Elsevier

Current Opinion in Psychology

Volume 28, August 2019, Pages 37-41
Current Opinion in Psychology

Waking up to the problem of sleep: can mindfulness help? A review of theory and evidence for the effects of mindfulness for sleep

https://doi.org/10.1016/j.copsyc.2018.10.005Get rights and content

Highlights

  • Sleep disturbance is common and is associated with serious health consequences.

  • Mindfulness practice may target several risk factors for sleep disturbance.

  • More RCTs are needed to test efficacy of mindfulness interventions (MBIs) for sleep.

  • Mechanisms of MBIs for sleep outcomes are poorly understood.

  • MBIs for sleep disturbance need to be more affordable, accessible, and scalable.

The high incidence of poor sleep and associated negative health consequences substantiates the need for effective behavioral sleep interventions. We offer an integrative model of sleep disturbance whereby key risk factors for compromised sleep quality and quantity are targeted through mindfulness practice—namely, experiential awareness, attentional control, and acceptance. Theoretical considerations and burgeoning evidence suggest that mindfulness-based interventions (MBIs) may be promising treatments for improving sleep outcomes. However, evidence is mixed due to heterogeneity in design and methods across studies. More rigorous RCTs are needed to determine the efficacy and underlying mechanisms of MBI’s for sleep. MBIs that are affordable, accessible, and scalable are needed to improve sleep outcomes at the population level.

Section snippets

Etiological model of sleep disturbance

Sleep disturbance is thought to be initiated and perpetuated by the following sequential cognitive and behavioral processes: first, excessive daytime and nighttime rumination [21], second, primary arousal (i.e. initial negative appraisal about daytime consequences of poor sleep that results in distress and physiological activation)—‘If I don’t sleep tonight, I’m going to fail at my job tomorrow and be fired.’ [22]; third, secondary arousal (i.e. the negative secondary or metacognitive

Theoretical framework for mindfulness and sleep disturbance

In Figure 1, we present an integrative etiological model of sleep disturbance from several cognitive and behavioral frameworks and demonstrate how processes that are core to the practice of mindfulness may target key risk factors for sleep disturbance [26]. The practice of mindfulness involves three core processes (experiential awareness, attentional control, and acceptance) that have the potential to target each of the risk factors for sleep disturbance. For example, mindfulness-based

Mindfulness-based interventions and sleep

The literature on the effects of mindfulness for sleep is comprised primarily of investigations that have tested mindfulness-based stress reduction (MBSR) or mindfulness-based therapy for insomnia (MBTI), a tailored derivative of MBSR and CBT-I (for reviews see Refs. [30,31]). The most compelling evidence for the effects of MBIs for insomnia come from randomized controlled trials that have compared MBIs to rigorous comparison conditions. For example, in one study, MBSR demonstrated greater

Future directions

A prevalent criticism of evidence-based psychological treatments for sleep disturbance (e.g. CBT-I) and also of MBIs is that they are not readily accessible, scalable, or affordable [26]. Although recent reviews suggest that alternative delivery (e.g. online versus in person) [38] or minimal facilitator involvement [39] could be encouraging intervention directions, we are unaware of any published results from studies that have tested alternatives to in-person delivery of MBIs for sleep

Conflict of interest statement

Nothing declared.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

  • •• of outstanding interest

Acknowledgements

This work was supported by the National Institutes of Health [grant number K23AT009208]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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