RELAXATION, MINDFULNESS, MEDITATION AND SLEEP – The research evidence base
Before listing the research, allow me to say this. Having assisted people for over 4 decades to apply relaxation, mindfulness and meditation to manage their sleep disturbances, three things really stand out.
- Regular relaxation-based mindfulness and meditation improve sleep patterns significantly
Over the years, many people have reported significant sleep benefits when they practice using the key practices we have included on the Allevi8 App. My sense of this is the deep physical relaxation is very important as a foundation, and then mindfulness and meditation lead to a calmer, more relaxed mind. The two together then combine so that many people, including those dealing with major illnesses like cancer and MS report it is easier to go to sleep, easier to get back to sleep if they do happen to wake, and their quality of sleep feels deeper and more refreshing.
So in fact, many of the people I have helped sleep better found regular practice was the key. The 3 practices most commonly agreed upon to be helpful have been the Deep Relaxation, the Main Practice and the Healing Light Imagery practices.
- Specific techniquesfor when you need extra help
The best support to use as you are going to sleep, or to use again if you do need help to return to sleep during the night, is the simplified Deep Relaxation exercise. As guided in the Sleep section of Allevi8, this exercise has a simple introduction and at the end it fades into silence. Many people have told me they fall asleep around half way through when listening to this track in bed, and many have used it repeatedly without ever hearing how it ends!
- Attitude is important
As we all know, worrying does not help, so do what you can to let go of dwelling on whether you are sleeping or not, how much you are sleeping, or how often you are waking. This approach is actually supported by sleep research that indicates we receive almost as much benefit from simply lying in bed relaxed, as we might from being fully asleep. Maybe this is where the Deep Relaxation exercise comes in again. This exercise does reliably lead to deep relaxation of body and mind, so do what you can to let go of any worry and simply relax into the exercises and the restful nature of simply being in bed.
WHAT DOES THE RESEARCH HAVE TO SAY?
- The size of the problem
Sleep disturbance is widespread with significant adverse consequences on quality of life for the individual and significant economic burden for society. Approximately 6% to 20% of adults suffer from an insomnia disorder, characterized as persistent difficulty falling or staying asleep with concomitant waking dysfunction, making it the most prevalent sleep disorder.
Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn, Sleep Med Rev, 2002, vol. 6 – P97-111
Morin CM et al. Prevalence of insomnia and its treatment in Canada, Can J Psychiatry, 2011, Vol 6- P540- 548.
Roth T et al, Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, second edition criteria: results from the America insomnia survey, Biol Psychiatry, 2011, Vol 69, P 592 – 600.
- What might be possible? Early research
Although meditation is about cultivating restful awareness, it can help to significantly improve sleep. Early research indicated meditation to be associated with better sleep quality, being able to go to sleep more easily, longer sleep duration and less use of sleep medications.
Cohen L et al, Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004 May 15;100(10):2253-60.
These benefits may explain why meditation also can be responsible for reducing depression in those with chronic insomnia.
Britton WB, Haynes PL, Fridel KW, Bootzin RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med. 2010 Jul;72(6):539-48.
- Recent mindfulness and meditation sleep studies
What follows is a sample of some of the recent individual mindfulness and meditation sleep studies with links to the original articles. While not a definitive research compilation, they provide evidence to support the common clinical experience that both regular relaxation, mindfulness and meditation practice, along with the use of specific techniques, does in fact improve sleep patterns significantly.
- i) Alleviating chronic insomnia
This study involving 54 people, found mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia.
Jason C. Ong, PhD, Rachel Manber, PhD, Zindel Segal, PhD, Yinglin Xia, PhD, Shauna Shapiro, PhD, James K. Wyatt, PhD, A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia, Sleep, Volume 37, Issue 9, 1 September 2014, Pages 1553–1563,
- ii) Deep Relaxation alleviates anxiety and improves sleep for people affected by COVID-19
The researchers commented that through clinical observation, many COVID-19 patients developed anxiety and sleep disturbances after isolation treatment. Anxiety, as a kind of psychological stress, will trigger a series of physiological events and cause a decrease in immunity. Because the symptoms are mild in the early stage, but can suddenly worsen after a few days, the use of benzodiazepine-type sleep-promoting drugs may cause respiratory depression and delay the observation of the disease.
Therefore the Progressive Muscle Relaxation as used in the Deep Relaxation exercise on Allevi8) was trialled. Fifty one patients who entered a Hospital isolation ward were included in the study and randomly divided into experimental and control groups. The experimental group used progressive muscle relaxation (PMR) technology for 30 min per day for 5 consecutive days. During this period, the control group received only routine care and treatment.
The study concluded that using the Progressive Muscle Relaxation exercise (as guided during the Deep Relaxation exercise on Allevi8) as an auxiliary method can reduce anxiety and improve sleep quality in patients with COVID-19.
Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract. 2020;
iii) Reducing depression and fatigue; improving sleep
This randomised clinical trial showed Mindfulness Awareness Practices led to significant improvement relative to a thorough Sleep Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity.
Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(4):494–501.
iii) How does mindfulness improve sleep?
The authors of this study suggested that awareness and acceptance could be the mechanisms of mindfulness interventions in improving sleep quality, partly via reducing psychological stress.
Lau WKW, Leung MK, Wing YK, Lee TMC. Potential Mechanisms of Mindfulness in Improving Sleep and Distress. Mindfulness (N Y). 2018;9(2):547-555.
- iv) Does mindfulness lead in to better sleep?
This research examined whether a brief mindfulness induction immediately prior to sleep following night training might improve athletes’ sleep. University athletes were randomly assigned into experimental group (n= 32) and control group (n= 31). Following night training and just prior to sleep, those in the experimental group received a self-administered brief 6-min mindfulness induction via a video clip, whereas the control group participants viewed a similar 6-min video devoid of mindfulness induction passively. Results showed reduced pre-sleep arousal, and improved level of rest and overall sleep quality, but not sleep duration. These findings suggest that the brief mindfulness induction may be an effective approach for decreasing pre-sleep arousal and improving sleep quality after night training among athletes.
Effect of Brief Mindfulness Induction on University Athletes’ Sleep Quality Following Night Training. Li C et al; Front. Psychol., 12 April 2018
- v) Sleep quality– Mindfulness meditation interventions produce significant improvements – a meta- analysis
From 3303 total records, this study examined 18 trials with a total of 1654 participants. The study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. 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. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention and at follow-up.
These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
Rusch HL, Rosario M, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5-16.