How mindfulness changed my sleep: focus groups with chronic insomnia patients

Amber Hubbling, Maryanne Reilly-Spong, Mary Jo Kreitzer, Cynthia R Gross, Amber Hubbling, Maryanne Reilly-Spong, Mary Jo Kreitzer, Cynthia R Gross

Abstract

Background: Chronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness ('mindfulness training') may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits.

Methods: Adults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis.

Results: Four themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain benefits.

Conclusions: First-person accounts are consistent with published trial results of positive impacts of MBSR on sleep measured by sleep diary, actigraphy, and self-report sleep scales. Findings indicate that mindfulness training in a group format, combined with sleep hygiene education, is important for effective application of MBSR as a treatment for chronic insomnia.

References

    1. Anonymous. National Institutes of Health state-of-the-science conference final statement on manifestations and management of chronic insomnia in adults. SLEEP. 2005;28(9):1049–1057.
    1. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111. doi: 10.1053/smrv.2002.0186.
    1. National Research Council. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press; 2006.
    1. Kessler RC, Berglund PA, Coulouvrat C, Hajak G, Roth T, Shahly V, Shillington AC, Stephenson JJ, Walsh JK. Insomnia and the performance of US workers: results from the America Insomnia Survey. SLEEP. 2011;34(9):1161–1171.
    1. Fottrell Q. The eye-opening costs of America’s insomnia. Wall Street Journal Market Watch. 2012. .
    1. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005;56(3):332–343. doi: 10.1176/appi.ps.56.3.332.
    1. Buscemi N, Vandermeer B, Friesen C, Manifestations and Management of Chronic Insomnia in Adults. Rockville, MD: Agency for Healthcare Research and Quality; 2005. (Summary, Evidence Report/Technology Assessment: Number 125. AHRQ Publication Number 05-E021-1).
    1. Bootzin RR, Epstein DR. Understanding and treating insomnia. Annu Rev Clin Psychol. 2011;7:435–458. doi: 10.1146/annurev.clinpsy.3.022806.091516.
    1. Winbush NY, Gross CR, Kreitzer MJ. The effects of mindfulness-based stress reduction on sleep disturbance: a systematic review. EXPLORE. 2007;3:585–591. doi: 10.1016/j.explore.2007.08.003.
    1. Bootzin RR, Stevens SJ. Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clin Psychol Rev. 2005;25(5):629–644. doi: 10.1016/j.cpr.2005.04.007.
    1. Lundh LG. The role of acceptance and mindfulness in the treatment of insomnia. J Cogn Psychother. 2005;19(1):29–40. doi: 10.1891/jcop.19.1.29.66331.
    1. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain, and Illness. New York: Dell Publishing; 1990.
    1. Brown KW, Ryan RM, Creswell JD. Mindfulness: theoretical foundations and evidence for its salutary effects. Psychol Inq. 2007;18(4):211–237. doi: 10.1080/10478400701598298.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–183.
    1. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complem Med. 2009;15(5):593–600. doi: 10.1089/acm.2008.0495.
    1. Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med. 2005;12(4):278–285. doi: 10.1207/s15327558ijbm1204_9.
    1. Gross CR, Kreitzer MJ, Thomas W, Reilly-Spong M, Cramer-Bornemann M, Nyman JA, Frazier P, Ibrahim HN. Mindfulness-based stress reduction for solid organ transplant recipients: a randomized controlled trial. Altern Ther Health Med. 2010;16(5):30–38.
    1. Gross CR, Kreitzer MJ, Russas V, Treesak C, Frazier PA, Hertz MI. Mindfulness meditation to reduce symptoms after organ transplant: a pilot study. Altern Ther Health Med. 2004;10(3):58–66.
    1. Gross CR, Kreitzer MJ, Reilly-Spong M, Wall M, Winbush NY, Patterson R, Mahowald M, Cramer-Bornemann M. Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. EXPLORE. 2011;7(2):76–87. doi: 10.1016/j.explore.2010.12.003.
    1. Dobkin PL. Mindfulness-based stress reduction: what processes are at work? Complement Ther Clin Pract. 2008;14(1):8–16. doi: 10.1016/j.ctcp.2007.09.004.
    1. Mackenzie MJ, Carlson LE, Munoz M, Speca M. A qualitative study of self-perceived effects of mindfulness-based stress reduction (MBSR) in a psychosocial oncology setting. Stress Health. 2007;23(1):59–69. doi: 10.1002/smi.1120.
