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Treatment of chronic primary sleep onset insomnia with Kundalini Yoga: a randomized controlled trial with active sleep hygiene comparison
Abstract
Study objectives:
Prior studies have suggested a benefit of yoga for alleviating sleep disturbance; however, many studies have had methodological limitations. This trial study aimed to extend that literature by including an active sleep hygiene (SH) comparison.
Methods:
Participants aged 25-59 with a primary complaint of sleep onset insomnia lasting at least six months were block randomized to 8-week Kundalini Yoga or SH intervention, both consisting of initial 60-minute instruction and weekly check-ins. Daily sleep diaries and questionnaires were collected at baseline, throughout intervention, and at 6-month follow-up. Data were analyzed using linear mixed models (N=20 in each group).
Results:
Participant ratings of the interventions did not significantly differ. SH improved several diary and questionnaire outcomes, however, yoga resulted in even greater improvements corresponding to medium-to-large between-group effect sizes. Total sleep time increased progressively across yoga treatment (d=0.95, p=.002), concurrent with increased sleep efficiency (SE; d=1.36, p<.001) and decreased sleep onset latency (SOL; d=-1.16, p<.001), but without changes in pre-sleep arousal (d=-0.30, p=.59). Remission rates were also higher for yoga compared to SH, with ≥80% of yoga participants reporting average SOL<30 minutes and SE>80% at 6-month follow-up. For over 50% of yoga participants, the insomnia severity index decreased by at least 8 points at end of treatment and follow-up.
Conclusions:
Yoga, taught in a self-care framework with minimal instructor burden, was associated with self-reported improvements above and beyond an active sleep hygiene comparison, sustained at 6-month follow-up. Follow-up studies are needed to assess actigraphy and polysomnography outcomes, as well as possible mechanisms of change.
Clinical trial registration:
Yoga as a Treatment for Insomnia (ClinicalTrials.gov, NCT00033865).
... Insomnia is a common sleep problem and major public health issue. (1)(2)(3)(4)(5)(6) A variety of factors responsible for chronic insomnia includes cognitive and physiological arousal, psychological conditioning, genetic factors, and stress reactivity. (3,7) Change in life style has also played role for rising in cases of insomnia. ...
... (1)(2)(3)(4)(5)(6) A variety of factors responsible for chronic insomnia includes cognitive and physiological arousal, psychological conditioning, genetic factors, and stress reactivity. (3,7) Change in life style has also played role for rising in cases of insomnia. (8,9) Day time work is disturbed by sleep problems. ...
... (1,12,(14)(15)(16)(17)(18)(19) So, it seems requirement of non-pharmacological and easily available modalities in the management of insomnia. (1,12,19) Yoga activities as breathing and relaxation techniques can be benefi cial in conditions like stress (3,8,(20)(21)(22) and anxiety (8,23) which has key role to chronic insomnia. (3,8,(20)(21)(22)(23) Cconsidering this, it seems that yoga can be considered as a tool for the management of insomnia. ...
Background: Insomnia is a common sleep problem. change in life style has played role for rising in cases of insomnia. Day time work is disturbed by sleep problems. It can have adverse effects on physical and mental health in the long run. Yoga promotes physical, mental, and emotional health. It seems that yoga can be considered as a tool for the management of insomnia. Aim: To study role of yoga activities for parameters related to sleep health in people with insomnia. Methods: Researchers used the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines for reporting systematic reviews and meta-analysis. Researchers searched articles on PubMed, Google scholar and by manual search. Searched articles were screened for relevancy. By use of inclusion and exclusion criteria potential articles were selected. Results: Out of 232 articles, fi nally 4 studies included in current systematic review. The age of participants ranged from 25−70 years. Overall, included studies found benefi cial effect on parameter related to sleep health by yoga activities in people with insomnia. Conclusion: Yoga activities can be advantageous for sleep health in people with insomnia. Y oga activities can be useful as a part of therapy in people with insomnia. There is wide scope for further studies to assess benefi cial effects of yoga activities.
... Regarding the evaluation of study outcomes, the research included varied in their focus on therapeutic outcomes, hence employing diverse testing methodologies. The studies measured characteristics related to sleep quality (57,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73), or outcomes in other categories such as anxiety (58,65), depression (58,64,68), stress (64), heart rate (71), electroencephalography (65,71), or mood (73). The Pittsburgh Sleep Quality Index and scales were the most frequently utilized measures for assessing sleep quality. ...
... Yoga therapy, particularly Kundalini yoga and Yoga Nidra, has been proven to have a positive impact on improving sleep quality (71,72). By improving physical flexibility, enhancing muscle strength, deep breathing, and meditation practices, it not only improves sleep quality but also has a significant therapeutic effect on emotional disorders such as depression and anxiety (83). ...
... Leveraging Table 4, our analysis meticulously appraised the comprehensive quality of each study through the Joanna Briggs Institute (JBI) methodology, assigning a one-point increment for every "Yes" response, culminating in an aggregate score out of 13. Within this cohort of 17 randomized controlled trials (RCTs), the paper authored by Sat Bir distinguished itself with a high-quality score of 12 (reference 72), closely trailed by the contributions from En-Ting, Laśzlo, and Erica, each securing a commendable score of 11 (references 67,68,72). This echelon of papers stands apart for their rigorous alignment with quality parameters, whereas the corpus of remaining studies predominantly manifested moderate quality, with the exception of Shu-chuan's work, which uniquely aligns with the aforementioned group by also securing a score of 11 (references 67, 68, 72). ...
Introduction
Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi.
Methods
Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity.
Results
Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes.
Discussion
The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits.
Systematic review registration
PROSPERO, ID: CRD42024506393.
... [16][17][18] Recently, 8 weeks' practice of Kundalini yoga was shown to increase total sleep time, sleep efficiency, and decrease sleep onset latency in comparison to a control group intervention of sleep hygiene. 19 Another study showed a small change in outcomes of total minutes asleep during the time in bed, time spent awake after sleep onset, and the number of awakenings longer than 5 minutes, among the yoga group. 20 In another triple-arm study, there was a modest short-term effect of the Tibetan Yoga Program on the PSQI scores and objective actigraphy outcomes, with long-term benefits emerging after 3-6 months. ...
... Yoga's evidence with regard to objective sleep-related outcomes is scant and is based on diverse populations with varying methods and mixed results. [16][17][18][19][20][21][22][23][24] Longitudinal RCTs with rigorous control and long enough follow-ups are needed for generating strong evidence. [16][17][18] Sleep is one of the most essential needs of survival, other than breath, food, and mental calm. ...
... 23 Similarly, a statistically significant difference between polysomnography assessed sleep spindles of meditators and non-meditating controls was found in another trial suggesting that there was no difference in sleep efficiency and sleep architecture of the two groups. 24 Apart from the type of yoga intervention used (other than SKY), these studies were very different from ours as they assessed outcomes among different populations with varying health conditions, like patients with chronic primary sleep-onset insomnia, 19 women in late-transition menopause, 20 w o m e n w i t h c a n c e r (s t a g e 1-3), 21 postmenopausal women, 20,22 individuals with major depression, 23 Vipassana meditators, and healthy volunteers. 24 Their outcome assessment time points were 8 weeks, 19,23 12 weeks, 20 3-6 months, 21 4 months, 22 and 90 minutes, 24 all of which were very different from ours. ...
Background: Medical professionals (MPs) are facing stress, sleep deprivation, and burnout due to pandemic-related high patient inflow and consistent work shifts. Yoga and meditation are feasible, cost-effective, evidence-based, and well-accepted tools having multifold mental and physical health benefits.
Design: In this ongoing open-label single-arm trial, we assessed changes in sleep, heart rate variability (HRV), and vitals before and after a 4-day online breath meditation workshop (OBMW) among 41 MPs at a tertiary care hospital in northern India during COVID-19 pandemic.
Methods: Outcomes were assessed at baseline and after the 4-day workshop using a
ballistocardiography-based contactless health monitoring device. The workshop was conducted online. Two participants were excluded due to a lack of adherence.
Results: A highly significant increase was seen in total sleep duration (p = 0.000) and duration of deep sleep (p = 0.001), rapid eye movement (REM) sleep (p = 0.000), and light sleep (p = 0.032). HRV outcomes of the standard deviation of normal-to-normal R-R intervals (SDNN) and root mean square of successive differences between adjacent normal heartbeat (RMSSD) also improved significantly (p = 0.000) while heart rate reduced significantly (p = 0.001). No significant change was observed in breath rate, total time awake, or in the low-frequency by high-frequency (LF/HF) spectrum of HRV.
Conclusion: Four days of OBMW improved sleep and HRV among MPs, strengthening the fact that yoga and meditation can help induce psychophysical relaxation and prove to be an effective tool to combat stress and sleep deprivation. As the stakeholders in patient care, that is, MPs are healthy, it will further improve patient care and reduce the chance of medical errors.
