Pregnancy Insomnia And Postpartum Depression: Does Better Sleep Prevent Depression?

Recent research supports the connection between improved sleep and better maternal mental health

Insomnia During Pregnancy

Insomnia during pregnancy affects a significant portion of individuals, with studies showing prevalence rates between 25% and 40% across different trimesters.

Research has linked this sleep disruption with a range of adverse outcomes including:
- more difficult and painful labor experiences,
- increased risks of premature birth, and
- lower birth weights.

Additionally, these sleep disturbances correlate strongly with mental health challenges, particularly depression and anxiety which can negatively impact both mother and baby.

So is insomnia during pregnancy simply something that has to be endured?
Or can sleep during pregnancy be improved?

And if we can improve insomnia during pregnancy, would that improve the mental health outcomes of mothers?

A new study, published in the Journal of Affective Disorders, has shed some light on these questions, providing hope for improving sleep and enhancing maternal mental health and family welfare

The Connection Between Sleep and Postpartum Depression

Researchers from the University of British Columbia (UBC) performed a randomized controlled trial to examine whether addressing insomnia during pregnancy could reduce postpartum depression symptoms.

The study, a randomized controlled trial, included 62 women experiencing insomnia and assessed the effects of a five-week CBTI intervention specifically adapted for pregnancy.

Participants were evaluated for insomnia and depression symptoms at three key stages:

1. Before the intervention (T1)

2. Immediately after the intervention (T2)

3. Six months postpartum (T3)

The findings?

First the sleep bit. Compared to the control group:

• CBT-I significantly decreased insomnia diagnoses and symptoms; and

• Those in the CBTi group experienced improved overall sleep quality compared to controls

So that’s the sleep. What about the postpartum depression?

The study found that cognitive behavioral therapy for insomnia (CBTI) given during pregnancy can notably decrease symptoms of postpartum depression in new mothers.

• Participants in the CBT-i group were more likely to see decreases in their depressive symptoms immediately post-intervention (B = −0.54)

• The CBTi group were also less likely to experience depressive symptoms at six months postpartum follow-up (B = −0.67).

The authors concluded that the improvements in insomnia via CBTi led to significant indirect treatment effects on depressive symptoms both immediately after the intervention (T2) and at six months postpartum (T3).

Dr. Elizabeth Keys, an Assistant Professor in UBCO's School of Nursing stated:

"Our study contributes to the mounting evidence that treating insomnia during pregnancy is advantageous for various outcomes,"

Poor Sleep During Pregnancy: Questioning Common Assumptions

While poor sleep during and after pregnancy is often seen as unavoidable, Dr. Keys stressed the importance of early action in order to prevent further mental health problems later:

"Timely intervention is essential for infant and maternal mental health. Our research explores how tackling sleep problems, like insomnia, can result in improved mental health outcomes for families, supporting parents and their children to flourish."

Unfortunately most health systems ignore the role of sleep as an early warning for mental health issues, and many parents may be unaware of evidence-based treatments like CBTI.

"We need to investigate how to make this treatment more accessible to pregnant women nationwide, aiming to improve sleep health equity."

The study was published in the The Journal Of Affective Disorders, (Silang et al., 2024).

Silang, K., MacKinnon, A., Madsen, J., Giesbrecht, G. F., Campbell, T., Keys, E., Freeman, M., Dewsnap, K., Jung, J. W., & Tomfohr-Madsen, L. M. (2024). Sleeping for two: A randomized controlled trial of cognitive behavioural therapy for insomnia (CBTI) delivered in pregnancy and secondary impacts on symptoms of postpartum depression. Journal of Affective Disorders, 362, 670–678. https://doi.org/10.1016/j.jad.2024.07.117