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Factors associated with insomnia in pregnancy: A prospective Cohort Study
Abstract
Objective:
To quantify insomnia and their components in a longitudinal cohort of pregnant women and factors associated with insomnia.
Study design:
A prospective cohort of 486 healthy singleton pregnancies assembled before the 14th gestational week (February 2013 to March 2016). Insomnia data were collected pre-gestationally, in each trimester and six months post-partum, analysing five different moments. Multiple logistic regression analysis was performed to generate adjusted Odds Ratios (aOR) with 95% confidence intervals (CI) of determinants of insomnia in each trimester, defined using Athens Insomnia Scale (AIS) as score ≥8.
Results:
Insomnia prevalence was 6.1% (3.9-8.9) pre-gestational, 44.2% (39.3-49.6) in first trimester (T1), 46.3% (41.9-51.3) in second (T2) and 63.7% (57.7-67.8) in third trimester (T3). Post-gestational insomnia was 33.2% (28.2-37.9) (p < 0.001 pre-gestational vs T1, T2 vs T3 and T3 vs after pregnancy). There was worsening mean AIS score, from: 2.34 before pregnancy to 9.87 in T3 because the deterioration of nighttime sleep, in absolute terms, but daytime impact was higher in T1. Previous trimester insomnia was associated with insomnia in T2 (aOR = 4.21, 95% CI 2.78-6.37) and T3 (aOR = 4.43, 95% CI 2.77-7.08). Pre-gestational insomnia was determinant of insomnia in T1 (aOR 12.50, 95% CI 3.58-43.60) and obesity was associated with insomnia in T3 (aOR = 2.30, 95% CI 0.99-5.32). On the contrary, moderate physical activity reduced the odds of insomnia in T3 (aOR 0.65, 95% CI 0.40-1.03).
Conclusions:
Insomnia prevalence was high from the beginning of pregnancy, associated with pre-gestational insomnia. In late pregnancy, two out of three pregnant women suffering insomnia. Insomnia prevention should be targeted particularly to those with high body mass index and pre-gestational insomnia.
... Mid-pregnancy insomnia was associated with the occurrence of depression but was not significantly associated with postpartum depression [20]. Previous background of insomnia is the most important factor in developing this complication during pregnancy [24]. ...
... As the pregnancy progresses, the rate of insomnia increases and then decreases significantly after delivery [24]. Many studies have reported that sleep quality deteriorates during pregnancy and is often most disturbed in the third trimester [22]. ...
... Roman-Galvez et al. (2018), reported that the prevalence of insomnia in the first, second and third trimesters was 44.2, 46.3, and 63.7%, respectively. According to this study, obesity of pregnant woman, occupational status of pregnant women and previous background of insomnia were introduced as factors related to the high prevalence of insomnia during pregnancy [24]. ...
Background
Sleep disorders, which are among the foremost important medical care issues, are prevalent in pregnancy. The present study is a meta-analysis of the prevalence of insomnia in the third trimester of pregnancy. This study aims to systematically review the overall prevalence of insomnia in the third trimester of pregnancy through conducting a meta-analysis.
Method
The literature used in this meta-analysis for the topic discussed above were obtained through searching several databases, including SID, MagIran, IranDoc, Scopus, Embase, Web of Science (WoS), PubMed Science Direct and Google Scholar databases without time limitation until December 2020. Articles developed based on cross-sectional studies were included in the study. The heterogeneity of studies was investigated using the I2 index. Also, the possible effects of heterogeneity in the studied studies are investigated using meta-regression analysis.
Result
In 10 articles and 8798 participants aged between11–40, the overall prevalence of insomnia in the third trimester of pregnancy based on meta-analysis was 42.4% (95% CI: 32.9–52.5%). It was reported that as the sample size increases, the prevalence of insomnia in the third trimester of pregnancy increases. Conversely, as the year of research increases, the prevalence of insomnia in the third trimester of pregnancy decreases. Both of these differences were statistically significant (P < 0.05).
Conclusion
Insomnia was highly prevalent in the last trimester of pregnancy. Sleep disorders are neglected among pregnant women, and they are considered natural. While sleep disturbances can cause mental and physical problems in pregnant women, they can consequently cause problems for the fetus. As a result, maintaining the physical and mental health of pregnant mothers is very important. It is thus recommended that in addition to having regular visits during pregnancy, pregnant women should also be continuously monitored for sleep-related disorders.
... In contrast, the prevalence of insomnia disorder in the general population of women aged 18-45 years in Norway is approximately 11% [9]. Similar findings were observed in a cohort study of 486 women in Spain who were assessed for insomnia symptoms prior to pregnancy and at each trimester through 6 months postpartum [10]. In this study, 6.1% of women reported significant insomnia symptoms prior to gestation, which increased to 44.2% in the first trimester, 46.3% in the second trimester, to a peak of 63.7% by the third trimester. ...
... Even so, recent evidence suggests that physical activity and mindfulness may protect women against insomnia in the perinatal period. Indeed, physical activity has been associated with a reduced risk of the development of perinatal insomnia symptoms [10], perhaps in part because physical activity reduces obesity, which is a prospective predictor of perinatal insomnia symptoms [10,30]. Given the potential pathogenicity of rumination for insomnia, perinatal researchers have sought to identify factors that may protect against ruminative thinking. ...
... Even so, recent evidence suggests that physical activity and mindfulness may protect women against insomnia in the perinatal period. Indeed, physical activity has been associated with a reduced risk of the development of perinatal insomnia symptoms [10], perhaps in part because physical activity reduces obesity, which is a prospective predictor of perinatal insomnia symptoms [10,30]. Given the potential pathogenicity of rumination for insomnia, perinatal researchers have sought to identify factors that may protect against ruminative thinking. ...