Journal of the Association of Physicians of India (2022): 10.5005/japi-11001-0091
... Yoga includes physical exercises, breath regulation, relaxation, and meditation, which are believed to facilitate reductions in psychophysiological arousal and increases in mindfulness Hoge et al., 2013). There is also evidence for improvements in sleep/insomnia with yoga and mindfulness practices (Khalsa & Goldstein, 2021;Rusch et al., 2019;Wang et al., 2016;Wang et al., 2019). However, there is limited research investigating whether mind body interventions improve sleep among patients with GAD specifically (Hoge et al., 2013;Khalsa et al., 2015;Vøllestad et al., 2011). ...
... The SEdu control condition may have showed efficacy in improving sleep quality because psychoeducation about sleep and sleep hygiene was taught in the curriculum. Sleep hygiene includes behavioural and environmental recommendations intended to promote sleep and has been associated with improvements in sleep quality (Khalsa & Goldstein, 2021;O'Donnell & Driller, 2017). This information was provided in an educational format and was not personalised to participants, nor were participants instructed to change their sleep habits. ...
Sleep disturbances are present in ~65% of individuals with generalised anxiety disorder (GAD). Although both Kundalini yoga (KY) and cognitive behavioural therapy (CBT) are effective treatment options for GAD, little is known about how these treatments compare in improving sleep for GAD and what drives these changes. Accordingly, we examined the effects of CBT, KY, and stress education (SEdu; an attention control condition) on subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index [PSQI] and Insomnia Severity Index [ISI]) in a randomised controlled trial of 226 adults with GAD (mean age 33.37 years; 70% female; 79% White). We hypothesised that both CBT and KY would outperform SEdu in improving sleep disturbances. Three potential mediators of sleep improvement (worry, mindfulness, perceived stress) were also examined. In line with hypotheses, PSQI and ISI scores significantly improved from pre‐ to post‐treatment for all three treatment groups (all p < 0.001, all d > 0.97). However, contrary to predictions, sleep changes were not significantly greater for CBT or KY compared to SEdu. In mediation analyses, within‐person deviations in worry, mindfulness, and stress each significantly mediated the effect of time on sleep outcomes. Degree of change in sleep attributable to worry (CBT > KY > SEdu) and perceived stress (CBT, KY > SEdu) was moderated by treatment group. Personalised medicine as well as combined treatment approaches should be studied to help reduce sleep difficulties for patients with GAD who do not respond.
... 4 Another trial with the eight-week Kundalini yoga intervention has proved that yoga may benefit patients with insomnia as an adjunctive therapy to cognitive behavioral therapy. 24 Sleep deprivation is akin to stress-like situation that may activate the sympathetic nervous system and increase cortisol secretion, leading to a rise in blood pressure. 25 By activating the sympathetic nervous system, sleep leads to decreased HRV. 26 One possible explanation for improved sleep quality in terms of improved sleep latency and more deep sleep without disturbances after yoga could enhance physical and mental relaxation due to stretching and relaxing of muscles and brief meditation. ...
Objectives
The disturbed sleep quality among medical students due to their hectic schedule may negatively impact the cognition, consequently affecting their academic performance. With the hypothesis that short duration of simple yogic exercises may improve sleep quality and heart rate variability (HRV), and thus may improve cognitive abilities, the study aims to evaluate the outcome of short duration yoga training on HRV, cognition, and sleep in medical students.
Material and Methods
The participants of the study were young and apparently healthy medical students. The study commenced after the Institutional Scientific Re- search and Ethics Committee approval. The informed consent was taken from all the participants in writing. All parameters (height, weight, age, body mass index [BMI], systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) along with HRV, sleep quality (using Pittsburgh Sleep Quality Index [PSQI]), and cognitive ability (using Trail Making Tests Parts A & B [TMTs-A&B]) were assessed in the participants at baseline. Thereaf- ter, the students practiced yoga (asanas, pranayama, and meditation) under supervision of a yoga instructor and a faculty for the duration of one hour every day for six weeks. Measurements were repeated after six weeks. Depending on the normality of data and data distribution, the comparison was done using Wilcoxon Signed Rank Test or dependent samples t-test. The level of significance was kept as p < 0.05.
Results
Following six weeks of yoga sessions, a significant improvement in the high frequency power normalized unit (HFnu) and total power in comparison to baseline values was observed: 53.25± 10.14 versus 59.57 ± 9.61 and 3238 ± 1133 versus 3473 ± 1130, respectively. Significant difference at six weeks between baseline and post yoga values was observed in TMT-A (30.16 ± 5.04 vs 19.84 ± 2.76) and TMT-B (69.96 ± 12.99 vs 49.24 ± 10.99). Sleep quality also improved significantly after yoga sessions (baseline PSQI score of 10.68 ± 1.79 and post-PSQI score of 4.12 ± 1.67).
Conclusion
It was concluded that one hour of supervised yoga session every day for six weeks can improve HRV, sleep quality, and cognitive ability among medical students. Medical students should practice yoga regularly to improve cognitive function and sleep and to reduce cardiovascular morbidity.
... The study by Khalsa, et al in 157 women aged 25-59 year old with primary complaint of insomnia intervent with yoga with result that yoga associated with improvements and beyond an active sleep hygiene comaprison. 8 In a study of 186 late transition and postmenopausal women age 40-62 year old in study by Buchanan, et al, women asked to do 12 weeks of yoga, and the result showed there is small efects on sleep quality and potentially improved the sleep quality with yoga in women. 7 The study of efficacy of yoga also studied by Newton, et al in 249 women, that devided into 107 patients with yoga, 106 patients did exercise and 142 patients in usual activity. ...
Background: With prevalence estimates ranging from 4% to over 20% of the adult population, insomnia is the most prevalent sleep complaint and a serious public health problem. Yoga has also been utilized therapeutically since it is thought that various styles of yoga might have distinct psychophysiological effects. Aims : This systematic review is to review the effect of yoga on sleep quality and insomnia in women with sleep problem. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 33 articles, whereas the results of our search on SAGEPUB brought up 416 articles, our search on SCIENCE DIRECT brought up 1107 articles. The results of the search conducted for the last year of 2014 yielded a total 26 articles for PubMed, 265 articles for SAGEPUB and 684 articles for SCIENCE DIRECT. In the end, we compiled a total of 7 papers, 4 of which came from PubMed, 1 of which came from SAGEPUB and 2 of which came from SCIENCE DIRECT. We included seven research that met the criteria. Conclusion: In summary, when compared to non-active control settings, yoga intervention can help women manage their sleep issues in either pregnant women, worker, or women with disease.
... Tai Chi is another form of mind-body practice that has been shown to have salubrious effects on health biomarkers [74]; however, this study did not include direct measures of autonomic function. Combining mind-body practices with the interest in sleep extension paradigms, further explored in a recent report by Khalsa and Goldstein [75] of Kundalini Yoga for insomnia, observed an improvement in insomnia symptoms concurrent with increased total sleep time compared to an active sleep hygiene control, sustained through a 6-month follow-up. CBT-I remains the gold standard intervention for insomnia, however, with a trade-off of reduced total sleep time via sleep restriction as a core component of CBT-I. ...
The autonomic system plays an important role in regulating blood pressure (BP). BP is elevated at night when individuals remain awake and continues to be elevated during either the night or the day if wakefulness persists. There is a close relationship between the high frequency (HF) of the variability of the RR interval (RRI), an index of parasympathetic predominance, and delta power during slow wave sleep bouts. In addition, there is an HF rebound once sleep is permitted following sleep deprivation. Furthermore, this is the case for acute total sleep deprivation as well as for models of chronic sleep restriction. Evidence indicates that sleep is important for autonomic homeostasis.
It has long been recognized that physiological stress induces sympathetic activation. However, the simple fact that humans can voluntarily, and sometimes even with great pleasure, deprive themselves of sleep, has led us to overlook the role that deficient sleep plays as a physiological stressor. Physiological and epidemiological data have shown that short sleep is a risk factor for a broad range of morbidity and for all-cause mortality. Understanding the role sleep plays in autonomic regulation can open new opportunities for the development of sleep interventions to improve cardiovascular health.
Sleep hygiene education (SHE) as a single therapy for insomnia still lacks sufficient evidence. This study aimed to quantify the effects of SHE on insomnia treatment. A literature search was conducted on seven databases from inception up to 30 September 2024 to retrieve randomized controlled trials. Meta-analyses were performed to estimate the mean difference (MD) of Insomnia Severity Index (ISI) (primary outcome) using a random-effects model. Risk of Bias 2 tool was applied to measure methodological quality. Forty-two RCTs encompassing 4,245 adults (65.5% female) were included. The pooled results showed significant pretreatment-to-posttreatment improvement in ISI score (MD = 3.4, 95% confidence interval (CI) [2.08, 4.64]). However, SHE was inferior as a cognitive behavioral therapy for insomnia (CBT-I) (MD = 3.8, 95% CI [2.92, 4.76]), partial CBT-I (MD = 4.5, 95% CI [3.33, 5.60]), exercises (MD = 2.9, 95% CI [0.81, 5.04]), and acupressure (MD = 1.9, 95% CI [0.82, 3.00]) regarding the ISI score. The majority of included trials (85.71%) had a high overall risk of bias, and the remaining had “some concerns.” Future work is encouraged to generate robust evidence through the development of well-designed SHE as an examined intervention for insomnia that involves process evaluation and treatment fidelity.
