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Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum

Published online by Cambridge University Press:  07 July 2021

Bei Bei Open the ORCID record for Bei Bei [Opens in a new window] ,
Donna M. Pinnington ,
Nina Quin ,
Lin Shen ,
Michelle Blumfield ,
Joshua F. Wiley ,
Sean P. A. Drummond ,
Louise K. Newman  and
Rachel Manber
Bei Bei*
Affiliation:
Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia Centre for Women's Mental Health, Royal Women's Hospital, Victoria, Australia Department of Psychiatry, University of Melbourne, Victoria, Australia
Donna M. Pinnington
Affiliation:
Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia Centre for Women's Mental Health, Royal Women's Hospital, Victoria, Australia Department of Psychiatry, University of Melbourne, Victoria, Australia
Nina Quin
Affiliation:
Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia Centre for Women's Mental Health, Royal Women's Hospital, Victoria, Australia Department of Psychiatry, University of Melbourne, Victoria, Australia
Lin Shen
Affiliation:
Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia
Michelle Blumfield
Affiliation:
Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Victoria, Australia
Joshua F. Wiley
Affiliation:
Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia
Sean P. A. Drummond
Affiliation:
Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia
Louise K. Newman
Affiliation:
Department of Psychiatry, University of Melbourne, Victoria, Australia
Rachel Manber
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
*
Author for correspondence: Bei Bei, E-mail: bei.bei@monash.edu
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Abstract

Background

Sleep disturbance is common in gestational parents during pregnancy and postpartum periods. This study evaluated the feasibility and efficacy of a scalable cognitive behavioural therapy (CBT) sleep intervention tailored for these periods.

Methods

This is a two-arm, parallel-group, single-blind, superiority randomised controlled trial. Nulliparous females without severe medical/psychiatric conditions were randomised 1:1 to CBT or attention- and time-matched control. All participants received a 1 h telephone session and automated multimedia emails from the third trimester until 6 months postpartum. Outcomes were assessed with validated instruments at gestation weeks 30 (baseline) and 35 (pregnancy endpoint), and postpartum months 1.5, 3, 6 (postpartum endpoint), 12 and 24.

Results

In total, 163 eligible participants (age M ± s.d. = 33.35 ± 3.42) were randomised. The CBT intervention was well accepted, with no reported adverse effect. Intention-to-treat analyses showed that compared to control, receiving CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p values ⩽ 0.001), as well as at 24 months postpartum (p ranges 0.012–0.052). Group differences across the first postpartum year were non-significant. Participants with elevated insomnia symptoms at baseline benefitted substantially more from CBT (v. control), including having significantly lower insomnia symptoms throughout the first postpartum year. Group differences in symptoms of depression or anxiety were non-significant.

Conclusions

A scalable CBT sleep intervention is efficacious in buffering against sleep disturbance during pregnancy and benefitted sleep at 2-year postpartum, especially for individuals with insomnia symptoms during pregnancy. The intervention holds promise for implementation into routine perinatal care.

