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Living, and Sleeping, Mindfully

02/18/2016 08:19 am ET | Updated Feb 18, 2016
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What science is telling us about how mindfulness improves sleep

In recent years, we've seen a surge of interest in the benefits of mindfulness to health and well being. Mindfulness practices are increasingly being investigated, tested, and used as tools in preventing and treating physical and psychological dysfunction and illness and in enhancing health and wellness. Mindfulness is also attracting a lot of attention for its specific benefits to sleep.

What is mindfulness?
In broad terms, mindfulness involves focusing awareness on the present moment. In a mindful state, we allow ourselves to be aware of any thoughts, feelings, and physical experiences that occur, as well as to be aware of our external surroundings. Within this present-centered awareness, mindfulness incorporates self-acceptance, self-compassion, and a non-judgmental acknowledgement of all thoughts and feelings. In a practice of mindfulness, we seek to accept thoughts and feelings as they come and go, assigning no judgment or criticism to them--or to ourselves for having them. In a mindful focus on the present moment, we don't think ahead to the future, and we don't re-live the past.

Both mental and physical exercises and routines are used to create mindfulness--and these practices are now being looked at closely for their benefits to sleep. Meditation is among the most widely used mindfulness practices. Yoga, tai chi are mind-body exercises that can enhance mindfulness. Guided visualization, breathing exercises, and body-scan exercises also seek to create self-awareness and a mindful state that accepts without judgment the emotions and physical experiences of the present.

The goals and benefits of mindfulness to health and sleep
There are long-held, deeply rooted spiritual goals connected to mindfulness. In terms of their direct effects on health, mindfulness practices and therapies often seek to reduce stress and to enhance physical, psychological, and social well being.

What are the goals of mindfulness with regard to sleep? Mindfulness-based sleep therapy seeks to clear the way for the natural process of sleeping and waking to occur and unfold, less hampered by stress, worry, and attempts to control, overcome, or overcompensate for any obstacles to sleep that may exist. The "fight" to achieve sleep in the face of perceived obstacles often compounds the emotional turmoil and stress that surrounds sleep problems--and makes sleep itself more difficult. A series of recent studies indicate that mindfulness predicts better self-regulation of sleep and improved emotional and social well being, better psychological functioning, and stronger coping skills.

The application of mindfulness techniques to sleep is still very much in a developing phase--and the scientific inquiry into the effectiveness of these techniques is, while growing quickly, still relatively young. But mindfulness-based sleep therapy appears to be fast on the rise--gaining traction within sleep medicine and attracting interest of sleep scientists. Let's take a closer look at what recent research shows about the benefits of mindfulness to healthy sleep.

More mindfulness, better sleep
There's a body of recent research that establishes a strong connection between mindfulness practices and improved sleep quality. Many--though not all--studies of mindfulness and sleep have focused on the treatment of chronic insomnia, a sleep disorder estimated to affect 10-15 percent of the adult population.
• A clinical trial of 49 adults with moderate levels of sleep disturbance found mindfulness practices--including meditation and movement exercises--led to significant improvements to sleep. The adults in this study who received mindfulness-based treatment for sleep experienced improvements to insomnia symptoms, daytime fatigue, and to depression.
• Another recent trial of 54 adults with chronic insomnia found that both mindfulness-based stress therapy and mindfulness-based treatment for insomnia led to significant sleep gains, including reductions in total wake times, reducing insomnia severity, and lowering pre-sleep arousal levels. Both of these forms of mindfulness therapy demonstrated lasting, durable improvements to sleep.
Sleep quality improved significantly among a group of older adults (ages 75 and up) who participated in mindfulness-based stress therapy, according to a 2015 study.
• The use of mindfulness practices predicts both sleep quality and a circadian preference for mornings, as well as psychological well being, according to research.

Mindfulness for all ages
While several recent studies examine the effects of mindfulness over sleep in older adults, there's also been an increasing scientific interest in the benefits of mindfulness practices in improving sleep for young adults and adolescents. A 2011 study found that students who participated in taijiquan (also known as Tai Chi) increased their mindfulness and improved their sleep quality, as well as reducing their stress. Other recent research in younger populations has shown improvements to sleep through mindfulness therapy:
• Medical students practicing a four-week mind-body skills program experienced significant gains to sleep, as well as to other self-care behaviors such as exercise and social support.
• Research examining how mindfulness and self-compassion affected sleep and resilience among young health professionals (with an average age of 28) found a strong correlation between sleep disturbances and lower levels of mindfulness. Less mindfulness was also linked to less self-compassion and to higher stress.

A particularly interesting study investigated the effects of mindfulness-based sleep interventions in school, among a group of ninth-grade students at a girls' school. All the students who participated were experiencing poor sleep. After the mindfulness-for-sleep training, the students experienced improvements to sleep across several measures, including improved sleep onset, better sleep efficiency, and greater total sleep time. The students also shifted their bedtimes earlier, woke earlier, and displayed less variability in their bedtime and wake-time schedules. Sleep quality increased among the students who received mindfulness education, and sleep-related daytime dysfunction decreased.

