Introduction
Insomina is a problem that lasts for at least one month and where the affected person has difficulty getting to sleep, staying asleep, or waking in the morinng but not feeling fully restored. It affects about 9% of the population on a regular basis, although the actual rate of people effected may be higher. Insomnia is diagnosed when another form of sleep disorder or condition has been ruled out (e.g., sleep apnea). It frequently co-occurs with substance abuse, anxiety or depression, and is one of the most common psychological disorders. While there may be a number of original causes (e.g., physical stress, disturbed circadian rythms, poor sleep habits), stress and worry appear to be key causes and maintaining factors. Hence, meditation has been used for some time as a way of reducing stress and worry, and therefore improving sleep quality. Given mindfulness benefits for anxiety, stress, and depression, it follows that mindfulness training may also be helpful for insomnia. However, it is yet to be determined whether mindfulness training is a complete treatment approach. Outlined below is some of the emerging research investigating mindfulness for insonmia and poor sleep.
Summary of Research
A systematic review of the research literature on MBSR for sleep disturbance by Winbush, Gross, & Kreitzer (2007) found some positive support for the view that that increased mindfulness practice is associated with improved sleep and reduced sleep interfering cognitive processes like worry. More recent research studies draw similar conclusions for MBCT for the treatment of insomnia. That is, there were improvements in total sleep time, time to fall a sleep, sleep related worry, and self-reported sleep quality. A study by Ong and colleagues found similar postive results for a modified MBSR program that included behaviour therapy and educational components about sleep. While not a controlled study, they found that only 13% of treatment completers retained a diagnosis of insomnia, the remaining 87% had recovered. These results were maintained at 12 month follow-up. They concluded that mindfulness augmented with cognitive-behaviour therapy appears to produce more robust outcomes than mindfulness training alone.
A problem with all the previous studies is that they were not controlled. As such, two randomised controlled trials are underway to more robustly investigate the benefits of mindfulness. One study testing MBSR versus pharmacotherapy is being investigated by Cynthia Gross at the University of Minnesota. Another larger study is being investigated by Jason Ong of Rush University Medical Centre. This research group will compare MBSR versus Mindfulness for Insomnia versus a behaviour therapy delayed treatment condition. Dr Melissa Ree of The Marian Centre and University of Western Australia in Perth also has a PhD student investigating the benefits of mindfulness for insomnia. The Marian Centre regularly runs MBCT classes for persons with anxiety and depressive disorders, many of which have some form of sleep disturbance. For more information contact Dr Mark Craigie, MBCT therapist and Daypatient Coordinator (T: 93804999).
In all the research so far is promising but not totally conclusive. More controlled research trials will be required to more fully examine the benefits of mindfulness training for insomnia. It appears that for better outcomes, mindfulness training most probably will require enhancement with additional cognitive-behaviour therapy components that directly target insomina symptoms (e.g., education, sleep restriction, stimulus control, sleep hygeine). Notwithstanding, mindfulness training appears to be useful non-pharmacological approach for persons with insomnia or poor quality sleep.
References
Recommended:
- Harvey, G. A. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40, 869-893.
- Morin et al. (1999). Nonpharmacological treatment of insomnia: an american academy of sleep medicine review. Sleep, 22, 1134-1156.
Research:
- Bootzin, R. R. & Stevens, S. J. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review, 25, 629-644.
- Heidenreich, T. et al. (2006). Mindfulness-based cognitive therapy for persistent insomnia: A pilot study. Psychotherapy and Psychosomatics, 75, 188-189.
- Ong, J., Shapiro, S., & Manber, R. (2008). Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment development study. Behavior Therapy, 39, 171-182.
- Ong, J., Shapiro, S., & Manber, R. (2009). Mindfulness meditation and cognitive-behavior therapy for insomnia: a naturalistic 12-month follow-up. Explore, 5, 30-36.
- Bootzin, R. R., & Stevens, S. J. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review, 25, 629-644.
- Winbush, N., Gross, C., & Kreitzer, M. (2007). The effects of mindfulness-based stress reduction on sleep disturbance: a systematic review. Explore, 3, 585-591.
- Yook, K., et al. (2008). Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders: a pilot study. Journal of Nervous and Mental Disease, 196, 501-503.
Links:
- Cynthia Gross at the University of Minnesota. Mindfulness versus pharmacotherapy for chronic insomnia: a pilot study. Click here to go to clinical trial website.
- Jason Ong at Rush University Medical Centre. Mindfulness-based approaches for chronic insomnia. Click here to go to clinical trial website.
