Mindfulness-based therapies help fight insomnia in older adults

Mindfulness-based therapy for insomnia (MBTI) can help improve both objective and subjective sleep quality in elderly adults, according to a recent Singapore study. For individuals who had previously failed or have no access to frontline sleep therapies, MBTI could be a valid and effective alternative.

“MBTI is a relatively novel programme that comprises empirically supported behavioural strategies (eg, sleep restriction and stimulus control) with mindfulness instruction, inquiry, and practice. The current trial is the first to compare manualized MBTI against an active control condition in an adequately powered sample,” the researchers said.

The single-site, parallel-arm randomized clinical trial enrolled 127 participants (aged 50–80 years, 58.3 percent women) who were assigned to either MBTI (n=65) or a control sleep hygiene, education, and exercise programme (SHEEP n=62). Participants had Pittsburgh Sleep Quality Index (PSQI) score ≥5. The primary outcomes were PSQI change over 8 weeks and Insomnia Severity Index (ISI) scores.

Both treatment arms saw significant ISI improvements relative to baseline (MBTI: d, –1.27, 95 percent confidence interval [CI], –1.61 to –0.89; SHEEP: d, –0.69, 95 percent CI, –0.96 to –0.43). Insomnia severity was reduced to a greater degree in the MBTI group. [Psychol Med 2021;doi:10.1017/S0033291721002476]

None of the participants experienced adverse events related to the intervention, suggesting that MBTI was safe.

In terms of sleep quality, estimation tests showed significant improvements as early as week 4 in both the MBTI (d, –0.63, 95 percent CI, –0.90 to –0.36) and SHEEP (d, –0.62, 95 percent CI, –0.90 to –0.36) groups, which persisted until the postintervention follow-up (MBTI: d, –1.19, 95 percent CI, –1.51 to –0.85; SHEEP: d, –1.02, 95 percent CI, –1.31 to –0.71).

PSQI improvements were also stable for up to 6 months in both the MBTI (d, –1.05, 95 percent CI, –1.37 to –0.73) and SHEEP (d, –0.91, 95 percent CI, –1.21 to –0.63) groups.

MBTI likewise led to better sleep onset latency and wake after sleep onset latency, both of which remained significant after bootstrap analysis; SHEEP had no such effects. Actigraphy was used to measure both sleep outcomes.

Notably, ANOVA was able to establish a significant time-by-group interaction only for ISI. PSQI outcomes achieved significance only in estimation tests.

“Furthermore, none of the changes in secondary variables differed between groups,” the researchers said. “The incremental benefit of MBTI over active control was, as such, limited to only a few outcomes, with insomnia severity being the most notable.”

“We conclude that MBTI may be an attractive alternative for those who did not respond or do not have access to cognitive behavioural therapy for insomnia,” they said. “Future studies should examine whether MBTI leads to changes in cognitive or neurological functioning and probe more deeply into treatment mediators and moderators.”