Insomnia Image by David Green


About

Insomnia is largely caused by an over-active sympathetic nervous system. Yoga, meditation and mindfulness can help to stimulate the parasympathetic nervous system, lowering cortisol and adrenal fatigue, increasing energy levels. This is what makes them an effective insomnia treatment.

Practicing yoga’s physical postures, or asana, help to relieve muscle tension, contributing to a more relaxed state as preparation for sleep.

Power napping, spending ten minutes lying on your back with your feet up the wall or on a chair during the day, can balance the spinal fluids and mop up tiredness - paving the way for a better night's sleep.

Meditation and mindfulness can calm a busy mind, helping you detach from troubling thoughts, seeing them as just thoughts, enabling you to replace them with more positive interpretations that will not keep you awake at night.

Practicing slow, deep breathing (pranayama) can also be a good way to relax your body before going to bed.

Clinical studies point towards a regular practice of yoga, meditation and mindfulness as a way to increase total sleep time, and reduce the anxiety and depression that can be the result of chronic insomnia.


What the clinical studies say

Yoga
  • Improves restedness
  • Improves sleep onset latency (the time taken to transition from wakefulness to sleep)
  • Improves sleep quality
  • Increases sleep duration
  • Increases sleep efficiency
  • Increases total sleep time
  • Reduces fatigue
  • Reduces pain
Meditation
  • Improves quality of life
  • Improves sleep onset latency (the time taken to transition from wakefulness to sleep)
Mindfulness
  • Alleviates depression
  • Alleviates fatigue
  • Reduces anxiety
  • Reduces sleep and sleep-related arousal

The clinical studies

Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep–Wake Diaries
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

There is good evidence for cognitive and physiological arousal in chronic insomnia. Accordingly, clinical trial studies of insomnia treatments aimed at reducing arousal, including relaxation and meditation, have reported positive results. Yoga is a multicomponent practice that is also known to be effective in reducing arousal, although it has not been well evaluated as a treatment for insomnia. In this preliminary study, a simple daily yoga treatment was evaluated in a chronic insomnia population consisting of sleep-onset and/or sleep-maintenance insomnia and primary or secondary insomnia.

Participants maintained sleep–wake diaries during a pretreatment 2-week baseline and a subsequent 8-week intervention, in which they practiced the treatment on their own following a single in-person training session with subsequent brief in-person and telephone follow-ups. Sleep efficiency (SE), total sleep time (TST), total wake time (TWT), sleep onset latency (SOL), wake time after sleep onset (WASO), number of awakenings, and sleep quality measures were derived from sleep–wake diary entries and were averaged in 2-week intervals.

For 20 participants completing the protocol, statistically significant improvements were observed in SE, TST, TWT, SOL, and WASO at end-treatment as compared with pretreatment values.
Citations

120
Authors

Sat Bir S. Khalsa
Published

2004
Journal

Applied Psychophysiology and Biofeedback
Volume / Issue

29:4
Author's primary institution

Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Meditation training as a treatment for insomnia
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

A set of attention-focusing techniques derived from methods of meditation was compared with progressive relaxation and a waiting list as treatments for insomnia.

Analysis of data from 24 insomniacs recruited from the community showed both meditation and progressive relaxation to be superior to no treatment in reducing latency of sleep onset. These treatments did not differ in effectiveness.

At 6 months follow-up, both the meditation and progressive relaxation groups showed significant improvement over pretreatment levels on latency of sleep onset, while pretreatment and follow-up means for the control group did not differ.
Citations

82
Authors

Robert L. Woolfolk | Lucille Carr-Kaffashan | Terrence F. McNulty | Paul M. Lehrer
Published

1976
Journal

Behavior Therapy
Volume / Issue

7:3
Author's primary institution

Rugters Medical School, New Brunswick, New Jersey, USA
Combining Mindfulness Meditation with Cognitive-Behavior Therapy for Insomnia: A Treatment-Development Study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

This treatment-development study is a Stage I evaluation of an intervention that combines mindfulness meditation with cognitive-behavior therapy for insomnia (CBT-I).

Thirty adults who met research diagnostic criteria for Psychophysiological Insomnia (Edinger et al., 2004) participated in a 6-week, multi-component group intervention using mindfulness meditation, sleep restriction, stimulus control, sleep education, and sleep hygiene. Sleep diaries and self-reported pre-sleep arousal were assessed weekly while secondary measures of insomnia severity, arousal, mindfulness skills, and daytime functioning were assessed at pre-treatment and post-treatment.

