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Willoughby Britton, Ph.D.

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Meditation for Sleep: Paradoxes and Promises

Posted: 06/13/10 09:00 AM ET

Meditation-based therapies for stress, anxiety and depression have been making a comeback since the 1990s. Mindfulness meditation, in particular, has so thoroughly infiltrated mainstream psychiatry that mindfulness-based approaches have been called the "Third Wave of Behavior Therapies." At this point, there isn't too much question about whether mindfulness meditation is helpful for distress. The main focus for researchers now is why and how it works, and through what mechanism.

Does meditation improve depression by improving sleep? Being a clinical psychologist with an interest in both depression and sleep, I have spent the last several years investigating whether meditation-related improvements might be mediated by improvements in sleep. The idea seemed obvious: Poor sleep is a symptom of depression and it is also a risk factor for developing depression or relapsing. Meditation techniques, including mindfulness, have been found to calm the sympathetic nervous system's "fight or flight response" and decrease worry and rumination -- all the things that interfere with good sleep. But does meditation improve sleep? My first thought was "of course!"

Like any good American, I went online and Googled "Meditation + Sleep" and came up with nearly six million hits, the majority praising the sleep-promoting effects of meditation ("Meditation, a natural sleep aid") and selling meditation-based sleep products ("Achieve a better night's sleep with meditation techniques") -- many from medical professionals ("Sleeplessness? M.D. offers self-help tips and sleep meditation CD").

Based on the internet, it looks like meditation is great for sleep. Time to take a closer look at the scientific research...

How to Evaluate the Claims: Not All Research Is Equal

There are two general types of meditation studies: cross-sectional studies and longitudinal studies. Cross-sectional studies compare experienced meditators with non-meditators and are good place to start, but they can have hidden confounds that can obscure firm conclusions.

For example, if you compared a group of regular exercisers to non-exercisers and found that they were healthier, it would be easy to conclude that exercise makes you healthy. But what is not known is whether the exercisers also eat healthier diets, smoke or drink less or if the non-exercisers had a pre-existing health problem that prevented them from exercising.

The same problem applies to cross-sectional studies of meditators; it is unknown if the meditators were happier, less stressed or better sleepers before they started meditating, or whether they engage more in other health-promoting behaviors. Because of this, researchers put more value in longitudinal studies that measure sleep before and after learning meditation in people who have never meditated before.

It's also important that the longitudinal study is a "randomized controlled trial," or RCT, where half of the subjects are randomly allocated to the meditation group and the other half don't meditate. This helps control for effects that are based on expectancy (hope of trying something new) or increased familiarity with the measures over time.

A Review of the Science Comes up Lacking

When I followed up the enthusiastic Google claims on the scientific research database Medline, the evidence was less compelling. Only a handful of longitudinal studies had investigated the effects of mindfulness meditation on sleep. Nearly all the studies found an improvement in self-reported sleep following meditation, but when a control group was added, the meditation group didn't improve more than the control condition, which was usually a wait-list.

What was even more discouraging about the existing research was that they relied on self reports -- either a general rating of sleep quality, or an average of daily diaries. None of the studies used what is considered the "Gold Standard" of sleep research, the polysomnographic sleep study, which measures brainwaves (EEG), eye-movements and muscle tone overnight in a laboratory.

The next step was obvious: Do a longitudinal randomized control trial with laboratory-based polysomnographic sleep measures in a depressed population with sleep complaints. Twenty-six medication-free individuals with a history of depression were randomized into either an eight week mindfulness meditation program called "Mindfulness-based Cognitive Therapy" or a wait-list control condition. All participants underwent in-lab sleep recordings before and after the treatment condition and filled out daily sleep diaries.