Keywords

Sleepinsomniacognitive behavioural therapypregnancypostpartumperinatal

Information

Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 2 , January 2023 , pp. 513 - 523
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2013). A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), 1059–1068.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ®). Arlington, VA: Author.Google Scholar
Attkisson, C. C., & Zwick, R. (1982). The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5(3), 233–237.CrossRefGoogle ScholarPubMed
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.CrossRefGoogle ScholarPubMed
Bei, B., Asarnow, L. D., Krystal, A., Edinger, J. D., Buysse, D. J., & Manber, R. (2018). Treating insomnia in depression: Insomnia related factors predict long-term depression trajectories. Journal of Consulting and Clinical Psychology, 86(3), 282–293.CrossRefGoogle ScholarPubMed
Bei, B., Coo, S., & Trinder, J. (2015). Sleep and mood during pregnancy and the postpartum period. Sleep Medicine Clinics, 10(1), 25–33.CrossRefGoogle ScholarPubMed
Bei, B., Milgrom, J., Ericksen, J., & Trinder, J. (2010). Subjective perception of sleep, but not its objective quality, is associated with immediate postpartum mood disturbances in healthy women. Sleep, 33(4), 531–538.CrossRefGoogle Scholar
Bei, B., Pinnington, D. M., Shen, L., Blumfield, M., Drummond, S. P. A., Newman, L. K., & Manber, R. (2019). A scalable cognitive behavioural program to promote healthy sleep during pregnancy and postpartum periods: Protocol of a randomised controlled trial (the SEED project). BMC Pregnancy and Childbirth, 19(1), 254.CrossRefGoogle ScholarPubMed
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L., & Morin, C. M. (2012). The consensus sleep diary: Standardizing prospective sleep self-monitoring. Sleep, 35(2), 287–302.CrossRefGoogle ScholarPubMed
Carney, C. E., Edinger, J. D., Kuchibhatla, M., Lachowski, A. M., Bogouslavsky, O., Krystal, A. D., & Shapiro, C. M. (2017). Cognitive behavioral insomnia therapy for those with insomnia and depression: A randomized controlled clinical trial. Sleep, 40(4), 1–13.CrossRefGoogle ScholarPubMed
Collins, C. E., Burrows, T. L., Rollo, M. E., Boggess, M. M., Watson, J. F., Guest, M., … Hutchesson, M. J. (2015). The comparative validity and reproducibility of a diet quality index for adults: The Australian Recommended Food Score. Nutrients, 7(2), 785–798.CrossRefGoogle ScholarPubMed
Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86.CrossRefGoogle ScholarPubMed
Dørheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847–855.CrossRefGoogle ScholarPubMed
Edinger, J. D., Wyatt, J. K., Olsen, M. K., Stechuchak, K. M., Carney, C. E., Chiang, A., … Radtke, R. A. (2009). Reliability and validity of the Duke Structured Interview for Sleep Disorders for insomnia screening. 32, A265–A265.Google Scholar
Ellis, J. G., Cushing, T., & Germain, A. (2015). Treating acute insomnia: A randomized controlled trial of a ‘single-shot’ of cognitive behavioral therapy for insomnia. Sleep, 38(6), 971–978.Google ScholarPubMed
Facco, F. L., Grobman, W. A., Reid, K. J., Parker, C. B., Hunter, S. M., Silver, R. M., … Zee, P. C. (2017). Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. American Journal of Obstetrics and Gynecology, 217(4), 447.e1–447.e13.CrossRefGoogle ScholarPubMed
Felder, J. N., Baer, R. J., Rand, L., Jelliffe-Pawlowski, L. L., & Prather, A. A. (2017). Sleep disorder diagnosis during pregnancy and risk of preterm birth. Obstetrics and Gynecology, 130(3), 573–581.CrossRefGoogle ScholarPubMed
Felder, J. N., Epel, E. S., Neuhaus, J., Krystal, A. D., & Prather, A. A. (2020). Efficacy of digital cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: A randomized clinical trial. JAMA Psychiatry, 77(5), 484–492.CrossRefGoogle ScholarPubMed
Ho, F. Y.-Y., Chung, K.-F., Yeung, W.-F., Ng, T. H., Kwan, K.-S., Yung, K.-P., & Cheng, S. K. (2015). Self-help cognitive-behavioral therapy for insomnia: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 19, 17–28.CrossRefGoogle ScholarPubMed
Kalmbach, D. A., Cheng, P., O'Brien, L. M., Swanson, L. M., Sangha, R., Sen, S., … Drake, C. L. (2020). A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Medicine, 72, 82–92.CrossRefGoogle ScholarPubMed
Kempler, L., Sharpe, L. A., Marshall, N. S., & Bartlett, D. J. (2020). A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: A randomized controlled trial. Sleep, 43(11), zsaa101.CrossRefGoogle ScholarPubMed
King, L. S., Rangel, E., Simpson, N., Tikotzky, L., & Manber, R. (2019). Mothers’ postpartum sleep disturbance is associated with the ability to sustain sensitivity toward infants. Sleep Medicine, 65, 74–83.CrossRefGoogle ScholarPubMed
Lee, K. A. (1998). Alterations in sleep during pregnancy and postpartum: A review of 30 years of research. Sleep Medicine Reviews, 2(4), 231–242.CrossRefGoogle ScholarPubMed
Lee, K. A., & Gay, C. L. (2004). Sleep in late pregnancy predicts length of labor and type of delivery. American Journal of Obstetrics and Gynecology, 191(6), 2041–2046.CrossRefGoogle ScholarPubMed
