Preventing postpartum insomnia: findings from a three-arm randomized-controlled trial of cognitive behavioral therapy for insomnia, a responsive bassinet, and sleep hygiene.
Sleep
; 47(8)2024 Aug 14.
Article
in En
| MEDLINE
| ID: mdl-38736364
ABSTRACT
STUDY OBJECTIVES:
Insomnia symptoms are common during the perinatal period and are linked to adverse outcomes. This single-blind three-arm randomized-controlled trial examined whether two interventions targeting different mechanisms prevent postpartum insomnia.METHODS:
Participants were nulliparous females 26-32 weeks gestation with Insomnia Severity Index (ISI) scoresâ ≥â 8, recruited in Australia and randomized 111 to (1) a responsive bassinet (RB) designed to support infant sleep and reduce maternal sleep disruption until 6 months postpartum, (2) therapist-assisted cognitive behavioral therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (3) a sleep hygiene booklet (control; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome was ISI scores averaged T3-T5. Primary analyses were regressions controlling for baseline outcomes.RESULTS:
One hundred and twenty-seven participants (age Mâ ±â SDâ =â 32.62â ±â 3.49) were randomized (RBâ =â 44, CBT-Iâ =â 42, CTRLâ =â 41). Both interventions were feasible and well-accepted, with few related adverse events reported. Compared to CTRL, the average ISI across T3-T5 was lower for CBT-I (pâ =â .014, effect size [ES]â =â 0.56, medium) but not RB (pâ =â .270, ESâ =â 0.25, small). Exploratory findings on maternal insomnia diagnosis, sleep disturbance, sleep-related impairment, beliefs and attitudes about sleep, depression, anxiety, as well as infant sleep outcomes were also presented.CONCLUSIONS:
CBT-I but not RB reduced prenatal insomnia (very large effect) and prevented postpartum insomnia (medium effect). Further research is needed to examine the effects of both CBT-I and RB on other outcomes such as sleep-related well-being, postpartum depression, and maternal postpartum sleep duration. CLINICAL TRIAL REGISTRATION The Study for Mother-Infant Sleep (The SMILE Project) reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https//www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry ACTRN12619001166167.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cognitive Behavioral Therapy
/
Sleep Hygiene
/
Sleep Initiation and Maintenance Disorders
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Country/Region as subject:
Oceania
Language:
En
Journal:
Sleep
Year:
2024
Document type:
Article
Affiliation country:
Australia
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA