Pictured above: Dr. Soohyun Nam leads a virtual mindfulness session.
It happens to all of us – a sleepless night fraught with tossing and turning. As the minutes and sometimes hours tick by, you begin to calculate how much sleep you can still get and what the morning will bring without rest.
For most of us, this happens after a stressful day or event. But, for the approximately 30 percent of adults who struggle with insomnia, it can be a nightly occurrence. A disproportionate number of those individuals are Black women.
In a study funded by Women’s Health Research at Yale (WHRY), Soohyun Nam, PhD, Associate Professor at Yale School of Nursing, for the first time, is using an evidence-based stress-reduction intervention for insomnia that is culturally sensitive to the needs of Black women.
“When I worked with Black women to address obesity, diabetes, or hypertension, every conversation would lead to a discussion on stress and sleep disturbance,” Dr. Nam said. “I realized we had to find something tangible that could help these women manage the stressors contributing to their sleep difficulty.”
The intervention, mindfulness-based therapy for insomnia (MBTI), teaches acceptance of the stress one is feeling. Its practice places purposeful, non-judgmental attention on the present moment with a focus on breathing, thoughts, emotions, and physical sensations in the body. The goal of the therapy is to break the cycle that causes insomnia – namely, a focus on a stressful event leads to disturbed sleep, which in turn causes more stress over the consequences of not getting adequate rest, which keeps the body awake longer.
Dr. Nam tested this intervention in a clinical trial, which randomly placed women with insomnia into one of two groups. One group of study participants were advised about healthy eating, physical activity, and sleep hygiene to address stress, while the other study group was taught to use MBTI. Although both groups reported lower levels of stress, less severe insomnia, and fewer worries surrounding sleep, the women who participated in MBTI also reported fewer symptoms of depression and anxiety and had lower blood pressure.
“Many women in the Black community rarely have access to a health intervention for their insomnia. All the women in my study learned a method for dealing with their insomnia. However, learning how to reduce the effects of daily stressors in our MBTI group sessions gave women the benefit of improved mental health and blood pressure," Dr. Nam said.
Dr. Nam’s study also examined how social determinants of health impact for the women in this study.
“The time constraint is one of the main barriers to access for this health intervention in the Black community. Transportation barriers, childcare needs, and the cost are also factors that must be considered," Dr. Nam said. Most of the women who participated in this study are employed full-time, work at least two jobs, in addition to having caregiving responsibilities at home – making participation in an organized behavioral therapy outside the home difficult.
"This resulted in women knowing they weren't alone in experiencing stress."
Dr. Soohyun Nam
The need for remote communication during the height of the COVID-19 pandemic offered a breakthrough to address these hurdles. To maintain social distancing, the study was conducted remotely via Zoom. Dr. Nam and her team discovered that because of this modification, which allowed women to take part in the program at home, women attended sessions regularly and no participant left the study.
“Many women described their participation as something to look forward to.” Dr. Nam said. “After a long day of work, they could come home and log on to Zoom and learn skills with a community of women who share values, backgrounds, and responsibilities. This also resulted in women knowing they weren't alone in experiencing stress.”
The success of this study is the driving force behind the next phase of Dr. Nam’s work. She recently applied for a grant from the National Institutes of Health to further explore the use of MBTI in the Black community. Her proposal builds on her WHRY study while placing emphasis on community relationships that can identify people who may benefit most and connect them to the MBTI program.
“To address medical needs, you have to understand and deal with the related social issues,” Dr. Nam said. “The community engagement process is all about letting those you hope to serve talk about their lives and how you may be able to help, and then collaborate to make change."
