What do we really know about mindfulness and sleep health?

Echoes of Strain: A Two-Year Longitudinal Study on the Impact of China's Zero-COVID Policy on College Students' Insomnia and Depressive Symptoms

Purpose

In China, stringent and long-lasting infection control measures, which were called "dynamic zero-COVID policy", have significantly affected the mental health of college students, particularly concerning depressive and insomnia symptoms. This study aims to investigate how depressive and insomnia symptoms evolved among Chinese college students throughout the pandemic, including the beginning and end of the dynamic zero-COVID policy period.

Patients and Methods

We conducted a 2-years longitudinal survey involving 1102 college students, collecting data at three key time points. Depressive symptoms were assessed using the Patient Health Questionnaire-9, and insomnia symptoms were measured with the Youth Self-rating Insomnia Scale-8. Three contemporaneous symptom networks and two cross-lagged panel networks were constructed.

Results

In the current sample, the prevalence of clinically significant depressive symptoms was 6.1%, 8.9%, and 7.7% during the first, second, and third waves, respectively. The prevalence of clinically significant insomnia symptoms was 8.1%, 13.0%, and 14.1%. Over time, the severity of depressive and insomnia symptoms and network density increased, persisting at least one year after the pandemic and control measures ended. "Difficulty initiating sleep" bridged the two disorders, while "anhedonia" played a pivotal role in triggering and sustaining other symptoms.

Conclusion

This study underscores the lasting impact of the evolving zero-COVID policy on depressive and insomnia symptoms among college students, elucidating the underlying interaction mechanisms. There is a pressing need for a more comprehensive evaluation of the implementation of restrictive public policies, taking into account their potential long-term consequences.

Insomnia in teachers at the time of resumption of in-person instruction at schools amidst the COVID-19 pandemic: A cross-sectional study

BACKGROUND

The coronavirus (COVID-19) pandemic has affected people's economies, lifestyles, and physical, emotional, and sleep health. This research aimed to estimate the prevalence of insomnia and symptoms of stress, anxiety, and depression among teachers with the resumption of in-person instruction at schools following a hiatus after COVID-19 lockdowns in India. We also studied the association of teachers' insomnia with psychological symptoms and demographic variables.

METHODS

We conducted a cross-sectional survey between October -November 2021 after schools had reopened during the COVID-19 pandemic. Data was collected using standard questionnaires online among schoolteachers. We explored the association of insomnia with teachers' symptoms of stress, anxiety, depression, sex, school boards, and age groups.

RESULTS

Of 124 schoolteachers surveyed, the prevalence of insomnia was 37.9% (subthreshold in 25% and clinical in 12.9%). The prevalence of stress, depression, and anxiety was 20.2%, 30.6%, and 45.2%, respectively. There was a significant association (p<0.001) of insomnia with symptoms of anxiety, stress, and depression in univariate analysis. On multivariate analysis, we found that those feeling stressed had a 6.4 times higher risk of insomnia (95% CI: 1.5-28.3, p - 0.01). There was no association of insomnia with age, sex, school educational boards, and type of institution.

CONCLUSIONS

Over one-third (37.9%) of teachers reported having trouble sleeping when they returned to the school's typical face-to-face instruction modalities through COVID-19 times, and insomnia was more prevalent in those with stress.

Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial

BACKGROUND

One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep.

OBJECTIVE

We aim to verify the effectiveness of mindful breathing exercises using a tablet device.

METHODS

In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated.

RESULTS

On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5.

CONCLUSIONS

The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep.

TRIAL REGISTRATION

UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks.

The association between trait mindfulness and sleep problems: A three-level meta-analysis

Trait mindfulness has shown potential in relieving the symptoms related to sleep problems, but the relationship between trait mindfulness and sleep problems varies across studies. To explore this association and obtain reliable estimates, a three-level meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A comprehensive literature search identified 86 studies involving 87 independent samples and 35,521 participants. A total of 441 effect sizes were analyzed. The study indicated a negative association between trait mindfulness and sleep problems. Furthermore, the meta-analysis revealed significant moderating effects of study design, mindfulness facets, and measurement for trait mindfulness on this relationship. This study suggests that trait mindfulness is closely related to the alleviation of sleep problems. Furthermore, trait mindfulness is vital important in strengthening prevention and intervention measures targeting individuals' sleep problems.

Investigating the combined and unique contributions of positive psychological traits to sleep and exploring emotion regulation as a common mediator

The identification of variables which facilitate good quality and quantity sleep represents an important step in tackling the current global sleep loss epidemic. Previous research has established links between good sleep and the positive psychological traits of mindfulness, self-compassion, gratitude and optimism. However, studies have typically focused on single traits, limiting understanding of their collective and independent associations. The two studies reported here address this gap by exploring the combined and unique contributions of mindfulness, self-compassion, gratitude and optimism to sleep; Study 2 further investigated emotion regulation as a common underlying mechanism. Participants in both studies (Study 1 N = 268; Study 2 N = 333) completed online questionnaires assessing the four positive psychological traits and sleep quality and quantity; participants in Study 2 also completed measures of adaptive and maladaptive emotion regulation. Multiple regression analyses revealed that mindfulness, self-compassion, gratitude and optimism collectively accounted for 24.96% (Study 1) and 15.81% (Study 2) of the variance in overall sleep quality and quantity. Optimism and mindfulness emerged as significant linear predictors in their own right, with higher levels of optimism and mindfulness respectively being associated with better sleep. Study 2 further identified maladaptive emotion regulation as a common mediating mechanism. Findings highlight the importance of positive psychological traits in relation to sleep and indicate that optimism and mindfulness might make unique contributions to the prediction of sleep outcomes. Findings also flag emotion regulation as a potential common mediator of associations between positive psychological traits and sleep.

The moderating role of trait and state mindfulness between daily sleep and physical pain symptoms: an ecological momentary assessment and actigraphy study

Objective: Poorer sleep quality and insufficient sleep increase the risk of physical pain. The current study examined the daily associations between sleep and physical pain symptoms and tested the moderating role of trait and state mindfulness in this relationship. Methods: Sixty hospital nurses (Mage=35.4 ± 11.8 years) completed 14-day ecological momentary assessment (EMA) and sleep actigraphy. EMA measured physical pain frequency and interference (1×/day) and state mindfulness (3×/day). Multilevel modelling was used to examine the associations at the between-person and within-person levels. Results: After nights with poorer sleep quality, lower sleep sufficiency, and more insomnia symptoms, the frequency of physical pain symptoms and pain interference were greater than usual. Overall, those with poorer sleep quality, lower sleep sufficiency, and more insomnia symptoms reported more physical pain symptoms and greater pain interference. Higher state mindfulness buffered the negative within-person association between sleep efficiency and physical pain frequency. There was evidence that the joint moderating effects of trait and state mindfulness yielded more protective benefits in the relationship between sleep quality and physical pain than trait or state mindfulness alone. Conclusion: Even without mindfulness training, one's mindfulness may be protective against the adverse effects of poor sleep quality on physical pain.

Sleep and Pain in Veterans with Chronic Pain: Effects of Psychological Pain Treatment and Temporal Associations

Introduction

Chronic pain is highly prevalent in US military Veterans. Non-opioid and non-pharmacologic treatments are recommended when clinically appropriate, but research on the mechanisms underlying benefits of these treatments is lacking. Here, we examined the role of sleep in the effects of three non-pharmacologic pain treatments in Veterans. Specifically, we investigated whether treatment effects on sleep predicted treatment effects on pain occurring later, or vice versa.

Methods

Veterans enrolled in a randomized controlled trial were invited to participate in this supplementary sleep study. A total of 174 Veterans were randomized to one of three 8-session, in-person, group-based pain treatments: hypnosis, mindfulness meditation, or education control. Measurements included self-reported sleep disturbance, pain intensity, and pain catastrophizing; sleep duration was assessed with actigraphy. Sleep and pain measurements were obtained at baseline, posttreatment, and 3-month posttreatment follow-up.

Results

At baseline, average pain intensity was moderate (mean ± SD: 5.7 ± 1.7 on the 0-10 Numeric Rating Scale), pain catastrophizing was just below the clinically relevant threshold (mean ± SD: 28.6 ± 12.2 on the Pain Catastrophizing Scale), and subjective sleep disturbance exceeded the US population average (mean ± SD: 58.5 ± 8.1 on the Patient Reported Outcomes Measurement Information System Sleep Disturbance - Short Form). By contrast, objective sleep duration was consistent with the recommended daily sleep amount of 7-8 h for adults (mean ± SD: 8.3 ± 1.4 h). Across treatment conditions, pain intensity, pain catastrophizing, and subjective sleep disturbance were significantly less at posttreatment and 3-month follow-up than at baseline (p < 0.001). Actigraphic sleep duration did not differ significantly as a function of time. There was a high degree of covariation among the measures of pain intensity, pain catastrophizing, and sleep disturbance (p < 0.05). However, self-reported sleep disturbance was not significantly correlated with actigraphic sleep duration (|r| <= 0.13, p > 0.05). Sleep and pain variables observed at prior assessments predicted these same variables at subsequent assessments. There was no significant evidence that changes in pain preceded changes in sleep or that changes in sleep preceded changes in pain (all p > 0.05).

