Treating postpartum insomnia: a three arm randomised controlled trial of cognitive behavioural therapy and light dark therapy

Impact of sleep on postpartum health outcomes: a systematic review and meta-analysis

OBJECTIVE

To examine the impact of postpartum sleep interventions and postpartum sleep on maternal health outcomes.

DESIGN

Systematic review with random-effects meta-analysis. Online databases were searched on 12 January 2024.

STUDY ELIGIBILITY CRITERIA

Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1-year post partum), sleep interventions/exposures including (type, duration, frequency, alone or in combination with other components), comparator (control or different duration, frequency or type of sleep intervention) and outcomes: mental health, cardio-metabolic, postpartum weight retention (PPWR), low back pain and pelvic girdle pain, breastfeeding and urinary incontinence.

RESULTS

60 studies (n=20 684) from 14 countries were included. 'High' certainty of evidence showed that sleep interventions were associated with a greater decrease in depressive symptom severity compared with no intervention (five randomised controlled trials; n=992; standardised mean difference -0.27, 95% CI -0.40 to -0.14; small effect). Sleep interventions had no impact on the odds of developing depression ('moderate' certainty of evidence) or anxiety or anxiety symptom severity ('low' certainty of evidence). Additionally, 'low' certainty of evidence demonstrated no effect on cardiometabolic outcomes (systolic blood pressure, diastolic blood pressure, mean arterial pressure), anthropometric measures (maternal weight, body mass index) or prevalence of exclusive breastfeeding. 'Low' certainty of evidence from observational studies found that high-quality sleep reduces the odds of developing anxiety and reduces the severity of depression and anxiety symptoms. 'Low' and 'very low' certainty of evidence from observational studies found that shorter sleep duration is associated with greater PPWR.

CONCLUSIONS

Postpartum sleep interventions reduced the severity of depression symptoms.

Efficacy of bright light therapy for perinatal depression: A meta-analysis of a randomized controlled trial

BACKGROUND

Pharmacological treatments are commonly used in individuals experiencing perinatal depression (PPD); however, a debate regarding the reproductive safety of antidepressants is ongoing. Many pregnant women opt to discontinue antidepressant out of concern about potential negative effects on the developing fetus, while slow and ineffective antidepressant medications hinder improved outcomes in women with PPD. In recent years, bright light therapy (BLT) has gained traction as a treatment option for PPD; however, clinical trials findings examining the efficacy of BLT in this population have been inconclusive.

AIM

To validate the feasibility and safety of BLT for the treatment of PPD.

METHODS

We performed a meta-analysis of randomized controlled trials of patients with PPD treated with BLT vs placebo following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched PubMed, Embase, the Cochrane Library, and Web of Science for randomized controlled studies published up to December 2023. The results were evaluated using the standardized mean difference of improvement for depression scores and odds ratios (ORs) for remission rate, response rate, incidence of adverse events, and dropout rate.

RESULTS

The BLT group had higher PPD response rate [50.68% vs 33.08%; OR = 2.05; 95% confidence interval (CI): 1.25-3.35; P = 0.004; I^² = 35%] and remission rate (54.10% vs 18.52%; OR = 5.00; 95%CI: 2.09-11.99; P = 0.0003; I^² = 0%) than the placebo group. Improvements in depression scores were higher in the BLT group than the placebo group for the overall efficacy (standardized mean difference = -0.47; 95%CI: -0.80 to -0.13; P = 0.007). No significant differences between the two groups in drop-outs (21.84% vs 29.63%; OR = 0.63; 95%CI: 0.31-1.29; P = 0.21; I^² = 0%) or adverse events (17.89% vs 9.68%; OR = 2.01; 95%CI: 0.95-4.25; P = 0.07; I^² = 0%) were observed.

CONCLUSION

BLT can potentially treat PPD, showing better results than the control group in this study. BLT is effective and safe and could increase the available therapeutic options for PPD.

The effect of bright light therapy on sleep in pregnant women with major depressive disorder- a randomized controlled trial

PURPOSE

Bright light therapy (BLT) is a potential treatment for depression during pregnancy, which may also improve sleep. We investigated whether BLT has an effect on self-reported and actigraphy-estimated sleep in pregnant women diagnosed with depressive disorder.

METHOD

Sixty-seven pregnant women with a DSM-5 diagnosis of depressive disorder during pregnancy were randomly allocated to treatment with BLT (9,000 lx, 5,000 K) or dim red light therapy (DRLT, 100 lx, 2,700 K), which is considered placebo. For six weeks, both groups were treated daily at home for 30 min upon awakening. Follow-up took place at various time points. We collected data on sleep with the Pittsburgh Sleep Quality Index and with actigraphy wearables.

RESULTS

We found no statistically significant differences in treatment groups across any of the sleep parameters measured, namely sleep efficiency, duration, onset latency, fragmentation, and total sleep health as measured by self-report and actigraphy. Moreover, we observed no overall improvements in sleep during the treatment period.

CONCLUSIONS

The results suggest that any potential therapeutic effects of BLT might have on sleep are too small for the current study to detect.

CLINICAL TRIAL NUMBER

NTR5476; November 5th, 2015.

