Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial

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 postintervention. 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 postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. 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 postintervention, 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.

Trial registration: clinicaltrials.gov Identifier: NCT01534338.

Figure 1. Consolidated Standards of Reporting Trials Flow Diagram of the Single-Site, Parallel-Group Randomized Clinical Trial of MAPs Compared With SHE for Sleep Problems in Older Adults

ITT indicates intent-to-treat; MAPs, mindful awareness practices; and SHE, sleep hygiene education. ^aReasons included time limitations (n = 10) and upcoming surgery (n = 1), reportedly unrelated to sleep.

Figure 2. Estimated Pittsburgh Sleep Quality Index at Preintervention and Postintervention

Data are given as means (SEs). MAPs indicates mindful awareness practices; SHE, sleep hygiene education. ^aP = .002 for difference between groups, covarying for preintervention Pittsburgh Sleep Quality Index.

Figure 3. Estimated Fatigue Symptom Inventory–Interference and Beck Depression Inventory II Scores at Preintervention and Postintervention

Data are given as means (SEs). MAPs indicates mindful awareness practices; SHE, sleep hygiene education. ^aP = .001 for difference between groups, covarying for pretreatment Fatigue Symptom Inventory–Interference score. ^b P = .02 for difference between groups, covarying for pretreatment Beck Depression Inventory II score.