One is seven women may struggle to get a good night’s sleep during pregnancy, while many visits and milestones are tracked during the nine months of pregnancy, medications are only prescribed as needed. Finding non-medicated ways to sleep is preferable during pregnancy. Evidence shows that iCBT works to reduce the symptoms of depression and anxiety. Despite effective, scalable solutions, the gaps in those seeking help for mental health, and those receiving assistance persist. A digital solution can, in theory, begin to fill the gap by providing 24/7 digital access to support and skill-building tools without having the side effects of medication and can augment ongoing care.
A new paper in JAMA Psychiatry by Dr. Jennifer Felder from the University of San Francisco examines the efficacy of digital Cognitive Behavioral Therapy (CBT) for treating insomnia during pregnancy. The study screened a population of 2258 women using an online self-report questionnaire; from that initial pool of potential participants, 208 were randomized into a digital CBT, and 103 received standard treatment for insomnia, which consisted of medication or psychotherapy. Digital CBT consisted of 6 weekly 20 minute sessions.
Study participants completed all assessments online. Insomnia severity was assessed by a self-report tool, the Insomnia Severity Index. Sleep quality was assessed using a sleep diary; participants tracked the duration of sleep via self-report methods. Women were 33 years of age on average, and over 70% earned over $100,000. The sample was highly educated, with 86.5% having a college degree.
Results indicated that women in the digital CBT arm had significant reductions in the Insomnia Severity Index. Secondary outcomes, like sleep efficiency, global sleep quality, depression, and anxiety symptoms, also showed significant improvements compared to the usual care arm. The only measure that wasn’t significant between groups was sleep duration.
Overall this study shows there are alternatives to addressing insomnia in pregnancy. Perhaps the fact that sleep quality but not duration improved shows how persistent our circadian sleep-wake cycles are and a focus on CBT skill-building to ensure we fall asleep and stay asleep more easily is essential. It may have been too challenging to have sensor derived sleep data as opposed to self-report measures as the ability to recall events via self-report is rife with challenges. This study was also conducted in affluent educated women, so the findings aren’t broadly generalizable. It does offer us another area of focus of CBT that is scalable, but more research is needed to see how these tools can be deployed in diverse populations.
Thanks for reading – Trina
(Opinions are my own)
Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women: A Randomized Clinical Trial. JAMA Psychiatry. Published online January 22, 2020. doi:10.1001/jamapsychiatry.2019.4491