Abstract:

Objectives: To examine whether mindfulness meditation (MM) was associated with changes in objectively measured polysomnographic (PSG) sleep profiles and to relate changes in PSG sleep to subjectively reported changes in sleep and depression within the context of a randomized controlled trial. Previous studies have indicated that mindfulness and other forms of meditation training are associated with improvements in sleep quality. However, none of these studies used objective PSG sleep recordings within longitudinal randomized controlled trials of naïve subjects. Methods: Twenty-six individuals with partially remitted depression were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep and depression symptoms. Results: According to PSG sleep, MM practice was associated with several indices of increased cortical arousal, including more awakenings and stage 1 sleep and less slow-wave sleep relative to controls, in proportion to amount of MM practice. According to sleep diaries, subjectively reported sleep improved post MBCT but not above and beyond controls. Beck Depression Inventory scores decreased more in the MBCT group than controls. Improvements in depression were associated with increased subjective sleep continuity and increased PSG arousal. Conclusions: MM is associated with increases in objectively measured arousal during sleep with simultaneous improvements in subjectively reported sleep quality and mood disturbance. This pattern is similar to the profiles of positive responders to common antidepressant medications. BDI = Beck Depression Inventory; EEG = electroencephalogram; EMG = electromyogram; EOG = electrooculogram; HRSD = Hamilton Rating Scale for Depression; MBCT = Mindfulness-Based Cognitive Therapy; MM = mindfulness meditation; NWAK = number of awakenings; PSG = polysomnograph; RCT = randomized controlled trial; REM = rapid eye movement; SE = sleep efficiency; SOL = sleep onset latency; SWS = slow-wave sleep; TIB = time in bed; TST = total sleep time; WASO = wake after sleep onset.

Abstract:

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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01534338.

Abstract:

There is a growing interest in the effectiveness of mindfulness meditation for sleep disturbed populations. Our study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. To assess for relative efficacy, comparator groups were restricted to specific active controls (such as evidenced‐based sleep treatments) and nonspecific active controls (such as time/attention‐matched interventions to control for placebo effects), which were analyzed separately. From 3303 total records, 18 trials with 1654 participants were included. We determined the strength of evidence using four domains (risk of bias, directness of outcome measures, consistency of results, and precision of results). At posttreatment and follow‐up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls (ES 0.03 (95% CI –0.43 to 0.49)) and (ES –0.14 (95% CI –0.62 to 0.34)), respectively. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention (ES 0.33 (95% CI 0.17–0.48)) and at follow‐up (ES 0.54 (95% CI 0.24–0.84)). These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.

Abstract:

Interventions based on mindfulness meditation are increasingly common and evidence exists supporting their use. However, questions remain regarding treatment mechanisms accounting for beneficial effects. The current study examined 1 candidate mechanism-mindfulness practice quality-as a mediator of the link between practice time and outcome within mindfulness-based stress reduction (MBSR). Participants (n = 96) completed measures of mindfulness and psychological symptoms at baseline and posttreatment. A weekly questionnaire assessed practice time and quality over the 8 weeks of MBSR. Multilevel models accounted for nesting within participants, MBSR groups, and instructors. Results generally supported the reliability and validity of a weekly single-item practice quality measure. Greater practice time was associated with improved practice quality (r = .48). Increases in practice quality predicted improvements in self-report mindfulness and psychological symptoms (βs = .35, .30, and -.19, ps < .05), but not behavioral mindfulness (β = -.02, p = .879). In multilevel mediation models, improved practice quality mediated the link between practice time and changes in self-report mindfulness, suggesting improved practice quality functions as a mechanism linking practice time and outcome in MBSR. Future research evaluating practice quality in clinical samples, in tandem with intensive sampling paradigms (e.g., experience sampling) and objective (behavioral, physiological) outcomes may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Abstract:

Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use–related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.

Abstract:

Purpose of review Insomnia is the most common reported sleep disorder with limited treatment options including pharmacotherapy and cognitive behavioral therapy for insomnia. Pharmacotherapy can be complicated by tolerance and significant side-effects and cognitive behavioral therapy for insomnia providers are limited in number. This article reviews mindfulness meditation as an additional therapy for insomnia. Recent findings Both mindfulness-based stress reduction (MBSR) and mindfulness-based therapy for insomnia (MBTI) have been studied in the treatment of insomnia. Randomized controlled studies of MBSR and MBTI have shown overall reduction in sleep latency and total wake time and increase in total sleep time after mindfulness therapy using both patient reported outcome and quantitative measures of sleep. Mindfulness techniques have been shown to be well accepted by patients with long-lasting effects. A three-arm randomized study with MBSR, MBTI, and self-monitoring showed similar improvement in insomnia between the MBSR and MBTI groups, with possibly longer duration of efficacy in the MBTI group. Recent data show that MBTI is also an effective and accepted treatment for insomnia in older patients. Summary Increasing evidence shows that mindfulness meditation, delivered either via MBSR or MBTI, can be successfully used for the treatment of insomnia with good patient acceptance and durable results.