Meditation and Sleep Diaries Equally Beneficial for Self-Reported Sleep

According to sleep diaries, self-reported sleep improved following mindfulness meditation, just like in the other studies. But again, when compared to the control group, the effect disappeared. Filling out daily sleep diaries (but not meditating) was just as beneficial for sleep as meditation. When the act of measurement changes what is measured, we call that the "Hawthorne Effect." In this case, increased attention to daily sleep habits may have changed the participants' perception of their sleep quality or subtly encouraged them to adapt healthier sleep schedules. Thus, confirming previous studies, it does not appear that mindfulness meditation is especially good for improving (self-reported) sleep.

Results from the Sleep Lab

Even though the meditators said they were sleeping better, results from laboratory-based sleep and brain recordings told a different story. Contrary to our hypotheses that meditation would improve and deepen sleep, we found that meditation was associated with several indices of increased wakefulness and decreased sleep propensity, including more awakenings and stage one sleep (a lighter stage of sleep) and less stage three and four or "slow-wave sleep" (a deeper stage of sleep) compared to controls.

Even more compelling was the dose-response relationship between meditation practice amount and increases in wakefulness: the more one meditated, the more awake one's brain became.

Paradox and Promise

Before we jump to the conclusion that meditation makes sleep worse, it is important to mention that the increased wakefulness in the brain was associated with improvements in depression. The people who meditated the most (at least 30 minutes per day) had more wakeful brains and were less depressed, but also reported sleeping better. Interestingly, this paradoxical pattern of improvements in self-reported sleep and mood with a corresponding increase in brain wakefulness is also seen in depressed patients who respond positively to SSRI's like Prozac.

Be careful

Like most research, these findings provoke many more questions than they answer, but it's important not to speculate and to stick to the original question: Does meditation improve sleep? Our results, along with other longitudinal studies -- which have only examined mindfulness meditation and not other techniques -- do not support the widespread claims that meditation promotes better, deeper sleep. Much more research is needed. The take home message is that sometimes popular enthusiasm outpaces scientific research, and consumers should be as educated as possible about how to evaluate the evidence.

Tip: Always go to the original source: A detailed scientific report of this study can be found here.

 
Meditation-based therapies for stress, anxiety and depression have been making a comeback since the 1990s. Mindfulness meditation, in particular, has so thoroughly infiltrated mainstream psychiatry th...
Meditation-based therapies for stress, anxiety and depression have been making a comeback since the 1990s. Mindfulness meditation, in particular, has so thoroughly infiltrated mainstream psychiatry th...
 
 
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04:41 PM on 06/21/2010
A video of the author describing this study can be found at:

www.brown.edu/Faculty/Contemplative_Studies_Initiative/resources.html

scroll down to "When Empirical Science Trumps Popular Assumptions The Case of Meditation and Sleep"

Willoughby Britton, Ph.D.
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StrayTalk
09:56 PM on 06/14/2010
Put me in the category of meditation = more wakefulness much of the time. If I need to really sleep, I'll have a cup of herb tea and use self- hypnosis ( I don't call it guided meditation) That's usually effective about 90% of the time. Occasionally, I'll Iisten to music instead. I notice that some people posting make the assumption that what works for them will work for everyone else. Wrong.
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jeanneyogini
03:09 PM on 06/14/2010
I know people who say they benefit from mindfulness and that it helps them sleep, but I agree with you that there has been a lot of enthusiasm promoting it without proper scientific research to back the claims. I congratulate you for being so pragmatic and investigating the details of how the research was done.

