Sleep education during pregnancy for new mothers

BMC Pregnancy and Childbirth

Delwyn Bartlett¹  Louise Sharpe²  Liora Kempler² 

[1] Brain and Mind Research Institute, The University of Sydney, 100 Mallett Street, Camperdown, Australia;School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), Sydney, Australia

关键词: Psychoeducation;    Depression;    Postpartum;    Postnatal;    New mothers;    Sleep;   

Others  :  1151426
DOI  :  10.1186/1471-2393-12-155

 received in 2012-12-04, accepted in 2012-12-07,  发布年份 2012

【 摘 要 】

Background

There is a high association between disturbed (poor quality) sleep and depression, which has lead to a consensus that there is a bidirectional relationship between sleep and mood. One time in a woman’s life when sleep is commonly disturbed is during pregnancy and following childbirth. It has been suggested that sleep disturbance is another factor that may contribute to the propensity for women to become depressed in the postpartum period compared to other periods in their life. Post Natal Depression (PND) is common (15.5%) and associated with sleep disturbance, however, no studies have attempted to provide a sleep-focused intervention to pregnant women and assess whether this can improve sleep, and consequently maternal mood post-partum. The primary aim of this research is to determine the efficacy of a brief psychoeducational sleep intervention compared with a control group to improve sleep management, with a view to reduce depressive symptoms in first time mothers.

Method

This randomised controlled trial will recruit 214 first time mothers during the last trimester of their pregnancy. Participants will be randomised to receive either a set of booklets (control group) or a 3hour psychoeducational intervention that focuses on sleep. The primary outcomes of this study are sleep-related, that is sleep quality and sleepiness for ten months following the birth of the baby. The secondary outcome is depressive symptoms. It is hypothesised that participants in the intervention group will have better sleep quality and sleepiness in the postpartum period than women in the control condition. Further, we predict that women who receive the sleep intervention will have lower depression scores postpartum compared with the control group.

Discussion

This study aims to provide an intervention that will improve maternal sleep in the postpartum period. If sleep can be effectively improved through a brief psychoeducational program, then it may have a protective role in reducing maternal postpartum depressive symptoms.

Registration details

This trial is registered with the Australian New Zealand Clinical Trials Register under the registration number ACTRN12611000859987

