Sleep and Fatigue

Our recent work has focused on sleep problems in cancer patients, and how MBSR may be beneficial in treating this common problem in cancer patients. Similar to what others have reported, we found a very high proportion of our cancer patients with disordered sleep (approx. 85%) in a sample of 63 patients attending the

MBSR program. In these patients, sleep disturbance was closely associated with levels of self-reported stress and mood disturbance, and when stress symptoms declined over the course of the MBSR program, sleep also improved.110 Improvements were seen on the Pittsburgh Sleep Quality Index subscales of subjective sleep quality, sleep efficiency, and hours of sleep. On average, sleep hours increased by 1/2 to 1 hour per night. This is similar to our previous results, where sleep was measured using a less refined scale. Nonetheless the proportion of patients who reported their sleep as "good" improved from 40% before the program to 80% afterwards,111 reinforcing the more recent finding.

Reductions in fatigue had also been observed in our previous work, with scores on the Profile of Mood States subscales of vigor and fatigue both changing in favorable directions after the MBSR program.103 In the sleep study mentioned above, fatigue scores were also measured by a POMS subscale.110 The change in fatigue scores was statistically significant, and associations were found between fatigue and sleep at both pre- and post-intervention, such that more sleep difficulty was associated with greater fatigue. However, a statistically significant relationship was not found between improvements in fatigue and sleep, rather between changes in symptoms of stress and fatigue, and between changes in mood disturbance and fatigue. Therefore, it may be that as patients began to sleep better, they also became less stressed and moody, and subsequently became less tired and had more energy—a hypothesis that remains to be tested.

A study by Shapiro et al.112 also examined the relationship between participation in an MBSR program and sleep quality and efficiency in a breast-cancer population. They did not find statistically significant relationships between participation in an MBSR group and sleep quality; however, they did find that those who practiced more informal mindfulness reported feeling more rested.

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