As a teacher of meditation I have been studying the scientific data on mindfulness, zen, Transcendental Meditation and several other meditation techniques. I have discovered that different meditation practices effect the brain and physiology in different ways. Mindfulness has its own unique brain wave signature which is different from concentration techniques and transcendental meditation. It's really fascinating to see how the brain changes according to the mental technique being practiced. I look forward to more comparative research on meditation and it's benefits for sleep.
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goldenchoirboy
02:24 PM on 06/14/2010
I appreciate your acknowledgment of other forms of meditation. It's also important to note that the body of mindfulness research includes a variety of mindfulness type techniques, showing varying effects & not all about a single, standardized practice. This presents further reason to withhold sweeping conclusions (e.g., which mindfulness practice is a given study about?). The emerging paradigm is that different meditation techniques yield different results, involve different cognitive processes & produce different brain patterns. The old paradigm was that all meditation techniques as basically the same, producing the hypothesized "relaxation response." (Even though the RR was taught in medical schools for decades, it was never substantiated by comparative research & has now been invalidated by RCTs & meta-analysis on different practices.) You might look at the sleep- and depression-related research on Transcendental Meditation, which include RCTs and longitudinal studies. In the scientific literature, the cognitive process of TM is different from that of mindfulness: TM is "automatic self-transcending;" mindfulness is "open monitoring." The TM studies show good, consistent results. Some TM insomnia studies: Brooks & Scarano, PTSD veterans, effects on insomnia / Ljunggren G. Inflytandet av Transcendental Meditation pa neuroticism, medicinbruk och sömnproblem. Läkartidningen 74(47): 4212–4214, 1977 / Lovell-Smith H. D. Transcendental Meditation—treating the patient as well as the disease. The New Zealand Family Physician 9: 62–65, April 1982 / Orme-Johnson D. W., et al. Meditation in the treatment of chronic pain and insomnia. In National Institutes of Health Technology Conference, etc.
10:21 AM on 06/14/2010
An important precursor to “does meditation improve sleep?†is another question – “what is the purpose of sleep?†To suggest a lay-person’s answer: we sleep to gain rest, to recover from the day’s efforts, and to prepare to engage the following day.

The presupposition that self reporting is less valuable is questionable. From the perspective of a insomniac, which is more profound – feeling rested, or polysomnographic measurements? The latter may be the Gold Standard for researchers, but for someone suffering from insomnia, feeling refreshed is the more valuable currency.

During meditation the mind is awake, but the body rests very profoundly. Early studies suggested that meditators can be resting four times more deeply than sleep (Scientific American, Vol 226, 1972). It’s no surprise that regular meditators feel better and report a need for less sleep.

As to “…the more one meditated, the more awake one's brain became.†This is the very essence of the practice – to awaken our awareness. There is a story about Siddhartha Gautama that illuminates this perspective – when approached by a devotee and asked “What are you? Are you a saint or a god?†the Buddha simply replied, “I am awake.â€

So when asked “does meditation improve sleep?†we must counter with – “Does meditation deliver clarity, well-being and wakefulness?†The answer, based both on subjective personal reports and on four decades of scientific research is unequivocally, yes.

Sincerely,

Michael Miller
http://www.NewYorkMeditationCenter.com
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jeanneyogini
02:44 PM on 06/14/2010
mmiller500, your website does not state any scientific references to research on the meditation practice you promote. The point of this article was that the benefits of some meditation techniques are not substantiated by valid research.
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goldenchoirboy
03:08 PM on 06/14/2010
Michael, the Scientific American article you cite is not about meditation in general—as no study is. That study is about a specific meditation technique (Transcendental Meditation). And you may not be reading the findings accurately (it found metabolic rate dropped 16%, twice as much as sleep, not four times). As I mentioned above, the old paradigm and misunderstanding about meditation claimed that all practices are the same & you can use research on one practice to lend credibility to (or invalidate) other practices. I point this out because research does not support your generalization that "during meditation the mind is awake, but the body rests very profoundly." It depends on which meditation practice you are referring to. Not all practices have been found to provide deep physiological rest; in fact, according to meta-analysis, most practices provide rest no deeper than ordinary eyes-closed relaxation. As far as relaxed, inner wakefulness, this is associated with frontal alpha coherence, which hasn't been found during mindfulness (theta) or controlled focus techniques (gamma). But it has been found during TM, which is also shown to produce a state of relaxation much deeper than ordinary rest (measured by respiration rate, plasma lactate, skin response, etc.). Just as a doctor would not just say "give em a drug, any old drug," we cannot say "any old meditation will do" & have the same effects. For hypertension & stroke patients, lives could be at stake. Here's a call for evidence-based meditation.
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08:45 AM on 06/14/2010
Then it is time to question whether longer, deeper sleep itself should be end goal. Most studies have shown that a far worse symptom of depression is people sleeping much longer and deeper than they should.

