Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program

Authors

David A. Kalmbach, Henry Ford HealthFollow
Philip Cheng, Henry Ford HealthFollow
Anthony N. Reffi, Henry Ford HealthFollow
Jason C. Ong
Leslie M. Swanson
Colin A. Espie
Grace M. Seymour, Henry Ford HealthFollow
Mika Hirata, Henry Ford HealthFollow
Olivia Walch
D'Angela S. Pitts, Henry Ford HealthFollow
Thomas Roth, Henry Ford HealthFollow
Christopher L. Drake, Henry Ford HealthFollow

Recommended Citation

Kalmbach DA, Cheng P, Reffi AN, Ong JC, Swanson LM, Espie CA, Seymour GM, Hirata M, Walch O, Pitts DS, Roth T, and Drake CL. Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program. Sleep Adv 2023; 4(1):zpad031.

Document Type

Article

Publication Date

8-1-2023

Publication Title

Sleep Adv

Abstract

OBJECTIVES: Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this treatment approach remain unclear. The present study examined nocturnal cognitive arousal and sleep effort as potential treatment mechanisms for alleviating insomnia and depression via a mindfulness sleep program for pregnant women.

METHODS: Secondary analysis from a proof-of-concept trial of 12 pregnant women with DSM-5 insomnia disorder who were treated with Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness framework. Data were collected across eight weekly assessments: pretreatment, six sessions, and posttreatment. Measures included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC), and the Glasgow sleep effort scale (GSES). We used linear mixed modeling to test cognitive arousal and sleep effort as concurrent and prospective predictors of insomnia and depression.

RESULTS: Most patients reported high cognitive arousal before PUMAS (75.0%), which decreased to 8.3% after treatment. All insomnia remitters reported low cognitive arousal after treatment, whereas half of nonremitters continued reporting high cognitive arousal. Both nocturnal cognitive arousal and sleep effort were associated with same-week changes in insomnia throughout treatment, and sleep effort yielded a prospective effect on insomnia. Lower levels of nocturnal cognitive arousal and sleep effort prospectively predicted reductions in depression.

CONCLUSIONS: The present study offers preliminary evidence that reducing sleep effort and nocturnal cognitive arousal may serve as key mechanisms for alleviating insomnia and depression via mindfulness-based insomnia therapy. ClinicalTrials.gov ID: NCT04443959.

PubMed ID

37645455

Volume

4

Issue

1

First Page

031

Last Page

031