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
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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)