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

Abstract

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.

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

“…The average age of participants in each study ranged from 24 to 34 years. The light equipment for the two trials were light glasses and light visors, respectively (Lee et al., 2013 ; Verma et al., 2022 ), and the rest used light boxes. The intensity of light therapy ranges from 1250 to 10,000 lx, and all studies had morning treatment sessions.…”

“…The daily treatment duration ranged from 30 to 60 min, and the duration of treatment varied between 3 and 6 weeks. All trial controls were <1000 lx dim light, except for one study that used the usual treatment as a control (Verma et al., 2022 ).…”

Effects of Pilates Exercises to Depression and Sleep Quality on the Postpartum Period: A Randomized Controlled Study

“…We observed that 12 weeks of pilates training improved the sleep quality of postpartum women. Although there is only one study in the literature on the effect of pilates exercises on postpartum sleep quality (26), methods such as cognitive behavioral therapy and light-dark therapy were found to be effective in reducing sleep problems (43).…”

“…The sleep problem seen during the new motherhood period is one of the critical problems that may affect the mother-baby and mother-family harmony that can be seen in the mother (44). In the literature, methods such as cognitive behavioral therapy and Light dark therapy have been used and found effective to reduce sleep problems (43). The improvement in sleep quality, after sleep quality measurement results were compared (F=31,865; p<0.001, ηp2=0.375).…”

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

“…Napping was restricted in studies of individuals with alcohol use disorder (Arnedt et al, 2011), breast cancer (Quesnel et al, 2003), comorbid depression (Wagley et al, 2013), and other psychiatric disorders (Crönlein et al, 2014(Crönlein et al, , 2019(Crönlein et al, , 2020. Strategic napping was recommended for shift workers (Järnefelt et al, 2020) and during perinatal periods (Bei et al, 2023;Manber et al, 2019Manber et al, , 2023Verma et al, 2022) when experiencing significant sleep debt or waking sleepiness. Review of psychiatric medications and adjusting their timing has also been used to reduce daytime sleepiness and subsequently minimise napping (Chiu et al, 2018;Waite et al, 2016).…”