A reader wrote yesterday asking for advice: “I’ve been reading through your website but have yet to see an article on how to manage sleep with chronic illness. I’m currently experiencing health challenges that are keeping me awake at night. What would you recommend for people experiencing health issues, especially moderate to severe ones?”
Insomnia combined with other health problems is bound to cause distress. But help is at hand. New research shows that tai chi reduced insomnia symptoms in breast cancer survivors, suggesting that it may help with insomnia linked to other health problems, too.
When Insomnia Is Not the Only Problem
Sometimes insomnia is the only health problem a person has. But insomnia more commonly occurs in conjunction with other health issues—everything from mood disorders and chronic pain to gastrointestinal problems and heart disease.
Part of the solution when you’re in this situation (sometimes referred to as comorbid insomnia) lies in getting treatment for the associated health problem. This will involve consulting a medical or psychiatric specialist.
But even when treatment is successful at controlling other health problems, trouble sleeping often persists. Women successfully treated for breast cancer have twice the rate of insomnia as occurs in the general population, as well as depression and fatigue. This is hardly surprising: A diagnosis of breast cancer is distressing in and of itself, never mind the invasive (although often effective) treatment options. But then you never know if or when the cancer might come back. Such chronic health concerns take an emotional toll that can interfere with sleep.
CBT for Insomnia Can Help
Cognitive behavioral therapy (CBT) is the gold standard in treatment for insomnia these days. This combination of sleep restriction, stimulus control, and talk therapy has been shown to be an effective treatment for insomnia in cancer survivors. Research shows it’s also effective in relieving insomnia in people with depression and people with other psychiatric and medical conditions.
But CBT for insomnia is not widely available nor can everyone afford it. Besides, it can be challenging to adhere to the protocol. CBT does not suit everyone.
UCLA investigators wanted to find a more accessible, less expensive type of therapy for breast cancer survivors experiencing insomnia that would equal CBT in efficacy. So they conducted a randomized, partially blinded study pitting CBT against tai chi.
Why Tai Chi?
Tai chi, a practice involving slow, flowing movement combined with meditation and deep breathing, is said to alleviate stress and anxiety and promote energy and stamina. In the words of the study’s authors, tai chi emphasizes “control over physical function and arousal-related responsiveness . . . through the mindful performance of repetitious, nonstrenuous, slow-paced movement.”
This type of activity might have an effect on sleep. And in fact a handful of studies have shown that tai chi does indeed relieve insomnia symptoms.
So investigators recruited 90 breast cancer survivors, aged 42 to 83 years, who were experiencing insomnia, depression, and fatigue. Half of them then received three months of weekly instruction in CBT for insomnia. The other half received three months of weekly instruction in a westernized form of tai chi called tai chi chih.
At 15 months following the start of treatment (one year after treatment ended), nearly half of the participants in both groups showed marked improvement in their sleep, or complete or nearly complete remission of their insomnia symptoms. Both groups also experienced a robust reduction in fatigue severity and depression.
The novelty of this result is that for these survivors of breast cancer, the practice of tai chi chih resulted in sleep improvements equivalent to those obtained with CBT. Tai chi may be similarly useful for insomnia sufferers with other distressing health problems.
Lowering Arousal, Reducing Inflammation
The mechanisms by which tai chi relieves insomnia symptoms aren’t understood. But research has shown that tai chi:
- Cuts down on arousal of the sympathetic nervous system. The sympathetic nervous system becomes active when you detect a threat, increasing vigilance and triggering bodily preparations to fight or flee.
- Reduces inflammation. Inflammation is part of the body’s response to infection and tissue damage and is necessary to the healing process. But when inflammation becomes chronic it leads to disease.
Both arousal and inflammation have a negative effect on sleep. So it follows that a practice such as tai chi, which reduces them, might help.
Tai chi is worth checking into for people with comorbid insomnia and other distressing health conditions. Classes are offered in many locales. You can even learn tai chi by watching YouTube videos or using a smartphone app.
If you’ve practiced tai chi, what effect, if any, did it have on your sleep?