Positive effects of a weighted blanket on insomnia

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Cite this publication
Insomnia is a common occurrence and can have a negative impact on physiological, psychological and social well-being. There is a need for simple, effective solutions to increase sleep quality. It has been suggested that weighted blankets and vests can provide a beneficial calming effect, especially in clinical disorders. Hence, we aimed to investigate the effects of a chain weighted blanket on insomnia, using objective and subjective measures. Objectively, we found that sleep bout time increased, as well as a decrease in movements of the participants, during weighted blanket use. Subjectively, the participants liked sleeping with the blanket, found it easier to settle down to sleep and had an improved sleep, where they felt more refreshed in the morning. Overall, we found that when the participants used the weighted blanket, they had a calmer night's sleep. A weighted blanket may aid in reducing insomnia through altered tactile inputs, thus may provide an innovative, non-pharmacological approach and complementary tool to improve sleep quality.
Journal of Sleep Medicine & Disorders
Cite this article: Ackerley R, Badre G, Olausson H (2015) Positive Effects of a Weighted Blanket on Insomnia. J Sleep Med Disord 2(3): 1022.
*Corresponding author
Gaby Badre, SDS Kliniken, Vasaplatsen 8, 411 34
Gothenburg, Sweden, Tel: 46-31-107-780; Fax: 46-31-107-
781; Email:
Submitted: 09 May 2015
Accepted: 22 May 2015
Published: 25 May 2015
© 2015 Badre et al.
Research Article
Positive Effects of a Weighted
Blanket on Insomnia
Ackerley R1,2, Badre G1,2* and Olausson H1,2,3
1Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
2SDS Clinic, ESRS accredited Sleep Research Laboratory, Gothenburg, Sweden
3Clinical and Experimental Medicine, University of Linköping, Sweden
Insomnia is a common occurrence and can have a negative impact on physiological,
psychological and social well-being. There is a need for simple, effective solutions to
increase sleep quality. It has been suggested that weighted blankets and vests can
provide a benecial calming effect, especially in clinical disorders. Hence, we aimed
to investigate the effects of a chain weighted blanket on insomnia, using objective and
subjective measures. Objectively, we found that sleep bout time increased, as well as a
decrease in movements of the participants, during weighted blanket use. Subjectively,
the participants liked sleeping with the blanket, found it easier to settle down to sleep
and had an improved sleep, where they felt more refreshed in the morning. Overall, we
found that when the participants used the weighted blanket, they had a calmer night’s
sleep. A weighted blanket may aid in reducing insomnia through altered tactile inputs,
thus may provide an innovative, non-pharmacological approach and complementary
tool to improve sleep quality.
ANOVA: Analysis of Variance; ASD: Autism Spectrum
Disorders; BMI: Body Mass Index; ISI: Insomnia Severity Index;
KSS: Karolinska Sleepiness Scale; PSG: Polysomnography; REM:
Rapid Eye Movements; Karolinska Sleepiness Scale; TST: Total
Sleep Time; VAS: Visual Analog Scale; WASO: Wake after Sleep
According to most epidemiological studies, up to a third of the
population in industrialized countries suffers from poor sleep [1-
5]. This problem affects all categories of people from teenagers
to the elderly, and is increasing due to modern lifestyles and
the associated stressors, especially in cities. The impairment of
sleep has short- and long-term effects. It can lead to depression,
burn-out, psychosomatic disorders and addictions, as well as
other serious health problems (e.g. metabolic, cardiovascular)
[3,4,6,7]. It can affect professional lives (e.g. loss in productivity,
poor judgments, accidents, inadequate emotional reactions),
with great economic consequences. It can also have a negative
impact on social and family life. Pharmacological and behavioral
(e.g. cognitive, relaxation) methods are commonly used to treat
sleep disorders. However, drugs are often addictive or have
side effects, and psychological/behavioral methods require long
treatment sessions and it may take time to achieve satisfactory
results. Hence, there is a need for additional, simpler methods to
promote and maintain better sleep.
The application of deep pressure, through for example
weighted vests and blankets, has been reported to produce a
calming and relaxing effect in clinical conditions such as autism
    
