Bright Light Therapy to Promote Sleep in Mothers of Low-Birth-Weight Infants

Abstract

Having a low-birth-weight (LBW) infant in a neonatal intensive care unit (NICU) can intensify a mother’s sleep disturbances due to both stress and the dim lighting in the ICU setting, which desynchronizes circadian rhythms. The purpose of this pilot study was to examine the effectiveness of a 3-week bright light therapy intervention on sleep and health outcomes of mothers with LBW infants in the NICU. Controlled stratified randomization was used to assign 30 mothers to a treatment or control group. Data were collected at pretreatment (second week postpartum) and after the 3-week intervention. Sleep data were assessed by wrist actigraph (total sleep time [TST], circadian activity rhythms [CARs]) and the General Sleep Disturbance scale. Other outcome variables were measured by the Lee’s Fatigue scale, Edinburgh Postpartum Depression scale, and the Medical Outcomes Short Form 36, version 2. Mothers averaged 26.6 ( SD = 6.3) years of age, and the majority were Black (73%). The mean gestational age for the infants was 27.7 ( SD = 2.0) weeks. Small to large effect sizes were found when comparing the pre- to posttreatment differences between groups. Although none of the differences were statistically significant in this small sample, for mothers in the treatment group nocturnal TST ( d = .33), CAR ( d = 1.06), morning fatigue ( d = .22), depressive symptoms ( d = .40), physical health–related quality of life ( d = .33), and mental health–related quality of life ( d = .60) all improved compared to the control group. Bright light therapy is feasible for mothers with infants in an NICU. Clinically significant improvements have been evidenced; a larger-scale trial of effectiveness is needed.

NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis

“…The funnel plot of depression studies ( Fig 4) does not suggest a notable lack of symmetry. The study by Lee and colleagues 23 was somewhat unique in its moderate effect size and large SE, which likely reflect its distinct intervention approach. To assess potential bias resulting from this study, we conducted a sensitivity analysis and did not observe a notable impact by excluding the study.…”

“…Three studies assessed CBT interventions, 10,25,27 4 studies assessed education-based approaches, 9, 21, 24, 26, 31 1 study assessed an intervention to promote anxiety reduction and infant sensitivity training, 22 1 study assessed a series of mother-infant "calming activities, " 29 1 study assessed 2 methods involving infant stimulation and touch, kangaroo care, and an auditory-tactile-visualvestibular intervention, 28 1 study assessed an interview tool to improve parent-physician communication, 30 and 1 study assessed bright light therapy. 23 Three of the studies on education-based approaches assessed the same intervention, the Creating Opportunities for Parent Empowerment Program (COPE) 9,21,24,26 ; all other studies assessed different interventions.…”

“…As shown in Table 2, 2 studies were evaluated as having high risk for bias, 10, 28 4 studies as having moderate risk for bias, 21,23,25,30 and 5 studies as having low risk for bias. 9,22,24,26,27 We excluded the studies at high risk of bias from quantitative analyses based on recommendations for best practices in meta-analyses.…”

Depressive symptoms and the relationship of stress, sleep, and well-being among NICU mothers

“…This study used a cross-sectional comparative study design and included the baseline data from a feasibility study [26] and a pilot study [32] of two-phase randomization trials examining the effects of bright light therapy on sleep and depressive symptoms among the mothers with an infant in the NICU. A convenience sample of 55 mothers from three urban hospitals in the southeast United States completed the Phase I protocol during the postpartum 10 th to 13 th days while the infants were hospitalized and the mothers slept at home.…”

Sleep and its relationship to health in parents of preterm infants: a scoping review

“…After completing the screening process, eleven studies were ultimately included in the review. Nine studies were retrieved as articles [ 46 – 54 ], and two were retrieved as dissertations [ 55 , 56 ] (Table 1 ). Schaffer had published a paper based on a dissertation [ 56 , 57 ], but because the dissertation contained more data, only it was included in the review.…”