A digital version of cognitive behavioral therapy, or dCBT, previously shown to reduce insomnia during pregnancy, may, according to a new study by researchers at UC San Francisco.
The study, which appears in the current issue of Sleep, is unique in that it shows that non-depressed women who received dCBT for insomnia during pregnancy also slept better and had less depression several months after giving birth. The study is a continuation of a study published in JAMA Psychiatry in January 2020 that shows that the treatment reduces insomnia, depression, and anxiety symptoms during pregnancy.
“We were excited to see if the insomnia benefits of dCBT persisted after the baby was born, especially given the demands of a young infant,” said Jennifer Felder, PhD, assistant professor of psychiatry and nuclear research at UCSF’s Osher Center for Integrative Health UCSF, who led the study. “We were particularly pleased to see that the benefits not only for insomnia but also for mental health in general lasted for up to six months.”
Insomnia during pregnancy is common but insufficiently researched
About 38 percent of women suffer from insomnia during pregnancy, which in turn is associated with a 30 percent increased risk of premature birth. However, there is still little research into whether sleep interventions are effective in pregnant women.
We know that puerperium can be a prone time for depression, and it is possible that this intervention could prevent it.
Jennifer Felder, PhD, Assistant Professor of Psychiatry
Studies to prevent postpartum depression, which affects up to 15 percent of women, have focused on women with a history of depression or subclinical symptoms of depression. No research has tested whether treating insomnia can prevent postpartum depression.
“I’ve heard patients say over and over that their postpartum mental health began to suffer when their insomnia began, suggesting that there is a connection,” Felder said. “We know that the postpartum period can be a prone time for depression, and it is possible that this intervention could prevent it.”
The current study enrolled 208 participants, 105 of whom were randomly assigned to dCBT treatment – a self-paced sleep app called Sleepio that patients used for up to six sessions for 20 minutes each. Three months after giving birth, 4 percent of women who used the app were rated likely to be depressed compared to 18 percent of women who received standard care.
Digital Therapy: More Affordable, Scalable
Usual care included medication or general sleep hygiene tips from doctors and others. dCBT may work better because it is more individual and addresses the factors known to perpetuate insomnia, Felder said.
“Participants can set their own goals and their treatment recommendations are based on their sleep for the past week,” said Felder. “The magic of the treatment lies in what happens between sessions, the tactics participants put into practice like keeping a sleep diary, stabilizing wake time, reducing the time in bed tossing and prioritizing adequate relaxation before bed. ”
Given the lack of psychiatric clinicians trained in cognitive behavioral therapy, testing treatments that women can actually access is important, added Felder, “This is a scalable intervention with a low risk profile – and it works.”
Felder said she and her colleagues plan to conduct a large-scale study in the near future to conclusively determine whether dCBT for insomnia prevents postpartum depression. In addition, she is currently piloting a mindfulness-based intervention to help pregnant people manage sleep disorders caused by discomfort, pain, or an active mind.
Co-authors: Other authors include Elissa Epel, PhD, Andrew Krystal, MD, and Aric Prather, PhD, from the UCSF Department of Psychiatry and Behavioral Sciences; and John Neuhaus, PhD, of the UCSF Department of Epidemiology and Biostatistics.
Financing: The study was supported by the UCSF California Preterm Birth Initiative transdisciplinary postdoctoral fellowship, funded by Marc and Lynne Benioff, and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR001872.
Disclosure: Krystal advises several health technology and pharmaceutical companies, including Big Health, which makes Sleepio. His involvement in the current study was manuscript drafting.
The Sleepio app is a for-profit app with an annual subscription of approximately $ 530 that is covered by some health insurers and large employers. Other dCBTi apps for insomnia are Somryst and CBT-i Coach.
The University of California, San Francisco (UCSF) is entirely focused on health sciences and is dedicated to advancing health worldwide through advanced biomedical research, graduate education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as the UCSF’s primary academic medical center, includes high-level specialty hospitals and other clinical programs and has offices across the Bay Area.