disorder, and pervasive developmental disorders [8-15]. Applying
high levels of anxiety or arousal [16] and deep pressure touch may
also alleviate anxiety (e.g. in dental environments and bipolar
disorder [17,18]). There are also anecdotal reports suggesting
relief from deep pressure touch and many nursing homes are
experimenting with weighted blankets.
A weighted blanket that is more than 10% of a person’s body
Most of the research on weighted blankets has focused on their
use in children with clinical disorders, such as ASD. However, the
majority of these studies do not probe sleep objectively. To our
knowledge only one study has systematically investigated the
use of a weighted blanket during bedtime and this was in children
with ASD and severe sleep problems, using some objective
measures. The study found no increase in the total sleep time;
however, the blanket was favored by both the children and their
parents [20].
There is a need for systematic studies into the potential
those with insomnia. Hence, the aim of the present study was to
investigate whether the use of a weighted blanket may have a
Badre et al. (2015)
J Sleep Med Disord 2(3): 1022 (2015) 2/7
positive impact on adults with sleeping problems, mainly chronic
There are several weighted blankets on the market. For this
study we used a new type of chain-weighted blanket (Somna AB,
Stenkullen, Sweden), currently used both in nursing homes for
the elderly and in patients with ASD. The weight is provided by a
metal chain construction, which is evenly distributed throughout
the blanket and provides constant tactile stimulation across the
body. The participant can choose to sleep with the chain or the
padding side of the blanket closest to their body (hence provide a
different sensation). They can also use an additional quilt, either
over or under the blanket. The blanket is weighted without being
thick, and the fabric is such that the blanket does not particularly
provide additional warmth. Three weights were available (6, 8
or 10 kg) and the participants could select the most comfortable
one. The majority of the participants in the present study selected
the 8 kg blanket.
Study design
A repeated-measures study was undertaken in two clinical
sites in Sweden, over the course of a year. For each participant,
the study lasted 4 weeks. There was no control group, as the
participants were their own control, with baseline pre-test and
post-test measures. The study was approved by the Ethical
Committee of the Sahlgrenska Academy in Gothenburg and was
conducted according to the Declaration of Helsinki. Written,
informed consent was obtained from all the participants before
taking part and they were paid for their time. Prior to undertaking
the study, an effect size analysis was conducted to ascertain the
      
effects. This was based on statistical analyses from objective
and subjective results of a previous pilot study on 5 participants.
Cohen’s d was used to calculate an effect size of 0.75, with a power
of 0.8 (ratio 4:1 between type 1: type 2 errors); a minimum of 26
participants was required to gain statistical differences. Hence,
we aimed to recruit 30 participants to account for drop-out and
technical failures, due to the complexity of the study and its
Study population
The inclusion criteria were: participants’ of\genders, aged
        
  
nights a week (> 3 days) for more than 3 months, and having
feelings of not being refreshed when waking up in the morning.
If they were on medication upon entering the study, this was
continued throughout the trial period. Otherwise they had to
be healthy. The exclusion criteria were presence of illnesses
or newly discovered problems (<6 months), for example, sleep
apnea, untreated metabolic disorders or high blood pressure.
The participants should not have changed any medication in the
prior 4 weeks to commencing the study.
Participants were selected by advertising at the sleep clinics
lthy participants
complaining of chronic insomnia were recruited for the study;
31 completed the protocol (11 men, 20 women). For further
details about the participants, see Table 1. Prior to the study,
the participants also completed various questionnaires covering
environmental and lifestyle factors, including their health status,
irregularity in sleep-wake patterns and life style, variability of
sleep during the weekend, the presence of any sleep phase delay
or advance, their perception of sleep quality, and if they used any
The level of insomnia per participant was determined
according to the 7-item Insomnia Severity Index (ISI) [21], which
assesses the nature, severity, and impact of insomnia in their
life. Each question is rated from 0 (no problem) to 4 (severe
problem), with the total possible score being 28. A score of less
threshold insomnia, while 15-21 represents moderate insomnia
and a score greater than 22 indicate severe insomnia. The
         