    1. Weitz MV, Fisher K, Lachman VD. The journey of women with breast cancer who engage in mindfulness-based stress reduction: a qualitative exploration. Holist Nurs Pract. 2012;26(1):22–29. doi: 10.1097/HNP.0b013e31823c008b.
    1. Morone NE, Lynch CS, Greco CM, Tindle HA, Weiner DK. “I felt like a new person.” The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. J Pain. 2008;9(9):841–848. doi: 10.1016/j.jpain.2008.04.003.
    1. Carroll D, Lange B, Liehr P, Raines S, Marcus MT. Evaluating mindfulness-based stress reduction: analyzing stories of stress to formulate focus group questions. Arch Psychiatr Nurs. 2008;22(2):107–109. doi: 10.1016/j.apnu.2007.12.004.
    1. Frisvold MH, Lindquist R, McAlpine CP. Living life in the balance at midlife: lessons learned from mindfulness. West J Nurs Res. 2012;34(2):265–278. doi: 10.1177/0193945911424171.
    1. Kerr CE, Josyula K, Littenberg R. Developing an observing attitude: an analysis of meditation diaries in an MBSR clinical trial. Clin Psychol Psychother. 2011;18(1):80–93. doi: 10.1002/cpp.700.
    1. Kerrigan D, Johnson K, Stewart M, Magyari T, Hutton N, Ellen JM, Sibinga EM. Perceptions, experiences, and shifts in perspective occurring among urban youth participating in a mindfulness-based stress reduction program. Complement Ther Clin Pract. 2011;17(2):96–101. doi: 10.1016/j.ctcp.2010.08.003.
    1. Szanton SL, Wenzel J, Connolly AB, Piferi RL. Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility. BMC Complement Altern Med. 2011;11:44. doi: 10.1186/1472-6882-11-44.
    1. Edinger JD, Bonnet MH, Bootzin RR, Doghramji K, Dorsey CM, Espie CA, Jaieson AO, McCall WV, Morin CM, Stepaski EJ. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine work group. SLEEP. 2004;27(8):1567–1596.
    1. Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research. 4. Thousand Oaks, California: SAGE; 2009.
    1. Baer RA, editor. Mindfulness-based Treatment Approaches: A clinician’s guide to evidence-base and applications. Amsterdam: Elsevier Academic Press; 2006.
    1. Center for mindfulness in medicine, health care, and society. .
    1. Santorelli SF, Kabat-Zinn J. Mindfulness-based Stress Reduction Professional Training: MBSR Curriculum Guide and Supporting Materials. Worcester, MA: Center for Mindfulness in Medicine, Health Care and Society, University of Massachusetts-Worcester; 2002.
    1. Patlak M. Your Guide to Healthy Sleep. Bethesda, MD: National Institutes of Health: National Heart, Lung, and Blood Institute; 2005. (NIH Publication No. 06-5271).
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288. doi: 10.1177/1049732305276687.
    1. Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. J Clin Psychol. 2006;62(3):373–386. doi: 10.1002/jclp.20237.
    1. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6(6):537–559. doi: 10.1177/1745691611419671.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48. doi: 10.4278/0890-1171-12.1.38.
    1. Bandura A. Self-efficacy: The Exercise of Control. New York: W.H. Freeman and Company; 1997.
    1. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–848.
    1. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001;56(3):218–226.
    1. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry. 1974;37(1):37–46.
    1. Ong JC, Shapiro SL, Manber R. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study. Behav Ther. 2008;39:171–182. doi: 10.1016/j.beth.2007.07.002.
    1. Mason O, Hargreaves I. A qualitative study of mindfulness-based cognitive therapy for depression. Brit J Med Psychol. 2001;74(Pt 2):197–212.
    1. Creswell J. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 3. Thousand Oaks, CA: SAGE; 2009.
    1. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307. doi: 10.1016/S1389-9457(00)00065-4.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Morin CM, Blais F, Savard J. Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behav Res Ther. 2002;40(7):741–752. doi: 10.1016/S0005-7967(01)00055-9.
    1. Hansen D. Forbes. Forbes, Inc; 2012. A guide to mindfulness at work.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe