![]() ![]() It is also exciting to see that CBT-I treatment was associated with improvements in depressive symptoms and anxiety. This is the first study to use a digital form of CBT-I in pregnant women with insomnia, and it has demonstrated that digital CBT-I may be an effective and practical approach to managing women with insomnia during pregnancy. The benefit of CBT-I treatment was maintained at the follow-up visit, which took place approximately 18 weeks after entry into the study. In addition, women receiving the CBT-I intervention experienced greater improvements in depressive symptoms and anxiety than women receiving standard care. The magnitude of the effect size was large. ![]() Compared to women receiving standard care, women randomized to receive digital CBT-I experienced statistically significantly greater improvements in insomnia symptom severity, sleep efficiency, and global sleep quality. Participants were assessed at 10 weeks after randomization (post-intervention) and at 18 weeks after randomization (follow-up). Most of the participants were white (66.3%), married or cohabiting (94.2%), had a college degree (86.5%), and earned $100?000 or more per year (67.8%). The 208 participants in this study had a mean age of 33.6 years and a mean gestational age of 17.6 weeks at baseline. Women receiving treatment as usual had no limits placed on the use of non-study treatments, including medication and psychotherapy. Participants also had access to a moderated online community and a library of sleep information. ![]() The digital CBT-I program, Sleepio (Big Health), could be accessed via website or iOS app and included 5 main components: sleep restriction, stimulus control, cognitive therapy, relaxation techniques, and sleep hygiene education. Women randomized to digital CBT-I received six weekly sessions of approximately 20 minutes each. Women with acute depressive symptoms, as defined as a score of 15 or greater on the Edinburgh Postnatal Depression Scale (EPDS) scale, active suicidality, self-reported bipolar disorder or psychosis were excluded. In this randomized controlled trial, pregnant women up to 28 weeks’ gestation were assessed using an online self-report questionnaire, and 208 women reporting insomnia were randomized to receive digital CBT-I (n?=?105) or to treatment as usual (n?=?103) for insomnia. So what can we offer to women who would like CBT for insomnia?Ī recent study from Felder and colleagues pilots the use of digitally delivered CBT for pregnant women with insomnia. So why don’t we refer all women with insomnia for CBT-I? It can be challenging, even in metropolitan, medically well-endowed cities like Boston, to find providers with expertise in this modality of treatment, and there are many other places in the United States which have much worse access to mental health services. In a recent study, Manber and colleagues demonstrated that CBT-I was effective in a group of pregnant women with insomnia. There are data to support the safety of certain sleep-promoting medications during pregnancy, including benzodiazepines and sedative-hypnotic agents (Z-drugs) however, many women would prefer to avoid the use of medications during pregnancy, if possible.Ĭognitive-behavioral therapy (CBT-I) specifically designed for insomnia may be a useful adjunct or alternative to medication. Sleep disruption is a common complaint during pregnancy, with 15% to 80% of women reporting sleep problems during the first trimester and 66% to 97% of women in the third trimester. ![]()
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