daytime consequences of insomnia (i.e. daytime sleepiness). This
consisted of a questionnaire with answers ranging from 0 (no
chance of dozing) to 3 (high chance of dozing) to give a total out
of 24 points.
After screening and consent, the eligible participants slept
for a week in their habitual environment, which consisted the
pre-test baseline period. The following test period followed
consisted of two consecutive weeks during which the participant
used the weighted blanket every night. They pre-selected a
blanket weight, but if they felt that it was too light or heavy, they
could change it after no more than two nights into the test. The
participant returned the blanket after these two test weeks and
slept for one more week in their ordinary, habitual conditions
(post-test period).
Methods for studying sleep patterns
The trial design included both objective (physiological) and
subjective (self-report) measures.
Continuous actigraphy (Actiwatch; Cambridge
Neurotechnology Ltd, Cambridge, UK) and comprehensive
polysomnography (PSG) recordings, in the participants’ own
home, were obtained.
The actigraphy watch consisted of an accelerometer that was
worn on the same wrist continuously during the 4 week period.
Data were stored in the watch unit. Analyses of patterns and
frequencies of movements were done by validated algorithms for
the recognition of basic sleep-wake patterns. The participants’
time-to-bed and waking-up time were reported in their sleep
        
were conducted on these sleep periods. The variables analyzed
included sleep latency, assumed sleep, total wake time, sleep
fragmentation index, number of bouts of immobile time and
their frequency, as well as the number of sleep bouts and their
duration. We did not want to interfere with the ordinary lifestyle
and activities of the participants, though we recommended that
Badre et al. (2015)
J Sleep Med Disord 2(3): 1022 (2015) 3/7
Characteristic Number Mean ± SD Range
Age (all)
47 ± 14 years
43 ± 13 years
21-66 years
25-60 years
21-66 years
BMI (all)
25.8 ± 5.2
25.4 ± 5.8
20 ± 5
20 ± 6
6 ± 4
6 ± 3
6 ± 4
Weight of blanket/weight of participant 31  12% -38%
Question No Occasionally/Yes Often
Do you take sleep medication? 66% 21% 14%
Do you have an irregular sleep cycle? 66% 21% 14%
Is your sleep different at the weekend? 48% 34% 17%
Do you have a phase delay with sleep?  10%
Do you do shift work?  7%
Table 1: Details about the participants.
Abbreviations: BMI: Body Mass Index; ISI: Insomnia Severity Index
they avoid major irregularities, if it meant a large variation in
their sleep-wake pattern e.g. going to bed late and getting up
late during the weekend. For participants that showed these
deviation for 2 or more days), we restricted the analysis to 5
continuous days/nights for both the pre-test and the test period,
which typically did not include weekends where the larger
sleeping deviations tended to occur.
The PSG was measured using a 23 channel ambulatory
polygraph that recorded electroencephalography (electrical brain
activity), electromyography (muscle activity), electrooculography
(eye movements), electrocardiography (heart beat), respiratory
activity and oxygen content in the blood (pulse oximetry), while
a sensor pad, placed under the sheets, recorded body movements
and positions during the night (Biosaca; Swedsleep AB,
Gothenburg, Sweden). Two comprehensive PSG recordings were
test (no weighted blanket) week and one at the end of the third
week (test period, with the weighted blanket). PSG analysis was
done using the REM Logic software (Embla Systems LLC).
Further to conventional PSG analysis a validated automatic
system for analyzing body movements [23] was used (U-sleep;
Swedsleep AB, Gothenburg, Sweden). Based on the sensor pad it
according to their duration(from < 5 s to >15 s), representing
jerks or twitches, minor or major adjustments, and turns in the
bed. The total number and duration of each of these measures
were calculated, as well as the distribution per recording hour,
with an emphasis on the next-to-last hour prior to waking up.
The following measures were gained: wake after sleep onset
         