Purpose of Review
The perinatal period is a time of high risk for insomnia and mental health conditions. The purpose of this review is to critically examine the most recent literature on perinatal insomnia, focusing on unique features of this period which may confer specific risk, associations with depression and anxiety, and emerging work on perinatal insomnia treatment.
Recent Findings
A majority of perinatal women experience insomnia, which may persist for years, and is associated with depression and anxiety. Novel risk factors include personality characteristics, nocturnal perinatal-focused rumination, and obesity. Mindfulness and physical activity may be protective. Cognitive-behavioral therapy for insomnia is an effective treatment.
Summary
Perinatal insomnia is exceedingly common, perhaps due to factors unique to this period. Although closely linked to perinatal mental health, more work is needed to establish causality. Future work is also needed to establish the role of racial disparities, tailor treatments, and determine whether insomnia treatment improves perinatal mental health.
... However, the prevalence of different sleep disturbances during pregnancy still remains unclear, as most of the previous studies have been crosssectional, or small. Only one study has previously reported the prevalence rates of different insomnia symptoms throughout pregnancy [12]. ...
... One study found a persistently high sleepiness throughout pregnancy [5], whereas another study showed that sleepiness was the most frequent in early pregnancy, subsequently diminishing later [6]. Two more studies, however, proposed a U-shape occurrence of sleepiness with the lowest occurrence in mid-pregnancy [12,23]. ...
... Using the same sleep questionnaire as in our study, Hedman et al., reported in their longitudinal study of 325 pregnant women that sleep quality declined and insomnia increased as pregnancy proceeded [11]. Similarly, Roman-Galves et al., reported in their longitudinal study of 402 women that insomnia scores measured by the Athens Insomnia Scale increased during pregnancy [12]. Our large study therefore confirmed the findings in previous smaller studies showing that insomnia is a highly frequent symptom during pregnancy and increases towards late pregnancy. ...
Objective
To evaluate alteration in insomnia and sleepiness symptoms during pregnancy and assess early pregnancy risk factors for these symptoms, especially depressive and anxiety symptoms.
Methods
A cohort of 1858 women was enrolled from the FinnBrain Birth Cohort Study. Insomnia and sleepiness symptoms were measured in early, mid- and late pregnancy with the Basic Nordic Sleep Questionnaire. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale and anxiety symptoms with the Symptom Checklist-90/Anxiety Scale. General linear models for repeated measures were conducted.
Results
General sleep quality decreased (p < 0.001) and all insomnia types (p < 0.001) and sleep latencies (p < 0.001) increased as pregnancy proceeded. Snoring increased, but witnessed apneas remained rare. Nevertheless, morning (p = 0.019) and daytime (p < 0.001) sleepiness decreased from early to both mid-pregnancy and late pregnancy (p = 0.006 and p = 0.039). Women took more naps in early and late pregnancy compared to mid-pregnancy (both p < 0.001). Women with higher baseline anxiety symptoms had greater increase in sleep latency. At each pregnancy point, higher depressive and anxiety symptoms were associated with higher insomnia (p < 0.001) and sleepiness scores (p < 0.001) and higher depressive symptoms with longer sleep latencies (p < 0.001).
Conclusion
We found a marked increase in insomnia symptoms throughout pregnancy. However, sleepiness symptoms did not increase correspondingly. Both depressive and anxiety symptoms in early pregnancy were associated with higher insomnia and sleepiness symptoms in later stages of pregnancy which emphasizes the importance of their assessment in early pregnancy.
... Insomnia is the most prevalent sleep disturbance experienced in women during pregnancy, affecting 52%-61% of pregnant women [1]. The prevalence of insomnia during pregnancy is high from the start and two thirds of pregnant women suffer from insomnia in the later period of pregnancy [2]. One previous study found that 97% of the women at the end of pregnancy reported middle-of-the-night awakenings, but only less than a third of the women considered sleep disruption as a problem [3]. ...
... In addition, poor sleep quality during pregnancy is associated with psychosocial and physiologic stress [19]. Furthermore, past history of insomnia, advanced trimester, high BMI, age and depression symptoms are risk factors for insomnia [2,20], while moderate physical activity has protective effects [21]. Now it is important to pay more attention to examine the prevalence and risk factors of insomnia for health professionals to clear the influence on the pregnant population. ...
... Now it is important to pay more attention to examine the prevalence and risk factors of insomnia for health professionals to clear the influence on the pregnant population. However, the majority of previous prevalence studies of insomnia in pregnancy used insomnia symptoms [5] or less rigorous diagnostic criteria of insomnia based on the different assessment tools [2,9,22]. In addition, the prevalence and risk factors of insomnia in Chinese women during pregnancy is not well studied. ...
Background:
Insomnia is common during pregnancy but the prevalence and risk factors of insomnia in Chinese women during pregnancy is not well studied. This study aimed to examine the prevalence of insomnia and its risk factors in Chinese women during pregnancy.
Methods:
In this cross sectional study, 436 Chinese pregnant women with Insomnia Severity Index (ISI) ≥ 8 were clinically assessed using the insomnia criteria based on the combination of DSM-IV (Diagnostic and Statistical Manual-4th Edition) and ICD-10 (International Classification of Dieases, 10th Edition). Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pregnancy Pressure Scale (PPS), Perceived physical discomfort level and number, Epworth Sleepiness Scale (ESS), and a general socio-demographic questionnaire were administered.