Discussion

For this study's Veterans, treatment-related changes in sleep and pain appeared to occur in parallel. The concomitant changes in sleep and pain suggest that therapies improving pain in Veterans may yield attendant benefits for the treatment of sleep, and possibly vice versa.

Low mindfulness is related to poor sleep quality from middle adolescents to emerging adults: a process model involving resilience and emotional dysfunction

OBJECTIVES

Transitions from middle adolescence into merging adulthood, a life stage between age 15-25, has a high prevalence of sleep problems. Mindfulness is a trait defined as being attentive to the present moment which positively relates to sleep quality. In this study, we aimed to investigate how resilience and emotional dysfunction may influence the relationship between trait mindfulness and sleep quality.

METHODS

The Five Facet Mindfulness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Scales were used to measure the key variables through an online survey of 497 participants between middle adolescence and emerging adults (317 females, mean age 18.27 ± 0.76 years). A process model was built to investigate the mediating roles of resilience and emotional dysfunction in the impact of trait mindfulness on sleep quality, together with the relationships between their specific components.

RESULTS

We found a positive association between mindfulness and sleep quality through resilience and through emotional dysfunction, and through the sequential pathway from resilience to emotional dysfunction. Of note, acting with awareness (mindfulness facet) showed significant indirect effects on sleep quality, mediated by resilience and emotional dysfunction.

CONCLUSIONS

Our findings may unveil the underlying mechanisms of how low mindfulness induces poor sleep quality. The findings indicate that conceiving mindfulness as a multifaceted construct facilitates comprehension of its components, relationships with other variables, and underscores its potential clinical significance given its critical implications for mental health.

Insomnia

OBJECTIVE

This article provides an overview of the current definitions, diagnostic tools, and overall management of insomnia.

LATEST DEVELOPMENTS

The treatment of insomnia has shifted over time, with a growing emphasis on nonpharmacologic therapies as a first-line intervention and the leveraging of technology to aid in the dissemination of these therapies. With this evolution, the definition of insomnia has changed to reflect a common treatment pathway. As pharmacologic treatment options have increased, so has concern about the dangerous short-term and long-term adverse effects of these treatment options.

ESSENTIAL POINTS

Insomnia is a common disorder, frequently overlapping with other neurologic and psychiatric disorders, which can cause significant distress and disruption to patients' lives. Nonpharmacologic therapies are highly effective and are now considered first-line treatments. Although efficacy is variable, numerous pharmacologic interventions are available, and many options come with considerable concern about adverse effects, particularly in populations over 65 years old.

Mindfulness as an Adjunct or Alternative to CBT-I

Mindfulness-based interventions (MBIs) are programs that teach mindfulness concepts through guided meditation and self-regulation practices. MBIs have been found to improve sleep and reduce cognitive arousal, which are central to the development and perpetuation of insomnia. In this article, we review theoretic frameworks and clinical trial effectiveness data supporting MBIs for insomnia. Based on this review, we provide suggestions for using MBIs as an adjunct or alternative treatment option to CBT-I with regard to how, when, and for whom. We conclude with an agenda for future directions that can clarify the use of mindfulness as a treatment option for insomnia.

Beneficial Effects of an Online Mindfulness-Based Intervention on Sleep Quality in Italian Poor Sleepers during the COVID-19 Pandemic: A Randomized Trial

