Sleep problems are common in the general population, with up to half of Singaporean adults reporting insufficient or inadequate sleep. Sleep quality tends to deteriorate with age, and poor sleep is a modifiable risk factor for multiple disorders, including cardiovascular disease and cognitive impairment.
Currently, insomnia is treated either with medication or psychological interventions. However, even first-line treatments such as cognitive behavioral therapy have limitations – up to 40% of patients are not relieved of their symptoms of insomnia after undergoing this treatment. In addition, in Singapore there is a long wait time to receive such treatment, as it is usually delivered as individual therapy and the local providers available are limited.
To research alternative approaches to treating insomnia, lead researcher, Assistant Professor Julian Lim of the Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore (NUS), in collaboration with the Psychology Department at Singapore General Hospital, turned to mindfulness-based treatment. Mindfulness is the awareness of thoughts, feelings, and bodily sensations from moment to moment, and the practice of accepting those experiences without judging or reacting to them. Supported by scientific evidence, the practice of mindfulness is becoming increasingly popular as a way to reduce stress, treat mental health issues, and improve overall well-being.
The randomized controlled study compared mindfulness-based therapy for insomnia (MBTI) with an active sleep hygiene education and exercise (SHEEP) program to see if the former could improve outcomes of sleep in older people with sleep disorders. A total of 127 participants, aged 50 to 80, were randomized and split between the two programs – 65 received MBTI while 62 went through SHEEP. The two interventions consisted of eight weekly sessions of two hours each.
The MBTI course included formal mindfulness exercises such as mindful eating, sitting meditation, mindful movement, and body scans. This was followed by a group discussion about their experiences over the past week, as well as applying mindfulness practices and principles that directly addressed their sleep difficulties. In addition, participants learned good sleep habits and behavioral strategies they could use to improve their sleep.
On the other hand, the SHEEP course provided participants with information on sleep biology, self-monitoring of sleep behavior, and taught about changes to their habits and environment that could improve sleep quality. Participants also learned and practiced sleep-promoting exercises such as diaphragmatic breathing, morning and evening stretching movements, and progressive muscle relaxation.
Although the quality of sleep improved in all areas, the study found that MBTI was more effective than SHEEP in reducing symptoms of insomnia. Additionally, MBTI led to observable improvements when sleep was measured objectively – using activity monitors worn on the wrist and recording electrical brain activity while participants slept at home. These objective measures showed that MBTI participants took less time to fall asleep and spent less time awake at night, whereas this was not observed in SHEEP participants.
Explaining the results of the study, Assistant Professor Julian Lim said: “Insomnia is strongly linked to over-arousal, or the inability to turn off the ‘fight or flight’ system when it’s time to sleep. . It usually starts because of a triggering stressful event and persists because some people develop poor sleep patterns and dysfunctional thoughts about sleep. The MBTI uses behavioral strategies to directly tackle poor sleep habits, such as encouraging people to get out of bed if they are having difficulty sleeping to rebuild the association between bed and good sleep, and sleeping skills. mindfulness to equip people with more flexible strategies for dealing with dysfunctional or arousing thoughts. “
The demonstration of mindfulness-based therapy as a viable treatment for insomnia presents possible valid alternatives for people who have failed or do not have access to standard first-line therapies. Such treatment can be provided in groups inside and outside of a medical setting, providing members of the public with sleep problems easier and more effective access to seek help. “
Julian Lim, Principal Investigator and Assistant Professor, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, national university of singapore
The study was published in the journal Psychological medicine on July 1, 2021 and was funded by the Singapore Millennium Foundation, the Far East Organization, and seed funding from Duke-NUS Medical School and NUS.
The Center for Sleep and Cognition at NUS Yong Loo Lin School of Medicine studies the scientific basis of human behavior and ways to improve sleep. Through research and advocacy efforts, the Center seeks to improve human cognitive potential as well as reduce the impact of lifestyle factors and neurodegenerative diseases on cognition and well-being.
Perini, F., et al. (2021) Mindfulness-based therapy for insomnia in older people with difficulty sleeping: a randomized clinical trial. Psychological medicine. doi.org/10.1017/S0033291721002476.