This is a good case of a researcher asking the wrong question. The question is not, "does meditation promote better (defined as deeper and longer) sleep?" The question is, "How, in what ways and to what extent does meditation help those who suffer from depression?"
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LeaderofMen
Bilingual former US Marine.
07:51 AM on 06/14/2010
I did TM for over 20 years, twice a day. It eventually caused me to NOT sleep properly due to the amount of wakefulness I experienced. This was becoming a problem because of my 8-5p day. I quit TM, and voila, I was able to get a full night's sleep again.
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
07:37 AM on 06/14/2010
The main cause of poor sleep is insulin.
Obesity and sleeplessness are directly linked; each causes the other.

If you have trouble sleeping, lose weight. Stop eating grains and their products (flour, bread, etc).
And NO ARTIFICIAL SWEETENERS: they cause insulin release, obesity and sleeplessness.

"Animal studies have indicated that artificial sweeteners can cause body weight gain. A sweet taste induces an insulin response, which causes blood sugar to be stored in tissues (including fat)"

http://en.wikipedia.org/wiki/Sugar_substitute
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JohnSawyer
arglebargy
06:12 AM on 06/14/2010
It sounds to me like informing the test subjects that the purpose of these studies is to test effects of meditation on sleep, is enough to have an effect on their sleep. Why not try NOT telling them what's being tested for, until after the tests are done? Don't even ask them to keep a sleep diary--if a person's subjective impression of the quality of their sleep is considered not as accurate as the measurements made of brainwaves, etc., then why bother asking the person to evaluate themselves?

This also raises the question as to which really IS more accurate: a person's self-evaluation, or a machine's? And are these particular machines measuring the real indicators of sleep quality? Shouldn't tests be done to measure a person's ability to complete tasks, perform specific mental operations, etc. after waking, rather than just relying on "traditional" measurements of brainwaves, muscle tension, etc while sleeping to determine how well a person is sleeping?
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UltimateLifestyle
04:20 AM on 06/14/2010
Very interesting.

Being a devoted meditator myself, I would be inclined to support the idea that meditation aids a healthy nights sleep - even being a tool in itself during the more restless nights to fall asleep (when waking in the dark of night, concerned about trivialities, I try to enter a meditative state of mind, in that I calm my thoughts to silence so I can fall back asleep).

I would be interested to hear what more comes of this research, and the results of all future research into the relationship of meditation on sleep, but regardless, the health benefits afforded by developing and keeping a strong meditation practice are tangible. Personally I found that my blood pressure dropped, I became a lot more relaxed and accepting of life / life's events, and my concentration and focus gained more clarity and sharpness. Ultimately, meditation helps to keep me grounded when life gets too chaotic, or self doubt haunts me.

Many thanks for a wonderful article.

Peace and much love

Lara Jane
Founder of the Ultimate Lifestyle Project
http://ultimatelifestyleproject.com/mind-body-soul
03:04 AM on 06/14/2010
I have a great mindful meditation practice (recommended by my doctors) that knocks me out all night long.

I pick up my pipe, pack it with the medical mj I grow, smear some hash oil on top that I make, puff away, put on some Joss Stone, mellow out, crawl into bed, and zone out.

I didn't have to join a group, practice any kind of religion, or pay some specialist. Now please excuse me as I get ready for bed:))
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UltimateLifestyle
04:21 AM on 06/14/2010
hilarious. Your way works too, but doesn't make for an enthusiastic start the next morning when waking up! ;)
09:42 PM on 06/14/2010
You have the wrong strain and are not doing it right:)

First thing I wake up, I pack a bowl or three, maybe eat some pot cookies or get the roommate to give me a massage with some medicated olive oil, and check out the HuffPost. .

