Mindfulness-Based Therapy For Insomnia May Improve Sleep Onset Latency Discrepancy


MBTI was effective in reducing sleep onset latency discrepancy but not wake after sleep onset discrepancy.

Mindfulness-Based Therapy For Insomnia May Improve Sleep Onset Latency Discrepancy

Noof Abdullah Saad Shaif, MBBS, MSc

Mindfulness-based therapy for insomnia may have a positive effect on sleep onset latency (SOL) discrepancy, according to a new study.

Led by Noof Abdullah Saad Shaif, MBBS, MSc, of Yong Loo Lin School of Medicine in Singapore, the study assessed the effectiveness of mindfulness-based therapy for insomnia (MBTI) in patients, particularly as it impacts the discrepancy between self-reported estimation of sleep and objective measures.

“At present, cognitive-behavioural therapy (CBT) for insomnia is the frontline treatment for insomnia disorder,” Shaif and colleagues wrote. However, they noted that such interventions may be costly with high dropout and non-response rates. As such, alternative and effective interventions are necessary for this patient population.

The Study

The investigators thus performed a secondary analysis of a previous randomized controlled study, which compared the effectiveness of MBTI against a sleep hygiene, education, and exercise program (SHEEP) among a group of older adults.

According to Shaif, MBTI involves mindful practices and inquiry drawn from Jon Kabat-Zinn’smindfulness-based stress reduction (MBSR) program along with behavioral strategies used in CBT for insomnia. MBTI specifically “focuses on metacognition by increasing awareness of the psychophysiological states that are present when experiencing insomnia symptoms and instructing patients on how to adopt a more flexible attitude towards these experiences.”

During the trial, patients in both MBTI and SHEEP programs attended 8 weekly face-to-face sessions lasting 2 hours. The investigators from that study matched interventions for time spent with instructors, amount of homework, and general content. They considered patients to have completed their invention if they had attended 6 of the 8 weekly sessions.

As such, 55 patients completed the MBTI program, while 58 patients completed the SHEEP program. All patients were between ages 50–80 years, presented with no cognitive impairment (assessed by (a) mini-mental state examination and Montreal cognitive assessment), and self-reported sleep problems over the past month.

At inclusion, patients self-reported average wakefulness after sleep onset (WASO) of >30 min (n = 73), average sleep onset latency (SOL) of >30 min (n = 63), or average total sleep time (TST) of <6.5 h (n = 69).

“Subjective and objective sleep parameters were measured using sleep diaries, polysomnography (PSG), and actigraphy,” the investigators wrote. “Sleep discrepancies were calculated using the Bland–Altman method for sleep onset latency (SOL) and wake after sleep onset (WASO).”

The Results

Shaif and team observed that sleep onset latency discrepancy as measured by polysomnography and actigraphy decreased significantly following both MBTI and SHEEP interventions (SOLPSG_discrep, P = .016; SOLActi_discrep, P <.001). However, in both groups, there were no significant changes in wake after sleep onset discrepancy (WASOPSG_discrep, P = .81).

They further found a correlation between change in sleep onset latency discrepancy and change in insomnia symptoms and objectively measured trait mindfulness, measured using the five facet mindfulness questionnaire (FFMQ).

Their analysis showed that WASOActi_discrep increased significantly in the SHEEP cohort but not withMBTI.

“Mindfulness-based therapy for insomnia was effective in reducing sleep onset latency discrepancies and improving sleep perception in older adults with sleep disturbances, which in turn drove an improvement in sleep quality and insomnia symptoms,” the investigators wrote.

“Increases in trait mindfulness may have been an important mechanism in improving sleep perception in the mindfulness-based therapy for insomnia group,” they concluded.

The study, “Effects of mindfulness-based therapy for insomnia and a sleep hygiene/exercise programme on subjective-objective sleep discrepancy in older adults with sleep disturbances: Exploratory secondary analysis of a randomised clinical trial,” was published online in The Journal of Sleep Research.

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