Prevalence of insomnia and associated factors among postpartum mothers in Mattu City, Southwest Ethiopia: a community-based study

BACKGROUND

Insomnia during the postpartum period has short-term and long-lasting effects on the health of the mother and her baby. Hence, this study assessed the prevalence of insomnia and its associated factors among postpartum mothers in Mattu City.

METHODS

A community-based cross-sectional study was conducted among randomly selected 451 postpartum mothers in Mattu City from May 1 to June 1, 2022. A structured questionnaire was used to conduct a face-to-face interview. Athens's Insomnia Scale (AIS) standardized tool was used to measure insomnia. EpiData version 4.4.2.1 and Statistical Package for Social Sciences version 26 were used for data entry and analysis, respectively. Factors significantly affecting insomnia were identified using a binary logistic regression analysis at a p-value of less than 0.05.

RESULTS

The prevalence of insomnia was found to be 29.3% (95% CI: 25, 33.5). Parity (AOR = 3.36; 95% CI: 1.88, 5.60), unplanned pregnancy (AOR = 6.15; 95% CI: 5.23, 11.55), lack of postnatal follow-up (AOR = 3.82; 95% CI: 1.85, 7.90), partner dissatisfaction with the gender of the current baby (AOR = 5.73; 95% CI: 3.23, 10.2), partner daily alcohol use (AOR = 3.12; 95% CI: 1.66), and postpartum intimate partner violence (AOR = 2.60; 95% 4.67) were found to be factors significantly associated with insomnia.

CONCLUSIONS

Generally, three in ten mothers were suffering from insomnia in the study area. Therefore, health professionals and health extension workers need to endorse and enhance the counseling of the postpartum mother and her partner jointly. In addition, the media and other concerned bodies should focus on the identified factors to overcome them.

Neuroimaging signatures and a deep learning modeling for early diagnosing and predicting non-pharmacological therapy success for subclinical depression comorbid sleep disorders in college students

Objective

College students with subclinical depression often experience sleep disturbances and are at high risk of developing major depressive disorder without early intervention. Clinical guidelines recommend non-pharmacotherapy as the primary option for subclinical depression with comorbid sleep disorders (sDSDs). However, the neuroimaging mechanisms and therapeutic responses associated with these treatments are poorly understood. Additionally, the lack of an early diagnosis and therapeutic effectiveness prediction model hampers the clinical promotion and acceptance of non-pharmacological interventions for subclinical depression.

Methods

This study involved pre- and post-treatment resting-state functional Magnetic Resonance Imaging (rs-fMRI) and clinical data from a multicenter, single-blind, randomized clinical trial. The trial included 114 first-episode, drug-naïve university students with subclinical depression and comorbid sleep disorders (sDSDs; Mean age=22.8±2.3 years; 73.7% female) and 93 healthy controls (HCs; Mean age=22.2±1.7 years; 63.4% female). We examined altered functional connectivity (FC) and brain network connective mode related to subregions of Default Mode Network (sub-DMN) using seed-to-voxel analysis before and after six weeks of non-pharmacological antidepressant treatment. Additionally, we developed an individualized diagnosing and therapeutic effect predicting model to realize early recognition of subclinical depression and provide objective suggestions to select non-pharmacological therapy by using the newly proposed Hierarchical Functional Brain Network (HFBN) with advanced deep learning algorithms within the transformer framework.

Results

Neuroimaging responses to non-pharmacologic treatments are characterized by alterations in functional connectivity (FC) and shifts in brain network connectivity patterns, particularly within the sub-DMN. At baseline, significantly increased FC was observed between the sub-DMN and both Executive Control Network (ECN) and Dorsal Attention Network (DAN). Following six weeks of non-pharmacologic intervention, connectivity patterns primarily shifted within the sub-DMN and ECN, with a predominant decrease in FCs. The HFBN model demonstrated superior performance over traditional deep learning models, accurately predicting therapeutic outcomes and diagnosing subclinical depression, achieving cumulative scores of 80.47% for sleep quality prediction and 84.67% for depression prediction, along with an overall diagnostic accuracy of 82.34%.

Conclusions

Two-scale neuroimaging signatures related to the sub-DMN underlying the antidepressant mechanisms of non-pharmacological treatments for subclinical depression. The HFBN model exhibited supreme capability in early diagnosing and predicting non-pharmacological treatment outcomes for subclinical depression, thereby promoting objective clinical psychological treatment decision-making.

The role of sleep protection in preventing and treating postpartum depression

Postpartum sleep disruption is a risk factor for postpartum depression (PPD) as well as a potential treatment target. In the first 6 months after delivery, when the risk of PPD is greatest, fragmented maternal sleep is most often related to necessary infant night feedings. Clinicians' conversations about planning for and navigating postpartum sleep should include questions about patient expectations, cultural traditions, and available support. For women at high risk of PPD, or with moderate to severe PPD or other symptoms of mental illness, protecting one 4-5 hour period of consolidated nighttime sleep may be necessary and effective. This can be achieved by having another adult step in for 1-2 infant night feedings or by employing other strategies. OBs can encourage high-risk patients to develop a postpartum plan for sleep protection by initiating this conversation during pregnancy.

