Mindfulness-based Stress Reduction Versus Pharmacotherapy for Chronic Primary Insomnia: A Randomized Controlled Clinical Trial

Explore (NY). Mar-Apr 2011;7(2):76-87. doi: 10.1016/j.explore.2010.12.003.

Abstract

Objective: The aim of this study was to investigate the potential of mindfulness-based stress reduction (MBSR) as a treatment for chronic primary insomnia.

Design: A randomized controlled trial was conducted.

Setting: The study was conducted at a university health center.

Patients: Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th Edition were randomized 2:1 to MBSR or pharmacotherapy (PCT).

Interventions: Mindfulness-based stress reduction, a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat, was provided, with ongoing home meditation practice expectations during three-month follow-up; PCT, consisting of three milligrams of eszopiclone (LUNESTA) nightly for eight weeks, followed by three months of use as needed. A 10-minute sleep hygiene presentation was included in both interventions.

Main outcomes: The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and wrist actigraphy were collected pretreatment, posttreatment (eight weeks), and at five months (self-reports only).

Results: Between baseline and eight weeks, sleep onset latency (SOL) measured by actigraphy decreased 8.9 minutes in the MBSR arm (P < .05). Large, significant improvements were found on the ISI, PSQI, and diary-measured total sleep time, SOL, and sleep efficiency (P < .01, all) from baseline to five-month follow-up in the MBSR arm. Changes of comparable magnitude were found in the PCT arm. Twenty-seven of 30 patients completed their assigned treatment. This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary, actigraphy, well-validated sleep scales, and measures of remission and clinical recovery.

Trial registration: ClinicalTrials.gov NCT00515177.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Actigraphy / methods
  • Adult
  • Aged
  • Azabicyclo Compounds / therapeutic use*
  • Eszopiclone
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Meditation*
  • Middle Aged
  • Patient Compliance
  • Piperazines / therapeutic use*
  • Sleep Initiation and Maintenance Disorders / drug therapy
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Sleep* / drug effects
  • Stress, Psychological / therapy*
  • Treatment Outcome
  • Young Adult

Substances

  • Azabicyclo Compounds
  • Hypnotics and Sedatives
  • Piperazines
  • Eszopiclone

Associated data

  • ClinicalTrials.gov/NCT00515177