Yoga Not Superior to Physical Conditioning for Improving Sleep Quality in Women With Incontinence: JAMA
USA: A new study has found that a 3-month yoga program did not improve sleep quality or reduce sleep disruption more than general physical conditioning in women with incontinence.
The findings, published in JAMA Network Open, are from a secondary analysis of a randomized clinical trial conducted by Ellie Hough and colleagues from the University of California, San Francisco.
The research team aimed to determine whether yoga, often recommended for enhancing sleep in adults with chronic conditions, offers distinct sleep-related benefits for women who experience urinary incontinence. Although yoga is promoted as a holistic practice that combines physical movement with mindfulness, the study found no unique advantage over a basic exercise routine matched for time and attention.
The trial was conducted across three Northern California sites between 2018 and 2022, with interventions delivered both in-person and online due to the COVID-19 pandemic. Women aged 45 to 90 years with daily urinary incontinence were enrolled and randomly assigned either to a structured hatha yoga program or to a nonspecific physical conditioning group. Both interventions lasted three months and included twice-weekly guided sessions, with those in the yoga group also asked to complete an additional hour of self-directed practice each week.
Sleep quality and nighttime awakenings were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Pittsburgh Sleep Diary, while nocturnal urination frequency was documented through voiding diaries. Of the 240 participants (mean age 62 years), more than half reported poor sleep quality at baseline, and a similar proportion woke at least once nightly to urinate.
The key findings were as follows:
- Over the three months, both groups experienced slight improvements in sleep outcomes, but the differences between them were not statistically significant.
- The yoga group showed an average improvement of 0.37 points on the PSQI, whereas the physical conditioning group improved by 0.66 points, indicating no meaningful advantage of yoga.
- Measures of wakefulness after sleep onset revealed minimal differences between the two intervention groups.
- Sleep quality declined as nighttime urination increased, regardless of the intervention.
- Participants who woke up two or more times during the night had significantly higher (worse) PSQI scores than those with fewer awakenings, highlighting the impact of nocturnal voiding on sleep disturbance.
The authors noted several limitations. Sleep was assessed only through self-reported tools, without objective measures like actigraphy or polysomnography. The yoga program was not specifically designed to target sleep, and some participants did not have sleep issues at baseline. The switch to virtual sessions during the pandemic may have affected participation and outcomes. Since both groups received active interventions, the study also cannot determine whether yoga provides benefits over no exercise.
Despite the popularity of yoga for enhancing sleep, the findings indicate that its effects may not surpass those of general physical activity in this population. The researchers emphasized the need for more rigorous trials to better understand how complementary therapies influence sleep, particularly in adults managing chronic health conditions.
Reference:
Hough E, Goldstein LA, Subak LL, et al. Effects of Hatha Yoga vs Physical Conditioning on Sleep in Women With Urinary Incontinence: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2025;8(12):e2546499. doi:10.1001/jamanetworkopen.2025.46499
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