Results:
The results showed that about 20% of the pregnant women met the strict diagnosis criteria of insomnia. Independent-samples t-test revealed that several risk factors were correlated with the group with insomnia (N = 84) compared to the group without insomnia (N = 352). Binary Logistic regression analysis found that more significant bed partner influence (OR = 1.92, 95% CI: 1.03-3.60), depressive symptoms (OR = 1.07, 95% CI: 1.00-1.14), daytime sleepiness (OR = 1.07, 95% CI: 1.01-1.14), subjective somatic discomfort (OR = 2.27, 95% CI: 1.11-4.65), kinds of somatic discomfort (OR = 1.14, 95% CI: 1.03-1.27) and later gestation (OR = 1.05, 95% CI: 1.01-1.09) were significantly associated with insomnia.
Conclusion:
In this cohort of Chinese pregnant women, about a fifth of women suffered from clinically significant insomnia. Measures to prevent the adverse effects of insomnia should be provided to pregnant women with depressive symptoms, Sleep disturbance of the bed partner, excessive daytime sleepiness and somatic discomfort, especially late in gestation.
... Despite the high prevalence of abnormal and disturbed sleep during pregnancy and the adverse health ramifications, studies evaluating changes in sleep patterns and the associated predictive factors across pregnancy trimesters are scarce. Few prospective cohort studies have analyzed changes in sleep patterns during pregnancy in the same cohort of women [16,[18][19][20][21][22], with the majority assessing only two time points [12]. ...
... In our study, multiparous women reported a modest increase in poor sleep that occurred only in the first trimester, by 1.62 times. This finding differs from other studies that reported poor sleep among multiparous women in the first, second [18], and third trimesters [21] of pregnancy. This discrepancy may be because, as pregnancy progresses, parity-related differences may be obscured by other factors, such as fetal growth and frequent urination, and difficulty finding a comfortable position may considerably disturb sleep, irrespective of parity [9]. ...
This study aimed to assess sleep patterns during the three trimesters of pregnancy and whether vitamin D concentrations, along with other risk factors, are associated with these alterations. In a longitudinal study, 140 pregnant women (age 18 to 39 years) were followed throughout their first, second, and third trimesters. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) at each trimester, along with an assessment of biochemical parameters, including serum vitamin D levels. The information that was collected included anthropometric data, socio-economic status, dietary intake, and physical activity. The PSQI was higher in mid and late pregnancy than in early pregnancy (both p = 0.001), and the sleep duration was also higher in late versus early pregnancy. Linear regression analyses revealed independent predictors of deteriorating sleep quality from early to late pregnancy, including low income (B ± SE −0.60 ± 0.26, p = 0.03) and low serum vitamin D levels in the second trimester (B ± SE −0.20 ± 0.01, p = 0.04). Energy intake and sitting in the second half of pregnancy were positively associated with changes in the PSQI score from the second to third trimesters (B ± SE 0.15 ± 0.07, p = 0.048) and (B ± SE 0.01 ± 0.00, p = 0.044), respectively. Low socio-economic status, low serum vitamin D levels, greater energy intake, and sitting time were associated with worsening patterns of sleep quality from early to late pregnancy.
... and 33.2% (28.2-37.9), respectively [25]. Risk factors for SSD include nulliparous, obesity, high blood pressure, and old age. ...
... These factors are indirectly associated with glucose intolerance during pregnancy [2]. Furthermore, pre-pregnancy insomnia is a risk factor for insomnia in the first trimester of pregnancy (AOR = 12.50) and obesity is related to insomnia in the third trimester of pregnancy (AOR = 2.30), but moderate physical activity can decrease insomnia in the third trimester (AOR = 0.65) [25]. ...
This study aimed to asses previous research results about bio-physiological alterations during pregnancy and postpartum, and make clear outlook about prevalence and related factors of sleep disorders during pregnancy and postpartum. In this review, the articles that published from 2000 to 2019 were reviewed. Related articles were searched from databases in English language. After evaluation of inclusion and exclusion criteria, articles were chosen and reviewed based on the University of York strategies. Sleep disorders in present study were classified according to the International Classification of Sleep Disorders-3. The search revealed 4449 articles, after evaluating and assessing qualified articles, finally 56 article selected to review. According to the results of this review, The prevalence of sleep disorders was almost 76%–97% in whole pregnancy. The most common sleep disorders included central disorders of hyper somnolence (waking up in the middle of the night, daytime sleepiness, sleeplessness) or insomnia, sleep-related movement disorders (restless legs syndrome), sleep related breathing disorders (obstructive sleep apnea), and parasomnia. In addition, sleep disorder may continue 3–12 months postpartum (33.2%). Sleep disorders induced by physiological processes (fetal movement, excessive weight gain, male sex of the fetus, and multiparty), health-related risks (metabolism disorders, cardiovascular diseases, and mood disorders), and physical or sexual abuse in childhood. In addition, these disorders could have maternal outcomes that can be greatest trigger to postpartum psychiatric disorders and fetal outcomes that have harmful sequences during childhood (sexual, fertility, emotional, and cognitive problems). Health care providers should evaluate the mothers’ sleep quality because sleep disorder leads to harmful consequences in fetuses and children.
... This form was prepared by the researchers based on the literature review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The form consists of 3 parts and 32 questions. ...
... However, our study revealed that most women did not go to the doctor for insomnia. Similarly, some authors reported that insomnia significantly linked with pregnancy-related problems [15,16,18,21,25]. Because of the complex and common co-morbid nature of insomnia, even if the problems related to pregnancy are minimized, the insomnia may not improve immediately. ...
