Sleep quality and quantity is increasingly recognized as a key determinant of physical and mental well-being. The long work hours and demanding schedules of medical professionals and trainees can predispose people to serious sleep deprivation, putting health care professionals at substantially higher risk for Alzheimer’s disease, metabolic syndrome and cardiovascular disease (to name a few). Poor sleep can also contribute to more errors in the workplace and impacts our ability to focus and absorb new information. As medical students, generally we want to our brains to be primed for learning on any rotation. Additionally, the stress that often accompanies medical training can both feed into poor sleep hygiene and be exacerbated by it. So, this prompts the question: can meditation be useful for sleep?
A study (1) done at University of California, Los Angles recruited and randomized older adults (>55 years old) with sleep disturbance into a structured mindfulness meditation program or a structured sleep hygiene course. The mindfulness program (available online here -> http://marc.ucla.edu) consisted of 2-hour sessions for 6 weeks done in a group, with 5-20 minutes of daily meditation done alone. This was compared to a sleep-based hygiene course which was 2 hours per week for 6 weeks which acted as the control. The researchers primarily looked at self-reported sleep quality (PSQI: Pittsburgh Sleep Quality Index). Secondary study outcomes included depression, fatigue, and perceived stress and anxiety. Additionally, sleep disruption has been linked with increased plasma levels of NF-kB, an inflammatory protein, so this was also monitored in study participants.
The study found that sleep quality improved in both groups but there was a greater improvement observed in those receiving the mindfulness-based course. With regards to depression, anxiety and self-reported fatigue, the mindfulness-based intervention showed significant changes on these scales between baseline and postintervention scores. Individuals doing the sleep hygiene course saw similar improvement in self-reported fatigue, but no significant change on the other scales. The changes in sleep quality and daytime functioning observed amongst participants in the mindfulness group are considered clinically relevant with an effect size 0.89. This compares favourably with pharmacotherapy for insomnia which several meta-analyses have shown have mean effect sizes of 0.87 (2,3). The inflammatory protein, NF-kB, decreased significantly in both groups between the baseline and post-intervention visit. The authors concluded that mindfulness meditation may be introduced to older adults as a short-term solution for moderate sleep disturbance. But what is really going on here, mechanistically? It is suggested that mindfulness may attenuate automatic arousal and distress and increase relaxation by imparting increased control over the autonomic nervous system, reducing worry and rumination.
What does this mean for the average medical student? This study focused on older adults who are already experiencing sleep disturbances, so it does not directly apply to medical students. That said, it does indicate that mindfulness could be one of many tools available to induce relaxation and improve sleep in adults. So, if you have ever felt extremely exhausted after a long day of clinic or studying at the library – so tired you might fall asleep right there – but then you immediately perk up when your head hits the pillow, your mind racing with to-do lists an thoughts of the day, a daily meditation practice might be worth a try.
References
(1) Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. 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. doi:10.1001/jamainternmed.2014.8081
(2) Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29(9):1155-1173.
(3) Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF III, Kupfer DJ. Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. JAMA. 1997;278(24):2170-2177.
This article was written by Zoe O’Neill, a medical student at McGill University and member of the McGill Med Mindfulness Team.
The Mindful Medical Learner 