【 授权许可】

   
2012 Kempler et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Sejnowski TJ, Destexhe A: Why do we sleep? Brain Res 2000, 886(1–2):208-223.
• [2]Scharf MT, et al.: The energy hypothesis of sleep revisited. Prog Neurobiol 2008, 86(3):264-280.
• [3]Stickgold R, Walker MP: Sleep-dependent memory consolidation and reconsolidation. Sleep Med 2007, 8(4):331-343.
• [4]Hammond EC: Some Preliminary Findings on Physical Complaints from a Prospective-Study of 1,064,004 Men and Women. Am J Publ Health Nation Health 1964, 54(1):11-23.
• [5]Groeger JA, Zijlstra FRH, Dijk DJ: Sleep quantity, sleep difficulties and their perceived consequences in a representative sample of some 2000 British adults. J Sleep Res 2004, 13(4):359-371.
• [6]Ravan AR, et al.: Thirty-six-year secular trends in sleep duration and sleep satisfaction, and associations with mental stress and socioeconomic factors - results of the Population Study of Women in Gothenburg, Sweden. J Sleep Res 2010, 19(3):496-503.
• [7]Kronholm E, et al.: Trends in self-reported sleep duration and insomnia-related symptoms in Finland from 1972 to 2005: a comparative review and re-analysis of Finnish population samples. J Sleep Res 2008, 17(1):54-62.
• [8]Bartlett DJ, et al.: Predictors of primary medical care consultation for sleep disorders. Sleep Med 2008, 9(8):857-864.
• [9]Pilcher JJ, Huffcutt AI: Effects of sleep deprivation on performance: A meta-analysis. Sleep 1996, 19(4):318-326.
• [10]Morawetz: Insomnia and Depression: Which Comes First? Sleep Res Online 2003, 5(2):77-81.
• [11]Peterson MJ, Benca RM: Sleep in mood disorders. Psychiatr Clin North Am 2006, 29(4):1009-1032. abstract ix
• [12]Johnson EO, Roth T, Breslau N: The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk. J Psychiatr Res 2006, 40(8):700-708.
• [13]Angell M: Diagnostic and Statistical Manual of Mental Disorders, 4th edition. New York Rev Books 2011, 58(12):20-22.
• [14]Ohayon MM, Roth T: Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res 2003, 37(1):9-15.
• [15]Benca RM, Peterson MJ: Insomnia and depression. Sleep Med 2008, 9:S3-S9.
• [16]Taylor DJ, et al.: Epidemiology of insomnia, depression, and anxiety. Sleep 2005, 28(11):1457-1464.
• [17]Ford DE, Kamerow DB: Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989, 262(11):1479-1484.
• [18]Breslau N, et al.: Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biol Psychiatry 1996, 39(6):411-418.
• [19]Riemann D, Voderholzer U: Primary insomnia: a risk factor to develop depression? J Affect Disord 2003, 76(1–3):255-259.
• [20]Hedman C, et al.: Effects of pregnancy on mothers' sleep. Sleep Med 2002, 3(1):37-42.
• [21]Pregnancy and Sleep. 2011. 2012, http://www.sleepfoundation.org/article/sleep-topics/pregnancy-and-sleep webcite
• [22]Neau JP, et al.: Restless Legs Syndrome and Pregnancy: A Questionnaire Study in the Poitiers District, France. Eur Neurol 2010, 64(5):268-274.
• [23]Santiago JR, et al.: Sleep and sleep disorders in pregnancy. Ann Intern Med 2001, 134(5):396-408.
• [24]Moline M, Broch L, Zak R: Sleep Problems Across the Life Cycle in Women. Curr Treat Options Neurol 2004, 6(4):319-330.
• [25]Facco FL, et al.: Sleep Disturbances in Pregnancy. Obstet Gynecol 2010, 115(1):77-83.
• [26]Mindell JA, Jacobson BJ: Sleep disturbances during pregnancy. J Obstet Gynecol Neonatal Nurs 2000, 29(6):590-597.
• [27]Goyal D, Gay CL, Lee KA: Patterns of sleep disruption and depressive symptoms in new mothers. J Perinat Neonatal Nurs 2007, 21(2):123-129.
• [28]Gay CL, Lee KA, Lee SY: Sleep patterns and fatigue in new mothers and fathers. Biol Res Nurs 2004, 5(4):311-318.
• [29]Waters MA, Lee KA: Differences between primigravidae and multigravidae mothers in sleep disturbances, fatigue, and functional status. J Nurs Midwifery 1996, 41(5):364-367.
• [30]Signal TL, et al.: Sleep duration and quality in healthy nulliparous and multiparous women across pregnancy and post-partum. Aust N Z J Obstet Gynaecol 2007, 47(1):16-22.
• [31]Paterson LQP, et al.: Persistent Genital and Pelvic Pain after Childbirth. J Sex Med 2009, 6(1):215-221.
• [32]Ostgaard HC, Andersson GBJ: Postpartum Low-Back-Pain. Spine 1992, 17(1):53-55.
• [33]Smith MT, Haythornthwaite JA: How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev 2004, 8(2):119-132.
• [34]Guilleminault C, Eldridge FL, Dement WC: Insomnia with sleep apnea: a new syndrome. Science 1973, 181(4102):856-858.
• [35]Bjornsdottir E, et al.: Insomnia in untreated sleep apnea patients compared to controls. J Sleep Res 2011, 21(2):131-138.
• [36]Righetti-Veltema M, et al.: Risk factors and predictive signs of postpartum depression. J Affect Disord 1998, 49(3):167-180.
• [37]Hiscock H, et al.: Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child 2007, 92(11):952-958.
• [38]Phillips J, Sharpe L, Nemeth D: Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatr 2010, 44(3):280-289.
• [39]Stremler R, et al.: A behavioral-educational intervention to promote maternal and infant sleep: A pilot randomized, controlled trial. Sleep 2006, 29(12):1609-1615.
• [40]Franzen PL, Buysse DJ: Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci 2008, 10(4):473-81.
• [41]Morin CM, Rodrigue S, Ivers H: Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med 2003, 65(2):259-267.
• [42]Sadeh A: The role and validity of actigraphy in sleep medicine: An update. Sleep Med Rev 2011, 15(4):259-267.
• [43]Mindell JA: Sleep Deprived No More. United States of America: Marlowe & Company - Avalon Publishing Group; 2007:275.
• [44]Burnham MM, et al.: Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study. J Child Psychol Psychiatry 2002, 43(6):713-725.
• [45]Henderson JMT, et al.: Sleeping Through the Night: The Consolidation of Self-regulated Sleep Across the First Year of Life. Pediatrics 2010, 126(5):E1081-E1087.
• [46]Bartlett D: Place of birthing and adjustment to motherhood. Sydney, Australia: School of Behavioural Sciences, Macquarie University; 1993:61.
• [47]Kennedy HP, et al.: Negotiating sleep - A qualitative study of new mothers. J Perinat Neonatal Nurs 2007, 21(2):114-122.
• [48]Wang MY, Wang SY, Tsai PS: Cognitive behavioural therapy for primary insomnia: a systematic review. J Adv Nurs 2005, 50(5):553-64.
• [49]Morin CM, Culbert JP, Schwartz SM: Nonpharmacological Interventions for Insomnia - a Metaanalysis of Treatment Efficacy. Am J Psychiatry 1994, 151(8):1172-1180.
• [50]Morin CM, Culbert JP, Schwartz SM: Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994, 151(8):1172-80.
• [51]Adams G, et al.: Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol 2004, 57(8):785-794.
• [52]Schulz KF, et al.: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010, 63(8):834-840.