Abstract
Background: Most women are at risk for some degree of sleep disturbance (insomnia) during pregnancy because of the hormonal and physical changes, which may negatively affect women’s quality of life.
Aim: This study was carried out to determine the sleep disorders of pregnant women and to examine the effect of these disorders on their quality of life.Method: This cross-sectional and descriptive study conducted in a State University Hospital Obstetrics Clinic in Ankara, Turkey. In the collection of data, Individual Information Form, Pittsburgh Sleep Quality Index and SF-36 Quality of Life Scale were used. To analyze the collection data, Man Whitney U test, Kruskall Wallis test and Pearson correlation test were applied.
Results: 68.5% of women experienced insomnia. Insomnia was linked to a lower quality of life (p < 0.05). Advanced age, low education, low income, obesity, co-morbidity, multi-parity, multi-gravida, advanced gestational age, in-sufficient antenatal care and social support, sedentary life-style, drinking of tea and cigarette habit has been associated with poor sleep quality (p < 0.05).
Conclusion: Women suffered from insomnia during pregnancy, which affects quality of life adversely. Therefore, assessment of sleep should be an integral part of prenatal care. Further research is required to determine quality of life effect on sleep.
Keywords: Pregnancy, Sleep quality, Sleep disorder, Insomnia, Quality of life
... This form was prepared by the researchers based on the literature review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The form consists of 3 parts and 32 questions. ...
... However, our study revealed that most women did not go to the doctor for insomnia. Similarly, some authors reported that insomnia significantly linked with pregnancy-related problems [15,16,18,21,25]. Because of the complex and common co-morbid nature of insomnia, even if the problems related to pregnancy are minimized, the insomnia may not improve immediately. ...
... Headache frequency and headache intensity among Korean population [38] Nocturia [32,41] Lower limbs tingling sensations before sleep [41] High pain intensity in postherpetic neuralgia patients [45]. Fatigue, headaches, extremity pain, back pain in US Army [46] First and second trimester of pregnancy [58] Obesity was associated with insomnia in a pregnant women population [58] Chronic musculoskeletal pain in women and men [55] Stressors ...
... Headache frequency and headache intensity among Korean population [38] Nocturia [32,41] Lower limbs tingling sensations before sleep [41] High pain intensity in postherpetic neuralgia patients [45]. Fatigue, headaches, extremity pain, back pain in US Army [46] First and second trimester of pregnancy [58] Obesity was associated with insomnia in a pregnant women population [58] Chronic musculoskeletal pain in women and men [55] Stressors ...
Objectives
To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.
Methods
An integrative review performed in Pubmed, Virtual Health Library and CINAHL. Fourty eight articles published in Portuguese, English or Spanish from 2011 to 2018 were included. An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.
Results
There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions, except for grieving and frequent naps during the day. Smoking, caffeine intake, dysfunctional sleep beliefs, obesity and caregiver role strain are possible new related factors; chronic illness is a possible new associated conditions and Individuals going through changes in marital status, economically disadvantaged, female gender, increasing age and night shift worker are possible new at-risk populations.
Conclusion
The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis. The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification, thereby supporting the clinical reasoning of nurses and students.
... The reporting of this work is compliant with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. We carried out a prospective cohort study (PROY-PP 2015-01): 'Lifestyles in pregnant women' in which other habits besides caffeine intake were measured: smoking [17], insomnia [18], physical activity [19], and Adherence to the Mediterranean Diet (AMD). Volunteer midwives selected women from February 2013 to February 2016, from 47 Health Centers. ...
Maternal caffeine consumption is associated with adverse gestational outcomes. The aim of this study was to assess the intake of caffeine and factors associated with the non-adherence to caffeine intake recommendations in a cohort of 463 women before (T0) and in each trimester of gestation (T1, T2, and T3), by using validated questionnaires. Caffeine intake (median (mg/day), IQR) was 100.0 (181.1) at T0, 9.42 (66.2) at T1, 12.5 (65.6) at T2, and 14.0 (61.1) at T3 (p < 0.001). Non-compliance prevalence (intake > 200 mg/day) was 6.2% at T1, 4.2% at T2, and 2.7% at T3. Not being an active smoker at T1 (OR = 0.17; 95% CI 0.05–0.59) and T2 (OR = 0.22; 95% CI 0.09–0.52), adherence to the Mediterranean Diet at T1 (OR = 0.50; 95% CI 0.28–0.88) and T2 (OR = 0.39; 95% CI 0.15–1.02), and moderate physical activity at T1 (OR = 0.50; 95% CI 0.28–0.88) were inversely associated with caffeine consumption. Although caffeine intake may be considered low, intake prevalence increases throughout pregnancy. Although the main source of caffeine during pregnancy is coffee, attention must be also paid to the increasingly intake of chocolate, of which the effect during pregnancy is controversial. Smoking, non-adherence to a good quality diet, and light physical activity are associated with a higher caffeine intake and a lower compliance with caffeine intake recommendations. Perinatal dietary and lifestyle educational policies are needed.