Background
Poor or insufficient sleep adversely affects various physiological and psychological functions, impacting body systems such as the endocrine, metabolic, and immune systems.
Objectives
Despite available pharmacological and non-pharmacological treatments, the impact of chronic yoga interventions on sleep quality in individuals with sleep problem syndrome remains underexplored. This scoping review aims to consolidate existing research on yoga interventions and their effects on sleep quality, providing evidence for yoga as a non-pharmacological alternative to reduce reliance on medications.
Methods
A systematic search across PubMed, Web of Science, and Scopus identified 1,559 studies, with 57 meeting inclusion criteria for yoga’s effects on sleep quality.
Results
Overall, the included studies reported either significant improvements in sleep quality (or related) parameters or no change. Moderator analyses revealed that intervention duration and session frequency can influence sleep outcomes. Short-duration interventions (≤6 weeks) showed a large mean effect on sleep quality (9.41%; 95% CI 3.06 to 15.42%), with 54% of studies reporting statistically significant improvements. Medium-duration interventions (7–16 weeks) demonstrated consistent benefits, including a large mean effect on sleep quality (8.74%; 95% CI 2.93 to 14.55%) and a very large reduction in insomnia severity (13.19%; 95% CI 11.10 to 15.98%). However, sleep efficiency exhibited smaller effects (0.73%; 95% CI −1.99 to 3.45%). Long-duration interventions (≥17 weeks) produced the most robust results, with 100% of the studies reporting significant improvements, including a 7.92% increase in sleep quality (95% CI 3.23 to 12.60%). With regard to session frequency, low-frequency sessions (1–2 per week) yielded significant improvements in insomnia severity (13.66%; 95% CI 8.72 to 18.59%) and sleep quality (8.13%; 95% CI 2.67 to 13.59%). Moderate-frequency sessions (3–4 per week) balanced accessibility and efficacy, producing a large mean effect on sleep quality (9.21%; 95% CI 3.66 to 14.76%). High-frequency sessions (≥5 per week) demonstrated a similarly large effect on sleep quality (8.24%; 95% CI 2.28 to 14.20%), although the data were limited.
Conclusion
Tailoring yoga interventions by duration and frequency is valuable, with chronic practice offering a safe, effective alternative to medication. Future research should refine protocols for specific populations and sleep challenges.
Objective
The purpose of this study was to determine, for the first time, whether the application of a self-management program with global postural re-education (GPR) influences stress and sleep quality in female health science students.
Methods
In this randomized controlled trial pilot study, forty-one female health science students were randomized into a control group (n=21) and an intervention group (n=20). Participants underwent 8 weeks of self-management with and without GPR, after familiarization and therapy training. Outcomes included the State-Trait Anxiety Inventory (STAI) questionnaire and cortisol levels in saliva measured with the “CORTISOL Saliva ELISA SA E-6000” kit. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a Sleep Diary; total sleep time (TST), sleep onset latency (SOL), wakefulness after sleep onset (WASO), sleep efficiency (SE), and perceived sleep quality or satisfaction were assessed using the Likert scale.
Results
After self-treatment with GPR, participants in the intervention group showed lower cortisol levels compared to the control group (p = 0.041). Additionally, the intervention group demonstrated statistically significant improvements in sleep quality according to their PSQI (p = 0.010), STAI (p = 0.043), SOL (p = 0.049), and SE (p = 0.002).
Conclusion
This study shows that self-management through GPR helps reduce stress and improve sleep quality in female health science students.
Clinical Trial Registration
https://clinicaltrials.gov/, identifier NCT05488015.
Cognitive behavioral therapy (CBT) is one of the standard conventional treatments for posttraumatic stress disorder (PTSD). However, recent studies have reported the benefits of yoga for reducing PTSD symptoms including a Kundalini Yoga (KY) intervention. The purpose of this study was to test the efficacy of a novel combined 8-week CBT and KY program for treating PTSD symptoms and improving sleep quality in a single group trial of 26 adults with PTSD. PTSD symptoms (PTSD checklist-5) and sleep quality (Pittsburgh Sleep Quality Index) were assessed at baseline, post intervention, and at 2-month follow-up. Both CBT and yoga homework compliance were also measured. Total PTSD symptom scores as well as the cluster symptoms (intrusion, avoidance, arousal/reactivity, and negative alterations in cognitions and mood) were significantly improved following the program, all p < .01. The improvements in total PTSD scores, intrusion, avoidance, arousal/reactivity were maintained at follow-up, with all values still less ( p < .01) than baseline. The negative alterations in cognitions and mood symptom cluster continued to improve further at follow-up compared to post-intervention values ( p < .05). Total sleep score ( p < .05) and the subscales of sleep disturbance ( p < .01), daytime dysfunction ( p < .05), and sleep quality ( p < .01) were significantly improved after the program and these improvements were maintained at follow-up compared to baseline. Sleep medication use was decreased ( p < .05) and sleep latency was improved ( p < .01) at follow-up only compared to baseline. There was a significant positive correlation ( p < .05) between the completion of the yoga home practice and post change in total sleep scores. These results show that a combined KY and CBT intervention resulted in decreased PTSD symptoms and improved sleep quality and suggest this program may constitute an additional treatment option for PTSD.
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P – Patient, problem, or population; I – Intervention; C – Comparison, control, or comparator; O – Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.
The Brazilian physiotherapists are working in Sleep field in Brazil, both in clinical practice and research. There are only a few professionals in light of the huge demand of sleep disorder's patients. This text aims to gather evidence and propose protocols to produce guidelines of clinical practice in the performance of physiotherapists in Brazil. It addresses Obstructive Sleep Apnea Syndrome, Neuromuscular Disorders, Restless Legs Syndrome, Periodic Leg Movements, Fibromyalgia and Sleep Bruxism.
Insomnia is a prevalent disorder and it leads to relevant impairment in health-related quality of life. Recent clinical guidelines pointed out that Cognitive-Behavior Therapy for Insomnia (CBT-I) should be considered as first-line intervention. Nevertheless, many other interventions are commonly used by patients or have been proposed as effective for insomnia. These include melatonin, light exposure, exercise, and complementary and alternative medicine. Evaluation of comparable effectiveness of these interventions with first-line intervention for insomnia is however still lacking. We conducted a systematic review and network meta-analysis on the effects of these interventions. PubMed, PsycInfo, PsycArticles, MEDLINE, and CINAHL were systematically searched and 40 studies were included in the systematic review, while 36 were entered into the meta-analysis. Eight network meta-analyses were conducted. Findings support effectiveness of melatonin in improving sleep-onset difficulties and of meditative movement therapies for self-report sleep efficiency and severity of the insomnia disorder. Some support was observed for exercise, hypnotherapy, and transcranial magnetic resonance, but the number of studies for these interventions is still too small. None of the considered interventions received superior evidence to CBT-I, which should be more widely disseminated in primary care.
Background:
To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis.
Methods:
Medline/PubMed, ClinicalKey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June, 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), or objective instruments such as polysomnography, actigraphy, and safety of the intervention. For each outcome, a standardized mean difference (SMD) and confidence intervals (CIs) of 95% were determined.
Results:
Nineteen studies in this systematic review included 1832 participants. The meta-analysis of the combined data conducted according to Comprehensive Meta-Analysis showed a significant improvement in sleep (SMD = - 0.327, 95% CI = - 0.506 to - 0.148, P < 0.001). Meta-analyses revealed positive effects of yoga using PSQI scores in 16 randomized control trials (RCTs), compared with the control group in improving sleep quality among women using PSQI (SMD = - 0.54; 95% CI = - 0.89 to - 0.19; P = 0.003). However, three RCTs revealed no effects of yoga compared to the control group in reducing insomnia among women using ISI (SMD = - 0.13; 95% CI = - 0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = - 0.15; 95% CI = - 0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri/postmenopausal women using PSQI (SMD = - 0.31; 95% CI = - 0.95 to 0.33; P = 0.34). Yoga was not associated with any serious adverse events.
Discussion:
This systematic review and meta-analysis demonstrated that yoga intervention in women can be beneficial when compared to non-active control conditions in term of managing sleep problems. The moderator analyses suggest that participants in the non-breast cancer subgroup and participants in the non-peri/postmenopausal subgroup were associated with greater benefits, with a direct correlation of total class time with quality of sleep among other related benefits.
Background:
Yoga was recommended in both clinical and nonclinical populations as therapy methods. The diversity of yoga practice as a therapy method has rarely been discussed and it is essential to address the effects of yoga on stress.
Primary study objective:
This article aims to investigate the effect of different types of yoga on stress in healthy population. On the other hand, the authors intended to figure out yoga effects on stress systematically.
Methods/design:
A systematic literature review was conducted to identify articles that assess the effect of yoga and yoga-related interventions on stress reduction in nonclinical populations. Studies were classified according to the length of the intervention, yoga type, and measures of outcome. The studies were selected throughout last 5 years (January 2014 to November 2018) by using the key searching term yoga and stress incorporation with tension and pressure. The selection process followed the Prisma flow diagram.
