‘Objective improvements’ in sleep seen with use of mindfulness in MS
Interventions may increase time spent asleep while in bed, review finds
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Sleep issues, particularly a lack of restful sleep at night, are common among people with multiple sclerosis. (Photo from iStock)
- Mindfulness significantly improved sleep efficiency, or time asleep in bed, for people with multiple sclerosis, a study found.
- Physical activity, however, showed inconsistent benefits in improving sleep.
- The researchers noted that both objective and subjective measures are crucial for evaluating the effects of sleep interventions.
In multiple sclerosis (MS), mindfulness may increase the time a patient spends asleep while in bed, but physical activity appears to have small and inconsistent benefits on sleep.
That’s according to a meta-analysis of five published studies that looked at the impact of interventions designed to improve sleep among people with MS.
“Objective improvements in sleep were reported following mindfulness and only using one measure (sleep efficiency),” the researchers wrote, noting, “however, [that] the small number of included studies limits definitive conclusions.”
In sharing the study’s highlights, the team noted that “mindfulness improved sleep, as assessed using activity monitors.” Further, “physical activity improved sleep in most included studies, but the effects were not consistent across outcomes,” the team wrote.
The study, titled “Do sleep interventions improve sleep in MS? A systematic review and meta-analysis of activity monitor assessed outcomes,” was published in the journal Multiple Sclerosis and Related Disorders.
Problems falling and staying asleep are common in MS, and lack of restful sleep can worsen people’s symptoms and disrupt daily life.
Most studies on sleep have relied on subjective measures
Finding effective approaches to manage sleep issues is essential, but, according to the researchers, most studies looking into this have relied on patients’ answers to questionnaires — which, being subjective, are not always the most reliable measure.
Activity monitors that track movement and rest can provide objective data that complement these more subjective questionnaires. However, there are limited data on which measures from these devices can be used to determine the effectiveness of sleep interventions in MS. It is also unknown if these objective measures differ from more subjective outcomes assessed with questionnaires.
To explore this, a team of researchers in Australia reviewed published studies, involving adults with MS, that had assessed interventions aimed at improving sleep. These studies had used activity monitors to measure sleep parameters.
A total of 10 studies were ultimately used. Most were randomized clinical trials, in which participants are randomly assigned to a treatment or a control group.
Sleep was measured using six metrics: total sleep time, sleep efficiency, total time in bed, sleep onset latency, or the time it takes to fall asleep, wake after sleep onset — time awake after initially falling asleep — and number of awakenings. Sleep efficiency is a person’s time asleep as a percentage of time in bed, and is used as a marker of restful sleep.
Across the studies, there were 231 patients in total, with 114 receiving an intervention and 117 in control groups. Mean ages ranged from 31.9 to 57.4 years. Most patients had relapsing–remitting MS, in which periods of worsening symptoms are followed by recovery.
Six studies recruited patients who reported problems with sleep, such as poor sleep quality, insomnia, or restless legs syndrome, an uncomfortable sensation in the legs that causes a constant urge to move, which can disrupt sleep.
The studies tested several interventions to improve sleep. These included mindfulness, physical activity, cognitive behavioral therapy, which is a form of talk therapy, and medications. Transcranial direct current stimulation, which uses low electrical currents on the scalp to calm brain activity, was also assessed in the studies.
Physical activity was tested in four studies. These included moderate-intensity aerobic exercise, combined aerobic and strength training, and resistance training. Weekly video sessions to encourage physical activity were also tested. Most studies measured all six sleep metrics using activity monitors, usually worn for a median of seven days. These interventions generally improved at least one metric, although the benefits were inconsistent, the researchers noted.
Both subjective, objective assessments important, researchers say
In all but one study, subjective sleep measures improved, the researchers noted.
“Assessing whether a sleep intervention is effective based on objective or subjective methods gives different answers in the same study, suggesting both methods should be utilised in studies assessing sleep as an outcome, as each provides unique and clinically relevant information,” the researchers wrote.
Looking at the other interventions, talk therapy led to objective reductions in time in bed and total sleep time, and subjective measures showed better sleep efficiency and reduced time in bed.
Pharmacological interventions were assessed in two studies and there were increases in total sleep time compared with the control group. Finally, transcranial direct current stimulation did not change sleep measures coming from activity monitors, but patients reported less daytime sleepiness.
Assessing whether a sleep intervention is effective based on objective or subjective methods gives different answers in the same study, suggesting both methods should be utilised in studies assessing sleep as an outcome, as each provides unique and clinically relevant information.
Only four studies were eligible for a meta-analysis, which pools data from multiple studies for a more precise estimate of an intervention’s effect. Of all interventions, only mindfulness showed a significant effect, the researchers noted — specifically improving sleep efficiency, meaning patients spent more of their time in bed actually sleeping.
“Only sleep efficiency showed a statistically significant moderate improvement in the meta-analysis,” the researchers wrote.
The team called for additional research to learn more, noting that, while the quality of the studies ranged from moderate to high, the number was small and interventions and activity monitors varied across the studies.
“Future trials should consider a wider range of outcome measures and longer time horizons,” the researchers concluded.
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