Predictors of change in relationship satisfaction among Black postpartum mothers

The transition to parenthood can be a challenging time for the relationships of new parents and result in declines in relationship satisfaction. Although a robust literature has identified characteristics that predict changes in relationship satisfaction during this period, the relationships of Black mothers postpartum remain understudied. To address this gap, we examined a set of relational, individual, and external characteristics as predictors of relationship satisfaction trajectories over the first four months postpartum. First-time Black mothers (N = 93, 22.6% married, 52.7% cohabiting, 24.7% not cohabiting) reported on relational, individual, and external characteristics at 1 week postpartum and their relationship satisfaction at 1, 8, and 16 weeks postpartum. Mothers who reported more commitment and partner support were higher in initial satisfaction, as were mothers who were married or cohabiting with a partner (relative to mothers who were not cohabiting with their partner). Mothers with clinically significant depressive symptoms at 1 week postpartum had lower initial relationship satisfaction than mothers without clinically significant depressive symptoms. Mothers' sleep difficulties and experiences of racial discrimination were associated with changes in relationship satisfaction over time; mothers experiencing more sleep difficulties and racial discrimination experienced larger declines in satisfaction. These findings offer new insights into risk and protective factors associated with relationship satisfaction among Black mothers during the early postpartum period and can inform multicomponent interventions to enhance their relationship functioning.

The effects of light therapy on depression and sleep in women during pregnancy or the postpartum period: A systematic review and meta-analysis

BACKGROUND

In recent years, light therapy has been tried for the treatment of depression and sleep in pregnancy or postnatal period women, but the results have been inconclusive. This meta-analysis is the first to systematically review the effects of light therapy on depression and sleep disturbances in women during pregnancy and the postnatal period.

METHODS

We searched for randomized controlled studies in PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Chinese Biomedical Database up to January 2023. The standardized mean difference (SMD) was used to assess the efficacy of the outcome indicators.

RESULTS

Eight studies were eventually included in the analysis. The results showed that light therapy was more effective than the placebo group in terms of depression (SMD = .34, CI = .08-.61) and sleep (SMD = .64,95%CI = .28-1.00). Subgroup analysis could not explain the significant heterogeneity. There were no serious adverse effects in either the light therapy or placebo groups.

CONCLUSIONS

Light therapy could be considered an effective treatment for depression and sleep disturbances in women during pregnancy and the postnatal period. However, future high-quality trials with larger sample sizes are still needed.

Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go?

Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.

Insomnia and circadian rhythm: a bibliometrics study and visualization analysis via CiteSpace

Objective

The present study aimed to use CiteSpace to analyze the status of insomnia and circadian rhythm, identify the hot spots and trends, and provide a basis for future study.

Method

The Web of Science database was searched for studies related to insomnia and circadian from its inception to 14 April 2023. CiteSpace was used to generate online maps of collaboration between countries and authors and revealed hot spots and frontiers in insomnia and circadian rhythm.

Results

We searched 4,696 publications related to insomnia and circadian rhythm. Bruno Etain was the most prolific author with most publications, i.e., with 24 articles. The USA and the University of California were the leading country and the top institution in this field of study, with 1,672 and 269 articles, respectively. There was active cooperation between institutions, countries, and authors. Hot topics focused on circadian rhythm sleep disorders, circadian clock, light therapy, melatonin, and bipolar disorder.

Conclusion

Based on the CiteSpace results, we recommend a more active collaboration between various countries, institutions, and authors to conduct clinical and basic research related to insomnia and circadian rhythm. Ongoing research focuses on the interaction of insomnia with circadian rhythms and the corresponding pathways of clock genes and by extension, the role of circadian rhythms in disorders such as bipolar disorder. Modulation of circadian rhythms may be a hot spot for future insomnia therapies (such as light therapy and melatonin).

Integrating technology to increase the reach of CBT-I: state of the science and challenges ahead

In this Round Table Discussion, an international panel of experts discuss issues related to the use of technology in the delivery of cognitive behavioral therapy for insomnia (CBT-I), in order to increase its reach. Panelists were, in alphabetical order, Carmela Alcántara, PhD, an Associate Professor at Columbia University School of Social Work in New York, USA, Bei Bei, PhD., an Associate Professor at Monash University in Melbourne, Australia, Charles M. Morin, PhD., a Professor of Psychology at Laval University in Quebec City, Canada, and Annemieke A. van Straten, PhD., a Professor of Clinical Psychology at the Vrije Universiteit in Amsterdam, the Netherlands. The session was chaired by Rachel Manber, PhD., a Professor of Psychiatry and Behavioral Sciences at Stanford University, in Palo Alto, California, USA. In their introductions each panelist discussed the use of technology in their respective country. All indicated that the most common way technology is used in the treatment of insomnia is through the use of video calls (telemedicine) to deliver individual CBT-I, and that this is mostly covered by publicly funded health insurance programs such as Medicare, especially since the COVID-19 pandemic. There are also some fully automated insomnia treatment programs, but they're often not covered by Medicare or other health insurance programs.