Results:
Totally, 12 articles elaborating on the effects of yoga or yoga-related interventions on stress management and remission were included in the review. This review included various types of yoga practice (e.g., Hatha yoga, Bikram yoga, Kundalini yoga, Sudarshan Kriya yoga, Kripalu yoga, Yin yoga). A time spectrum was conducted from 4 wks to 28 wks. This review revealed that most types of yoga have positive effects on stress reduction in heathy populations.
Conclusion:
Further studies are recommended to examine the long-term effect of yoga and underlying psychological mechanisms causing stress and mental restrain. In addition, it is suggested to consider age as a risk factor affecting the effect of yoga on stress.
Study Objectives
Research indicates that sleep efficiency below 80% substantially increases mortality risk in elderly persons. The aim of this study was to identify factors that would best predict poor sleep efficiency in the elderly, and to determine whether associations between these factors and sleep efficiency were similar for men and women and for younger and older elderly persons.
Methods
A total of 2,468 individuals aged 65–96 years (40.7% men) participated. They were recruited via random generation of telephone numbers according to a geographic sampling strategy. The participants agreed to have health professionals visit their home and to answer structured interview questions. Sleep efficiency was calculated based on interview responses. Descriptive statistics and logistic regressions were conducted.
Results
The factors most strongly associated with sleep efficiency below 80% were pain, nocturia, sleep medication use, and awakening from bad dreams. Some factors varied by sex: women aged 75 years and older or who had an anxiety disorder were more likely to have sleep efficiency below 80%, whereas being single or having painful illness raised the likelihood for men only. Except for sex, all the factors that showed associations with sleep efficiency affected younger and older elderly persons similarly.
Conclusion
Poor sleep efficiency is prevalent among elderly persons. The results shed new light on factors associated with poor sleep efficiency, highlighting the presence of sex differences and that certain factors make no significant contribution, such as typically proscribed sleep hygiene behaviors, mood disorders, and illness in general.
Background/Purpose: Sleep plays an important role in individuals health. The functions of the brain, the cardiovascular system, the immune system, and the metabolic system are closely associated with sleep. As a prevalent sleep disorder, insomnia has been closely concerned, and it is necessary to find effective therapies. In recent years, a growing body of studies has shown that mind-body therapies (MBTs) can improve sleep quality and ameliorate insomnia severity. However, a comprehensive and overall systematic review has not been conducted. In order to examine the effect of MBTs on insomnia, we conducted a systematic review and meta-analysis evaluating the effects of MBTs on sleep quality in healthy adults and clinical populations.
Methods: PubMed, EMBASE, the Cochrane Library and review of references were searched up to July 2018. English-language studies of all designs evaluating the effect of MBTs on sleep outcomes in adults with or without diseases were examined. To calculate the SMDs and 95% CIs, we used a fixed effect model when heterogeneity was negligible and a random effect model when heterogeneity was significant.
Results: 49 studies covering 4506 participants published between 2004 to 2018 were identified. Interventions included Meditation, Tai Chi, Qigong, and Yoga which lasted 4 to 24 weeks. The MBTs resulted in statistically significant improvement in sleep quality and reduction on insomnia severity, but no significant effects on sleep quantity indices, which were measured by sleep diary or objective measures. We analyzed the effects of Tai Chi and Qigong separately as two different MBTs for the first time and found that Qigong had a slight advantage over Tai Chi in the improvement of sleep quality. Subgroup analyses revealed that the effect of MBTs on sleep quality in healthy individuals was larger than clinical populations. The effect of MBTs might be influenced by the intervention duration but not the frequency.
Conclusions: MBTs can be effective in treating insomnia and improving sleep quality for healthy individuals and clinical patients. More high-quality and well-controlled RCTs are needed to make a better conclusion in further study.
There is a growing interest in the effectiveness of mindfulness meditation for sleep disturbed populations. Our study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. To assess for relative efficacy, comparator groups were restricted to specific active controls (such as evidenced‐based sleep treatments) and nonspecific active controls (such as time/attention‐matched interventions to control for placebo effects), which were analyzed separately. From 3303 total records, 18 trials with 1654 participants were included. We determined the strength of evidence using four domains (risk of bias, directness of outcome measures, consistency of results, and precision of results). At posttreatment and follow‐up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls (ES 0.03 (95% CI –0.43 to 0.49)) and (ES –0.14 (95% CI –0.62 to 0.34)), respectively. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention (ES 0.33 (95% CI 0.17–0.48)) and at follow‐up (ES 0.54 (95% CI 0.24–0.84)). These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
Complementary health is the use of holistic or unconventional medicine with mainstream Western medicine for health and wellness (1,2). Past research has identified yoga, meditation, and seeing a chiropractor as some of the most commonly used approaches (3). This report examines changes over time in the percentage of adults who used yoga, meditation, and chiropractors in the past 12 months, as well as variation by sex, age, and race and Hispanic origin. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Both very low and very high levels of regular physical activity have been associated with degraded sleep quality. Cross‐national variations in habitual physical activity levels, therefore, may contribute to cross‐national differences in insomnia prevalence. The present study assesses and compares the extent to which weekly durations of moderate‐intensity physical activity contribute to insomnia risk. Demographic, sleep, physical activity and general health profiles were obtained from a convenience sample of 9,238 adults drawn from five countries (South Africa, Australia, China, South Korea and the UK) using social media. Insomnia prevalence, using DSM‐5 criteria, ranged from 4.1% (China) to 14.8% (UK). Evaluating risk using logistic regression adjusted only for age and gender, the lowest level of activity (<10 continuous min per week) was associated with significant insomnia risk (odds ratio = 1.37; 95% confidence interval = 1.05–1.79; p < 0.05). However, when adjusted for all covariates except country, only the highest level of physical activity (>300 min per week) was associated with significantly increased insomnia risk (odds ratio = 1.30; 95% confidence interval = 1.03–2.51; p < 0.05). Risk associated with high activity remained after the addition of “country” to the model (odds ratio = 1.31; 95% confidence interval = 1.02–1.69; p < 0.05). Across all models, female gender, low‐rated health, low education and older age consistently increased insomnia risk. These cross‐national data indicate that extremes of inactivity/activity can significantly influence insomnia risk independent of country. Insomnia risk associated with very low levels of activity may be mediated by poorer health and disadvantageous social status. However, while very high levels of activity increase insomnia risk independent of health and demographic factors, they may also confound with personally and occupationally demanding lifestyles.
Medical yoga is defined as the use of yoga practices for the prevention and treatment of medical conditions. Beyond the physical elements of yoga, which are important and effective for strengthening the body, medical yoga also incorporates appropriate breathing techniques, mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have shown that yoga can positively impact the body in many ways, including helping to regulate blood glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It also has been shown to have important psychological benefits, as the practice of yoga can help to increase mental energy and positive feelings, and decrease negative feelings of aggressiveness, depression and anxiety.
BACKGROUND:Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. OBJECTIVES:The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. DATA SOURCES:We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. METHODS:Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. RESULTS:We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p
Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. Eleven randomized controlled trials examining a total of 1460 participants were included. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges's g) ranging from 0.21 to 1.09. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 wk follow-up. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.
Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.
Cognitive behavioral therapy for insomnia (CBT-I) is the most prominent nonpharmacologic treatment for insomnia disorders. Although meta-analyses have examined primary insomnia, less is known about the comparative efficacy of CBT-I on comorbid insomnia.
To examine the efficacy of CBT-I for insomnia comorbid with psychiatric and/or medical conditions for (1) remission from insomnia; (2) self-reported sleep efficiency, sleep onset latency, wake after sleep onset, total sleep time, and subjective sleep quality; and (3) comorbid symptoms.
A systematic search was conducted on June 2, 2014, through PubMed, PsycINFO, the Cochrane Library, and manual searches. Search terms included (1) CBT-I or CBT or cognitive behavioral [and its variations] or behavioral therapy [and its variations] or behavioral sleep medicine or stimulus control or sleep restriction or relaxation therapy or relaxation training or progressive muscle relaxation or paradoxical intention; and (2) insomnia or sleep disturbance.
Studies were included if they were randomized clinical trials with at least one CBT-I arm and had an adult population meeting diagnostic criteria for insomnia as well as a concomitant condition. Inclusion in final analyses (37 studies) was based on consensus between 3 authors' independent screenings.
Data were independently extracted by 2 authors and pooled using a random-effects model. Study quality was independently evaluated by 2 authors using the Cochrane risk of bias assessment tool.
A priori main outcomes (ie, clinical sleep and comorbid outcomes) were derived from sleep diary and other self-report measures.
At posttreatment evaluation, 36.0% of patients who received CBT-I were in remission from insomnia compared with 16.9% of those in control or comparison conditions (pooled odds ratio, 3.28; 95% CI, 2.30-4.68; P < .001). Pretreatment and posttreatment controlled effect sizes were medium to large for most sleep parameters (sleep efficiency: Hedges g = 0.91 [95% CI, 0.74 to 1.08]; sleep onset latency: Hedges g = 0.80 [95% CI, 0.60 to 1.00]; wake after sleep onset: Hedges g = 0.68; sleep quality: Hedges g = 0.84; all P < .001), except total sleep time. Comorbid outcomes yielded a small effect size (Hedges g = 0.39 [95% CI, 0.60-0.98]; P < .001); improvements were greater in psychiatric than in medical populations (Hedges g = 0.20 [95% CI, 0.09-0.30]; χ2 test for interaction = 12.30; P < .001).
