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IntroductionSleep disturbance is common and associated with compromised health status. Cognitive processes characterized by stress and worry can cause, or contribute to, sleep complaints. This study systematically evaluated the evidence that sleep can be improved by mindfulness-based stress reduction (MBSR), a formalized psychoeducational intervention that helps individuals self-manage and reframe worrisome and intrusive thoughts.
Methods
Articles were identified from searches of Medline, Allied and Complementary Medicine Database, CINAHL, PsycINFO, Digital Dissertations, and the Cochrane Central Register of Controlled Trials. Eligible for inclusion were English language clinical trials of MBSR that reported preintervention and postintervention measures of sleep quality or duration. Studies employing multicomponent interventions were excluded. Studies were reviewed independently by the first and second authors.
Results
Thirty-eight articles were identified for review. Seven met inclusion criteria. Lack of standardized outcome measures precluded pooling of results for quantitative data analysis. Sleep report measures varied (standardized scales, single item, sleep diaries). Four studies (all uncontrolled) found that MBSR significantly improved measures of sleep quality or duration. The remaining studies found no statistically significant difference between treatment and control conditions.
Conclusions
To date, controlled studies have not clearly demonstrated the positive effects of MBSR on sleep quality and duration. However, there is some evidence to suggest that increased practice of mindfulness techniques is associated with improved sleep and that MBSR participants experience a decrease in sleep-interfering cognitive processes (eg, worry). More research is needed using standardized sleep scales and methods, with particular attention to the importance of MBSR home practice.
OBJECTIVE: The aim of this study was to investigate the potential of mindfulness-based stress reduction (MBSR) as a treatment for chronic primary insomnia.DESIGN: A randomized controlled trial was conducted.
SETTING: The study was conducted at a university health center.
PATIENTS: Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th Edition were randomized 2:1 to MBSR or pharmacotherapy (PCT).
INTERVENTIONS: Mindfulness-based stress reduction, a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat, was provided, with ongoing home meditation practice expectations during three-month follow-up; PCT, consisting of three milligrams of eszopiclone (LUNESTA) nightly for eight weeks, followed by three months of use as needed. A 10-minute sleep hygiene presentation was included in both interventions.
MAIN OUTCOMES: The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and wrist actigraphy were collected pretreatment, posttreatment (eight weeks), and at five months (self-reports only).
RESULTS: Between baseline and eight weeks, sleep onset latency (SOL) measured by actigraphy decreased 8.9 minutes in the MBSR arm (P < .05). Large, significant improvements were found on the ISI, PSQI, and diary-measured total sleep time, SOL, and sleep efficiency (P < .01, all) from baseline to five-month follow-up in the MBSR arm. Changes of comparable magnitude were found in the PCT arm. Twenty-seven of 30 patients completed their assigned treatment. This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary, actigraphy, well-validated sleep scales, and measures of remission and clinical recovery.
OBJECTIVE: The aim of this study was to investigate the potential of mindfulness-based stress reduction (MBSR) as a treatment for chronic primary insomnia.DESIGN: A randomized controlled trial was conducted.
SETTING: The study was conducted at a university health center.
PATIENTS: Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th Edition were randomized 2:1 to MBSR or pharmacotherapy (PCT).
INTERVENTIONS: Mindfulness-based stress reduction, a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat, was provided, with ongoing home meditation practice expectations during three-month follow-up; PCT, consisting of three milligrams of eszopiclone (LUNESTA) nightly for eight weeks, followed by three months of use as needed. A 10-minute sleep hygiene presentation was included in both interventions.
MAIN OUTCOMES: The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and wrist actigraphy were collected pretreatment, posttreatment (eight weeks), and at five months (self-reports only).
RESULTS: Between baseline and eight weeks, sleep onset latency (SOL) measured by actigraphy decreased 8.9 minutes in the MBSR arm (P < .05). Large, significant improvements were found on the ISI, PSQI, and diary-measured total sleep time, SOL, and sleep efficiency (P < .01, all) from baseline to five-month follow-up in the MBSR arm. Changes of comparable magnitude were found in the PCT arm. Twenty-seven of 30 patients completed their assigned treatment. This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary, actigraphy, well-validated sleep scales, and measures of remission and clinical recovery.