Abstract:

BACKGROUND AND OBJECTIVE Sleep disturbance is a common problem among adults with obesity. Mindfulness interventions have been shown to improve sleep quality in various populations but have not been investigated in adults with obesity. The aim of this study was to compare the effects of a mindfulness-based weight-loss intervention with an active control on self-reported sleep quality among adults with obesity. METHOD This study was a secondary analysis of a randomized controlled trial and included 194 adults with a body mass index in the range 30-45 kg/m2. The treatment intervention included mindfulness-based eating and stress-management practices, and the active control intervention included training in progressive muscle relaxation (PMR). Both groups received identical diet and exercise guidelines in 17 group sessions conducted over 5.5 months that were matched for time, attention, and social support. The primary outcome of this analysis was between-group change in self-reported sleep quality, which was assessed using the Pittsburgh Sleep Quality Index (PSQI) global score at baseline and at 6, 12, and 18 months. RESULTS Between-group differences in mean PSQI change scores in the mindfulness group (n = 100) compared to the control group (n = 94) were -0.27 (-0.68, 1.22; p = 0.58) at 6 months, -0.57 (-0.35, 1.50; p = 0.22) at 12 months, and -0.50 (-0.53, 1.53; p = 0.34) at 18 months, all in the direction of more sleep improvement in the mindfulness group but none reaching statistical significance. In the mindfulness group, average weekly minutes of meditation practice time was associated with improved sleep quality from baseline to 6 months. CONCLUSIONS No statistically significant evidence was found that a weight-loss program that incorporates mindfulness improves self-reported sleep quality compared to a control diet/exercise intervention that included PMR. Within the mindfulness group, average weekly minutes of mindfulness practice was associated with improved sleep quality.

Abstract:

The coronavirus disease-2019 (COVID-19) epidemic is associated with impaired sleep quality in nurses for several reasons. The present study aimed to determine the effect of an online mindfulness-based stress reduction (MBSR) program on improving the sleep quality of nurses working in the COVID-19 care units. In this randomized controlled clinical trial study, all nurses in the 2 COVID-19 patient care units were randomly assigned to the control and intervention groups. The MBSR program was implemented online for 7 weeks for the intervention group by a trainer. The Pittsburgh Sleep Quality Index (PSQI) was completed online by the participants in both groups before and after the intervention. The results of the data analysis indicated that the intervention improved the scores of subjective sleep quality, sleep latency, and sleep efficiency in the intervention group. In the control group, there was a significant increase in the scores of subjective sleep quality, daily performance, and the total index score in the posttest. Besides, there was a significant difference between the 2 groups in only 2 components of sleep latency and subjective sleep quality. The MBSR program can be an effective intervention to improve the sleep quality of nurses working in COVID-19 intensive care units who are at risk of sleep quality disorders in stressful situations.

Abstract:

Sleep of inadequate quantity and quality is increasing in the present 24 h society, with a negative impact on physical and mental health. Mindfulness-based interventions (MBIs) generate a state of calm behavior that can reduce hyperactivity and improve sleep. We hypothesized that our specific MBI, administered online, may improve sleep quality and foster emotion regulation and mindfulness. The Pittsburgh Sleep Quality Index (PSQI), Sleep Condition Indicator (SCI), Arousal Predisposition Scale (APS), Ford Insomnia Response to Stress Test (FIRST), Sleep Hygiene Index (SHI) and Insomnia Severity Index (ISI) were used to measure sleep quality and stability. Emotion regulation and mindfulness were measured via the Emotion Regulation Questionnaire (ERQ) and Five Facet Mindfulness Questionnaire (FFMQ). Our MBI included 12 biweekly integral meditation (IM) classes, recorded IM training for individual practice, and dietary advice to promote sleep regulation. Fifty-six voluntary poor sleepers with a PSQI score of >5 were randomly allocated to treated (n = 28) and control (n = 28) groups. Linear mixed models were used to estimate the effectiveness of the intervention. Statistically significant results were observed in the FFMQ sub-domain non-reactivity to inner experience (β = 0.29 [0.06; −0.52], p = 0.01), PSQI (β = −1.93 [−3.43; −0.43], p = 0.01), SCI (β = 3.39 [0.66; 6.13], p = 0.02) and ISI (β = −3.50 [−5.86; −1.14], p = 0.004). These results confirm our hypothesis regarding the beneficial effects of our intervention on sleep quality.