Cognitive behavioral therapy for insomnia is efficacious for improving insomnia symptoms and sleep parameters for patients with comorbid insomnia. A small to medium positive effect was found across comorbid outcomes, with larger effects on psychiatric conditions compared with medical conditions. Large-scale studies with more rigorous designs to reduce detection and performance bias are needed to improve the quality of the evidence.
Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia.
To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia.
Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening.
Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia, with studies of insomnia comorbid with medical, sleep, or psychiatric disorders excluded.
Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%).
Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64% female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95% CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE% improved by 9.91% (CI, 8.09% to 11.73%), and changes seemed to be sustained at later time points. No adverse outcomes were reported.
Our narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and the accuracy of estimates at later time points was less clear.
CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes.
None. (PROSPERO: CRD42012002863).
Background
A growing number of randomized controlled trials (RCTs) have investigated the therapeutic value of yoga interventions. This bibliometric analysis aimed to provide a comprehensive review of the characteristics of the totality of available randomized yoga trials.
Methods
All RCTs of yoga were eligible. Medline/PubMed, Scopus, the Cochrane Library, IndMED, and the tables of content of yoga specialty journals not listed in medical databases were screened through February 2014. Bibliometric data, data on participants, and intervention were extracted and analyzed descriptively.
Results
Published between 1975 and 2014, a total of 366 papers were included, reporting 312 RCTs from 23 different countries with 22,548 participants. The median study sample size was 59 (range 8–410, interquartile range = 31, 93). Two hundred sixty-four RCTs (84.6%) were conducted with adults, 105 (33.7%) with older adults and 31 (9.9%) with children. Eighty-four RCTs (26.9%) were conducted with healthy participants. Other trials enrolled patients with one of 63 varied medical conditions; the most common being breast cancer (17 RCTs, 5.4%), depression (14 RCTs, 4.5%), asthma (14 RCTs, 4.5%) and type 2 diabetes mellitus (13 RCTs, 4.2%). Whilst 119 RCTs (38.1%) did not define the style of yoga used, 35 RCTs (11.2%) used Hatha yoga and 30 RCTs (9.6%) yoga breathing. The remaining 128 RCTs (41.0%) used 46 varied yoga styles, with a median intervention length of 9 weeks (range 1 day to 1 year; interquartile range = 5, 12). Two hundred and forty-four RCTs (78.2%) used yoga postures, 232 RCTs (74.4%) used breath control, 153 RCTs (49.0%) used meditation and 32 RCTs (10.3%) used philosophy lectures. One hundred and seventy-four RCTs (55.6%) compared yoga with no specific treatment; 21 varied control interventions were used in the remaining RCTs.
Conclusions
This bibliometric analysis presents the most complete up-to-date overview on published randomized yoga trials. While the available research evidence is sparse for most conditions, there was a marked increase in published RCTs in recent years.
Over the past decades, cognitive neuroscience has witnessed a shift from predominantly disembodied and computational views of the mind, to more embodied and situated views of the mind. These postulate that mental functions cannot be fully understood without reference to the physical body and the environment in which they are experienced. Within the field of contemplative science, the directing of attention to bodily sensations has so far mainly been studied in the context of seated meditation and mindfulness practices. However, the cultivation of interoceptive, proprioceptive and kinesthetic awareness is also said to lie at the core of many movement-based contemplative practices such as Yoga, Qigong, and Tai Chi. In addition, it likely plays a key role in the efficacy of modern somatic therapeutic techniques such as the Feldenkrais Method and the Alexander Technique. In the current paper we examine how these practices are grounded in the concepts of embodiment, movement and contemplation, as we look at them primarily through the lens of an enactive approach to cognition. Throughout, we point to a series of challenges that arise when Western scientists study practices that are based on a non-dualistic view of mind and body.
Context:
The aging process is associated with physiological changes that affect sleep. In older adults, undiagnosed and untreated insomnia may cause impaired daily function and reduced quality of life (QoL). Insomnia is also a risk factor for accidents and falls that are the main cause of accidental deaths in older adults and, therefore, is associated with higher morbidity and mortality rates in older populations.
Objectives:
The research team aimed to (1) examine the efficacy of a yoga intervention (YI) for the treatment of insomnia in older adults, (2) determine the ability of yoga to enhance the QoL of older adults, and (3) establish the applicability of yoga practice for older people in a Western cultural setting.
Design:
A waiting-list controlled trial. Settings • The study took place in Jerusalem, Israel, from 2008-2009.
Participants:
Participants were older men and women (age ≥ 60 y) with insomnia.
Intervention:
The YI group participated in 12 wk of classes, held 2 ×/wk, incorporating yoga postures, meditative yoga, and daily home practice of meditative yoga.
Outcome measures:
The study used self-report assessments of sleep quality using the following: (1) sleep quality-the Karolinska Sleepiness Scale (KSS), the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI), and daily sleep and practice logs; (2) mood states-the Depression Anxiety Stress Scale long form (DASS-42) and the Profile of Mood States short form (POMS-SF); (3) a health survey (SF-36); and (4) mobile at-home sleep studies.
Results:
Compared with controls, the YI group showed significant improvements in a range of subjective factors, including overall sleep quality; sleep efficiency; sleep latency and duration; self-assessed sleep quality; fatigue; general well-being; depression; anxiety; stress; tension; anger; vitality; and function in physical, emotional, and social roles.
Conclusions:
Yoga was shown to be safe and improved sleep and QoL in a group of older adults with insomnia. Outcomes depended on practice compliance.
Buddhist meditation practices have become a topic of widespread interest in both science and medicine. Traditional Buddhist formulations describe meditation as a state of relaxed alertness that must guard against both excessive hyperarousal (restlessness) and excessive hypoarousal (drowsiness, sleep). Modern applications of meditation have emphasized the hypoarousing and relaxing effects without as much emphasis on the arousing or alertness-promoting effects. In an attempt to counterbalance the plethora of data demonstrating the relaxing and hypoarousing effects of Buddhist meditation, this interdisciplinary review aims to provide evidence of meditation's arousing or wake-promoting effects by drawing both from Buddhist textual sources and from scientific studies, including subjective, behavioral, and neuroimaging studies during wakefulness, meditation, and sleep. Factors that may influence whether meditation increases or decreases arousal are discussed, with particular emphasis on dose, expertise, and contemplative trajectory. The course of meditative progress suggests a nonlinear multiphasic trajectory, such that early phases that are more effortful may produce more fatigue and sleep propensity, while later stages produce greater wakefulness as a result of neuroplastic changes and more efficient processing.
Yoga as a life-style practice has demonstrated beneficial effects. The role of yoga in the elderly for such benefits merits investigation.
The aim of this study is to examine the effects of yoga intervention on quality-of-life (QOL) and sleep quality in the elderly living in old age homes.
Single blind controlled study with block randomization of elderly homes.
A total of 120 subjects from nine elderly homes were randomized in to yoga group (n=62) and waitlist group (n=58). Subjects in the yoga group were given yoga intervention daily for 1 month and weekly until 3 months and were encouraged to practice yoga without supervision until for 6 months. Subjects in waitlist group received no intervention during this period. Subjects were evaluated with World Health Organization Quality of Life (WHOQOL)-BREF for measuring QOL and Pittsburgh Sleep Quality Index for sleep quality in the baseline and after 6 months.
Independent t-test and repeated measures analysis of covariance respectively was used to measure the difference in outcome measures between the two groups at baseline and after the study period.
Subjects in the yoga group had significantly higher number of years of formal education. Subjects in the yoga group had significant improvement in all the domains of QOL and total sleep quality after controlling for the effect of baseline difference in education between the two groups.
Yoga intervention appears to improve the QOL and sleep quality of elderly living in old age homes. There is a need for further studies overcoming the limitations in this study to confirm the benefits of yoga for elderly in QOL and sleep quality.
Background: An estimated 30-50% of the general population
is affected by insomnia and 10% have chronic insomnia. Yoga
therapy is beneficial in such disorders and it has fewer side
effects.
Aim: The aim of this study was to find out the effect of yoga
therapy on selected psychological variables among men with
insomnia.
Methods: Forty males with insomnia were divided randomly
into 2 groups (the experimental and the control groups). The
experimental group received eight weeks of yoga therapy, while
the control group did not receive any therapy. The pre and post
treatment stress and the self confidence scores were taken.
Results: There was a significant improvement in the stress
scores and the self confidence scores in the experimental
group. There were neither any side effects nor any drop outs.
Conclusion: We conclude that yoga is an effective treatment
option for the patients with insomnia. There are no major side
effects.