Sleep of inadequate quantity and quality is increasing in the present 24 h society, with a negative impact on physical and mental health. Mindfulness-based interventions (MBIs) generate a state of calm behavior that can reduce hyperactivity and improve sleep. We hypothesized that our specific MBI, administered online, may improve sleep quality and foster emotion regulation and mindfulness. The Pittsburgh Sleep Quality Index (PSQI), Sleep Condition Indicator (SCI), Arousal Predisposition Scale (APS), Ford Insomnia Response to Stress Test (FIRST), Sleep Hygiene Index (SHI) and Insomnia Severity Index (ISI) were used to measure sleep quality and stability. Emotion regulation and mindfulness were measured via the Emotion Regulation Questionnaire (ERQ) and Five Facet Mindfulness Questionnaire (FFMQ). Our MBI included 12 biweekly integral meditation (IM) classes, recorded IM training for individual practice, and dietary advice to promote sleep regulation. Fifty-six voluntary poor sleepers with a PSQI score of >5 were randomly allocated to treated (n = 28) and control (n = 28) groups. Linear mixed models were used to estimate the effectiveness of the intervention. Statistically significant results were observed in the FFMQ sub-domain non-reactivity to inner experience (β = 0.29 [0.06; -0.52], p = 0.01), PSQI (β = -1.93 [-3.43; -0.43], p = 0.01), SCI (β = 3.39 [0.66; 6.13], p = 0.02) and ISI (β = -3.50 [-5.86; -1.14], p = 0.004). These results confirm our hypothesis regarding the beneficial effects of our intervention on sleep quality.

Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial

OBJECTIVE

Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults.

METHODS

We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50-80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO).

RESULTS

Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = -1.27, 95% confidence interval (CI) -1.61 to -0.89; SHEEP: d = -0.69, 95% CI -0.96 to -0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = -1.19; SHEEP: d = -1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASO_actigraphy (MBTI: d = -0.30; SHEEP: d = 0.02), SOL_actigraphy (MBTI: d = -0.25; SHEEP: d = -0.09), and WASO_PSG (MBTI: d = -0.26; SHEEP (d = -0.18). There was no change in SOL_PSG. No participants withdrew because of adverse effects.

CONCLUSIONS

MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

Effects of mindfulness-based stress reduction on adults with sleep disturbance: an updated systematic review and meta-analysis

OBJECTIVE

Mindfulness-based stress reduction (MBSR) is a meditation-based therapy originally recommended for stress management. However, it is currently used to alleviate sleep disturbances. Therefore, this contemporary systematic review aimed to elucidate the clinical effects of MBSR on sleep quality and sleep-related daytime impairment in adults with sleep disturbances, including chronic insomnia disorders.

DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs).

METHODS

A comprehensive search was conducted using the following databases: Ovid MEDLINE, AMED, Ovidembase, PsycINFO, Cochrane Library, CINAHL, and four domestic databases: KoreaMed, KISS, KMbase and NDSL. The final search update was performed in June 2022. Two researchers independently selected relevant studies, assessed the risk of bias and extracted the data.

RESULTS

Of the 7516 records searched, 20 RCTs and 21 reports were included. In the subgroup analysis, MBSR did not improve objective or subjective sleep quality in chronic insomnia and cancers. However, MBSR versus waitlist control might have been effective in improving subjective sleep quality, but with substantial heterogeneity (standardised mean difference=-0.32; 95% CI: -0.56 to -0.08; I²=71%). In addition, MBSR compared with active control did not improve the sleep-related daytime impairments including depression, anxiety, stress, fatigue and quality of life. The overall risk of bias included in this review was a concern because of performance and detection bias.

CONCLUSIONS

MBSR might be ineffective for improving sleep quality in patients with chronic insomnia and cancers. In addition, more than half of the RCTs included in this review had small sample sizes and were vulnerable to performance and detection biases. Therefore, well-designed RCTs with larger sample sizes are required to confirm the clinical effects of MBSR in adults with sleep disturbances.

PROSPERO REGISTRATION NUMBER

CRD42015027963.

"Hidden gains"? Measuring the impact of mindfulness-based interventions for people with mild traumatic brain injury: a scoping review

BACKGROUND

Mindfulness-based interventions can support recovery from mild traumatic brain injury (mTBI). Although measurement is a key determinant of outcomes, there is no comprehensive assessment of measurement approaches used to capture outcomes of these programs. Here, we review the domains targeted, measurement techniques used, and domains and techniques most affected by mindfulness-based interventions for mTBI.

METHODS

We conducted a scoping review. After screening and full-text review, we included 29 articles and extracted data related to measurement domains, techniques, and results.

RESULTS

We identified 8 outcome domains, each with multiple subdomains. The most common domains were cognitive symptoms and general health/quality of life. No quantitative studies directly assessed sleep, physical-function, or pain-catastrophizing. Self-report was the most common measurement technique, followed by performance-based methods. Coping, somatic symptoms, emotional symptoms, stress response, and domains of cognition (particularly attention) were the most frequently improved domains. Qualitative results described benefits across all domains and suggested novel areas of benefit. Biomarkers did not reflect significant change.