Abstract:

It has been recently proposed that mindfulness can improve sleep quality through the mediating role on psychological distress and that acceptance may play a pivotal role in mindfulness beneficial effects. The aim of the present work was to understand the effects of the COVID-19 lockdown on dispositional mindfulness, sleep, and distress, and on their relationships. In particular, we wanted to test the hypothesis that the detrimental effects of lockdown on sleep depended on mindfulness and distress (including anxiety and depression) and that the acceptance facet of mindfulness played the leading role. A longitudinal study based on self-report questionnaires was conducted on 39 Italian adults (M age = 35.03, SD = 14.02; 21 men) assessing mindfulness, distress, and sleep quality before (23 December 2019–8 March 2020) and during (27 April 2020–10 May 2020) the first Italian COVID-19 lockdown. Lockdown decreased mindfulness while increasing distress and sleep problems. Path analysis showed that the effects of lockdown on sleep were fully mediated by mindfulness and distress. Furthermore, a more detailed analysis showed that these effects were mainly dependent on the acceptance component of mindfulness working through anxiety. The present study confirms, in the context of the COVID-19 lockdown, a model according to which mindfulness, and specifically acceptance, influences sleep through the mediating role of distress.

Abstract:

We examine whether mindfulness can neutralize the negative impact of COVID-19 stressors on employees’ sleep duration and work engagement. In Study 1, we conducted a field experiment in Wuhan, China during the lockdown between February 20, 2020, and March 2, 2020, in which we induced state mindfulness by randomly assigning participants to either a daily mindfulness practice or a daily mind-wandering practice. Results showed that the sleep duration of participants in the mindfulness condition, compared with the control condition, was less impacted by COVID-19 stressors (i.e., the increase of infections in the community). In Study 2, in a 10-day daily diary study in the United Kingdom between June 8, 2020, and June 19, 2020, we replicate our results from Study 1 using a subjective measure of COVID-19 stressors and a daily measure of state mindfulness. In addition, we find that mindfulness buffers the negative effect of COVID-19 stressors on work engagement mediated by sleep duration. As the COVID-19 pandemic is ongoing and the number of reported cases continues to rise globally, our findings suggest that mindfulness is an evidence-based practice that can effectively neutralize the negative effect of COVID-19 stressors on sleep and work outcomes. The findings of the present study contribute to the employee stress and well-being literature as well as the emerging organizational research on mindfulness.

Abstract:

Objectives The aim of this study was to test whether a cognitive behavioral and mindfulness-based group sleep intervention would improve sleep and anxiety on school nights in a sample of at-risk adolescents. We also examined whether benefits to sleep and anxiety would be mediated by improvements in sleep hygiene awareness and presleep hyperarousal. Methods Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into a sleep improvement intervention (n = 63) or active control "study skills" intervention (n = 60). Preintervention and postintervention, participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Sleep Beliefs Scale (SBS), and Presleep Hyperarousal Scale (PSAS) and wore an actiwatch and completed a sleep diary for five school nights. Results The sleep intervention condition was associated with significantly greater improvements in actigraphy-measured sleep onset latency (SOLobj), sleep diary measured sleep efficiency (SEsubj), PSQI, SCAS, SBS, and PSAS, with medium to large effect sizes. Improvements in the PSQI and SCAS were specifically mediated by the measured improvements in the PSAS that resulted from the intervention. Improvements in SOLobj and SEsubj were not specifically related to improvements in any of the putative treatment mechanisms. Conclusions This study provides evidence that presleep arousal but not sleep hygiene awareness is important for adolescents' perceived sleep quality and could be a target for new treatments of adolescent sleep problems.

Abstract:

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study (n = 213) aimed to determine whether perseverative cognition, indicated by rumination and intrusive thoughts, and emotion regulation, measured by avoidance, thought suppression, emotion suppression, and cognitive reappraisal, partly accounted for the hypothesized relationship between changes in mindfulness and two health-related outcomes: sleep quality and stress-related physical symptoms. As expected, increased mindfulness following the MBSR program was directly correlated with decreased sleep disturbance (r = −0.21, p = 0.004) and decreased stress-related physical symptoms (r = −0.38, p < 0.001). Partial correlations revealed that pre-post changes in rumination, unwanted intrusive thoughts, thought suppression, experiential avoidance, emotion suppression, and cognitive reappraisal each uniquely accounted for up to 32% of the correlation between the change in mindfulness and change in sleep disturbance and up to 30% of the correlation between the change in mindfulness and change in stress-related physical symptoms. Results suggest that the stress-reducing effects of MBSR are due, in part, to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders.

Abstract:

Abstract Objective High incidence of sleep problems in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) has been described. Mindfulness meditation has emerged as a novel approach to sleep disturbances and insomnia remediation. This preliminary study tested the efficacy of Mindfulness-Oriented Meditation (MOM) training on sleep quality and behavioral problems in children with ADHD. Design Twenty-five children with ADHD aged 7-11 years underwent two programs three times per week for eight-weeks: the MOM training (15 children) and an Active Control Condition (10 children). Main Outcome Measures Objective and subjective measures of sleep quality and behavioral measures were collected before and after the programs. Results Positive effects on sleep and behavioral measures were found only in the MOM group. Conclusion Although they are preliminary, our results indicate that MOM training is a promising tool for ameliorating sleep quality and behavioral manifestations in ADHD.