latency, latency to deep sleep and rapid eye movements (REM),
number of awakenings, amount of deep sleep and REM, arousal
index, number of stage shifts, of sleep cycles, deep and REM sleep,
average deep sleep period, and sleep spindles index.
Subjective measures
During the whole experimental period, the participants
 
perception together, with any comments about their night’s sleep
and any environmental changes of importance. Each morning,
they also reported their ‘sleep quality’ in a visual analog scale
(VAS; with the end-anchors ‘Very good’ and ‘Very bad’), as well
      
very sleepy) [24].
At the end of the study the participants reported their
subjective feelings about using the weighted blanket in an 8-item
with the blanket (Table 2), where lower scores indicated more
favorable feelings towards the weighted blanket. Two further
questions were asked: (i) ‘Which side of the blanket is closest to
your body most of the time?’ and (ii) ‘Did you use something else
as a cover, in addition to the weighted blanket?’ These were to
assess how the participants used the weighted blanket.
Data analysis
Statistical studies were made using SPSS (version 22; IBM,
Armonk, NY) and Prism (version 6; Graph Pad, La Jolla, CA)
        
analyses have been conducted on normalized data, as most of
the variables were not normally distributed. Hence, parametric,
interval statistics were carried out on the actigraphy, PSG and
U-sleep measures and repeated-measures analysis of variance
(ANOVA) tests were used. We compared the pre- and post-
test data with the weighted blanket data for each variable
     
controlled for multiple comparisons. It was not always possible
Badre et al. (2015)
J Sleep Med Disord 2(3): 1022 (2015) 4/7
Score between 1 10
1 Comfortable Uncomfortable
2 How is your experienced sleep quality, as compared to having no weighted blanket? Better Worse
3  Awkward
4 Not at all Very
5 Does the blanket affect your temperature in bed? Not at all Very
6 Is it easier to settle down to sleep with the blanket? Very Not at all
7 Does the blanket give you a sense of security? Very Not at all
8 How do you feel in the morning with the blanket? More rested More tired
Table 2: The participants rated their subjective feelings about sleep with the weighted blanket using a visual analog scale for questions 1-8.
to include all of the participants per measure due to issues such
as technical problems. The effects of confounding variables,
such as the participant’s gender, age, use of medication, were
tested as covariates. As the behavioral measures were based on
questionnaires, non-parametric, ordinal tests were used for the
Additional analyses were conducted on a sub-set of
participants who rated the weighted blanket favorably, which
was based on their subjective assessment scores, where lower
scores indicated a higher liking. The criteria for exclusion
         
score on questions 1-8 of more than 5, a maximum score of 8 or
more, and scores of 8 or more on more than two questions.
          
SD), which indicated insomnia of moderate severity (see Table
1 for further details).The mean Epworth score was 6.1 (±3.7 SD)
indicating that the participants had minor issues with sleepiness
in the daytime, with further details in Table 1.
The actigraphy was used to determine variables about sleep
metrics; therefore only the sleep period was analyzed, with the
time-in-bed adjusted according to each participant’s sleep diary.
Actigraphy was obtained from 27 participants, from a total of
26 different measures, although some of these measures were
seemingly redundant (e.g. immobility expressed in minutes
        
differences were found in comparing the pre-test period to the
        
         
when using the weighted blanket. Furthermore, the total activity
score during the time in bed (p < 0.001) and the average dark
        
decreased, during weighted blanket use. These measures are
shown in Figure 1.
There was an effect on the results from one of the covariates,
        
blanket, if the participant used medication. The further analysis
    
Pre-Test Blanket Post-Test
Mean sleep bout time (mins)
* **
Pre-Test Blanket Post-Test
Mean dark activity (mins)
Pre-Test Blanket Post-Test
Total activ ity score
*** *
Figure 1       
sleep periods from actigraphy measurements.
actigraphy measures, where there was (A) an increase in the mean
sleep bout time, and decreases in (B) the total activity score and (C)
         
