Research
Insomnia Treatment Preferences During Pregnancy

https://doi.org/10.1016/j.jogn.2017.01.005Get rights and content

Abstract

Objective

To determine pregnant women's preferences for the treatment of insomnia: cognitive behavioral therapy (CBT-I), pharmacotherapy, or acupuncture.

Design

A cross-sectional survey of pregnant women.

Setting

We recruited participants in person at a low-risk maternity clinic and a pregnancy and infant trade show and invited them to complete an online questionnaire.

Participants

The sample (N = 187) was primarily White (70%), married or common-law married (96%), and on average 31 years of age; the mean gestational age was 28 weeks.

Methods

Participants read expert-validated descriptions of CBT-I, pharmacotherapy, and acupuncture and then indicated their preferences and perceptions of each approach.

Results

Participants indicated that if they experienced insomnia, they preferred CBT-I to other approaches, χ2(2) = 38.10, p < .001. They rated CBT-I as the most credible treatment (η2partial = .22, p < .001) and had stronger positive reactions to it than to the other two approaches (η2partial = .37, p < .001).

Conclusion

Participants preferred CBT-I for insomnia during pregnancy. This preference is similar to previously reported preferences for psychotherapy for treatment of depression and anxiety during pregnancy. It is important for clinicians to consider women's preferences when discussing possible treatment for insomnia.

Section snippets

Potential Treatments for Insomnia in Pregnancy

Among psychotherapeutic treatments, cognitive behavioral therapy for insomnia (CBT-I) is a nonpharmacologic, evidence-based treatment that combines elements of cognitive (e.g., challenging maladaptive beliefs about sleep) and behavioral (e.g., sleep restriction) therapy to treat insomnia. In a number of clinical trials, researchers indicated that CBT-I was effective to reduce symptoms of insomnia, and benefits continued for as long as 3 years posttreatment (Backhaus et al., 2001, Edinger

Methods

The study was a cross-sectional survey of women during pregnancy. We recruited participants in person between October 2014 and March 2015 from waiting rooms in low-risk maternity clinics and at a pregnancy and infant trade show in Calgary, Alberta, Canada. The inclusion criteria included pregnancy and ability to read and write in English. The project was approved by the Institutional Review Board at the University of Calgary.

Results

In total, 187 women completed the survey; one did not complete the demographics questionnaire, and an additional eight dropped out before they completed the sleep and mood questionnaires. Nine participants declined to report their ages, and four declined to report gestational ages. Most participants were White, employed, and married or common-law married; had median household incomes of CAN$90,000 to $100,000 per year; and were pregnant with their first children. Via three single-item yes/no

Discussion

Most participants in our study (51%) indicated that they preferred CBT-I as a treatment for insomnia over pharmacotherapy (12%) or acupuncture (37%). Our participants also perceived CBT-I to be the most credible treatment and expected it to be the most effective for them personally. The magnitude of this effect was particularly strong when we investigated differences between credibility (η2partial = .38) and personal reaction ratings (η2partial = .54) of CBT-I versus pharmacotherapy.

Acknowledgment

Supported by the Social Sciences and Humanities Research Council of Canada and the Alberta Children's Hospital Research Institute.

Ivan D. Sedov, MSc, is a graduate student in the Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

References (48)

  • J. Mindell et al.

    Sleep patterns and sleep disturbances across pregnancy

    Sleep Medicine

    (2015)
  • M.L. Okun et al.

    A review of sleep-promoting medications used in pregnancy

    American Journal of Obstetrics and Gynecology

    (2015)
  • D. Riemann et al.

    The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies

    Sleep Medicine Reviews

    (2009)
  • H. Skouteris et al.

    Assessing sleep during pregnancy: A study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms

    Women's Health Issues

    (2009)
  • M.E. Addis et al.

    Why, why, why? Reason-giving and rumination as predictors of response to activation- and insight-oriented treatment rationales

    Journal of Clinical Psychology

    (1999)
  • J. Backhaus et al.

    Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia

    European Archives of Psychiatry and Clinical Neuroscience

    (2001)
  • K.R. Baratte-Beebe et al.

    Sources of midsleep awakenings in childbearing women

    Clinical Nursing Research

    (1999)
  • D.K.L. Cheuk et al.

    Acupuncture for insomnia

    Cochrane Database of Systematic Reviews

    (2012)
  • J.L. Cox et al.

    Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

    The British Journal of Psychiatry

    (1987)
  • J. da Silva et al.

    Acupuncture for insomnia in pregnancy—A prospective, quasi-randomised, controlled study

    Acupuncture in Medicine

    (2005)
  • J. Edinger et al.

    Cognitive behavioral therapy for treatment of chronic primary insomnia: A randomized controlled trial

    JAMA

    (2001)
  • J.D. Edinger et al.

    Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep?

    Sleep: Journal of Sleep and Sleep Disorders Research

    (2001)
  • F.L. Facco et al.

    Sleep disturbances in pregnancy

    Obstetrics and Gynecology

    (2010)
  • A.M. Fernández-Alonso et al.

    Factors related to insomnia and sleepiness in the late third trimester of pregnancy

    Archives of Gynecology and Obstetrics

    (2012)
  • Cited by (0)

    Ivan D. Sedov, MSc, is a graduate student in the Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

    Sherryl H. Goodman, PhD, is a professor in the Department of Psychology, Emory University and in the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.

    Lianne M. Tomfohr-Madsen, PhD, is an assistant professor in the Department of Psychology, University of Calgary and holds a professorship at the Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.

    The authors report no conflict of interest or relevant financial relationships.

    View full text