Preventing postpartum insomnia: findings from a three-arm randomised controlled trial of Cognitive Behavioural Therapy for Insomnia, a responsive bassinet, and sleep hygiene.

STUDY OBJECTIVES:Insomnia symptoms are common during the perinatal period and are linked to adverse outcomes. This single-blind 3-arm randomised controlled trial examined whether two interventions targeting different mechanisms prevent postpartum insomnia. METHODS:Participants were nulliparous females 26-32 weeks gestation with Insomnia Severity Index (ISI) scores≥8, recruited in Australia and randomised 1:1:1 to: (a) a responsive bassinet designed to support infant sleep and reduce maternal sleep disruption until 6 months postpartum (RB), (b) therapist-assisted cognitive behavioural therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (c) a sleep hygiene booklet (control; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome was ISI scores averaged T3-T5. Primary analyses were regressions controlling for baseline outcomes. RESULTS:127 participants (age M±SD=32.62±3.49) were randomised (RB=44, CBT-I=42, CTRL= 41). Both interventions were feasible and well-accepted, with few related adverse events reported. Compared to CTRL, the average ISI across T3-T5 was lower for CBT-I (p=.014, effect size [ES]=0.56, medium) but not RB (p=.270, ES=0.25, small). Exploratory findings on maternal insomnia diagnosis, sleep disturbance, sleep-related impairment, beliefs and attitudes about sleep, depression, anxiety, as well as infant sleep outcomes were also presented. CONCLUSIONS:CBT-I but not RB reduced prenatal insomnia (very large effect) and prevented postpartum insomnia (medium effect). Further research is needed to examine the effects of both CBT-I and RB on other outcomes such as sleep-related wellbeing, postpartum depression, and maternal postpartum sleep duration.