Differentiating perinatal Insomnia Disorder and sleep disruption: A longitudinal study from pregnancy to 2 years postpartum

SLEEP ◽  
2022 ◽  
Author(s):  
Nina Quin ◽  
Jin Joo Lee ◽  
Donna M Pinnington ◽  
Louise Newman ◽  
Rachel Manber ◽  
...  
Keyword(s):  
Mental Health ◽  
Longitudinal Study ◽  
Controlled Trial ◽  
Structured Interview ◽  
Sleep Disruption ◽  
Depression And Anxiety ◽  
P Values ◽  
Sleep Complaints ◽  
Insomnia Disorder ◽  
Randomised Controlled

Abstract Study Objectives Insomnia Disorder diagnoses require persistent sleep complaints despite “adequate sleep opportunity”. Significant perinatal sleep disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates. Methods 163 nulliparous females (age M±SD=33.35±3.42) participating in a randomised-controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and PROMIS measures for sleep and mental health at 30 and 35 weeks’ gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when DSM-5 Insomnia Disorder criteria were: (1) met (Insomnia Disorder), (2) not met only because of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3.) not met due to other criteria (Low Complaint). Results Proportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3-11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2-4 times higher (21.4-40.4%) across time-points. Mixed effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (p-values<.01), but depression and anxiety were comparable (p-values>.12). Conclusion Assessing sleep complaints without considering sleep opportunity can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and perinatal sleep disruption were associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed.

scholarly journals 0459 Is It Having a Baby or Me? Differentiating Insomnia Disorder and Sleep Disruption from Pregnancy to 2 Years Postpartum

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A176-A176
Author(s):  
N Quin ◽  
J Lee ◽  
D M Pinnington ◽  
L Shen ◽  
R Manber ◽  
...  
Keyword(s):  
Specific Treatment ◽  
Structured Interview ◽  
Sleep Disruption ◽  
Depression And Anxiety ◽  
Sleep Complaints ◽  
Time Points ◽  
Maternal Sleep ◽  
Insomnia Disorder ◽  
Pregnancy And Postpartum ◽  
Sleep Condition

Abstract Introduction Insomnia Disorder (Insomnia) diagnosis requires sleep complaints to persist despite “sleep-conducive conditions and adequate sleep opportunity”. Women experience significant sleep disruption during pregnancy and postpartum periods due to physiological changes and night-time infant care, but not all women with sleep complaints meet Insomnia criteria. This study examined sleep and mental health correlates of Insomnia Disorder and sleep complaints in the context of a randomised controlled trial for improving maternal sleep. Methods 163 generally healthy first-time mothers (age M±SD=33.4±3.5) with singleton pregnancy repeated the following assessments at 28-30 and 35-36 weeks’ gestation, and 1.5, 3, 6, 12, and 24 months postpartum: the Insomnia module of the Duke Structured Interview for Sleep Disorders, PROMIS Sleep-Related Impairment, Depression, and Anxiety Short Forms. We compared clinical features when DSM-5 Insomnia criteria (less the 3-month criteria) were (1) met (Insomnia), (2) not met only because of the sleep condition/opportunity criteria (Sleep Disruption), and (3) not met due to low symptom/distress (Low Complaint). Results 944 interviews and 1009 questionnaire were collected across 7 time-points. Proportions of women meeting Insomnia criteria were 16.0% and 19.8% during early and late third trimester, and ranged 5.3-11.7% during the 5 postpartum time-points. If the sleep condition/opportunity criteria were not considered, rates of “Insomnia” would have been 2-4 times higher at 21.4-40.4% across all time-points. Mixed effects models, controlling for intervention allocation, showed that compared with Insomnia, Sleep Disruption had comparable depression (p=.68) and anxiety (p=.23), and somewhat lower sleep-related impairment (p=.06). These symptoms were lowest for Low Complaint. Conclusion Both Insomnia and Sleep Disruption were associated with significant daytime impairment, depression, and anxiety. Assessing sleep complaints without considering sleep condition/opportunity can result in over-diagnosis of perinatal Insomnia in these women with primarily sleep disruption; these women may have limited benefits from Insomnia-specific treatment. Interventions for maternal sleep should carefully differentiate between Insomnia and other sleep concerns (e.g., sleep disruption/opportunity, sleepiness/fatigue) and appropriately address each. Support Australasian Sleep Association, Monash University, Royal Women’s Hospital Foundation. National Health and Medical Research Council, Department of Education and Training.

scholarly journals P153 Sleep timing and chronotype in perinatal periods: Longitudinal changes and associations with wellbeing from pregnancy to 2 years postpartum

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A71-A71
Author(s):  
S Verma ◽  
D Pinnington ◽  
R Manber ◽  
B Bei
Keyword(s):  
Mental Health ◽  
Sleep Duration ◽  
Controlled Trial ◽  
Community Sample ◽  
P Values ◽  
Sleep Complaints ◽  
Time Points ◽  
Sleep Timing ◽  
Group Allocation ◽  
Over Time

Abstract Introduction Significant changes to sleep occur during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined associations between chronotype and insomnia, sleep-related impairment, and mood at seven different perinatal time-points. Methods Data were from a 2-arm randomised controlled trial testing behavioural sleep and diet interventions. A community sample of nulliparous females without severe sleep/mental health conditions participated. Participants self-reported bedtime, rise-time, chronotype (short Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over seven time points: gestation weeks 30 and 35, and postpartum months 1.5, 3, 6, 12 and 24. Results 163 participants (mean age 33.4±3.4 years) took part. Mixed effects models adjusting for age and group allocation showed that both bed- and rise-times became progressively earlier by approximately 20–30 minutes over time (p<.001); chronotype shifted progressively towards more morningness (p<.01). After adjusting for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values<.001); at each time-point, associations between chronotype and symptoms of depression and anxiety were non-significant (p-values>0.65). Conclusions Sleep timing and chronotype became progressively earlier over the first two postpartum years. Greater morningness was associated with less sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms of these findings may be investigated through further research.