The program given to students included training in mindfulness practices along with education about sleep hygiene, healthy sleep schedules and habits, and coping skills to deal with bedtime worrying.

Sleep problems and other health conditions, treated with mindfulness
Often, sleep troubles such as insomnia exist alongside other health issues. Research conducted in recent years has shown that mindfulness-based therapies can help improve sleep among people with co-existing mental and physical health conditions:
• Mindfulness-based stress therapy for veterans with mental health problems led to improved sleep, reduced stress, and less depression, according to a 2013 study.
• Among people with insomnia and anxiety disorders, mindfulness-based cognitive therapy delivered significant improvements to sleep quality and decreased symptoms of insomnia, according to research.
• Twelve weeks of mindfulness-based stress reduction significantly improved sleep among women with breast cancer--increasing sleep time and reducing nighttime awakenings--according to the results of research published in 2015.
• Another 2015 study of cancer patients with insomnia investigated the effects of mindfulness-based therapy and cognitive behavioral therapy for sleep. Researchers found patients treated with this combination of therapies increased their ability to act with awareness, and to practice non-judgment. They also found patients demonstrated less emotional reactivity. These changes were associated with significant shifts in patients' attitudes about sleep, and reductions to dysfunctional beliefs about sleep.

Mindfulness with other sleep therapy
Mindfulness is often considered as a treatment alongside other non-pharmacological sleep therapies, particularly in conjunction with cognitive-behavioral therapy (CBT) for sleep. CBT is an established, highly effective form of treatment for insomnia and other sleep problems. Treating sleep with mindfulness in combination with CBT brings together awareness-raising and behavioral change directed at sleep habits and sleep regulation.

Mindfulness techniques (such as meditation) can complement sleep-related behavioral adjustments (such as stimulus control and sleep restriction) to help re-frame thoughts, emotions, and experiences surrounding sleep. A number of studies conducted in recent years have demonstrated that mindfulness practices used with cognitive-behavioral therapy result in lasting, positive changes to sleep.

Rather than a sleeping pill, be mindful of sleep
Sleep scientists have begun to compare the effectiveness of mindfulness-based sleep treatment to that of prescription sleep medication. A clinical trial conducted by researchers at University of Minnesota's College of Pharmacy compared mindfulness-based stress reduction to sleep medication in treating chronic insomnia. Participants spent eight weeks either in a mindfulness program or taking daily doses of eszoplicone (Lunesta). Sleep was measured using sleep diaries, wrist actigraphy, and standard sleep questionnaires. Mindfulness delivered improvements to sleep--including reduced insomnia, improved sleep quality, increased sleep time, and better sleep efficiency--that were comparable to sleep medication.

The mechanisms behind mindfulness
Scientists are also working to understand better how it is that mindfulness exerts positive changes over sleep. Several studies in recent years have examined the underlying mechanisms of mindfulness' effects on sleep. Their results are beginning to shed light on how mindfulness changes both the body and the mind in ways beneficial to sleep:
• Mindfulness practices used during the workday are associated with better sleep quality at night, according to a 2014 study. Researchers linked daytime mindfulness to improved nighttime sleep. They found that mindfulness practiced during the workday increased participants' ability to detach psychologically from work during the evening hours--and this increased detachment was a factor in sleep improvements.
• Recent studies link mindfulness practices to changes in cortisol levels that appear beneficial to sleep-wake cycle. Cortisol is a hormone that stimulates alertness and vigilance, and is important to the regulation of the body's 24-hour sleep-wake cycle. Cortisol is also a significant biomarker of stress, and excess or poorly timed increases to levels of cortisol are connected to over-vigilance, stress and anxiety, and sleep problems. A number of studies have established links between mindfulness practices and changes to cortisol levels that occur along with improvements to sleep.

Learning more about mindfulness and sleep
So what's next for the exploration of mindfulness in helping sleep? Scientific research has established strong associations between states of mindfulness and improved sleep--but we're still looking to see and understand a causal relationship between the two. It's also important we pursue a deeper understanding of how mindfulness works, and the mechanisms by which it aids sleep. (That knowledge can inform not only our understanding of mindfulness, but may also broaden our understanding of how sleep itself works.)

With growing evidence of mindfulness' effectiveness in treating sleep, we need to see more research aimed at determining the best methods for delivering that treatment. And it's time to see investigations of how mindfulness-based sleep therapy may work in treating sleep disorders other than insomnia.

The power of mindfulness to improve sleep and treat sleep disorders is an exciting and important area of scientific inquiry with significant real-world implications for how we treat disrupted sleep. Low-cost, nonpharmacalogic, and easily adoptable, mindfulness-based sleep therapy may offer a path to relief for people with insomnia and other sleep difficulties.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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