The Quest for Mindful Sleep: a Critical Synthesis of the Impact of Mindfulness-Based Interventions for Insomnia

Current Sleep Medicine Reports, Jul 2016

Mindfulness-based interventions (MBIs) for insomnia and sleep disturbances are receiving increasing clinical and research attention. This paper provides a critical appraisal of this growing area investigating the application of MBIs for people with insomnia and sleep disturbance. First, we discuss the theoretical justification for how mindfulness meditation practice may affect sleep processes. Second, we provide a focused review of literature published between January 1, 2012 and April 1, 2016 examining the impact of MBIs on sleep, broken down by whether insomnia or sleep disturbance was a primary or secondary outcome. Recommendations for future research are discussed.

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The Quest for Mindful Sleep: a Critical Synthesis of the Impact of Mindfulness-Based Interventions for Insomnia

Curr Sleep Medicine Rep The Quest for Mindful Sleep: a Critical Synthesis of the Impact of Mindfulness-Based Interventions for Insomnia Sheila N. Garland 0 1 2 Eric S. Zhou 0 1 2 Brian D. Gonzalez 0 1 2 Nicole Rodriguez 0 1 2 Sheila N. Garland 0 1 2 0 Rutgers Cancer Institute of New Jersey , 195 Little Albany Street, New Brunswick, NJ 08903 , USA 1 Dana-Farber Cancer Institute , 450 Brookline Avenue, Boston, MA 02215 , USA 2 Department of Pediatrics, Harvard Medical School , 25 Shattuck Street, Boston, MA 02115 , USA Mindfulness-based interventions (MBIs) for insomnia and sleep disturbances are receiving increasing clinical and research attention. This paper provides a critical appraisal of this growing area investigating the application of MBIs for people with insomnia and sleep disturbance. First, we discuss the theoretical justification for how mindfulness meditation practice may affect sleep processes. Second, we provide a focused review of literature published between January 1, 2012 and April 1, 2016 examining the impact of MBIs on sleep, broken down by whether insomnia or sleep disturbance w as a p rimary or seconda ry outcome. Recommendations for future research are discussed. Mindfulness; Meditation; Insomnia; Sleep disturbance; Intervention - Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John’s, NF A1B 3X9, Canada Division of Oncology, Faculty of Medicine, Memorial University, 300 Prince Phillip Dr., St. John’s, NF A1B 3V6, Canada Introduction/Background Insomnia is a universal concern affecting individuals across the lifespan. A multi-national cross sectional survey of 25,579 individuals suggests that 35 % of the population reports some difficulty initiating and maintaining sleep, or non-restorative sleep at least 3 days per week, with 10 % reporting significant daytime consequences of poor sleep [ 1 ]. The most common treatment for trouble sleeping continues to be prescription sleep aids with recent estimates suggesting that 4 % of the US population (approximately 11 million people) endorsed its use within the preceding 30 days [ 2 ]. However, sleeping aids are associated with a number of negative health outcomes including increased risk for motor vehicle accidents [ 3 ], falls and fractures in the elderly [ 4 ], the development of comorbid psychiatric [ 5 ] and medical conditions [ 6 ], and increased overall mortality [ 7 ], and may not be desired by patients with chronic medical illnesses [ 8 ]. Considering the possible risks associated with prescription sleep aid use and the lack of efficacy data in various populations with chronic illness [ 9, 10 ], it is important to provide patients with evidence-based alternatives that fit their unique needs. Cognitive behavior therapy for insomnia (CBT-I) is a highly effective non-pharmacological intervention for insomnia that is considered first-line treatment for chronic insomnia disorder [ 11, 12 ]. Strong evidence demonstrates that CBT-I and hypnotic medications are equally effective in the shortterm, whereas the gains from CBT-I are significantly better maintained over time relative to hypnotic therapies [ 13–15 ]. Despite the endorsement of CBT-I as a first-line treatment for insomnia disorder from both the National Institutes of Health [ 11 ] and the American Academy of Sleep Medicine [ 12 ], several barriers to accessing CBT-I remain. First, there is a lack of awareness among the general public [ 16 ] and primary care providers [ 17 ] to the existence of, and evidence for, CBT-I. Second, despite solid efforts to increase the number of trained professionals [ 18 ] and provide alternative delivery models [ 19–21 ], the reach of CBT-I remains limited in large part to major cities and academic medical centers [ 22 ]. Lastly, insurance reimbursement for CBT-I can be poor, particularly if delivered by non-physician mental health providers (e.g., psychologists) [ 23 ]. Despite the evidence that CBT-I is an effective intervention with lasting effects [ 13–15 ], there are still a significant number of individuals whose insomnia does not fully respond to CBTI. In a study evaluating CBT-I for persistent insomnia in adults, 40 % did not report a significant treatment response and 61 % continued to experience insomnia symptoms following therapy [ 13 ]. One potential explanation is poor adherence to treatment [ 24 ]. Several core components of CBT-I (e.g., sleep restriction and stimulus control) can be difficult to implement and often result in a short-term worsening of symptoms and patient discomfort [ 25, 26 ]. It is clear that though CBT-I must be considered a key component in the treatment of insomnia, it may not be the right approach for every individual. The application of mindfulness-based interventions (MBIs) for insomnia and sleep disturbances is receiving increasing amounts of clinical and research attention. Mindfulness intentionally brings awar (...truncated)


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Sheila N. Garland, Eric S. Zhou, Brian D. Gonzalez, Nicole Rodriguez. The Quest for Mindful Sleep: a Critical Synthesis of the Impact of Mindfulness-Based Interventions for Insomnia, Current Sleep Medicine Reports, 2016, pp. 142-151, Volume 2, Issue 3, DOI: 10.1007/s40675-016-0050-3