Polysomnographic and Subjective Profiles of Sleep Continuity Before and After Mindfulness-Based Cognitive Therapy in Partially Remitted Depression
Abstract
Objectives: To examine whether mindfulness meditation (MM) was associated with changes in objectively measured polysomnographic (PSG) sleep profiles and to relate changes in PSG sleep to subjectively reported changes in sleep and depression within the context of a randomized controlled trial. Previous studies have indicated that mindfulness and other forms of meditation training are associated with improvements in sleep quality. However, none of these studies used objective PSG sleep recordings within longitudinal randomized controlled trials of naïve subjects. Methods: Twenty-six individuals with partially remitted depression were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep and depression symptoms. Results: According to PSG sleep, MM practice was associated with several indices of increased cortical arousal, including more awakenings and stage 1 sleep and less slow-wave sleep relative to controls, in proportion to amount of MM practice. According to sleep diaries, subjectively reported sleep improved post MBCT but not above and beyond controls. Beck Depression Inventory scores decreased more in the MBCT group than controls. Improvements in depression were associated with increased subjective sleep continuity and increased PSG arousal. Conclusions: MM is associated with increases in objectively measured arousal during sleep with simultaneous improvements in subjectively reported sleep quality and mood disturbance. This pattern is similar to the profiles of positive responders to common antidepressant medications. BDI = Beck Depression Inventory; EEG = electroencephalogram; EMG = electromyogram; EOG = electrooculogram; HRSD = Hamilton Rating Scale for Depression; MBCT = Mindfulness-Based Cognitive Therapy; MM = mindfulness meditation; NWAK = number of awakenings; PSG = polysomnograph; RCT = randomized controlled trial; REM = rapid eye movement; SE = sleep efficiency; SOL = sleep onset latency; SWS = slow-wave sleep; TIB = time in bed; TST = total sleep time; WASO = wake after sleep onset.
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Britton et al. found that as little as 5-10 min/day for 2-3 days/week increased self-reported sleep duration by more than an hour, but as practice times approached 30 min/day, sleep duration began to decrease and cortical arousal began to increase.
“Britton et al.175 found that as little as 5–10 min/day for 2–3 days/week (<1 h/week) increased self-reported sleep duration by more than an hour, but that as practice times approached 30 min/day (>3 h/week), then sleep duration began to decrease (Fig. 2D) and cortical arousal began to increase (Fig. 2A–C).164”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [164]
Each objective index of increased cortical arousal was correlated with amount of home meditation practice in a linear dose-dependent fashion, supporting that increased arousal was due to meditation.
“Each of these objective indices of increased cortical arousal was correlated with amount of home meditation practice in a linear dose-dependent fashion, which further supports that the increased arousal was due to meditation.”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [164]
In an EEG-based longitudinal randomized controlled trial, Britton et al. found increased wakefulness and decreased sleep propensity following Mindfulness-Based Cognitive Therapy that was correlated with improved mood and meditation practice amount.
“In an EEG-based longitudinal randomized controlled trial (RCT), Britton et al.164 found increased wakefulness and decreased sleep propensity following Mindfulness-Based Cognitive Therapy (MBCT) that was correlated with improved mood and meditation practice amount.”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [164]
Over the trial, the MBCT group increased in stage-1 minutes, awakenings, and arousals, and decreased in percent slow-wave sleep compared to waitlist controls.
“Over the course of the trial, the MBCT group increased in stage-1 minutes, awakenings, and arousals, and decreased in percent of slow-wave (stage 3 and 4) sleep compared to waitlist controls.”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [164]
Several polysomnographic sleep studies have found greater cortical arousal during sleep in meditators, including increased stage-1 sleep, alpha-theta wake-like EEG, arousals, reduced slow-wave sleep, and increased gamma.
“In support of such increased wakefulness during sleep, several polysomnographic sleep studies have found greater cortical arousal during sleep in meditators, including increased stage-1 sleep, alpha-theta (wake-like) EEG, arousals, reduced slow-wave sleep,144, 162,164 and increased gamma.165”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [164]
Although there was no overall treatment effect on sleep duration, average diary total sleep at post-treatment was negatively correlated with minutes of daily practice, so more meditation was associated with less sleep.
“Although there was no overall treatment effect on sleep duration, average (diary) total sleep at post-treatment was negatively correlated with minutes of daily practice, so that more meditation was associated with less sleep (Fig. 2A–D).”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [164]
Low practice amounts in MBCT participants increased sleep duration, but as practice amount approached 30 minutes per day, sleep duration and depth began to decrease and cortical arousal began to increase.
“Low practice amounts in MBCT participants increased sleep duration, but as practice amount approached 30 minutes per day, sleep duration and depth began to decrease and cortical arousal (awakenings and microarousals) began to increase.”
From Can mindfulness be too much of a good thing? The value of a middle way (2019) · cites this paper as [51]
Britton et al. found an inflection point below which meditation practice was sleep-promoting and above which it was sleep-inhibiting.
“For example, Britton et al. [50,51] found an inflection point below which meditation practice was sleep-promoting and above which sleep-inhibiting.”
From Can mindfulness be too much of a good thing? The value of a middle way (2019) · cites this paper as [51]
A few studies have shown worse average outcomes (increased negative effects) for mindfulness training compared to control conditions.
“While a few studies have shown worse average outcomes (increased negative effects) for mindfulness training compared to control conditions [6,7,40,51], the use of means and effect sizes typically obscures individual differences and extreme scores [60].”
From Can mindfulness be too much of a good thing? The value of a middle way (2019) · cites this paper as [51]
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- Authors
- Britton, W. B., Haynes, P. L., Fridel, K. W., & Bootzin, R. R.
- Affiliations
- Brown University (US)
- University of Arizona (US)
- Corresponding author
- Britton, Willoughby B.
- Venue
- Psychosomatic Medicine
- Published
- 2010-07
- Volume
- 72
- Issue
- 6
- Pages
- 539-548
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2028773250
- Cited by
- 125
- References
- 80
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 6 · 2023: 3 · 2022: 11 · 2021: 10 · 2020: 5 · 2019: 9 · 2018: 2 · 2017: 7 · 2016: 13 · 2015: 14 · 2014: 9 · 2013: 9 · 2012: 10
- FWCI
- 9.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (T32MH067553, MH067553-05)
- National Center for Complementary and Integrative Health (T32AT001287)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- mindfulness meditation, mindfulness-based cognitive therapy, depression, sleep continuity, sleep quality, polysomnography, cortical arousal, sleep awakenings, slow-wave sleep, stage 1 sleep, antidepressant response
- MeSH terms
- Adult, Arousal, Major Depressive Disorder, Depressive Disorder, Major, Electroencephalography, Female, Humans, Male, Medical Records, Middle Aged, Personality Inventory, Psychiatric Status Rating Scales, Psychotherapy, Group, Surveys and Questionnaires, Severity of Illness Index, Sleep Wake Disorders, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Polysomnography, Meditation, Secondary Prevention
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