4. Discussion
anxiety, eating behaviors, arousability, Sleep disorders, APS, insomnia
APS, CARDIOVASCULAR DISEASES
Sleep disorders, as characterized by poor sleep quantity and/or quality, have a high prevalence in the general population and are associated with an increased risk of developing mental, metabolic, and cardiovascular diseases, thus representing a public health issue [In our study, we tested the beneficial effect of a short online MBI on sleep quality, quantity, and continuity, and on emotional regulation and mindfulness in poor sleepers. We detected a beneficial effect of our intervention in improving sleep quality and in decreasing insomnia symptoms and severity, as indicated by the statistically significant results obtained in the global score of PSQI (β = −1.93 [−3.43; −0.43], It is important to note that before the intervention, 68% of the participants in the control group and 71% of the participants in the intervention group reported an insomnia condition. This rate decreased to 57% and 14%, respectively, after the intervention. Furthermore, 10% of the participants in the control group and 25% of the participants in the treated group reported no longer having poor sleep quality.Without considering the psychological scales (ERQ and FFMQ), the smallest effect size we found was on the use of sleep medication (PSQI component); followed by the effect size on the SHI and FIRST scales. The largest effect size was found on subjective sleep quality (PSQI Component 1), followed by the ISI scale. As regards PSQI, our results are in line with the effects reported for educational, behavioral and/or cognitive treatments for insomnia [In the interpretation of our results, it is helpful to consider that this study took place during a period when COVID-19 was still very widespread in Italy, and as shown in a study conducted on 2291 Italian, 57.1% experienced poor sleep quality, 32.1% high levels of generalized anxiety symptoms, and 41.8% psychological distress [We found no changes in predisposition to arousability (as measured by APS), nor in the sleep reactivity trait (as measured by FIRST). These results might be explained by the fact that these are probably too stable traits to change after such a short intervention. Interestingly, in our study, 40 out of 56 subjects yielded a FIRST score of ≥18 at t0, thus indicating a high risk of insomnia [As for sleep hygiene behaviors, measured by SHI, we found no changes either on the whole scale or on single items. We expected that the change to a more mindful mindset would result in the improvement of some dysregulated behaviors. Since the participants showed only a small change or no change in their level of different mindfulness domains, we can assume that the benefits of the intervention led only to more immediate effects (i.e., stress relief, relaxation) that helped the participants to improve their sleep without affecting their mindset in a significant way. Another possible explanation is the high average age of participants. Spontaneous changes in habitual rooted behavior are more difficult. Although the dietary advice was a non-mandatory part of our intervention, we registered a low–medium adherence to the diet in most of the participants. As confirmed by SHI, the participants showed difficulty in actively regulating or changing their eating behaviors, even when they knew it could improve their sleep quality.Whilst we expected our intervention to produce noticeable changes in emotional regulation strategies and dispositional mindfulness, we did not find significant effects on them, except for on a sub-component of dispositional mindfulness, which is non-reactivity to inner experience. A possible interpretation is that our intervention was only effective in helping participants reach healthier sleep by providing them with a practical tool to auto-regulate their biological and psychological systems. This means that our intervention worked efficiently on the compelling evident needs of the participants without being able to produce a deeper shift in their emotional regulation strategies and their overall mindfulness level. Such a shift might require more consistent practice.The limitations of our study were: (i) the results may only be applicable to people who are willing to meditate and interested in the theme of meditation given the nature of our intervention, i.e., the obviously voluntary-based enrolment; (ii) the sole use of self-report measures; and (iii) the absence of monitoring of the individual practice of meditation with subsequent difficulties in the estimation of a dose–response effect.