Richard R. Bootzin

The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study

OBJECTIVE The diagnosis of breast cancer, the most common type of cancer among American women, elicits greater distress than any other diagnosis regardless of prognosis. Therefore, the present study examined the efficacy of a stress reduction intervention for women with breast cancer. METHODS As part of a larger, randomized, controlled study of the effects on measures of stress of a mindfulness-based stress reduction (MBSR) intervention for women with breast cancer, the current analyses examined the effects on sleep complaints. RESULTS Analyses of the data indicated that both MBSR and a free choice (FC) control condition produced significant improvement on daily diary sleep quality measures though neither showed significant improvement on sleep-efficiency. Participants in the MBSR who reported greater mindfulness practice improved significantly more on the sleep quality measure most strongly associated with distress. CONCLUSION MBSR appears to be a promising intervention to improve the quality of sleep in woman with breast cancer whose sleep complaints are due to stress.

Naps Promote Abstraction in Language-Learning Infants

Infants engage in an extraordinary amount of learning during their waking hours even though much of their day is consumed by sleep. What role does sleep play in infant learning? Fifteen-month-olds were familiarized with an artificial language 4 hr prior to a lab visit. Learning the language involved relating initial and final words in auditory strings by remembering the exact word dependencies or by remembering an abstract relation between initial and final words. One group napped during the interval between familiarization and test. Another group did not nap. Infants who napped appeared to remember a more abstract relation, one they could apply to stimuli that were similar but not identical to those from familiarization. Infants who did not nap showed a memory effect. Naps appear to promote a qualitative change in memory, one involving greater flexibility in learning.

Stimulus Control Instructions

The goals of stimulus control instructions are to help the insomniac learn to fall asleep quickly and to maintain sleep. These goals are reached by strengthening the bed as a cue for sleep, weakening it as a cue for activities that might interfere with sleep, and helping the insomniac acquire a consistent sleep rhythm. Although there are many causes of insomnia, poor sleep habits are often an important contributor.

The Prevalence of Nightmares and Their Independence From Anxiety

Although several studies have examined the prevalence of nightmares and their relationship to anxiety, this is the first to have used daily dream logs, rather than retrospective self-reports, to monitor nightmare frequency. 220 undergraduates were administered self-report measures of anxiety and for 2 weeks recorded the number of their nightmares in logs. 47% of Ss reported at least one nightmare during the study period. The dream logs yielded an estimated mean annual nightmare frequency of 23.6, which is 2.5 times as great as the estimate yielded by retrospective reports (p less than .01). Nightmare frequency and anxiety were uncorrelated. The findings indicate that nightmares are more prevalent than has been reported, and their frequency unrelated to self-reported anxiety.

An evaluation of behavioral treatments for insomnia in the older adult

Behavioral treatments were evaluated for their effect on the subjective and objective sleep of older adult insomniacs (N = 53) aged 47 to 76 years. Conditions were support and sleep hygiene, support and sleep hygiene plus progressive relaxation, support and sleep hygiene plus stimulus control, or a measurement control group. The results indicated that all groups, including the measurement control group, were effective in improving the sleep diary assessed awakenings, nap time, and feeling refreshed upon awakening. Subjects at 3 weeks felt less depressed and felt that they had more control over their sleep. Stimulus control was most effective in improving sleep at the posttherapy period. A 2-year follow-up showed that the stimulus control subjects most frequently used the treatment instructions and had shorter sleep latencies and highest sleep quality. Behavioral treatments were found to be effective in improving the perception of sleep among older adult insomniacs.

Effects of the 1989 San Francisco earthquake on frequency and content of nightmares.

In a systematic evaluation of the effects of a natural disaster on nightmares, nightmare frequency was found to be about twice as high among 92 San Francisco Bay area college students as among 97 control subjects in Tucson, Arizona, after the 1989 Loma Prieta earthquake. Subjects in California had not only more nightmares in general but substantially more nightmares about earthquakes. Over a 3-week period, about 40% of those in the San Francisco Bay area reported one or more nightmares about an earthquake, as compared with only 5% of those in Arizona. However, nightmares about earthquakes were not more emotionally intense than other nightmares. These findings support the long-held view that the experience of a potentially traumatic event can result in more frequent nightmares, particularly about the event itself, but contradict the common opinion that nightmares about such events are unusually intense.

The Contribution of Mindfulness Practice to a Multicomponent Behavioral Sleep Intervention Following Substance Abuse Treatment in Adolescents: A Treatment Development Study

Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use-related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.

Sleep and the Menstrual Cycle

To evaluate changes in sleep across the phases of the menstrual cycle, sleep-wake diaries were completed by 32 healthy women twice daily for 2 menstrual cycles. There was a significant increase in sleep onset latency and a significant decrease in sleep efficiency and sleep quality during the luteal phase. This increase in sleep disturbance was observed in the entire sample and was not related to the severity of other premenstrual symptoms. However, women having increased severity of other premenstrual symptoms reported greater luteal increase in daytime sleepiness. Thus, although menstruating women are likely to show increased sleep disturbance during the luteal phase, those with other, more severe premenstrual symptoms are more likely to experience a luteal increase in daytime sleepiness.

Morningness–eveningness and depression: Preliminary evidence for the role of the behavioral activation system and positive affect

There is considerable evidence of circadian rhythm abnormalities in mood disorders. Morningness-eveningness, the degree to which people prefer organizing their activity and sleep patterns toward the morning or evening, is related to circadian phase and is associated with mood, with relatively greater psychological distress among evening types. Given that circadian rhythms may also relate to the Behavioral Activation System (BAS) and positive affect (PA), but not to the Behavioral Inhibition System (BIS) or negative affect (NA), it was hypothesized that individual differences in BAS sensitivity and levels of PA, but not BIS and NA, would explain the association between morningness-eveningness and depression in a sample of 208 individuals with a range of depressive symptomatology. As predicted, increasing eveningness was associated with greater depression, lower BAS, and lower PA, but not directly associated with NA. Path analyses supported a model wherein morningness-eveningness is associated with depression via multi-step indirect paths including BAS-Reward Responsiveness, PA, and NA. A path between BIS and depression was distinct from the one involving morningness-eveningness. A variety of alternative path models all provided a weaker fit to the data. Thus, results were consistent with the BAS and PA mediating the effects of morningness-eveningness on depression.

Circadian rhythms, sleep, and substance abuse.

Substance abuse is linked to numerous mental and physical health problems, including disturbed sleep. The association between substance use and sleep appears to be bidirectional, in that substance use may directly cause sleep disturbances, and difficulty sleeping may be a risk factor for relapse to substance use. Growing evidence similarly links substance use to disturbances in circadian rhythms, although many gaps in knowledge persist, particularly regarding whether circadian disturbance leads to substance abuse or dependence. Given the integral role circadian rhythms play in regulating sleep, circadian mechanisms may account in part for sleep-substance abuse interactions. Furthermore, a burgeoning research base supports a role for the circadian system in regulating reward processing, indicating that circadian mechanisms may be directly linked to substance abuse independently of sleep pathways. More work in this area is needed, particularly in elucidating how sleep and circadian disturbance may contribute to initiation of, and/or relapse to, substance use. Sleep and circadian-based interventions could play a critical role in the prevention and treatment of substance use disorders.