... Insomnia Penyebab insomnia yaitu Rahim semakin membesar, masalah psikologis (perasaan takut, gelisah atau khawatir menghadapi persalinan), dan sering BAK pada malam hari. Cara mengatasinya yaitu mandi air hangat sebelum tidur, minum air hangat sebelum tidur, mengurangi aktivitas yang dapat membuat susah tidur, menghindari makan porsi besar 2-3 jam sebelum tidur, mengurangi kebisingan dan cahaya, dan tidur dengan posisi relaks (Chaudhry & Susser, 2018;Hashmi et al., 2016;Román-Gálvez et al., 2018 Penyebab kram pada kaki yaitu kadar kalsium rendah dalam darah; uterus semakin membesar sehingga menekan pembuluh darah dipanggul, kelelahan, sirkulasi darah ke daerah kaki kurang. Cara mengatasinya yaitu memenuhi asupan kalisium (susu, sayuran warna hijau), melakukan senam hamil, menjaga kaki agar selalu dalam keadaan hangat, mandi air hangat sebelum tidur, duduk dengan meluruskan kaki tarik kaki kearah lutut, memijat otot-otot yang kram, merendam kaki yang kram dengan air hangat (Hensley, 2009;Supakatisant & Phupong, 2015;Zhou et al., 2015) g. ...
Pendahuluan: Pada perkembangan normal kehamilan, ibu hamil akan mengalami banyak gejala ketidaknyamanan sebagai bentuk adaptasi fisiologis. Sebagian besar ibu hamil tidak melakukan apapun untuk mengurangi gejala ketidaknyamanan yang mereka rasakan. Hal ini dapat disebabkan karena kurangnya pengetahuan ibu hamil tentang cara mengurangi gejala ketidaknyamananTujuan: kegiatan pengabdian kepada masyarakat berupa penyuluhan ini bertujuan untuk meningkatkan pengetahuan dan pemahaman ibu hamil tentang ketidaknyamanan kehamilan pada trimester 3 dan cara mengatasinya.Metode: kegiatan diawali dengan memberikan kuesioner ketidaknyaman yang dirasakan ibu hamil dan pre test. Selanjutnya memberikan edukasi yang ditujukan kepada ibu hamil trimester 3 selama 30 menit dankemudian melakukan evaluasi dengan memberikan soal post test.Hasil: hasil kuesioner menunjukkan banyak peserta mengalami ketidaknyamanan pada kehamilan trimester 3 yaitu sering BAK, insomnia, konstipasi, kram pada kaki, keputihan, dan nyeri ulu hati. Rerata nilai post test peserta penyuluhan lebih tinggi (80,95) dibandingkan dengan nilai pre test (46,03). Hasil post test menunjukkan bahwa materi kegiatan edukasi ini dapat dipahami oleh pesertaKesimpulan: Perlu edukasi berkelanjutan tentang ketidaknyaman kehamilan trimester 1, 2, dan 3 serta cara mengatasinya yang dapat dilaksanakan dalam kelas ibu hamil Kata kunci: ketidaknyamanan, ibu hamil, trimester 3
... Poor sleep quality and insomnia in pregnancy are more prevalent as pregnancy progresses, possibly related to pregnancy physical symptoms or discomfort [18], or high pre-pregnancy BMI condition [19]. ...
Introduction: Insomnia is a frequent condition during pregnancy. The aim of this study was to assess if a walking promotion program from the 12th Gestational Week (GW) of pregnancy helps to prevent insomnia and improve the quality of sleep at third trimester. Materials and Methods: A prospective, randomized, and controlled trial was conducted with 270 pregnant women divided into 3 groups in parallel: maximum intervention group, I1 (pedometer and goal of 10,000 steps/day), minimum intervention group, I2 (pedometer without a goal), and control group (no intervention). All groups received recommendations about physical activity in pregnancy. A structured interview was performed at 13th, 20th, and 32nd GW, collecting pedometer mean steps/day, Athens Insomnia Scale (AIS), and Pittsburgh questionnaire (PSQI). Lineal regression models were conducted to determine the association between mean steps/day at 31st GW and AIS or PSQI score. Results: At 19th GW, groups I1 and I2 reached a mean of 6267 steps/day (SD = 3854) and 5835 steps/day (SD = 2741), respectively (p > 0.05). At 31st GW mean steps/day was lower for I2 (p < 0.001). Insomnia and poor sleep quality prevalence increased through pregnancy, but no differences between groups, within trimesters, were found (p > 0.05). Lineal regression showed no association between the average steps/day at third trimester of pregnancy and AIS and PSQI scores. Conclusions: Our walking promotion program based on pedometers did not help to prevent insomnia in the third trimester of pregnancy.
... Güncel bir meta-analizde insomnianın, gebelerin %38.2'sini etkilediği, bu oranın ilk trimesterde %25.3, ikinci trimesterde %27.2 ve son trimesterde %39.7 olduğu saptanmıştır (20). Son trimesterde olma, gebelikten önce uyku sorunu yaşama, 30 yaşından büyük olma, düşük eğitim seviyesi, nulliparite, istemsiz gebelik, kötü obstetrik öykü, gebeliğe eşlik eden sağlık sorunları, sosyal destek azlığı, obezite, sigara içme, kötü uyku hijyeni, hareketli bir fetuse veya küçük bir çocuğa sahip olma durumunda insomnia riski artmaktadır (7,10,14,35). Gebelik yakınmaları fetal hareketler, emosyonel kaygılar, doğum eylemi ve diğer uyku sorunları ise insomniayı tetiklemektedir (7,14). Maternal ve fetal sağlığa olan olumsuz etkileri nedeniyle insomnianın gebelikte rutin olarak taranması, erken dönemde tanılanarak, tedavi edilmesi önerilmektedir (20). ...