Little, R. J. A., & Rubin, D. B. (2002). Statistical analysis with missing data. Hoboken, NJ, USA: John Wiley & Sons, Inc.CrossRefGoogle Scholar
Manber, R., Bei, B., Simpson, N., Asarnow, L., Rangel, E., Sit, A., & Lyell, D. (2019). Cognitive behavioral therapy for prenatal insomnia: A randomized controlled trial. Obstetrics and Gynecology, 133(5), 911–919.CrossRefGoogle ScholarPubMed
Manber, R., Buysse, D. J., Edinger, J., Krystal, A., Luther, J. F., Wisniewski, S. R., … Thase, M. E. (2016). Efficacy of cognitive-behavioral therapy for insomnia combined with antidepressant pharmacotherapy in patients with comorbid depression and insomnia: A randomized controlled trial. The Journal of Clinical Psychiatry, 77(10), e1316–e1323.CrossRefGoogle ScholarPubMed
Manber, R., Steidtmann, D., Chambers, A. S., Ganger, W., Horwitz, S., & Connelly, C. D. (2013). Factors associated with clinically significant insomnia among pregnant low-income Latinas. Journal of Women's Health, 22(8), 694–701.CrossRefGoogle ScholarPubMed
McBean, A. L., & Montgomery-Downs, H. E. (2013). Timing and variability of postpartum sleep in relation to daytime performance. Physiology & Behavior, 122, 134–139.CrossRefGoogle ScholarPubMed
Morin, C. M., Vallières, A., Guay, B., Ivers, H., Savard, J., Mérette, C., … Baillargeon, L. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: A randomized controlled trial. JAMA, 301(19), 2005–2015.CrossRefGoogle ScholarPubMed
Morin, C. M., Vallières, A., & Ivers, H. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30(11), 1547–1554.CrossRefGoogle ScholarPubMed
Nunes, E. V., Pavlicova, M., Hu, M.-C., Campbell, A. N., Miele, G., Hien, D., & Klein, D. F. (2011). Baseline matters: The importance of covariation for baseline severity in the analysis of clinical trials. The American Journal of Drug and Alcohol Abuse, 37(5), 446–452.CrossRefGoogle ScholarPubMed
Peuhkuri, K., Sihvola, N., & Korpela, R. (2012). Diet promotes sleep duration and quality. Nutrition Research, 32(5), 309–319.CrossRefGoogle ScholarPubMed
Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., & PROMIS Cooperative Group (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283.CrossRefGoogle ScholarPubMed
R Core Team. (2020). R: A language and environment for statistical computing. Retrieved from http://www.R-project.orgGoogle Scholar
Sedov, I., Madsen, J. W., Goodman, S. H., & Tomfohr-Madsen, L. M. (2019). Couples’ treatment preferences for insomnia experienced during pregnancy. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 37(1), 46–55.CrossRefGoogle ScholarPubMed
Sedov, I. D., & Tomfohr-Madsen, L. M. (2021). Trajectories of insomnia symptoms and associations with mood and anxiety from early pregnancy to the postpartum. Behavioral Sleep Medicine, 19(3), 395–406.CrossRefGoogle ScholarPubMed
Sharma, V., & Mazmanian, D. (2003). Sleep loss and postpartum psychosis. Bipolar Disorders, 5(2), 98–105.CrossRefGoogle ScholarPubMed
Sheehan, D. V., Lecrubier, Y., Harnett Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., … Dunbar, G. C. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry: The Journal of the Association of European Psychiatrists, 12(5), 232–241.CrossRefGoogle Scholar
Sivertsen, B., Hysing, M., Dørheim, S. K., & Eberhard-Gran, M. (2015). Trajectories of maternal sleep problems before and after childbirth: A longitudinal population-based study. BMC Pregnancy and Childbirth, 15(1), 129.CrossRefGoogle ScholarPubMed
Slavin, V., Gamble, J., Creedy, D. K., Fenwick, J., & Pallant, J. (2019). Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population – validation of the PROMIS Global Short Form. BMC Pregnancy and Childbirth, 19(1), 370.CrossRefGoogle Scholar
Smith, M. T., Huang, M. I., & Manber, R. (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25(5), 559–592.CrossRefGoogle ScholarPubMed
Spielman, A. J., Caruso, L. S., & Glovinsky, P. B. (1987). A behavioral perspective on insomnia treatment. The Psychiatric Clinics of North America, 10(4), 541–553.CrossRefGoogle ScholarPubMed
Sweeney, B. M., Signal, T. L., & Babbage, D. R. (2020). Effect of a behavioral-educational sleep intervention for first-time mothers and their infants: Pilot of a controlled trial. Journal of Clinical Sleep Medicine, 16(8), 1265–1274.CrossRefGoogle ScholarPubMed
van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45(3), 67.Google Scholar
Weinraub, M., Bender, R. H., Friedman, S. L., Susman, E. J., Knoke, B., Bradley, R., … Williams, J. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age. Developmental Psychology, 48(6), 1511–1528.CrossRefGoogle ScholarPubMed
Wilson, N., Wynter, K., Anderson, C., Rajaratnam, S. M. W., Fisher, J., & Bei, B. (2019). Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program. Sleep Medicine, 59, 33–41.CrossRefGoogle ScholarPubMed
Yu, L., Buysse, D. J., Germain, A., Moul, D. E., Stover, A., Dodds, N. E., … Pilkonis, P. A. (2011). Development of short forms from the PROMISTM sleep disturbance and sleep-related impairment item banks. Behavioral Sleep Medicine, 10(1), 6–24.CrossRefGoogle Scholar
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