Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults.

We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO).

Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects.

MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

睡眠不佳是多种疾病的可改变危险因素。一线治疗（例如失眠的认知行为疗法）有局限性，促使人们寻找替代方法。在这里，我们比较了基于正念的手动失眠疗法 (MBTI) 与睡眠卫生、教育和锻炼计划 (SHEEP) 在改善老年人主观和客观睡眠结果方面的作用。

我们进行了单点平行试验，在基线、干预后和 6 个月随访时收集了盲法评估。我们将 127 名年龄在 50-80 岁、匹兹堡睡眠质量指数 (PSQI) 评分≥5 的参与者随机分配到 MBTI ( n = 65) 或 SHEEP ( n = 62)，每周 2 小时的小组会议持续 8 周。主要结果包括 PSQI 和失眠严重程度指数，以及活动记录仪和多导睡眠图测量的入睡潜伏期 (SOL) 和入睡后醒来 (WASO)。

意向治疗分析显示两组的失眠严重程度均有所降低 [MBTI：Cohen 效应大小d = −1.27，95% 置信区间 (CI) -1.61 至 -0.89；绵羊：d = −0.69，95% CI −0.96 至 −0.43]，MBTI 显着改善。两组的睡眠质量改善相当（MBTI：d = −1.19；SHEEP：d = −1.02）。在客观睡眠测量中未观察到显着的交互作用。然而，只有 MBTI 降低了 WASO活动记录仪（MBTI：d = -0.30；SHEEP：d = 0.02）、SOL活动记录仪（MBTI：d = -0.25；SHEEP：d = -0.09）和 WASO PSG(MBTI: d = −0.26; SHEEP ( d = −0.18)。SOL PSG没有变化。没有参与者因为不良反应退出。

MBTI 可有效改善老年人的主观和客观睡眠质量，对于失败或无法获得标准前线疗法的人来说可能是一种有效的替代方案。