Uyku, temel bir insan gereksinimi olup sağlıklı ve kaliteli bir yaşam için gereklidir. Kadınlar, horlama dışındaki uyku bozukluklarını, erkeklere kıyasla iki kat daha fazla yaşamaktadır. Gebelik, doğum ve doğum sonu dönemlerde var olan uyku sorunları şiddetlenmekte veya yeni başlangıçlı uyku sorunları gelişmektedir. Maternal uykudaki bozulmalar, gebeliğin ilk trimesterinde başlamakta, ikinci trimesterde azalmakta ve son trimesterde en üst seviyeye ulaşmaktadır. Doğum eylemindeki pek çok kadın; hastanede bulunma, kontraksiyonlar, yapılan müdahaleler, kullanılan ilaçlar, emosyonel sorunlar nedeniyle uyuma güçlüğü yaşamaktadır. Postpartum ilk günlerde ise emzirme ve bebek bakımı gibi nedenlerle annenin uykusu sıkça bölünmektedir. Doğumdan üç-altı ay sonra maternal uyku sorunları azalmakta fakat uyku kalitesi gebelikten önceki haline dönmemektedir. Yaşanan uyku sorununun türü, süresi, sıklığı ve şiddeti ile ilişkili olarak farklı obstetrik komplikasyonlar gelişebilmektedir. Bu duruma bağlı olarak hem maternal hem de fetal morbidite ve mortalite hızları artmaktadır. Maternal uyku sorunları, erken dönemde tanılanıp uygun şekilde yönetildiğinde ise bu sorunların, anne, fetüs ve yenidoğan sağlığına olan olumsuz etkileri azaltılabilmektedir. Bu nedenle sağlık ekibi üyelerinin, özellikle de ebe ve hemşirelerin; maternal uyku sorunlarını ihmal etmemesi, erken dönemde tanılaması, uygun şekilde yönetmesi ve kadınların başa çıkma mekanizmalarını arttırması gerekmektedir.
Abstract The Impact of Maternal Sleep Problems on Obstetric Outcomes and Care Sleep is a basic human need and is essential for a healthy and quality life. Women experience sleep disorders other than snoring twice more often than men. During pregnancy, childbirth and postpartum periods, existing sleep problems become severer, and new-onset sleep problems develop. Disorders in maternal sleep begin in the first trimester, decrease in the second trimester, and reach the highest level in the last trimester. Many women giving birth have trouble in sleeping due to staying in hospital, contractions, interventions, drugs used, and emotional problems. In the first postpartum days, the mother's sleep is frequently interrupted for reasons such as breastfeeding and infant care. Three to six months after birth, maternal sleep problems decrease, but sleep quality returns to its pre-pregnancy state. Different obstetric complications develop in association with the type, duration, frequency, and severity of the sleep problem. Depending on this situation, both maternal and fetal morbidity and mortality rates increase. When maternal sleep problems are diagnosed and managed appropriately in the early period, the adverse impacts of these problems on maternal, fetal, and neonatal health can be decreased. Therefore, healthcare team members and especially midwives and nurses should not ignore maternal sleep problems. They should diagnose them in the early period, manage them appropriately and enhance the coping mechanisms of women.
... Güncel bir meta-analizde insomnianın, gebelerin %38.2'sini etkilediği, bu oranın ilk trimesterde %25.3, ikinci trimesterde %27.2 ve son trimesterde %39.7 olduğu saptanmıştır (20). Son trimesterde olma, gebelikten önce uyku sorunu yaşama, 30 yaşından büyük olma, düşük eğitim seviyesi, nulliparite, istemsiz gebelik, kötü obstetrik öykü, gebeliğe eşlik eden sağlık sorunları, sosyal destek azlığı, obezite, sigara içme, kötü uyku hijyeni, hareketli bir fetuse veya küçük bir çocuğa sahip olma durumunda insomnia riski artmaktadır (7,10,14,35). Gebelik yakınmaları fetal hareketler, emosyonel kaygılar, doğum eylemi ve diğer uyku sorunları ise insomniayı tetiklemektedir (7,14). Maternal ve fetal sağlığa olan olumsuz etkileri nedeniyle insomnianın gebelikte rutin olarak taranması, erken dönemde tanılanarak, tedavi edilmesi önerilmektedir (20). ...
Sleep is a basic human need and is essential for a healthy and quality life. Women experience sleep disorders other than snoring twice more often than men. During pregnancy, childbirth and postpartum periods, existing sleep problems become severer, and new-onset sleep problems develop. Disorders in maternal sleep begin in the first trimester, decrease in the second trimester, and reach the highest level in the last trimester. Many women giving birth have trouble in sleeping due to staying in hospital, contractions, interventions, drugs used, and emotional problems. In the first postpartum days, the mother's sleep is frequently interrupted for reasons such as breastfeeding and infant care. Three to six months after birth, maternal sleep problems decrease, but sleep quality returns to its pre-pregnancy state. Different obstetric complications develop in association with the type, duration, frequency, and severity of the sleep problem. Depending on this situation, both maternal and fetal morbidity and mortality rates increase. When maternal sleep problems are diagnosed and managed appropriately in the early period, the adverse impacts of these problems on maternal, fetal, and neonatal health can be decreased. Therefore, healthcare team members and especially midwives and nurses should not ignore maternal sleep problems. They should diagnose them in the early period, manage them appropriately and enhance the coping mechanisms of women.
... Insomnia has both psychological and physical implications, with associations with depression, anxiety, coronary artery disease and hypertension all reported [41,42]. Risk factors for pregnancy-associated insomnia that have been identified in prospective studies include pre-gestational insomnia, obesity and depressive symptoms [43,44]. ...
Sleep disturbances are common in pregnancy and affect sleep quality. The maternal body is going through constant physical and physiological changes to adapt to the growing fetus. Sleep disorders may manifest at any point during pregnancy; some may result in adverse maternal or fetal outcomes. A strong clinical suspicion is crucial to identify sleep disorders in pregnancy and their management should be evaluated with a multidisciplinary team approach. In this review, we provide an overview of changes in sleep during pregnancy and summarise the key features of common sleep disorders in pregnancy, including practical tips on their management.
