Last week in the new Mindfulness Based Healthy Living course we were exploring exercise and sleep habits for promoting health and wellbeing. In the realm of sleep we are looking at improving sleep hygiene and introducing periods of non-sleep deep rest, such as bodyscan, yoga nidra and progressive relaxation. So, I thought it would be good to look at mindfulness and sleep in this blog. As usual I have searched for meta-analyses and systematic reviews to get an overview of the link between mindfulness practice and sleep quality.
Sleep is usually assessed in terms of quantity and quality, typically using validated self-report questionnaires, using a series of sleep parameters including:
Sleep onset latency – how long it takes you to fall asleep;
Number of awakenings during the night or sleep disturbances;
Total wake time – the amount of time awake after the onset of sleep;
Sleep duration;
Depth of sleep;
General satisfaction with sleep or subjective sleep quality;
Daytime dysfunction; and
Use of sleeping medication.
Winbush et al (2007) was an early systematic review of seven articles about the effects of MBSR (or adaptations of MBSR) on sleep disturbance. Sleep disturbance can be caused by stress and worry and so it makes sense that MBSR, which is an intervention that helps individuals self-manage and reframe worrisome and intrusive thoughts, might also improve sleep. However, at that time a lack of standard outcome measures to assess sleep quality prevented a meta-analysis from being conducted. Four studies without a control group found that MBSR significantly improved measures of sleep quality or duration. The remaining studies found no difference between MBSR and the control conditions. They call for more research and as we will see below that more research was indeed done!
Gong et al (2016) was a meta-analysis of six randomised controlled trials on mindfulness meditation for insomnia, sleep disorders or sleep disturbance. Mindfulness meditation included the eight week mindfulness courses of Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Based Stress Reduction (MBSR). It concluded that mindfulness meditation improved sleep parameters of total wake time and sleep quality, but did not impact other sleep parameters. They conclude that mindfulness meditation might be a promising option for insomnia in combination with other approaches.
Rusch et al (2019) was a systematic review and meta-analysis of eighteen randomised control trials relating to the effect of mindfulness meditation on sleep quality. The trials had active controls, in which the group not practicing mindfulness experienced an alternative evidence-based sleep treatment or another time and attention matched intervention. The mindfulness interventions included in the study were in-person, structured mindfulness meditation training and the authors give examples such as MBSR and Vipassana meditation. The results indicate that mindfulness seemed to work as well as alternative sleep treatments, but better than non-sleep treatment interventions in treating some aspects of sleep disturbance. These results persisted at 5 to 12 months after the intervention and there was no evidence of increased risk of harm, with lower percentages reporting poorer sleep quality (3 to 7%) compared to the control groups (12 to 24%). In addition, some of the trials in Rusch et al (2019) found a correlation between at home practice time and sleep quality improvement.
Suh et al (2021) was a systematic review and meta-analysis of ten randomised or quasi-randomised control trials of Mindfulness Based Stress Reduction (MBSR) for improving sleep quality in cancer survivors, as cancer survivors commonly suffer from sleep disturbance. The mindfulness interventions considered included Mindfulness Based Stress Reduction (MBSR) or adaptations of MBSR for cancer care. They found that MBSR is more likely to increase sleep quality than usual care, but is no more beneficial than CBT for insomnia. They conclude that MBSR is a promising option for cancer survivors. However, limitations include that the sample was mainly women, with average age between 54 and 59 and so the results are not generalisable to other populations.
So, there may be some benefits to sleep quality from a regular mindfulness meditation practice. I certainly sleep well these days!
Written by Heather Regan-Addis
Heather Regan-Addis is a Founder Member and Director of the Mindfulness Association.
Heather delivers training for the Mindfulness Association on our two Post Graduate Master’s degree courses as well as on our regular courses in Mindfulness, Compassion, Insight and on our Teacher training programmes.
References
Gong et al, 2016
https://www.sciencedirect.com/science/article/abs/pii/S0022399916303579
Rusch et al, 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557693/
Suh et al, 2021
https://www.sciencedirect.com/science/article/pii/S096522992100008X
Winbush et al, 2007
https://www.sciencedirect.com/science/article/abs/pii/S1550830707002741