I'm a medical patient who grows his own and makes his own oils, butters, foods, etc.
10:56 PM on 06/14/2010
I also walk about two hours everyday up and down Seattle hills. I don't own a car anymore and walk everywhere. I highly recommend it for weight control, stress reduction, appetite, and good sleep. Not to mention that I haven't bought a gallon of gas in three years and am not contributing to the BP catastrophe that our society created.
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sprider
Born lucky
11:05 PM on 06/15/2010
It does make everything better. Much much better.
Helps to sleep. Nice to wake n bake. Unfortunately, I live in Utah, so no legal availability. Yet.
You are a lucky man
01:27 AM on 06/14/2010
Believe me, I understand the reticence toward getting involved with a 'group.' Thirty years ago I was skeptical, too when a friend wanted to take me to a meditation group meeting, known as a 'satsang.' I'm glad I went. Meditation transformed my life. I was an insomniac from childhood and meditation fixed that. The group I learned from, was not pushy in wanting people to get involved. I was lucky. The guru, yes, I learned from an Indian guru whose objective was to bring meditation to the 'west.' You could learn the technique free, but a special weekend 'Intensive' cost money. If I was able to do it, it was more than affordable, because I've always been cash poor. Now lots of people became devotees and joined this group. I didn't and a lot of people I met didn't. They simply took the meditation knowledge and technique and incorporated into their lives. In all fairness, I think a lot of people leave themselves open to exploitation. It doesn't exonerate the exploiters who take advantage of vulnerable people, but we must be responsible and protect ourselves in all aspects of life because people are out there. But there are books on the subject, tapes, etc. Try it. If it doesn't work and if you are open, find a teacher and exercise common sense and caution. Frankly, you can sit in front of a fish tank while listening to classical music and find meditative bliss.
12:40 AM on 06/14/2010
It is good to see you verbalize from the heart and your clarity on this important subject can be easily observed. Tremendous post and will look forward to your future update.

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12:32 AM on 06/14/2010
Does anybody have a non dogmatic based, non religious based, non yoga based, non "trying to get you to believe like I believe" based meditation?
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12:35 AM on 06/14/2010
I should have added, non "financial gain at my expense" based as well
01:12 AM on 06/14/2010
"How to Meditate: A Guide to Self-Discovery" by Lawrence LeShan is a simple guide to meditation and considered the most sensible guide on the subject. It covers various techniques and doesn't proselytize. Your library should have it, however it's not an expensive book. Lots of second-hand stores have it at a reduced price. Maybe even a garage sale for peanuts. Either way, it's a no-nonsense, non "trying to get you to believe like I believe" guide and the only cost is the price of the book.
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UltimateLifestyle
04:24 AM on 06/14/2010
i wrote an article on 'developing a peaceful mind' by simply focusing on using our breath as a tool to calm and focus our minds attention. Nothing to buy, shied away from religion myself, nothing to do with yoga :

http://ultimatelifestyleproject.com/developing-peaceful-mind/

Peace and much love
Lara
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bcinu2
Slow down and go Faster
09:54 PM on 06/13/2010
In the mid seventies, my family watched the Merve Griffen show with his guest the Maharishi mariach Yogi. It was he who brought Transcendental Meditation to America. We were all extremely impressed with the show. We contacted the Society and were taught the process by a certified TM instructor who himself had been trained by the Maharishi himself in Italy. I have used the process now for over 30 years. I can say to this day I believe in TM and the effects it has along with the uses for it I have developed on my own. It is as it was very cheap at half the price. We paid 125.00/person. I am chronically depressed as long as I can remember. TM has helped me to stay away from suicide. I do take zoloft and trazadone. Between the combination of these three plus living by a 12 step way of life, I find peace. I recommend to any and all who can avail themselves to this program to do so without haste. It takes a couple of months of working on the technique, but once you have it it is wonderful and very refreshing...peace,,,,,,,,,bc
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realitytrumpsbull
two 'alves of coconut!
10:57 PM on 06/13/2010
How much honest exercise do you get, per day?