TY - JOUR
T1 - Treating postpartum insomnia
T2 - a three arm randomised controlled trial of cognitive behavioural therapy and light dark therapy
AU - Verma, Sumedha
AU - Quin, Nina
AU - Astbury, Laura
AU - Wellecke, Cornelia
AU - Wiley, Joshua F.
AU - Davey, Margot
AU - Rajaratnam, Shantha M.W.
AU - Bei, Bei
N1 - Funding Information:
Verma and Quin are recipients of Australian Government Research Training Program Scholarship. Bei (APP1140299) and Wiley (APP1178487) are supported by National Health and Medical Research Council Fellowships. The funding sources had no role in design or undertaking of the current trial, including data analyses, interpretation, or decision to submit the manuscript for publication.
Publisher Copyright:
© The Author(s), 2022. Published by Cambridge University Press.
PY - 2023/9/9
Y1 - 2023/9/9
N2 - Background. Insomnia symptoms are common during the postpartum period, yet interventions remain scarce. This trial aimed to simultaneously examine the efficacy of cognitive behavioural therapy (CBT) and light dark therapy (LDT), targeting different mechanisms, against treatment-as-usual (TAU), in reducing maternal postpartum insomnia symptoms. Methods. This three-arm randomised controlled trial recruited from the general community in Australia. Nulliparous females 4–12 months postpartum with self-reported insomnia symptoms [Insomnia Severity Index (ISI) scores >7] were included; severe medical/psychiatric conditions were excluded. Participants were randomised 1:1:1 to CBT, LDT, or TAU stratified by ISI (< or ≥14) and infant age (< or ≥8 months). Participants and principal investigators were unblinded. Six-week interventions were delivered via digital materials and telephone. The primary outcome was insomnia symptoms (ISI), assessed pre-, midpoint-, post- (primary endpoint), and one-month post-intervention. Analyses were intention-to-treat using latent growth models. Results. 114 participants (CBT = 39, LDT = 36, TAU = 39; Mage = 32.20 ± 4.62 years) were randomised. There were significantly greater reductions in ISI scores in CBT and LDT (effect sizes −2.01 and −1.52 respectively, p < 0.001) from baseline to post-intervention compared to TAU; improvements were maintained at follow-up. Similar effects were observed for self-reported sleep disturbance. There were greater reductions in fatigue in CBT (effect size = 0.85, p < 0.001) but not LDT (p = 0.11) compared to TAU. Changes in sleepiness, depression, and anxiety were non-significant compared to TAU (all p > 0.08). Four participants (11%) in the LDT group reported headaches, dizziness, or nausea; no others reported adverse events. Conclusions. Therapist-assisted CBT and LDT were feasible during the first postpartum year; data at post-intervention and 1-month follow-up support their safety and efficacy in reducing postpartum insomnia symptoms.
AB - Background. Insomnia symptoms are common during the postpartum period, yet interventions remain scarce. This trial aimed to simultaneously examine the efficacy of cognitive behavioural therapy (CBT) and light dark therapy (LDT), targeting different mechanisms, against treatment-as-usual (TAU), in reducing maternal postpartum insomnia symptoms. Methods. This three-arm randomised controlled trial recruited from the general community in Australia. Nulliparous females 4–12 months postpartum with self-reported insomnia symptoms [Insomnia Severity Index (ISI) scores >7] were included; severe medical/psychiatric conditions were excluded. Participants were randomised 1:1:1 to CBT, LDT, or TAU stratified by ISI (< or ≥14) and infant age (< or ≥8 months). Participants and principal investigators were unblinded. Six-week interventions were delivered via digital materials and telephone. The primary outcome was insomnia symptoms (ISI), assessed pre-, midpoint-, post- (primary endpoint), and one-month post-intervention. Analyses were intention-to-treat using latent growth models. Results. 114 participants (CBT = 39, LDT = 36, TAU = 39; Mage = 32.20 ± 4.62 years) were randomised. There were significantly greater reductions in ISI scores in CBT and LDT (effect sizes −2.01 and −1.52 respectively, p < 0.001) from baseline to post-intervention compared to TAU; improvements were maintained at follow-up. Similar effects were observed for self-reported sleep disturbance. There were greater reductions in fatigue in CBT (effect size = 0.85, p < 0.001) but not LDT (p = 0.11) compared to TAU. Changes in sleepiness, depression, and anxiety were non-significant compared to TAU (all p > 0.08). Four participants (11%) in the LDT group reported headaches, dizziness, or nausea; no others reported adverse events. Conclusions. Therapist-assisted CBT and LDT were feasible during the first postpartum year; data at post-intervention and 1-month follow-up support their safety and efficacy in reducing postpartum insomnia symptoms.
KW - circadian rhythm
KW - clinical trial
KW - cognitive behavioural therapy
KW - fatigue
KW - insomnia
KW - intervention
KW - light dark therapy
KW - perinatal
KW - postpartum
KW - sleep
UR - http://www.scopus.com/inward/record.url?scp=85164385818&partnerID=8YFLogxK
U2 - 10.1017/S0033291722002616
DO - 10.1017/S0033291722002616
M3 - Article
C2 - 36082412
AN - SCOPUS:85164385818
SN - 0033-2917
VL - 53
SP - 5459
EP - 5469
JO - Psychological Medicine
JF - Psychological Medicine
IS - 12
ER -
