Introducing insomnia meditation therapy: A novel behavioural intervention for insomnia

Abstract

Insomnia is a common condition, which is often trivialized by treating physicians. Primary Insomnia is widely viewed as a disorder of underlying inappropriate hyper-arousal interfering with sleep. Pharmaceutical treatments are effective during their duration of use but one needs to be cautious with potential adverse effects. Behavioral interventions maintain their efficacy long after the treatment period but their use is limited for a variety of reasons including the significant time involvement. There has been growing interest in alternative and complementary therapies with much of their appeal in their ability to be used in conjunction with or instead of conventional pharmaceutical therapies. Insomnia Meditation Therapy was developed during a Sleep Medicine fellowship at the University of Toronto as an easy to learn, brief behavioral intervention. Learning Objectives: (1). Review current evidence for underlying hyperarousal as it relates to Insomnia; (2) Become familiar with a novel meditation intervention specifically targeting hyperarousal; and (3) Review promising preliminary clinical results and ongoing future research. Thirty-four participants had three instructional sessions of meditation in a group format over the course of a month during 2011–2012. Each session lasted 45 min and incrementally taught breathing exercises, a technique of meditative imagery (MI) and a Non-Judgmental Awareness (NJA) meditation. Participants were asked to practice once during the day and immediately prior to bedtime for 20–30 min each time. The impact of IMT was assessed by validated questionnaires, AIS and PSQI. In addition the seven components of the PSQI were independently evaluated to determine which aspect of sleep quality improved. The results showed that 65% ( N = 22) participants’ improved as assessed by scores on both the AIS and PSQI. Specifically the mean AIS score of these 22 participants improved from 12.9 to 7.9 (SD = 3.6) at 3–4 weeks post introduction of IMT. Furthermore an analysis of the PSQI components revealed participant improvement as follows: 45.5% on daytime dysfunction, 44% on sleep efficiency, 39% on sleep latency, 38% on sleep quality, 34% on sleep duration, 21% on decreased medication use. Thus a substantial number of participants improved, and the improvements were substantial and critical. Not only did 65% of participants improve, on average they improved to a point of clinical significance (AIS < 10). Sleep quality improved (latency, efficiency and daytime dysfunction) and there was a trend towards decreased medication use. The implications of these observations are far reaching indeed if confirmed in future research. Compared to the other major meditation therapy developed to date (MBT-I), IMT is easier to teach and learn, less time invasive and less demanding for the practitioner and professional, produces a palpable reaction during the first session and has demonstrated improved nocturnal sleep and daytime function at 3–4 weeks post introduction. It can be considered the ultimate wind down routine prior to bedtime and be used in conjunction with other behavior and pharmaceutical treatments. The mentorship and opportunity offered by Drs. Colin Shapiro and Henry Moller, Sleep Research Laboratory and Sleep and Alertness Clinic, Toronto, Ontario, Canada.