Educational aims
To provide an overview of common sleep disorders in pregnancy and their management options.
To highlight the impact of the physiological changes in pregnancy on sleep.
To outline the type of sleep studies available to investigate sleep disorders in pregnancy.
... Over the course of pregnancy, sleep duration and efficiency decrease and sleep quality is further reduced (Hedman et al., 2002;Adler et al., 2021). Further, over 40% of women experience insomnia during the first trimester of pregnancy, increasing to over 60% by the third trimester (Román-Gálvez et al., 2018). Following birth, self-reported deteriorations in sleep quality, efficiency, and duration continue for both, mothers and fathers (Lee et al., 2000;Kang et al., 2002;Montgomery-Downs et al., 2013;Obeysekare et al., 2020). ...
A variety of organisms including mammals have evolved a 24h, self-sustained timekeeping machinery known as the circadian clock (biological clock), which enables to anticipate, respond, and adapt to environmental influences such as the daily light and dark cycles. Proper functioning of the clock plays a pivotal role in the temporal regulation of a wide range of cellular, physiological, and behavioural processes. The disruption of circadian rhythms was found to be associated with the onset and progression of several pathologies including sleep and mental disorders, cancer, and neurodegeneration. Thus, the role of the circadian clock in health and disease, and its clinical applications, have gained increasing attention, but the exact mechanisms underlying temporal regulation require further work and the integration of evidence from different research fields. In this review, we address the current knowledge regarding the functioning of molecular circuits as generators of circadian rhythms and the essential role of circadian synchrony in a healthy organism. In particular, we discuss the role of circadian regulation in the context of behaviour and cognitive functioning, delineating how the loss of this tight interplay is linked to pathological development with a focus on mental disorders and neurodegeneration. We further describe emerging new aspects on the link between the circadian clock and physical exercise-induced cognitive functioning, and its current usage as circadian activator with a positive impact in delaying the progression of certain pathologies including neurodegeneration and brain-related disorders. Finally, we discuss recent epidemiological evidence pointing to an important role of the circadian clock in mental health.
... Recent meta-analytic estimates suggest that 25-27% of pregnant women in the first two trimesters endorse clinically important insomnia symptoms, and that this rate increases to about 40% in the third trimester [1][2][3]. Several large-scale studies have shown that over half of women experience insomnia by the end of pregnancy [4][5][6][7][8][9]. Women who develop prenatal insomnia report reduced quality of life [10,11], and are at increased risk for preterm birth [12], maternal depression [8,[13][14][15], suicidal ideation [16], postpartum pain [17], and impaired mother-to-infant bonding [18,19]. ...
Study objectives
The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal.
Methods
Ninety-nine women (85.9% in the 2 nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Pre-Sleep Arousal Scale’s Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale.
Results
DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas the ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13.
Conclusions
Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.
... The unstable and unstructured nature of this developmental period is a time of increased vulnerability to the onset of mental health problems (Kessler et al. 2005), including eating disorders (e.g., Lipson and Sonneville 2017). Further developmental milestones, such as pregnancy and parenthood, can also have dramatic impacts on both sleep (Da Costa et al. 2021;Parfitt and Ayers 2014;Román-Gálvez et al. 2018;Sedov et al. 2021) and eating behaviors (Bye et al. 2021) and understanding how to support people as they navigate these times of increased stress is critical. Longitudinal studies are needed to better understand how insomnia and eating disorder symptoms may be associated with increased risk at developmental transition periods. ...
Sleep and eating are both essential life functions. Dysregulation in either sleep or eating behaviors can result in significant problems with physical and mental health. Insomnia is a common sleep complaint, in which people report difficulty with initiating or maintaining sleep or waking up too early. When these symptoms are frequent, chronic, and associated with daytime dysfunction, then individuals may meet the criteria of insomnia disorder. Despite emerging evidence suggesting that insomnia symptoms and insomnia disorder are elevated in people with eating disorders, there remains much to be learned about the mechanisms underlying the association between insomnia and eating disorder pathology. In this chapter, we provide the reader with an overview of the nature of insomnia disorder in people with eating disorders, potential mechanisms for their co-occurrence, and current evidence-based psychological methods of treating insomnia symptoms. Future directions for research are offered to drive further study, which has implications for how both eating disorders and insomnia symptoms are treated.
... Since prenatal stress is often associated with sleep disturbances during pregnancy, another target could be to reduce maternal sleep disturbances during pregnancy. In fact, based on questionnaires, insomnia during pregnancy shows a very high prevalence of about 40-60% (Dørheim et al. 2012;Román-Gálvez et al. 2018;Sivertsen et al. 2015). Recent results of a randomized controlled trial showed that cognitive behavioral therapy for insomnia is an effective nonpharmacological treatment for sleep insomnia during pregnancy (Manber et al. 2019). ...
Sleep is a necessary function of life and plays a key role in development. This chapter will discuss the association between prenatal stress and children’s sleeping behaviors. First, a description of the development of sleep-wake patterns in infancy will be provided. Second, an overview of the literature on the link between prenatal stress and sleep-wake behaviors will be presented from a developmental perspective. Then, key confounding variables that influence the association between prenatal stress and children’s sleep will be discussed. A few of the proposed mechanisms that could explain the relationship between prenatal stress and child sleep outcomes will also be reviewed. Lastly, clinical interventions targeting maternal stress and infant sleep will be discussed.