This pilot study evaluated the impact of Bikram Yoga on subjective and objective sleep parameters. We compared subjective (diary) and objective (headband sleep monitor) sleep measures on yoga versus nonyoga days during a 14-day period. Subjects (n = 13) were not constrained regarding yoga-practice days, other exercise, caffeine, alcohol, or naps. These activities did not segregate by choice of yoga days. Standard sleep metrics were unaffected by yoga, including sleep latency, total sleep time, and percentage of time spent in rapid eye movement (REM), light non-REM, deep non-REM, or wake after sleep onset (WASO). Consistent with prior work, transition probability analysis was a more sensitive index of sleep architecture changes than standard metrics. Specifically, Bikram Yoga was associated with significantly faster return to sleep after nocturnal awakenings. We conclude that objective home sleep monitoring is feasible in a low-constraint, real-world study design. Further studies on patients with insomnia will determine whether the results generalize or not.
Insomnia is the most common sleep disorder. Psychological, behavioral, and biological factors are implicated in the development and maintenance of insomnia as a disorder, although the etiology of insomnia remains under investigation, as it is still not fully understood. Cognitive behavioral therapy for insomnia (CBTI) is a treatment for insomnia that is grounded in the science of behavior change, psychological theories, and the science of sleep. There is strong empirical evidence that CBTI is effective. Recognition of CBTI as the first-line treatment for chronic insomnia (National Institutes of Health consensus, British Medical Association) was based largely on evidence of its efficacy in primary insomnia. The aim of this article is to provide background information and review recent developments in CBTI, focusing on three domains: promising data on the use of CBTI when insomnia is experienced in the presence of comorbid conditions, new data on the use of CBTI as maintenance therapy, and emerging data on the delivery of CBTI through the use of technology and in primary care settings.
The practice of yoga has been proven to have positive effects on reducing insomnia. Studies have also shown its effects on reducing climacteric symptoms. To date, however, no studies that evaluate the effects of yoga on postmenopausal women with a diagnosis of insomnia in a randomized clinical trial have been conducted. The aim of this study was to evaluate the effect of yoga practice on the physical and mental health and climacteric symptoms of postmenopausal women with a diagnosis of insomnia.
Postmenopausal women not undergoing hormone therapy, who were 50 to 65 years old, who had an apnea-hypopnea index less than 15, and who had a diagnosis of insomnia were randomly assigned to one of three groups, as follows: control, passive stretching, and yoga. Questionnaires were administered before and 4 months after the intervention to evaluate quality of life, anxiety and depression symptoms, climacteric symptoms, insomnia severity, daytime sleepiness, and stress. The volunteers also underwent polysomnography. The study lasted 4 months.
There were 44 volunteers at the end of the study. When compared with the control group, the yoga group had significantly lower posttreatment scores for climacteric symptoms and insomnia severity and higher scores for quality of life and resistance phase of stress. The reduction in insomnia severity in the yoga group was significantly higher than that in the control and passive-stretching groups.
This study showed that a specific sequence of yoga might be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia.
As insomnia is highly prevalent, and side effects of medication are well-known, mind-body interventions are increasingly being sought. The objective of this study is to present a narrative review regarding the effects of mind-body interventions for the treatment of insomnia.
A PubMed search was conducted including only randomized, controlled trials in which the main objective was to treat insomnia.
Twelve studies were selected. In three of the studies, objective parameters (polysomnography) were analyzed. Mind-body interventions were able to improve sleep efficiency and total sleep time. Most can ameliorate sleep quality; some can reduce the use of hypnotic drugs in those who are dependent on these drugs.
According to the studies we selected, self-reported sleep was improved by all mind-body treatments, among them yoga, relaxation, Tai Chi Chih and music. Cognitive behavioral therapy seems to be the most effective mind-body intervention. Cognitive behavioral therapy was the only intervention that showed better results than medication. However, considering that only five of the twelve studies chosen reached a score of 3 in the Jadad scale, new studies with a higher methodological quality have to be conducted especially in mind-body interventions that belong to the complementary or alternative medicine field.
Sleep restriction therapy (SRT) is one of the most effective treatments for insomnia. Restriction of time in bed (TIB) is assumed to be the central mechanism through which SRT improves sleep consolidation and reduces insomnia symptoms. This hypothesis has never been directly tested. We designed a randomised, controlled, dismantling trial in order to isolate the role of TIB restriction in driving both clinical and polysomnographic sleep outcomes.
Participants aged 25-55 who met DSM-5 diagnostic criteria for insomnia disorder were block-randomised (1:1) to four weeks of SRT or time in bed regularisation (TBR), a treatment that involves prescription of a regular but not reduced time in bed. The primary outcome was assessed with the insomnia severity index (ISI) at baseline, 4-, and 12-weeks post-randomisation. Secondary outcomes included sleep continuity (assessed via polysomnography, actigraphy, and diary) and quality of life. We performed intention-to treat analyses using linear mixed models.
Fifty-six participants (39 females, mean age=40.78±9.08) were assigned to SRT (n=27) or TBR (n=29). Daily monitoring of sleep via diaries and actigraphy confirmed large group differences in TIB (d range = 1.63-1.98). At 4-weeks post-randomisation the adjusted mean difference for the ISI was -4.49 (d=-1.40) and -4.35 at 12-weeks (d=-1.36), indicating that the SRT group reported reduced insomnia severity relative to TBR. Robust treatment effects in favour of SRT were also found for objective and self-reported sleep continuity variables (d range=0.40-0.92) and sleep-related quality of life (d=1.29).
For the first time we demonstrate that time in bed restriction is superior to the regularisation of time in bed on its own. Our results underscore the centrality of the restriction component in reducing insomnia symptoms and consolidating sleep.
Background. Cognitive arousal is central to models of sleep disturbance and insomnia, but findings are mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia.
Methods. Fifty-two adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal.
Results. Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency.
Conclusions. Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.
Over the past decade, the emergence of mindfulness meditation as a self-regulation practice has led to a substantial body of evidence on the use of mindfulness-based interventions (MBIs) for insomnia and sleep disturbances. This literature has matured with several randomized controlled trials now published and a number of systematic reviews and meta-analyses are recently available. Collectively, there is a general support for the effectiveness of MBIs on self-reported patient outcomes although the quality of studies varies and the findings on objective measures are equivocal. Building upon this literature, further research is needed to examine biological correlates associated with mindfulness practice, whether the timing of meditation practice is related to sleep outcomes, who is likely to succeed with MBI, and the use of technology in the delivery of MBIs.
Cognitive behavioral therapy for insomnia (CBT-I) is a treatment with moderate to large effects. These effects are believed to be sustained long-term, but no systematic meta-analyses of recent evidence exist. In this present meta-analysis, we investigate long-term effects in 30 randomized controlled trials (RCTs) comparing CBT-I to non-active control groups. The primary analyses (n =29 after excluding one study which was an outlier) showed that CBT-I is effective at 3-, 6- and 12-month compared to non-active controls: Hedges g for Insomnia severity index: 0.64 (3m), 0.40 (6m) and 0.25 (12m); sleep onset latency: 0.38 (3m), 0.29 (6m) and 0.40 (12m); sleep efficiency: 0.51 (3m), 0.32 (6m) and 0.35 (12m). We demonstrate that although effects decline over time, CBT-I produces clinically significant effects that last up to a year after therapy.
Objective:
Mindfulness-based interventions (MBI) have been shown to reduce subjective symptoms of insomnia but the effects on objective measures remain unclear. The purpose of this study was to examine sleep EEG microarchitecture patterns from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Therapy for Insomnia (MBTI).
Methods:
Sleep EEG spectral analysis was conducted on 36 participants with chronic insomnia (>6 months) randomized to 8-week MBSR, MBTI, or self-monitoring control (SM). Overnight polysomnography with 6-channel EEG was conducted at baseline, post-treatment, and 6-month follow-up. Spectral power averaged from channels C3/C4 across NREM epochs (excluding N1) was examined for within-group changes and relationships with self-report measures.
Results:
Increases in absolute NREM beta (16-25 Hz) power were observed from baseline to post-treatment (p = .02, d = 0.53) and maintained at 6-month follow-up (p = .01, d = 0.57) in the combined MBI groups, and additionally in the gamma (25-40 Hz) range at follow-up for the MBTI group only. No significant changes in these frequency bands were observed for SM. Following mindfulness intervention, NREM beta was positively associated with Five-Facet Mindfulness (FFM) score (rho = 0.37, p = .091) and negatively associated with Insomnia Severity Index (rho = -0.43, p = .047).
Conclusion:
These results in people with insomnia corroborate prior reports of increased high-frequency sleep EEG power associated with mindfulness training. This change in beta EEG pattern merits further evaluation as a potential marker of the effects of mindfulness meditation on sleep, especially given the paradoxical findings in the context of insomnia.
Clinical trial registration:
clinicaltrials.gov, NCT00768781.
Background:
Being a major health risk and very prevalent in the population, sleep problems are an important health care issue.
Methods:
We used the 2017 National Health Interview Survey (NHIS) to study the prevalence of sleep problems and the use of mind body medicine (MBM) among individuals with sleep problems in a representative sample of the US population (N = 26,742). Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of sleep problems and of MBM use in the past 12 months were identified.