CONCLUSIONS

Mindfulness-based interventions for mTBI impact a range of clinical domains and are best captured with a combination of measurement approaches. Using qualitative methods and expanding the breadth of outcomes may help capture underexplored effects of mindfulness-based interventions for mTBI.

Insomnia as an Unmet Need in Chronic Hematologic Cancer Patients: A study design of a randomized controlled trial evaluating a consumer-based meditation app for treatment of sleep disturbance (Preprint)

Background

To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population.

Objective

This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer.

Methods

In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention—the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-α, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks.

Results

This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame.

Conclusions

This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance.

Trial Registration

ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991

International Registered Report Identifier (IRRID)

PRR1-10.2196/39007

Mindfulness-Based Strategies for Improving Sleep in People with Psychiatric Disorders

PURPOSE OF THE REVIEW

To review the recent literature on mindfulness-based strategies for improving self-report and objective measures of sleep, in individuals with psychiatric disorders.

RECENT FINDINGS

Currently, research provides some support for the use of mindfulness-based interventions to improve sleep amongst individuals with psychiatric comorbidities. The strongest evidence was for the use of standardized programs, particularly for improving sleep in anxiety and depressive disorders. There is a paucity of well-controlled studies using validated subjective or objective measures of sleep. As these interventions were not specifically designed to target sleep, observed improvements may be an indirect consequence of reduced psychiatric symptoms. There is insufficient research into the application of mindfulness-based strategies to improve sleep or treat sleep disorders in people with psychiatric disorders. Well-controlled studies using standardized, mindfulness-based interventions developed to target sleep, such as mindfulness-based therapy for insomnia, may optimize the potential benefits of mindfulness for sleep in psychiatric populations.

Pregnant women’s use of a consumer-based meditation mobile app: A descriptive study

Objective

The objectives of this study were to explore the satisfaction of pregnant or recently pregnant women with the existing Calm app content (i.e. non-pregnancy) and preferences and recommendations for the types of pregnancy-specific content that would be helpful to pregnant women.

Methods

This study was a national cross-sectional survey of subscribers to a meditation mobile app (i.e. Calm). Eligible participants were currently pregnant or recently pregnant (within the past 12 months) and used Calm during their pregnancy. Participants were asked about their Calm usage and perceived benefits of Calm during pregnancy, and interest in pregnancy-specific content. Descriptive statistics were used to characterize the sample.

Results

Participants (N  =  111) were on average 34 years old (SD  =  5.4) and half of the sample was currently pregnant (N  =  55). The most common reasons for using the Calm app during pregnancy was for sleep problems (29%; n  =  31) or anxiety (27%; n  =  29). Women reported Calm was most helpful for improving sleep (32%; n  =  32), anxiety (25%; n  =  25), and stress (21%; n  =  21). Nearly all women wanted pregnancy-specific meditation content within the app (98%; n  =  98) and expressed interest in topics including pregnancy-related anxiety (68%; n  =  67), postpartum (50%; n  =  49), pregnancy-related sleep problems (41%; n  =  40), and labor and delivery (38%; n  =  37).

Conclusion

Women who used the Calm app during pregnancy found it helpful for improving sleep, anxiety, and stress but desire pregnancy-specific content. Future meditation mobile app studies should utilize pregnancy-specific content and test the feasibility and efficacy of sleep and mental health in pregnant women.

Accept Anxiety to Improve Sleep: The Impact of the COVID-19 Lockdown on the Relationships between Mindfulness, Distress, and Sleep Quality

It has been recently proposed that mindfulness can improve sleep quality through the mediating role on psychological distress and that acceptance may play a pivotal role in mindfulness beneficial effects. The aim of the present work was to understand the effects of the COVID-19 lockdown on dispositional mindfulness, sleep, and distress, and on their relationships. In particular, we wanted to test the hypothesis that the detrimental effects of lockdown on sleep depended on mindfulness and distress (including anxiety and depression) and that the acceptance facet of mindfulness played the leading role. A longitudinal study based on self-report questionnaires was conducted on 39 Italian adults (M age = 35.03, SD = 14.02; 21 men) assessing mindfulness, distress, and sleep quality before (23 December 2019–8 March 2020) and during (27 April 2020–10 May 2020) the first Italian COVID-19 lockdown. Lockdown decreased mindfulness while increasing distress and sleep problems. Path analysis showed that the effects of lockdown on sleep were fully mediated by mindfulness and distress. Furthermore, a more detailed analysis showed that these effects were mainly dependent on the acceptance component of mindfulness working through anxiety. The present study confirms, in the context of the COVID-19 lockdown, a model according to which mindfulness, and specifically acceptance, influences sleep through the mediating role of distress.