Data collected on recruitment, retention, compliance, and satisfaction indicate that the treatment protocol is feasible to deliver and is acceptable for individuals seeking treatment for insomnia. The overall patterns of change with treatment demonstrated statistically and clinically significant improvements in several nighttime symptoms of insomnia as well as statistically significant reductions in pre-sleep arousal, sleep effort, and dysfunctional sleep-related cognitions. In addition, a significant correlation was found between the number of meditation sessions and changes on a trait measure of arousal.

Together, the findings indicate that mindfulness meditation can be combined with CBT-I and this integrated intervention is associated with reductions in both sleep and sleep-related arousal.

Further testing of this intervention using randomized controlled trials is warranted to evaluate the efficacy of the intervention for this population and the specific effects of each component on sleep and both psychological and physiological arousal.
Citations

113
Authors

Jason C. Ong | Shauna L. Shapiro | Rachel Manber
Published

2008
Journal

Behavior Therapy
Volume / Issue

39:2
Author's primary institution

Stanford University Medical Center
Mindfulness Meditation and Cognitive Behavioral Therapy for Insomnia: A Naturalistic 12-Month Follow-up
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

A unique intervention combining mindfulness meditation with cognitive behavioral therapy for insomnia (CBT-I) has been shown to have acute benefits at post treatment in an open label study. The aim of the present study was to examine the long-term effects of this integrated intervention on measures of sleep and sleep-related distress in an attempt to characterize the natural course of insomnia following this treatment and to identify predictors of poor long-term outcome.

Analyses were conducted on 21 participants, who provided follow-up data at six and 12 months post treatment. At each time point, participants completed one week of sleep and meditation diaries and questionnaires related to mindfulness, sleep, and sleep-related distress, including the Pre-Sleep Arousal Scale, the Glasgow Sleep Effort Scale, the Kentucky Inventory of Mindfulness Skills, and the Insomnia Episode Questionnaire.

Analyses examining the pattern of change across time (baseline, end of treatment, six months, and 12 months) revealed that several sleep-related benefits were maintained during the 12-month follow-up period. Participants who reported at least one insomnia episode (≥1 month) during the follow-up period had higher scores on the Pre-Sleep Arousal Scale (P < .05) and the Glasgow Sleep Effort Scale (P < .05) at end of treatment compared with those with no insomnia episodes.

Correlations between mindfulness skills and insomnia symptoms revealed significant negative correlations (P < .05) between mindfulness skills and daytime sleepiness at each of the three time points but not with nocturnal symptoms of insomnia.

These results suggest that most sleep-related benefits of an intervention combining CBT-I and mindfulness meditation were maintained during the 12-month follow-up period, with indications that higher presleep arousal and sleep effort at end of treatment constitute a risk for occurrence of insomnia during the 12 months following treatment.
Citations

72
Authors

Jason C. Ong | Shauna L. Shapiro | Rachel Manber
Published

2009
Journal

EXPLORE: The Journal of Science and Healing
Volume / Issue

5:1
Author's primary institution

Department of Psychiatry and Behaviour Sciences, Stanford University, Stanford, CA, USA
Usefulness of Mindfulness-Based Cognitive Therapy for Treating Insomnia in Patients With Anxiety Disorders: A Pilot Study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

The objective of this study was to examine the usefulness of a mindfulness-based cognitive therapy (MBCT) for treating insomnia symptoms in patients with anxiety disorder.

Nineteen patients with anxiety disorder were assigned to an 8-week MBCT clinical trial. Participants showed significant improvement in Pittsburgh Sleep Quality Index (Z = −3.46, p = 0.00), Penn State Worry Questionnaire (Z = −3.83, p = 0.00), Ruminative Response Scale (Z = −3.83, p = 0.00), Hamilton Anxiety Rating Scale (Z = −3.73, p = 0.00), and Hamilton Depression Rating Scale scores (Z = −3.06, p = 0.00) at the end of the 8-week program as compared with baseline.

Multiple regression analysis showed that baseline Penn State Worry Questionnaire scores were associated with baseline Pittsburgh Sleep Quality Index scores.