where * p < 0.05 and *** p < 0.001.
the results.
The post-test actigraphy period was compared to both the
pre-test and weighted blanket periods. Due to participant drop-
out, only 22 participants completed the post-test, as compared to
the 27 who completed the pre-test and weighted blanket periods.
 differences between the pre- and post-
Badre et al. (2015)
J Sleep Med Disord 2(3): 1022 (2015) 5/7
weighted blanket and the post-test periods for the mean sleep
activity score (p = 0.018) and mean activity score (p = 0.015).
A total of 25 participants completed both PSG tests during
the pre-test stage and while using the weighted blanket. PSG is
a state-of-the-art measure for sleep studies, but the participants
often reported that it was disturbing, due to the equipment
weighted blanket test, as compared to the pre-test: the spindles
      
only the 21 participants (out of the 25 who completed the PSG, i.e.
    
         
=0.016).The effect of confounding variables on the PSG measures
was sought, where an effect of gender was found, but this was
only for the sleep spindles measure. Here, females had a higher
spindles index during use of the weighted blanket, as compared
to males (p = 0.024).
Movement analysis
The U-sleep data consisted of 6 measures collected from
23 of the 25 participants who completed the PSG (in 2 subjects
there were technical problems with the sensor pad). The mean
movements decreased in the next-to-last hour prior to waking
up, both in duration (p =0.001) and in number (p = 0.075).No
        
the U-sleep measures. A further analysis was run using only the
subjects that liked using the weighted blanket (n = 15). Here, the
number of movements in the next-to-last hour prior to waking
      
blanket use.
Subjective measures
   
participants. There were decreases in both of these measures,
meaning a better subjective sleep quality (sleep quality:
          
0.005; KSS decreased from 5.8 (pre-test) to 5.5 (during blanket
         
differences with either the pre-test or weighted blanket periods
    
were found for the confounding variables on the KSS or sleep
quality measures, nor were any further differences found when
only the participants that liked using the blanket (n = 20) were
In Figure 2, the subjective assessment of using the weighted
blanket showed that overall, the participants liked sleeping with
the blanket (p =0.035), found easier to settle down to sleep (p =
0.032) and reported a much better quality of sleep (p = 0.004),
feeling more refreshed in the morning (p = 0.045). They were
not disturbed by the weight of the blanket (p =0.012) and in fact,
felt a sense of security (p = 0.042). Furthermore, the weighted
blanket did not affect their temperature in bed. The majority of
participants (63%) preferred the padding side of the blanket to
be closest to their body during sleep. The majority also just used
the weighted blanket (63%), as compared to 30% who used an
additional quilt under the blanket and 7% who used a quilt over
the blanket.
In the present study, a chain weighted blanket was found to
be effective at improving sleep quality in recognized insomniacs,
both in parameters measured objectively and subjectively. The
impact was more pronounced objectively when the participants
reported having a positive experience of using the weighted
blanket and if they used sleep medication. No adverse effects of
using the weighted blanket were found.
Weighted blankets providing a ‘cocooning’ feeling and are
often recommended for young patients with ASD and in the
care of agitated elderly people. However, to our knowledge this
     
insomniacs. The ISI results validated that the selected group had
mild-to-moderate insomnia and their Epworth scores, expected
to be low in this group of subject, though within the normal
range, were also a little elevated (mean = 6, indicating some
tendency for daytime consequences), meaning that the blanket
 
mild sleep problems. Based on sensory integration, it has been
suggested that deep pressure and consistent sensory input,
such as provided by a heavy weight on the body, can reduce
physiological levels of arousal [25].A crucial point is that the
weight should not be too light or heavy, and the weight must
be evenly distributed throughout the fabric to provide constant
tactile stimulation distributed across the body, which the current
weighted blanket design provided.
There are many weighted blankets and vests on the market
with different designs, for example, those with metal chains
          
and ball quilts may provide different sensations (e.g. tactile,
thermal insulation) and have different weights, which need to
be adapted individually, as some patients may be more sensitive
to stimulation, thus requiring a lesser-weighted blanket. The
. Sleeping
2. Quality
3. Weight
4. Movement
5. Temperature
6. Settling
7. Security
8. Morning
* ** * * * *
Figure 2 Ratings of subjective feelings about sleep with the weighted
blanket. Each participant rated their feelings on VASs for eight items
(numbered 1-8, see questions in Table1), where lower numbers are
more favorable ratings towards the weighted blanket. The dotted line
indicates the level between liking and disliking. The asterisks indicate
        
