Improving Sleep Continuity Through Mindfulness Training for Better Cognitive Ageing.
Condition: Sleep Initiation and Maintenance Disorders; Cognitive Aging
MeSH terms: Sleep Initiation and Maintenance Disorders
Study type: Interventional

Summary: 
      Poor sleep quality is a known risk factor for cognitive decline in the elderly. Hearteningly,
      sleep is also a prime target for behavioral modification. In this study, the investigators
      propose to test mindfulness-based training (MBT) as an intervention to improve sleep quality
      by reducing sleep fragmentation, and hypothesize that these improvements will mediate the
      beneficial effects of MBT on sustained and executive attention. MBT consists of a suite of
      techniques aimed at enhancing awareness and acceptance of one's internal (e.g., thoughts and
      feelings) and external experiences in the present moment. Learning these techniques has been
      shown to improve sleep quality in patients with primary insomnia, and in other conditions
      associated with sleep disturbance. There is also increasing evidence that mindfulness
      training enhances multiple facets of cognition, including components of attention. In this
      study, the investigators will recruit 120 participants in a randomized controlled design,
      with 60 participants receiving MBT, and 60 receiving a sleep hygiene education and exercise
      program (SHEEP). Each intervention will last 8 weeks. Before and after the intervention, the
      investigators will collect objective and subjective measures of sleep quality, resting-state
      and task-related functional magnetic resonance imaging scans, and performance on standard
      laboratory tests of attention. The investigators hypothesize that, relative to SHE, MBT will
      result in significantly greater improvements in sleep quality and attentional metrics. They
      also predict that the cognitive changes will be mediated by the changes in sleep quality. If
      a positive result is found, this would indicate the use of MBT as a cost-effective behavioral
      intervention to stabilize or even improve cognition in the elderly, thus reducing the risk of
      dementia in this vulnerable population.
    

Detailed description: 
      Cognitive decline in the elderly is a rapidly growing concern in Singapore and other
      developed Asian nations. Among the major but understudied factors that may exacerbate this
      decline is poor sleep quality. Targeting sleep to decelerate or even reverse age-related
      cognitive decline may represent a low-cost, high-return solution to a widespread societal
      problem.

      To accomplish this goal, the investigators propose to test mindfulness-based training (MBT)
      as an intervention to improve sleep quality and cognition.

      In this pilot grant, the investigators will study a group of participants (N = 120) in a
      randomized controlled design pitting MBT (N =60) against sleep hygiene education (SHEEP, N =
      60).

      Hypothesis 1: MBT will lead to significantly greater improvements in sustained and executive
      attention relative to SHEEP (measured both behaviorally and using functional magnetic
      resonance imaging).

      Hypothesis 2: Cognitive outcomes will be mediated by improvements in subjective and objective
      sleep quality.

      Good sleep is critical for cognition at all ages, and especially in the elderly

      Adequate sleep is important for optimal cognitive function across the lifespan. Although the
      association between sleep and cognitive function is bi-directional, alterations in sleep
      frequently occur prior to the appearance of cognitive symptoms in Alzheimer's Disease (AD).
      Almost 50% of older adults report at least one sleep problem, and there is growing evidence
      that sleep complaints and disturbances might have negative effects on cognition.

      Retired older adults have the freedom to sleep ad libitum but this benefit is offset by
      age-associated changes in sleep such as poorer subjective quality, increased fragmentation
      and/or altered macrostructure. Although sleep duration is the measure that has received the
      most attention, there is accumulating evidence that sleep quality (Blackwell et al., 2014)
      and sleep fragmentation in particular, can have deleterious effects on brain structure and
      cognition. A change in sleep pattern in late adulthood can foreshadow cognitive decline,
      perhaps as a result of accumulation of neurotoxic substances that are normally cleared during
      sleep.
    

Intervention name(s): Mindfulness Based Therapy for Insomnia; Sleep Hygiene Education Exercise Program
Intervention type(s): Behavioral; Other
Intervention description(s): The mindfulness-based intervention consists of eight 2-hour sessions covering various mindfulness techniques (e.g. mindfulness of breath, body and movement, senses and informal practice, and empathy and compassion) that pertain to people with sleep problems and insomnia. Participants will be provided handouts for the information covered during these talks and discussions.; The Sleep Hygiene Education and Exercise Program has known relationships with good sleep quality. It will comprise 8 weekly 2-hour sessions. Each session will introduce a concept related to sleep and sleep hygiene. The facilitator will provide the theory and rationale behind the concept, and encourage participants to share and discuss their experiences related to the concept. The session will end with the participants evaluating how to implement the specific concept in their daily lives, and its potential implications for their sleep. Participants will be provided with a manual that outlines the concept and how they intend to apply it to their daily lives.
Other intervention name(s): MBTI; SHEEP
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be randomized to receive either a Mindfulness-based Therapy for Insomnia (MBTI) or a Sleep Hygiene Education Program (SHEP). The intervention is for 8 weeks. Measures will be administered prior to and on completion of the intervention.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Insomnia; Cognitive aging; Mindfulness