Results:
The prevalence of sleep problems was 49.3%, with higher prevalence being associated with higher age, being female, being non-Hispanic White, and higher education. Among individuals with sleep problems, 29.8% used MBM vs. only 17.5% without. Being less than 30 years of age, female, non-Hispanic White, living in the Western US, having a higher education, and being diagnosed with heart disease predicted MBM use among individual's with sleep problems. Yoga (16.3%), spiritual meditation (13.6%), and mindfulness meditation (7.5%) were the most used MBM approaches.
Conclusion:
The characteristics of individuals with sleep problems were largely in line with the literature, while notably Whites were more prone to sleep problems than other ethnicities. MBM treatments commonly used were yoga, spiritual meditation and mindfulness meditation; although evidence supports its use for sleep problems, tai chi was used rarely by the wider population. Further studies should explore reasons for ethnical differences in MBM use and why some effective MBM approaches are not commonly used.
Insomnia is recognised as the most prevalent sleep disorder. Untreated insomnia carries a heavy burden for patients and society. Exercise is proposed as a safe, inexpensive, and accessible non-pharmacological treatment. To the author's knowledge this is the first systematic review to investigate the sleep-enhancing effects of exercise by focusing exclusively on controlled trials comprising poor sleepers only and examining interventions consistent with national guidelines. Using a narrative synthesis, this review aimed to identify whether exercise improves objective and subjective sleep outcomes for people with insomnia.
Five papers including participants with insomnia disorder, and six papers including participants with insomnia symptoms were identified through electronic database searches (CINAHL plus, PsycINFO, EMBASE, MEDLINE, SPORTDiscus, CENTRAL) and quality assessed using the Clinical Trial Assessment Measure.
We found that exercise interventions led to improvements in subjective sleep quality for people with insomnia disorder and insomnia symptoms. However, exercise only improved objective and subjective measures of sleep continuity (sleep onset latency and sleep efficiency) for people presenting with insomnia symptoms, with a reduction in sleep onset latency being the most consistently observed effect across studies.
The reliability of significant findings is reduced by methodological limitations. Recommendations are made to improve the quality of future research.
Objective. - To provide physicians with a responsible assessment of the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Participants. - A nonfederal, nonadvocate, 12- member panel representing the fields of family medicine, social medicine, psychiatry, psychology, public health, nursing, and epidemiology. In addition, 23 experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, and behavioral and neurosciences presented data to the panel and a conference audience of 528 during a 1 1/4 - day public session. Questions and statements from conference attendees were considered during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third day. Evidence. - The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. Assessment Process. - The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Conclusions. - A number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.
Background and objectives:
Practices that include yoga asanas and mindfulness-based stress reduction for the management of stress are increasingly popular; however, the neurobiological effects of these practices on stress reactivity are not well understood. Many studies investigating the effects of such practices fail to include an active control group. Given the frequency with which people are selecting such interventions as a form of self-management, it is important to determine their effectiveness. Thus, this review investigates the effects of practices that include yoga asanas, with and without mindfulness-based stress reduction, compared to an active control, on physiological markers of stress.
Materials and methods:
A systematic review and meta-analysis of randomised controlled trials published in English compared practices that included yoga asanas, with and without mindfulness-based stress reduction, to an active control, on stress-related physiological measures. The review focused on studies that measured physiological parameters such as blood pressure, heart rate, cortisol and peripheral cytokine expression. MEDLINE, AMED, CINAHL, PsycINFO, SocINDEX, PubMed, and Scopus were searched in May 2016 and updated in December 2016. Randomised controlled trials were included if they assessed at least one of the following outcomes: heart rate, blood pressure, heart rate variability, mean arterial pressure, C-reactive protein, interleukins or cortisol. Risk of bias assessments included sequence generation, allocation concealment, blinding of assessors, incomplete outcome data, selective outcome reporting and other sources of bias. Meta-analysis was undertaken using Comprehensive Meta-Analysis Software Version 3. Sensitivity analyses were performed using 'one-study-removed' analysis. Subgroup analysis was conducted for different yoga and control group types, including mindfulness-based stress reduction versus non-mindfulness-based stress reduction based interventions, different populations, length of intervention, and method of data analysis. A random-effects model was used in all analyses.
Results:
Forty two studies were included in the meta-analysis. Interventions that included yoga asanas were associated with reduced evening cortisol, waking cortisol, ambulatory systolic blood pressure, resting heart rate, high frequency heart rate variability, fasting blood glucose, cholesterol and low density lipoprotein, compared to active control. However, the reported interventions were heterogeneous.
Conclusions:
Practices that include yoga asanas appear to be associated with improved regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system in various populations.
Difficulty initiating and/or maintaining sleep is a common issue. Patients experiencing insomnia symptoms frequently self-treat their symptoms with sleep medications. However, there remains concern regarding acute and long-term health impact of sleep medications. This review discusses the evidence supporting integrative approaches to insomnia treatment, including cognitive-behavioral therapy, and mind-body therapies (mindfulness meditation, yoga, tai chi), as well as emerging data for use of other less well supported approaches (dietary supplements, acupuncture).
Study objectives:
This study examined whether individuals with insomnia and objective short sleep duration <6h, a subgroup with greater risks of adverse health outcomes, differ in their response to cognitive behavioral therapy for insomnia (CBT-I) when compared to individuals with insomnia and normal sleep duration >6h.
Methods:
Secondary analyses of a randomized, clinical trial with 60 adults participants (n=31 women) from a single academic medical center. Outpatient treatment lasted 8 weeks, with a final follow-up conducted at 6 months. Mixed-effects models controlling for age, sex, CBT-I treatment group assignment, and treatment provider examined sleep parameters gathered via actigraphy, sleep diaries, and an Insomnia Symptom Questionnaire (ISQ) across the treatment and follow-up period.
Results:
Six months post-CBT-I treatment, individuals with insomnia and normal sleep duration >6h fared significantly better on clinical improvement milestones than did those with insomnia and short sleep duration <6h. Specifically, individuals with insomnia and normal sleep duration had significantly higher insomnia remission [ISQ<36.5; X2(1, N=60) =44.72, P<.0001], more normative sleep efficiency on actigraphy [SE>80%; X2(1, N=60) =21, P<.0001], normal level of MWASO <31 minutes [X2(1, N=60) =37.85, P<.0001], and a >50% decline in MWASO [X2(1, N=60) =60, P<.0001] compared to individuals with insomnia and short sleep duration. Additionally, those with insomnia and normal sleep duration had more success decreasing their TWT at the 6-month follow-up compared to those with insomnia and short sleep duration [X2(2, N=60) =44.1, P<.0001]. Receiver operating characteristic curve analysis found that using a 6-h cutoff with actigraphy provided a 95.7% sensitivity and 91.9% specificity for determining insomnia remission, with the area under the curve = 0.986.
Conclusions:
Findings suggest that individuals with insomnia and objective short sleep duration <6h are significantly less responsive to CBT-I than those with insomnia and normal sleep duration >6h. Using an actigraphy TST cutoff of 6 hours to classify sleep duration groups was highly accurate and provided good discriminant value for determining insomnia remission.
Background:
Insomnia is a widespread and debilitating condition that affects sleep quality and daily productivity. Although mindfulness meditation (MM) has been suggested as a potentially effective supplement to medical treatment for insomnia, no comprehensively quantitative research has been conducted in this field. Therefore, we performed a meta-analysis on the findings of related randomized controlled trials (RCTs) to evaluate the effects of MM on insomnia.
Methods:
Related publications in PubMed, EMBASE, the Cochrane Library and PsycINFO were searched up to July 2015. To calculate the standardized mean differences (SMDs) and 95% confidence intervals (CIs), we used a fixed effect model when heterogeneity was negligible and a random effect model when heterogeneity was significant.
Results:
A total of 330 participants in 6 RCTs that met the selection criteria were included in this meta-analysis. Analysis of overall effect revealed that MM significantly improved total wake time and sleep quality, but had no significant effects on sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, total wake time, ISI, PSQI and DBAS. Subgroup analyses showed that although there were no significant differences between MM and control groups in terms of total sleep time, significant effects were found in total wake time, sleep onset latency, sleep quality, sleep efficiency, and PSQI global score (absolute value of SMD range: 0.44-1.09, all p<0.05).
Conclusions:
The results suggest that MM may mildly improve some sleep parameters in patients with insomnia. MM can serve as an auxiliary treatment to medication for sleep complaints.
Aims and objectives:
Although many studies have assessed the efficacy of yoga in older individuals, minimal research has focused on how nurses use yoga to improve sleep quality and to reduce work stress after work hours. We used the Pittsburgh Sleep Quality Index in Chinese and the Questionnaire on Medical Worker's Stress in Chinese to determine the impact of yoga on the quality of sleep and work stress of staff nurses employed by a general hospital in China.
Background:
Disturbances in the circadian rhythm interrupt an individual's pattern of sleep.
Study design:
Convenient sampling method.
Methods:
One hundred and twenty nurses were randomised into two groups: a yoga group and a non-yoga group. The yoga group performed yoga more than two times every week for 50-60 minutes each time after work hours. The NG group did not participate in yoga. After six months, self-reported sleep quality and work stress were compared between the two groups, and then we used linear regression to confirm the independent factors related to sleep quality.