Badre et al. (2015)
J Sleep Med Disord 2(3): 1022 (2015) 6/7
effectiveness of a weighted blanket has been found to relate to
the mass of a person, where a blanket that weighs more than 10%
in the current study had a weight of blanket/participant
ratio of more than 12% (see Table 1). The longitudinal chain
construction of the present weighted blanket may adjust well to
the participant’s body, where an even weight is delivered over
the body from the whole blanket surface, with the longitudinal
 
with minor movements producing a stroking-like effect.
There are limitations to the current study design, which
include a lack of a control group, the long duration of the study,
some missing data, and the inability to provide a placebo weighted
blanket. The participants represented their own control (pre-
and post-test measures) in our cross-over design and a control
group would only have been necessary if the goal was to compare
different types of blankets. However, in some tests, we had
reduced numbers of participants (e.g. in the PSG), particularly
due to technical issues with this equipment-intensive technique.
As we calculated that we needed at least 26 participants for
participants, which allowed for some issues and participant drop-
out (which occurred mainly at the week 4 post-test stage).Giving
a weighted blanket to control participants without insomnia
would have been less meaningful, unless we were interested in
looking at a possible negative impact of the blanket. However, the
strengths of our design include the use of combined objective and
subjective assessments using different, independent methods,
and the use of a pre- and post-test baseline.
PSG is the golden standard to study sleep, but it can be
cumbersome, disturbing and is limited to a few nights, hence not
representative of the subject’s habitual night sleep. The PSG did
         
reporting a subjective positive impact of the blanket. Regarding
responsiveness of the brain to stimuli, where a decreased amount
suggests a ‘loss of contact’ with the external environment, hence
         
movement (U-sleep) analysis was based on recordings from the
   
PSG. Hence, we used the ‘next to last hour’ measure to assess
sleep, since the last hour is often characterized by a shallow
sleep. The participants showed a decrease of movements this
next to last hour, which represented a quieter, more restful sleep.
Therefore the combination with actigraphy made for a more
comprehensive evaluation of the effects of using the weighted
blanket over time. The actigraphy showed a number of objective
improvements in sleep, including a decrease in movements and
an increase in the length of sleep bouts.
Overall, these measures suggest the additional pressure
stimulation from the weighted blanket provided a calming effect
on the participants, by decreasing agitation and increasing the
quality of their sleep. This was demonstrated through a decrease
in movements during sleep with the weighted blanket, which
were increased in the pre- and post-test periods, and also the
subjective increased in sleep quality (measured by the VAS)
and KSS (which is a validated instrumental scale). Although
these subjective measures are possibly less clinically relevant,
it is important to consider the psychological effects of using the
weighted blanket (cf. [20]), for example, having a positive attitude.
Weighted blankets and deep pressure touch may work well for
insomniacs, both through psychological means (e.g. calming and
‘cocooning’, releasing anxiety [27]) and physiological means (e.g.
tactile input that decreases activity of the sympathetic nervous
system [28]).As increased sympathetic arousal likely affects
sleep quality negatively, reducing it may aid sleep.
The weighted chain blanket used in the present study had
a positive impact on sleep, both objectively and subjectively,
where a number of physiological and behavioral measures were
improved during weighted blanket use. When the participants
used the weighted blanket, they had a calmer night’s sleep,
with a decrease in movements. Subjectively, they believed that
using the blanket provided them with a more comfortable,
better quality, and more secure sleep. In conclusion, a weighted
blanket may aid in reducing insomnia through increased tactile
and proprioceptive inputs, may provide an innovative, non-
pharmacological approach and complementary tool to improve
sleep quality.
The study was supported by a grant from Somna AB. GB is
the Medical Director of SDS Clinic, where the study was overseen.
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