These findings suggest that MBCT can be effective at relieving insomnia symptoms by reducing worry associated sleep disturbances in patients with anxiety disorder. However, well-designed, randomized, controlled trials are needed to confirm our findings.
Citations

59
Authors

Yook Keunyoung | Lee Sang-Hyuk | Ryu Mi | Kmi Keun-Hyang | Choi Tae Kyou | Suh Shin Young | Kim Yong-Woo | Kim Borah | Kim Mi Young | Kim Myo-Jung
Published

2008
Journal

Journal of Nervous & Mental Disease
Volume / Issue

196:6
Author's primary institution

Department of Psychiatry-Bundang CHA Hospital, Pochon CHA University College of Medicine, Seongnam, Republic of Korea
Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

BACKGROUND:

Research suggests that stress-reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life. Yoga, an ancient Eastern science, incorporates stress-reduction techniques that include regulated breathing, visual imagery, and meditation as well as various postures. The authors examined the effects of the Tibetan yoga (TY) practices of Tsa lung and Trul khor, which incorporate controlled breathing and visualization, mindfulness techniques, and low-impact postures in patients with lymphoma.

METHODS:

Thirty-nine patients with lymphoma who were undergoing treatment or who had concluded treatment within the past 12 months were assigned to a TY group or to a wait-list control group. Patients in the TY group participated in 7 weekly yoga sessions, and patients in the wait-list control group were free to participate in the TY program after the 3-month follow-up assessment.

RESULTS:

Eighty nine percent of TY participants completed at least 2–3 three yoga sessions, and 58% completed at least 5 sessions. Patients in the TY group reported significantly lower sleep disturbance scores during follow-up compared with patients in the wait-list control group (5.8 vs. 8.1; P < 0.004). This included better subjective sleep quality (P < 0.02), faster sleep latency (P < 0.01), longer sleep duration (P < 0.03), and less use of sleep medications (P < 0.02). There were no significant differences between groups in terms of intrusion or avoidance, state anxiety, depression, or fatigue.

CONCLUSIONS:

The participation rates suggested that a TY program is feasible for patients with cancer and that such a program significantly improves sleep-related outcomes. However, there were no significant differences between groups for the other outcomes.
Citations

345
Authors

Lorenzo Cohen | Carla Warneke | Rachel T. Fouladi | M. Alma Rodriguez | Alejandra Chaoul-Reich
Published

2004
Journal

Cancer
Volume / Issue

100:10
Author's primary institution

The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Influence of Yoga & Ayurveda on self-rated sleep in a geriatric population
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background & objectives:

Sleep in older persons is characterized by decreased ability to stay asleep, resulting in fragmented sleep and reduced daytime alertness. Pharmacological treatment of insomnia in older persons is associated with hazardous side effects. Hence, the present study was designed to compare the effects of Yoga and Ayurveda on the self rated sleep in a geriatric population.

Methods:

Of the 120 residents from a home for the aged, 69 were stratified based on age (five year intervals) and randomly allocated to three groups i.e., Yoga (physical postures, relaxation techniques, voluntarily regulated breathing and lectures on yoga philosophy), Ayurveda (a herbal preparation), and Wait-list control (no intervention). The groups were evaluated for self assessment of sleep over a one week period at baseline, and after three and six months of the respective interventions.

Results:

The Yoga group showed a significant decrease in the time taken to fall asleep (approximate group average decrease: 10 min, P< 0.05), an increase in the total number of hours slept (approximate group average increase: 60 min, P< 0.05) and in the feeling of being rested in the morning based on a rating scale (P<0.05) after six months. The other groups showed no significant change.

Interpretation & conclusion:

Yoga practice improved different aspects of sleep in a geriatric population.
Citations

115
Authors

Swami Vivekananda Yoga Research Foundation | Bangalore | India
Published

2004
Journal

Indian Journal of Medical Research
Volume / Issue

121
Author's primary institution

Swami Vivekananda Yoga Research Foundation, Bangalore, India
Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Importance:

Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep.

Objective:

To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances.

Design, Setting, and Participants:

Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5).

Interventions:

A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework.

Main Outcomes and Measures:

The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at post intervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)–κB.

Results:

Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at post intervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at post intervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05).

Conclusions and Relevance:

The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate post intervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life.
Citations

0
Authors

David S. Black | Gillian A. O'Reilly | Richard Olmstead | Elizabeth C. Breen | Michael R. Irwin
Published

2015
Journal

JAMA Internal Medicine
Volume / Issue

Author's primary institution

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA

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