Do Brief Mindfulness Interventions (BMI) and Health Enhancement Programs (HEP) Improve Sleep in Patients in Hemodialysis with Depression and Anxiety?

(1) Objective: to determine if a brief mindfulness intervention (BMI) and a health education program (HEP) could improve measures of insomnia in patients undergoing hemodialysis. (2) Methods: this was a planned secondary analysis of a randomized controlled trial of BMI vs. HEP for hemodialysis patients with depression and/or anxiety symptoms. The primary outcome for the analysis was the Athens Insomnia Scale (AIS). The secondary outcome was consolidation of daily inactivity (ConDI), an actigraphy measure that describes sleep continuity and is based on a sleep detection algorithm validated by polysomnography. We also explored whether changes in AIS and ConDI were associated with changes in depression, anxiety, and quality of life scores over 8-week follow-up. (3) Results: BMI and HEP groups did not differ significantly from one another. Exposure to BMI or HEP improved sleep quality (baseline AIS 9.9 (±5.0) vs. 8-week follow-up 6.4 (±3.9), (V = 155.5, p = 0.015)), but not ConDI. Improvements in AIS were associated with lower depression scores (Rho = 0.57, p = 0.01) and higher quality-of-life scores (Rho = 0.46, p = 0.04). (4) Conclusions: mindfulness and HEP may be helpful interventions to improve self-reported sleep quality in patients undergoing hemodialysis. Decreases in insomnia scores were associated with decreased depression symptoms and increased quality of life scores.

Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study

BACKGROUND

Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app-delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students.

OBJECTIVE

This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms.

METHODS

We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list-controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time.

RESULTS

PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (ηp2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group.

CONCLUSIONS

This pilot study is the first to examine app-based mindfulness for PA students' mental health and investigate the impact of mindfulness on PA students' brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees.

A Randomized Controlled Trial to Examine the Feasibility and Preliminary Efficacy of a Digital Mindfulness-Based Therapy for Improving Insomnia Symptoms

Objectives

Insomnia has widespread negative implications for health and well-being. Online delivery of mindfulness-based therapy for insomnia (MBTI) has not previously been evaluated. This study investigated the feasibility and preliminary efficacy of a digital MBTI program for improving insomnia symptoms. It was hypothesized that a 6-week digital MBTI program would reduce insomnia symptoms and pre-sleep arousal and improve mood, compared to a waitlist control condition.

Methods

Twenty-seven participants (M = 29.44, SD = 11.97 years) experiencing insomnia symptoms (insomnia severity index [ISI] ≥ 8) were randomized to either a 6-week intervention or waitlist condition. Participants completed the ISI, pre-sleep arousal scale (PSAS), and the positive and negative affect schedule at baseline, mid-, and post-study. Feasibility was assessed across four domains (acceptability, implementation, practicality, and preliminary efficacy) using self-reports, attrition, program completions, and module completions.

Results

Feasibility data for the intervention indicated that there was 22% attrition, and 79% of the modules were completed. There were significantly greater reductions in the severity of insomnia symptoms (p < .001) and both cognitive (p = .03) and somatic (p = .02) subscales of the PSAS, at post-intervention compared to the waitlist group. There were no significant group differences in mood.

Conclusions

This study provides preliminary evidence of the feasibility and efficacy of a digital MBTI, which may assist in the broader dissemination of insomnia treatment.Trial RegistrationAustralian and New Zealand Clinical Trials Registry: ACTRN12620000398909.

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

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 (SH) comparison.

METHODS

Participants aged 25-59 with a primary complaint of sleep onset insomnia lasting at least six months were block randomized to 8-week Kundalini Yoga or SH intervention, both consisting of initial 60-minute instruction and weekly check-ins. Daily sleep diaries and questionnaires were collected at baseline, throughout 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. SH 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 (SE; d=1.36, p<.001) and decreased sleep onset latency (SOL; 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 SH, with ≥80% of yoga participants reporting average SOL<30 minutes and SE>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

Yoga as a Treatment for Insomnia (ClinicalTrials.gov, NCT00033865).

