Treatment of chronic primary sleep onset insomnia with Kundalini yoga: a randomized controlled trial with active sleep hygiene comparison

Abstract

Study objectives: Prior studies have suggested a benefit of yoga for alleviating sleep disturbance; however, many studies have had methodological limitations. This trial study aimed to extend that literature by including an active sleep hygiene comparison.

Methods: Participants aged 25-59 years with a primary complaint of sleep onset insomnia lasting at least 6 months were block randomized to an 8-week Kundalini yoga or sleep hygiene intervention, both consisting of initial 60-minute instruction and weekly check-ins. Daily sleep diaries and questionnaires were collected at baseline, throughout the intervention, and at 6-month follow-up. Data were analyzed using linear mixed models (n = 20 in each group).

Results: Participant ratings of the interventions did not significantly differ. Sleep hygiene improved several diary and questionnaire outcomes, however, yoga resulted in even greater improvements corresponding to medium-to-large between-group effect sizes. Total sleep time increased progressively across yoga treatment (d = 0.95, P = .002), concurrent with increased sleep efficiency (d = 1.36, P < .001) and decreased sleep onset latency (d = -1.16, P < .001), but without changes in pre-sleep arousal (d =-0.30, P = .59). Remission rates were also higher for yoga compared to sleep hygiene, with ≥ 80% of yoga participants reporting average sleep onset latency < 30 minutes and sleep efficiency > 80% at 6-month follow-up. For over 50% of yoga participants, the insomnia severity index decreased by at least 8 points at end of treatment and follow-up.

Conclusions: Yoga, taught in a self-care framework with minimal instructor burden, was associated with self-reported improvements above and beyond an active sleep hygiene comparison, sustained at 6-month follow-up. Follow-up studies are needed to assess actigraphy and polysomnography outcomes, as well as possible mechanisms of change.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Yoga as a Treatment for Insomnia; URL: https://ichgcp.net/clinical-trials-registry/NCT00033865; Identifier: NCT00033865.

Citation: Khalsa SBS, Goldstein MR. Treatment of chronic primary sleep onset insomnia with Kundalini yoga: a randomized controlled trial with active sleep hygiene comparison. J Clin Sleep Med. 2021;17(9):1841-1852.

Keywords: behavior therapy; clinical trial; insomnia; meditation; sleep hygiene; yoga.

Conflict of interest statement

All authors have seen and approved this manuscript. Work for this study was performed at Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. This study was funded by National Institutes of Health grants (NCCAM/NCCIH 5K01AT000066 and 1R21AT000266 to S.S.K.; NHLBI 5T32HL007901-22 to M.R.G.). S.B.S.K. is a certified teacher of Kundalini yoga as taught by Yogi Bhajan and currently serves as director of research for the Kundalini Research Institute, which serves to educate and promote the practice of Kundalini yoga as taught by Yogi Bhajan. S.B.S.K. receives grant and consultant funding from the Kundalini Research Institute.

© 2021 American Academy of Sleep Medicine.

Figures

Figure 1. CONSORT flow diagram of recruitment and participation.

CONSORT = Consolidated Standards of Reporting Trials.

Figure 2. Yoga practice volume over time.

Inset depicts average daily practice minutes in 2-week intervals. Error bars reflect standard error of the mean. FU = follow-up.

Figure 3. Changes in main self-reported outcomes across groups and time, including 6-month follow-up.

Daily sleep-wake diary variables were averaged across 2-week intervals. Error bars reflect standard error of the mean. See Figure S3 and Discussion for further visualization and commentary regarding data loss at the 6-month follow-up. ISI = Insomnia Severity Index, SH = sleep hygiene.

Figure 4. Clinical significance of main outcomes.

Clinical significance (remission rates) of main outcomes at postintervention and 6-month follow up for each group, using recommended cutoffs of less than 30 minutes for SOL, greater than 80% for SE, and less than 8 for ISI total score. ISI = Insomnia Severity Index, SE = sleep efficiency, SH = sleep hygiene, SOL = sleep onset latency.