scholarly journals Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India

2021 ◽  
Vol 6 (6) ◽  
pp. e003902
Author(s):  
Rachana Parikh ◽  
Adriaan Hoogendoorn ◽  
Daniel Michelson ◽  
Jeroen Ruwaard ◽  
Rhea Sharma ◽  
...  
Keyword(s):  
Mental Health ◽  
Low Income ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
New Delhi ◽  
Stepped Wedge ◽  
Whole School ◽  
Cluster Randomised ◽  
Randomised Controlled

IntroductionWe evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems.MethodsWe conducted a stepped-wedge, cluster randomised controlled trial with 70 classes in 6 secondary schools serving low-income communities in New Delhi, India.The classes were randomised to receive a classroom sensitisation session involving a brief video presentation and moderated group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents.ResultsBetween 20 August 2018 and 9 December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. The proportion of students referred in each trial conditionwas significantly higher in the IC (IC=21.7%, CC=1.5%, OR=111.36, 95% CI 35.56 to 348.77, p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%, CC=89.1%, Pearson χ2 (1)=16.92, p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%, CC=0.3%, OR=52.39, 95% CI 12.49 to 219.66,p<0.001).ConclusionA single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India.Trial registration numberNCT03633916.

scholarly journals Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050661
Author(s):  
Håvard Kallestad ◽  
Simen Saksvik ◽  
Øystein Vedaa ◽  
Knut Langsrud ◽  
Gunnar Morken ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Patient Education ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Group Differences ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

scholarly journals Consumer Feedback following Participation in a Family-Based Intervention for Youth Mental Health

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Andrew J. Lewis ◽  
Melanie D. Bertino ◽  
Narelle Robertson ◽  
Tess Knight ◽  
John W. Toumbourou
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Qualitative And Quantitative ◽  
Treatment Implementation ◽  
Consumer Feedback ◽  
Family Based ◽  
Randomised Controlled ◽  
Further Development

Background. This paper presents findings derived from consumer feedback, following a multicentre randomised controlled trial for adolescent mental health problems and substance misuse. The paper focuses on the implementation of a family-based intervention, including fidelity of delivery, family members’ experiences, and their suggestions for program improvements.Methods. Qualitative and quantitative data (n=21) were drawn from the Deakin Family Options trial consumer focus groups, which occurred six months after the completion of the trial. Consumer focus groups were held in both metropolitan and regional locations in Victoria, Australia.Findings. Overall reductions in parental isolation, increases in parental self-care, and increased separation/individuation were the key therapeutic features of the intervention. Sharing family experiences with other parents was a key supportive factor, which improved parenting confidence and efficacy and potentially reduced family conflict. Consumer feedback also led to further development of the intervention, with a greater focus on aiding parents to engage adolescents in services and addressing family factors related to adolescent’s mood and anxiety symptoms.Conclusions. Participant feedback provides valuable qualitative data, to monitor the fidelity of treatment implementation within a trial, to confirm predictions about the effective mechanisms of an intervention, and to inform the development of new interventions.

scholarly journals Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial

BMJ ◽  
2015 ◽  
pp. h6127 ◽  
Author(s):  
Hilde P A van der Aa ◽  
Ger H M B van Rens ◽  
Hannie C Comijs ◽  
Tom H Margrain ◽  
Francisca Gallindo-Garre ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomised Controlled Trial ◽  
Visually Impaired ◽  
Controlled Trial ◽  
Stepped Care ◽  
Depression And Anxiety ◽  
Randomised Controlled

scholarly journals A novel ACT-based video game to support mental health through embedded learning: a mixed-methods feasibility study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041667
Author(s):  
Darren J Edwards ◽  
Andrew H Kemp
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Video Game ◽  
Emotional Regulation ◽  
Cognitive Skills ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Mental Health Disorder ◽  
Acceptance And Commitment ◽  
Randomised Controlled

IntroductionIn recent years, serious video games have been used to promote emotional regulation in individuals with mental health issues. Although these therapeutic strategies are innovative, they are limited with respect to scope of treatment, often focusing on specific cognitive skills, to help remediate a specific mental health disorder.ObjectiveHere, we propose a protocol for assessing the feasibility of a novel acceptance and commitment therapy (ACT)-based video game for young adults.Methods and analysisThe Medical Research Council (MRC) framework will be used for developing a complex intervention to design and test the feasibility of an ACT-based video game intervention using a mixed-methods approach involving qualitative and quantitative data. The primary outcomes will include feasibility testing of recruitment processes and the acceptability of the intervention through qualitative interviews, attendance and rates of attrition. Secondary outcomes will involve a series of quantitative questionnaires to obtain effect sizes for power analysis, allowing for the ideal sample size for an appropriately powered, randomised controlled trial to be determined.Ethics and disseminationThis study has been approved by the Psychology Department Research Ethics Committee (2020-4929-3923) at Swansea University in the UK. Dissemination activities will involve publications in peer-reviewed journals, presentations at local and national conferences and promotion through social media.Trial registration numberNCT04566042.

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