Clinical Practice Guidelines on the Use of Integrative Body-Mind-Spirit (I-BMS) Treatment for People with Sleep Disorder/Problem

Background: Approximately 70 million people in the U.S. have sleep problems. Sleep problems may cause mental health and physical health issues. In recent years, I-BMS treatments have increasingly been used for treating sleep issues although there is a lack of practice guidelines based on empirical evidence. Based on a systematic review, this study aims to provide a practice guideline to inform clinicians and patients about safe and effective I-BMS treatments for sleep disorders/problems.

Method: A systematic review of randomized controlled trial on I-BMS treatments for sleep disorder/problems was conducted. Studies were identified through electronic databases including EBSCOhost, PubMed, Cochrane systematic review, Campbell Systematic Review, SSCI, and WorldCat Dissertations and Thesis using the keywords holistic OR body-mind OR complementary and alternative OR mind-body OR spirit OR meditat* OR relax* OR yoga OR tai chi OR qi gong OR mindful* OR therapeutic touch OR acupressure OR Tai qi OR Chi gong OR Reiki OR Aromatherapy OR Body work OR Massage AND sleep*.  Inclusion criteria were: (1) randomized controlled studies, (2) English language articles; (3) published studies in peer-reviewed journals; and (4) articles published between 2004 and 2014. A total of 58 studies were identified at the initial search. Thirty-one studies were included after title and abstract review and 15 studies were selected after full review of the articles. Studies were rated by The Quality Scoring Systems – a Modified Scale adapted from the Delphi Scoring Scale (scale 0-9). In addition, the study used The California Evidence-Based Clearinghouse for Child Welfare Scientific Rating Scale (CEBCCWSRS) to rate for the level of evidence available for each treatment category on a 1-6 scale with 1 as Well Supported—Effective Practice and 6 as Concerning Practice . Two independent reviewers rated each study for interrater reliability.

Result:

I-BMS treatments include: Taichi (4), acupressure (3), mindfulness practice (3), music (2), yoga (1), self-relaxation training (1), body-mind bridging (1). Taichi has a modified score of 6.38 and is a promising practice for sleep quality, insomnia. Mindfulness treatment has a modified score of 5.67 and is a promising practice for insomnia and sleep quality. Acupressure, yoga exercise, self-relaxation training and Body-mind bridging have modified scores of 6, 5.5, 3.5, and 6 respectively and are all considered as a promising practice for sleep quality. Music has a modified score of 3 and is a promising practice for deep sleep and sleep quality.

Implication: Taichi, mindfulness treatments, body-mind bridging and yoga are rated as high quality practice for sleep problems. However, based on CEBCCWSRS, all treatments are considered as promising practice but not well supported or supported practice. The reason for this lower ranking is a lack of long-term (12 month after termination) estimation of the effects. Only 2 studies have 12-month follow-up and showed no lost of effects. Several studies have less than 1-year long-term assessments. Overall, I-BMS practices for sleep problems are supported and proved to be safe. Future studies with multiple assessment points will be needed to further establish long-term effects of I-BMS on sleep problems/disorders