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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
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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