Mindfulness Versus Pharmacotherapy for Chronic Insomnia: A Pilot Study

The NIH's 2003 National Sleep Disorders Research Plan defines insomnia as "difficulty falling asleep, difficulty staying asleep or short sleep duration, despite adequate opportunity for sleep," and estimates that it affects 30% to 40% of adults. The prevalence of chronic insomnia, defined as sleep disturbances for 4 weeks or more, sleep disruption with daytime impairment, or regular, nightly sleep difficulty, is about 10% of the general population, with higher rates among women, older adults and clinical populations. Total direct and indirect costs of insomnia are estimated to be roughly $113 billion annually. While only about 3 million of the 70 million Americans with insomnia take prescription medications, annual prescription drug costs for insomnia exceed $2.1 billion dollars.

Mindfulness-Based Stress Reduction (MBSR), a standardized group program of training in mindfulness meditation and yoga, is a promising intervention for lifelong self-management of chronic insomnia. Mindfulness meditation training has been found to improve sleep outcomes in patients with chronic illnesses. Meditation may be defined as self-regulation of attention, and mindfulness has been described as paying attention in a particular, intentional way, moment-by-moment, without judging. MBSR originated with the Stress Reduction Clinic at the University of Massachusetts Medical Center and is currently used in over 250 clinics, hospitals, and health maintenance organizations in the US and abroad (www.umassmed.edu/cfm/srp/).

MVP#1 is a pilot study to establish feasibility, refine procedures and determine the optimal design for a planned full-scale trial. An active control drug, eszopiclone which is a widely used and FDA approved prescription sleep medication, is included in the pilot to provide a benchmark for efficacy. Outcomes will evaluated to determine if clinically important impacts are likely to be obtainable in the future full-scale trial.

Inclusion criteria

• Chronic insomnia defined as a) sleep onset latency and/or wake after sleep onset longer than 30 minutes per night, at least 3 nights per week; and b) Insomnia duration of at least 6 months, by self-report; and c) minimum of 1 daytime complaint by self-report (e.g. fatigue, mood disturbance);
• Between 18 and 65 years of age;
• English-speaking;
• Literate;
• Mentally intact;
• Interested in either medication or mind-body interventions;
• Able to attend weekly classes in a Minnesota Metro area;
• Able to comply with study sleep monitoring requirements;
• Willing to complete the informed consent process.

Exclusion criteria

• Sleep apnea or other primary sleep disorder suspected of being responsible for insomnia;
• Mental disorder or substance (including medications) suspected of being responsible for insomnia;
• General medical condition suspected of being responsible for the insomnia;
• Medically unstable (a hospital admission for non-elective purposes in the last 3 months or major surgery planned in the next 3 months);
• Serious preexisting mental health issues: suicidality or thought disorder/psychosis; or delirium or substance abuse;
• Treatment for depression or anxiety with initiation of therapy or dosage change within the last 6 months;
• Use of non-prescription sleep aids and unwilling or unable to discontinue these during the study;
• Use of prescription sleep medications or other medications known to affect sleep or be contraindicated with use of hypnotics, and unwilling or unable to discontinue these during the study;
• Known allergy to eszopiclone;
• Shift worker;
• Pregnant , breast-feeding or planning pregnancy in next 6 months;
• Previous cognitive behavioral therapy for insomnia or current psychotherapy;
• Prior MBSR class or regularly practicing mindfulness meditation.