Results:
Nurses in the yoga group had better sleep quality and lower work stress compared with nurses in the non-yoga group. The linear regression model indicated that nursing experience, age and yoga intervention were significantly related to sleep quality.
Conclusion:
Regular yoga can improve sleep quality and reduce work stress in staff nurses.
Relevance to clinical practice:
This study provides evidence that hospital management should pay attention to nurse sleep quality and work stress, thereby taking corresponding measures to reduce work pressure and improve health outcomes.
Objective: Insomnia is a prevalent disorder in the United States and elsewhere, has been associated with a range of somatic and psychiatric conditions, and adversely affects quality of life, productivity at work, and school performance. The objective of this study was to examine the trend in self-reported reported insomnia and excessive daytime sleepiness among US adults.
Methods: We used data of participants aged ≥20 years from the National Health Interview Survey for the years 2002 (30,970 participants), 2007 (23,344 participants), and 2012 (34,509 participants).
Results: The unadjusted prevalence of insomnia or trouble sleeping increased from 17.5% (representing 37.5 million adults) in 20002 to 19.2% (representing 46.2 million adults) in 2012 (relative increase: +8.0%) (P trend <0.001). The age-adjusted prevalence increased from 17.4% to 18.8%. Significant increases were present among participants aged 18-24, 25-34, 55-64, and 65-74 years, men, women, whites, Hispanics, participants with diabetes, and participants with joint pain. Large relative increases occurred among participants aged 18-24 years (+30.9%) and participants with diabetes (+27.0%). The age-adjusted percentage of participants who reported regularly having excessive daytime sleepiness increased from 9.8% to 12.7% (P trend <0.001). Significant increases were present in most demographic groups. The largest relative increase was among participants aged 25-34 years (+49%). Increases were also found among participants with hypertension, chronic obstructive pulmonary disease, asthma, and joint pain.
Conclusions: Given the deleterious effects that insomnia has on health and performance, the increasing prevalence of insomnia and excessive daytime sleepiness among US adults is a potentially troubling development.
Fourteen self-reported insomniacs (SRI) and 14 good sleepers (GS) had their cardiac neuronal activity assessed by heart rate variability (HRV) under controlled respiration at a slow frequency rate of 0.1 Hz, and a forced rate of 0.2 Hz during daytime rest. Nighttime sleep was measured by polysomnography. The SRI showed depressed high frequency power of HRV compared to the GS. An increased total power of HRV was observed among the SRI during slow, paced breathing compared with spontaneous breathing and 0.2 Hz. Sleep onset latency, number of awakenings, and awakening time during sleep were decreased and sleep efficiency was increased if SRI practiced slow, paced breathing exercises for 20 min before going to sleep. Our results indicate that there is autonomic dysfunction among insomniacs, especially in relation to vagal activity; however, this decreased vagal activity can be facilitated by practicing slow, paced breathing, thereby improving sleep quality.
Study objectives:
To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.
Design:
Randomized controlled, comparative efficacy trial.
Setting:
Los Angeles community.
Patients:
123 older adults with chronic and primary insomnia.
Interventions:
Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.
Measurements:
Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.
Results:
CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.
Conclusions:
Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.
Study objectives:
To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia.
Design:
Three-arm, single-site, randomized controlled trial.
Setting:
Academic medical center.
Participants:
Fifty-four adults with chronic insomnia.
Interventions:
Participants were randomized to either mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or an eight-week self-monitoring (SM) condition.
Measurements and results:
Patient-reported outcome measures were total wake time (TWT) from sleep diaries, the pre-sleep arousal scale (PSAS), measuring a prominent waking correlate of insomnia, and the Insomnia Severity Index (ISI) to determine remission and response as clinical endpoints. Objective sleep measures were derived from laboratory polysomnography and wrist actigraphy. Linear mixed models showed that those receiving a meditation-based intervention (MBSR or MBTI) had significantly greater reductions on TWT minutes (43.75 vs 1.09), PSAS (7.13 vs 0.16), and ISI (4.56 vs 0.06) from baseline-to-post compared to SM. Post hoc analyses revealed that each intervention was superior to SM on each of the patient-reported measures, but no significant differences were found when comparing MBSR to MBTI from baseline-to-post. From baseline to 6-month follow-up, MBTI had greater reductions in ISI scores than MBSR (P < 0.05), with the largest difference occurring at the 3-month follow-up. Remission and response rates in MBTI and MBSR were sustained from post-treatment through follow-up, with MBTI showing the highest rates of treatment remission (50%) and response (78.6%) at the 6-month follow-up.
Conclusions:
Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia.
Trial registration:
Mindfulness-Based Approaches to Insomnia: clinicaltrials.gov, identifier: NCT00768781.
This review will examine objective physiological abnormalities and medical comorbidities associated with insomnia and assess the need to measure parameters associated with these abnormalities for diagnosis and to monitor treatment outcomes. Findings are used to develop a decision tree for the work-up of insomnia patients. Currently available measures and those with possible future predictive value will be discussed. Costs, advantages, and the development of screening laboratory tests will be presented. It is concluded that there is a need to differentially evaluate insomnia patients based upon their comorbidities and the presence of objectively decreased total sleep time to direct optimal treatment. The development of objective diagnostic criteria and treatment outcome goals beyond subjective symptomatic relief will establish insomnia as a true medical problem and improve patient care.
To describe yoga practice and health characteristics of individuals who practice yoga, and to explore their beliefs regarding the effects of their yoga practice on their health.
A cross-sectional design with anonymous online surveys.
4307 randomly selected individuals from 15 US Iyengar yoga studios (n=18,160), representing 41 states; 1087 individuals responded, with 1045 (24.3%) surveys completed.
Freiberg Mindfulness Inventory, Mental Health Continuum (subjective well-being), Multi-factor Screener (diet), PROMIS sleep disturbance, fatigue, and social support, International Physical Activity Questionnaire.
Age: 19-87 years (M=51.7±11.7), 84.2% female, 89.2% white, 87.4% well educated (≥bachelor's degree). Mean years of yoga practice=11.4 (±7.5). BMI=12.1-49.4 (M=23.1±3.9). Levels of obesity (4.9%), smoking (2%), and fruit and vegetable consumption (M=6.1±1.1) were favorable compared to national norms. 60% reported at least one chronic/serious health condition, yet most reported very good (46.3%) or excellent (38.8%) general health. Despite high levels of depression (24.8%), nearly all were moderately mentally healthy (55.2%) or flourishing (43.8%). Participants agreed yoga improved: energy (84.5%), happiness (86.5%), social relationships (67%), sleep (68.5%), and weight (57.3%), and beliefs did not differ substantially according to race or gender. The more they practiced yoga, whether in years or in amount of class or home practice, the higher their odds of believing yoga improved their health.
Individuals who practice yoga are not free of health concerns, but most believe their health improved because of yoga. Yoga might be beneficial for a number of populations including elderly women and those with chronic health conditions.
Although several diagnostic systems define insomnia, little is known about the implications of using one versus another of them.
The America Insomnia Survey, an epidemiological survey of managed health care plan subscribers (n = 10,094), assessed insomnia with the Brief Insomnia Questionnaire, a clinically validated scale generating diagnoses according to DSM-IV-TR; International Statistical Classification of Diseases, Tenth Revision (ICD-10); and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) criteria. Regression analysis examines associations of insomnia according to the different systems with summary 12-item Short-Form Health Survey scales of perceived health and health utility.
Insomnia prevalence estimates varied widely, from 22.1% for DSM-IV-TR to 3.9% for ICD-10 criteria. Although ICD insomnia was associated with significantly worse perceived health than DSM or RDC/ICSD insomnia, DSM-only cases also had significant decrements in perceived health. Because of its low prevalence, 66% of the population-level health disutility associated with overall insomnia and 84% of clinically relevant cases of overall insomnia were missed by ICD criteria.
Insomnia is highly prevalent and associated with substantial decrements in perceived health. Although ICD criteria define a narrower and more severe subset of cases than DSM criteria, the fact that most health disutility associated with insomnia is missed by ICD criteria, while RDC/ICSD-only cases do not have significant decrements in perceived health, supports use of the broader DSM criteria.
There is a large body of evidence that Cognitive Behavioral Therapy for insomnia (CBT) is an effective treatment for persistent insomnia. However, despite two decades of research it is still not readily available, and there are no immediate signs that this situation is about to change. This paper proposes that a service delivery model, based on "stepped care" principles, would enable this relatively scarce healthcare expertise to be applied in a cost-effective way to achieve optimal development of CBT services and best clinical care. The research evidence on methods of delivering CBT, and the associated clinical leadership roles, is reviewed. On this basis, self-administered CBT is posited as the "entry level" treatment for stepped care, with manualized, small group, CBT delivered by nurses, at the next level. Overall, a hierarchy comprising five levels of CBT stepped care is suggested. Allocation to a particular level should reflect assessed need, which in turn represents increased resource requirement in terms of time, cost and expertise. Stepped care models must also be capable of "referring" people upstream where there is an incomplete therapeutic response to a lower level intervention. Ultimately, the challenge is for CBT to be delivered competently and effectively in diversified formats on a whole population basis. That is, it needs to become "scalable". This will require a robust approach to clinical governance.