed last year that the few times of the year when I can hear the crickets outside, I sleep better. Unfortunately the crickets are out here only a very short time of the year. Then I thought perhaps a recording of crickets might have the same effect and I found a few online and put them on a little mp3 player. I connected the player to a small radio and turned the volume low. Amazingly it worked, so I found a few other sounds like ocean waves and morning birds singing and added them to the mp3 player. It’s wonderful! I hope this helps!

  8. JP Says:

    Thank you, Rod! What a great observation/suggestion. Personally, I can attest to the relaxing effect of hearing rainfall while preparing for sleep. I love it!

    Be well!

    JP

  9. JP Says:

    Update: More support for mindfulness meditation re: sleep quality …

    http://archinte.jamanetwork.com/article.aspx?articleid=2110998

    Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial

    Importance: Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep.

    Objective: To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances.

    Design, Setting, and Participants: Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5).

    Interventions: A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework.

    Main Outcomes and Measures: The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)–κB.

    Results: Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05).

    Conclusions and Relevance: The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life.

    Be well!

    JP

  10. JP Says:

    Update 07/14/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26158889

    Sleep. 2015 Jun 22.

    Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and a Waiting List Condition.

    STUDY OBJECTIVES: To investigate the efficacy of cognitive behavioral therapy for insomnia (CBTI) in adolescents.

    DESIGN: A randomized controlled trial of CBTI in group therapy (GT), guided internet therapy (IT), and a waiting list (WL), with assessments at baseline, directly after treatment (post-test), and at 2 months follow-up.

    SETTING: Diagnostic interviews were held at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam. Treatment for GT occurred at the mental health care center UvAMinds in Amsterdam, the Netherlands.

    PARTICIPANTS: One hundred sixteen adolescents (mean age = 15.6 y, SD = 1.6 y, 25% males) meeting DSM-IV criteria for insomnia, were randomized to IT, GT, or WL.

    INTERVENTIONS: CBTI of 6 weekly sessions, consisted of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT was conducted in groups of 6 to 8 adolescents, guided by 2 trained sleep therapists. IT was applied through an online guided self-help website with programmed instructions and written feedback from a trained sleep therapist.

    MEASUREMENTS AND RESULTS: Sleep was measured with actigraphy and sleep logs for 7 consecutive days. Symptoms of insomnia and chronic sleep reduction were measured with questionnaires. Results showed that adolescents in both IT and GT, compared to WL, improved significantly on sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time at post-test, and improvements were maintained at follow-up. Most of these improvements were found in both objective and subjective measures. Furthermore, insomnia complaints and symptoms of chronic sleep reduction also decreased significantly in both treatment conditions compared to WL. Effect sizes for improvements ranged from medium to large. A greater proportion of participants from the treatment conditions showed high end-state functioning and clinically significant improvement after treatment and at follow-up compared to WL.

    CONCLUSIONS: This study is the first RCT that provides evidence that CBTI is effective for the treatment of adolescents with insomnia, with medium to large effect sizes. There were small differences between internet- and group therapy, but both treatments reached comparable endpoints.

    Be well!

    JP

  11. JP Says:

    Updated 09/02/18:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096902/

    Front Psychol. 2018 Aug 3;9:1365.

    Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia.

    Fibromyalgia syndrome (FMS) is a complex psychosomatic pain condition. In addition to generalized pain and various cognitive difficulties, new FMS diagnostic criteria acknowledge fatigue and sleep problems as core aspects of this condition. Indeed, poor sleep quality has been found to be a significant predictor of pain, fatigue, and maladaptive social functioning in this patient group. While there is promising evidence supporting the role of mindfulness as a treatment for FMS, to date, mindfulness intervention studies have principally focused on dimensions of pain as the primary outcome with sleep problems either not being assessed or included as a secondary consideration. Given the role of sleep problems in the pathogenesis of FMS, and given that mindfulness has been shown to improve sleep problems in other clinical conditions, the present study explored the effects of a mindfulness-based intervention known as Flow Meditation (Meditación-Fluir) on a range of sleep-related outcomes (subjective insomnia, sleep quality, sleepiness, and sleep impairment) in individuals with FMS. Adult women with FMS (n = 39) were randomly assigned to the 7 weeks mindfulness treatment or a waiting list control group. Results showed that compared to the control group, individuals in the mindfulness group demonstrated significant improvements across all outcome measures and that the intervention effects were maintained at a 3 month follow-up assessment. The Meditación-Fluir program shows promise for alleviating sleep problems relating to FMS and may thus have a role in the treatment of FMS as well as other pain disorders in which sleep impairment is a central feature of the condition.

    Be well!

    JP

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