Insomnia is the most commonly reported sleep disorder in the United States. The estimated 10% of adults affected by insomnia generally experience poor health outcomes and poor quality of life. Available treatment options include pharmacotherapy and cognitive behavioral therapy for insomnia (CBT-I). Pharmacotherapy can be complicated due to tolerance issues and the potential risk of side-effects. In addition, access to CBT-I is limited because only a small number of providers are trained to provide it. Recent studies have indicated that mindfulness meditation may be a simple, effective, and safe adjunct to traditional treatment for patients with insomnia.
Analyzing Mindfulness Meditation
Mindfulness meditation has been defined as the awareness of the present moment with attitudes of acceptance and openness. It aims to allow those who practice it to respond to stimuli in a non-judgmental manner and let go of certain beliefs, thoughts, or emotions that may cause distress. Mindfulness meditation can also help reduce the number of emotionally arousing or harmful conditioned responses. This can be particularly useful in patients with insomnia because this population is thought to be hyper-aroused and to experience mind-racing and ruminations when trying to fall asleep.
“There are logical reasons to consider mindfulness meditation as a treatment for insomnia,” write Joanne S. Martires, MD, Michelle Zeidler, MD, and colleagues in a literature review published in Current Opinion in Pulmonary Medicine. “Letting go, acceptance, and non-striving are principles in mindfulness meditation that are congruent with stimulus control.”
There are two ways in which mindfulness meditation is currently being used to help insomnia patients, explains Dr. Martires. The first is mindfulness-based stress reduction (MBSR), which focuses on relaxation techniques and addressing anxiety. The second is mindfulness-based therapy for insomnia (MBTI), which incorporates cognitive behavioral therapy and includes stimulus control and addressing sleep hygiene.
The authors reviewed case series and randomized controlled trials to assess how mindfulness has been incorporated into various sleep programs. “We found that mindfulness programs are effective in treating insomnia as well as comorbid anxiety and depression,” says Dr. Martires. “MBTI and MBSR can substantially improve sleep latency and total wake time. They can also increase total sleep time, based on patient-reported outcomes and quantitative measures of sleep. Both techniques are also well accepted by patients.” She says that decisions on which technique to utilize should be based on geographic availability.
“Unfortunately, one of the biggest challenges facing greater utilization of mindfulness meditation is the availability of practitioners who are trained to provide it,” says Dr. Zeidler. “It is important for physicians to identify clinicians in their region who can provide this therapy to their patients with insomnia.” Studies show that internet-based mindfulness meditation programs can effectively treat insomnia, Dr. Martires adds. This provides an alternative for patients living in areas where in-person programs are lacking.
“Adequate education on sleep disorders during medical school and residency is lacking,” says Dr. Zeidler. “This may be why physicians often prescribe sedative hypnotics as first-line therapy for insomnia. With increasing rates of morbidity and mortality that have been associated with these drugs, alternative therapies like mindfulness meditation and cognitive therapy should be considered as safe and effective treatments for insomnia.”
Martires J, Zeidler M. The value of mindfulness meditation in the treatment of insomnia. Curr Opin Pulm Med. 2015;21:547-552. Available at http://journals.lww.com/co-pulmonarymedicine/pages/articleviewer.aspx?year=2015&issue=11000&article=00002&type=abstract.
Ye Y, Zhang Y, Chen J, et al. Internet-based cognitive behavioral therapy for insomnia (ICBT-i) improves comorbid anxiety and depression-a meta-analysis of randomized controlled trials. PLoS One. 2015;10:e0142258.
Wang J, Yin G, Li G, et al. Efficacy of physical activity counseling plus sleep restriction therapy on the patients with chronic insomnia. Neuropsychiatr Dis Treat. 2015;11:2771-2778.
Conley S, Redeker N. Cognitive behavioral therapy for insomnia in the context of cardiovascular conditions. Curr Sleep Med Rep. 2015;1:157-165.