Holistic Approaches to Support Sleep in the Intensive Care Unit Patient

Sleep disruption in intensive care unit patients has internal, interpersonal, behavioral, and environmental factors to consider when developing sleep promotion protocols. Holistic approaches are integrative practices that go beyond modifying environmental factors. This article presents 3 holistic approaches that are cost-effective, easy to use, and independent nursing actions that are integrative in nature. Aromatherapy, guided imagery, and mindfulness show promising effects in the literature to improve comfort, anxiety and stress, which are thought to improve sleep.

Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial

The objective of this randomized controlled trial was to test whether a commercially available, mindfulness meditation mobile app, (i.e., Calm app), was effective in reducing fatigue (primary outcome), pre-sleep arousal, and daytime sleepiness (secondary outcomes) in adults with sleep disturbance (Insomnia Severity Index Score >10) as compared to a wait-list control group. Associations between the use of the Calm app (i.e., adherence to the intervention) and changes in sleep quality was also explored in the intervention group only. Adults with sleep disturbance were recruited (N = 640). Eligible and consenting participants (N = 263) were randomly assigned to the intervention (n = 124) or a wait-list control (n = 139) group. Intervention participants were asked to meditate using the Calm app ≥10 minutes/day for eight weeks. Fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, mid- (4-weeks) and post-intervention (8-weeks) in both groups, whereas sleep quality was evaluated only in the intervention group. Findings from intent-to-treat analyses suggest the use of the Calm app for eight weeks significantly decreased daytime fatigue (p = .018) as well as daytime sleepiness (p = .003) and cognitive (p = .005) and somatic (p < .001) pre-sleep arousal as compared to the wait-list control group. Within the intervention group, use of the Calm app was associated with improvements in sleep quality (p < .001). This randomized controlled trial demonstrates that the Calm app can be used to treat fatigue, daytime sleepiness, and pre-sleep arousal in adults with sleep disturbance. Given that the Calm app is affordable and widely accessible, these data have implications for community level dissemination of a mobile app to improve sleep-related symptoms associated with sleep disturbance. Trial registration: ClinicalTrials.gov NCT04045275.

Online prenatal trial in mindfulness sleep management (OPTIMISM): protocol for a pilot randomized controlled trial

Background

Sleep deficiency affects a majority of pregnant women with significant impact on daily function, mood, and pregnancy and birth outcomes. This ongoing study combines two evidence-based strategies for improving sleep and mood, mindfulness meditation and cognitive-behavioral therapy for insomnia (CBT-I), in a unique online format to address the particular needs of pregnant women. The purpose of this study is to test the feasibility and estimate the efficacy of this novel 6-week online mindfulness meditation intervention to help pregnant women in remission from depression self-manage insomnia.

Methods

This is a two-arm, parallel group randomized controlled trial. A total of 50 pregnant women between 12 and 28 weeks gestation will be recruited from the community and randomly assigned to a mindfulness or education-only control group in a 1:1 ratio. During the study, all participants will complete six weekly online modules, daily sleep diaries, and optional participation in a treatment-specific online discussion forum. Feasibility outcome measures will include study recruitment, retention, intervention adherence (number of online modules completed, number of meditation days per week), and intervention acceptability (8-item questionnaire). The primary clinical outcome measure will be sleep quality measured with the Pittsburgh Sleep Quality Index. Secondary outcome measures will include sleep measured with actigraphy and diaries (sleep efficiency, total sleep time, total wake time), Patient-Reported Outcomes Measurement Information System (PROMIS) measures (fatigue, sleep-related impairment, sleep disturbance); mood (depression, anxiety, positive affect, quality of life); and self-management and behavior change (potential self-efficacy, self-regulation, sleep problem acceptance, and trait mindfulness). Assessments will occur at baseline and post-intervention; an additional acceptability survey will be completed 4 weeks postpartum. Analyses will examine within-group differences in outcome change scores from baseline to post-intervention. Open-ended feedback will be analyzed using qualitative content analysis.

Discussion

This research is innovative in addressing sleep in pregnancy using a self-management research design and methods that can be accessible and cost-effective for large numbers of pregnant women. The results from this study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial.

Trial registration

ClinicalTrials.gov, NCT04016428. Registered on 11 July 2019. Updated version registered on 26 July 2019.