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Randomized controlled trial of cognitive behavioral therapy for perinatal insomnia: postpartum outcomes. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Manber, R., Bei, B., Suh, S., Simpson, N., Rangel, E., Sit, A., Lyell, D. J. 2023

Abstract

This study aimed to assess the effectiveness of cognitive behavioral therapy for insomnia (CBTI) during the postpartum period, as part of a larger randomized controlled trial of CBTI on perinatal insomnia.179 women of 18 to 30 gestational weeks with insomnia disorder were randomized to CBTI or an active control (CTRL) therapy. Participants were assessed between 18-32 weeks of pregnancy at baseline, after the intervention during pregnancy, and at 8, 18, and 30 weeks postpartum. The primary outcome were the Insomnia Severity Index (ISI) and total awake time (TWT), defined as minutes awake during the sleep opportunity period, assessed with actigraphy and sleep diaries. Included in the analyses were women who provided data for at least one of three postpartum assessments (68 in CBTI; 61 in CTRL).Piecewise mixed-effects models revealed a main effect reflecting reduction in ISI scores from 8 to 18 weeks postpartum (p = .036) and a non-significant increase from 18 to 30 weeks; significant effects for group allocation were present only in week 30 (p = .042). CTRL participants reported significantly longer time awake, excluding time spent caring for the infant, at each postpartum assessment; time awake at night caring for the infant did not differ between groups. There was no significant group difference in the postpartum trajectory of actigraphy measured TWT, the two diary measures of time awake (p-values > .05). CBTI participants with at least 50% reduction in ISI during pregnancy had consistently stable ISI scores (mean < 6) during the postpartum period; those in CTRL had variable ISI scores over time with large individual differences.For women with insomnia disorder during pregnancy, CBTI initiated during pregnancy conferred postpartum benefits in terms of wakefulness after sleep onset (excluding time spent caring for the infant) and insomnia severity, though the latter emerged only later in the postpartum period. These findings underscore the importance of treating insomnia during pregnancy, a conclusion that is further supported by our finding that pregnant women who responded to insomnia treatment during pregnancy experienced better sleep in the postpartum period.Clinicaltrials.gov, NCT01846585.

View details for DOI 10.5664/jcsm.10572

View details for PubMedID 37078188