... According to this definition, paranoid ideation seems to be related to two other symptoms already present in pregnant women: interpersonal sensitivity and phobic anxiety. Lack of sleep, considered one of the most widespread problems during pregnancy, has also been linked to paranoid ideation and psychoticism (Grezellschak et al., 2017;Román-Gálvez et al., 2018;Teran-Perez et al., 2012). These types of problems thus arise and are all related, with notable repercussions on maternal health. ...
Pregnancy is a life process that brings about a series of associated changes, both physical and psychological, in women. The psychopathological changes occurring in pregnant women due to the simple fact of this new vital stage are unknown. Therefore, the objective of this study was to compare the psychopathological symptoms present during pregnancy with those present in non-pregnant women, as well as the perceived stress and hair cortisol levels. For this, a group of non-pregnant women (n = 171) were compared with pregnant women who were in the first trimester (n = 124), second trimester (n = 200) and third trimester (n = 190). Moreover, 77 women were followed up to verify their psychopathological course of pregnancy. Differences were found between pregnant and non-pregnant women relating to a wide range of psychopathological symptoms, perceived stress and hair cortisol levels. The symptoms were greater in the group of pregnant women. By studying different types of psychopathological symptoms associated with pregnancy, it is possible to assign psychological interventions to given characteristics of pregnant women. In addition, we can broaden our knowledge about the psychological aspects of pregnancy and the changes associated with it.
... Various factors that have been reported to contribute to the high rate of insomnia during the 3 rd trimester include general discomfort (including backache), urinary frequency, and spontaneous awakenings or restless sleep. Foetal movements, heartburn, obesity, leg discomfort and fatigue are among other reasons [21][22][23]. ...
This study aimed at determining the prevalence as well as correlates of insomnia among pregnant women attending the antenatal clinic of a tertiary health centre in a developing country. Insomnia was assessed using the insomnia severity index among 237 consecutive women attending the Antenatal clinic of Ekiti State University Teaching Hospital. Other relevant data such as obstetric history and psychological morbidity were collected using structured forms and the data was analysed using SPSS version 20. Logistic regression was done to determine factors associated with insomnia. Prevalence of insomnia among the respondents was 32.5% and factors associated with insomnia included high maternal age (OR = 1.092, CI = 1.013-1.177, P value = 0.022), and having psychological morbidity (OR= 1.218, CI= 1.067-1.390, P value= 0.004). Though a higher number of women in the 3rd trimester had insomnia, this was however not statistically significant. This study has shown that insomnia during pregnancy is a common occurrence most especially during the last trimester of pregnancy. Common factors associated with it include older age of the patient and having a psychological morbidity. Screening for insomnia and offering some form of management may reduce some of the medical and psychological complications that may arise in the child and mother.
... It has also been found in the literature that the depression level of pregnant women was 30.5% (42) and insomnia prevalence was 57%, without any noticeable change in pregnancy advancement (45). However, one study in Spain observed that insomnia was more severe in the third trimester than it was in the first and second counterparts: 44% for the first trimester, 46% for the second one, and 64% for the last one (46). The high prevalence of insomnia, depression, and worry in this study can be a result of dissatisfaction with the country's economic condition, occupational status, and income because 87.5% of women were unemployed and 71.9% were dissatisfied with their family's economic condition. ...
Objective: Physical activity (PA), insomnia, depression, and worry were the key factors affecting pregnant women’s quality of life (QoL). The present study aimed to determine quality of life and its relationship with physical activity, insomnia, depression, and worry in pregnant women.
Method: This was an observational cross sectional study, conducted among 256 healthy pregnant women using 5 questionnaires: WHOQOL-brief (WHO Quality of Life Questionnaire, brief version, ISI (Insomnia Severity Index), PSWQ (Penn State Worry Questionnaire), ZSRDS (Zung Self-Rating depression Scale), and Pregnancy Physical Activity Questionnaire (PPAQ).
Results: There was a significant relationship between general QoL, insomnia, and worry with educational background, number of children, and occupation (P < 0.05). Depression had a significant relationship with occupation (P < 0.05). PA did not have a significant relationship with demographic information. However, insomnia had a significantly negative relationship with general QoL, general health, and psychological health (P < 0.05). The worry variable had also a significant negative relationship with general QoL, general health, and physiological health (P < 0.05). Depression had a significant negative relationship with general health, physical health, and psychological health (P < 0.05). There was no significant relationship between physical activities in pregnancy with QoL, depression, worry, and insomnia.
Conclusion: Women need to be informed about the necessity of controlling and reducing insomnia, worry, and depression to have a higher QoL. PA declined during the second and third trimester of pregnancy. However, PA in pregnancy can positively impact general QoL.
... Insomnia is a commonly reported sleep disturbance during pregnancy with a prevalence rate ranging from 44% to 75% [79][80][81]. The rate of insomnia increases progressively throughout pregnancy with the worse symptoms occurring during the third trimester [79,80]. ...
Introduction: Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations.
Areas covered: The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients’ characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative ‘Z-drug’ hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia.
Expert opinion: A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.
... In the first trimester, the level of insomnia is 13-80%, and it increases to 66-97% in the second trimester. 7 Studies conducted in Turkey have shown that the level of insomnia among pregnant women varies between 39% and 86%. [9][10][11] The belief that pregnancy is a happy period and that it comes with emotional well-being has been abandoned; if pregnant women experience severe physical, social, and personal stress factors, events such as pregnancy, delivery, and being a parent may result in developmental and situational crises for mothers .4 ...
Background:
Sleep problems during pregnancy may cause many complications that reduce quality of life.
Aim:
This study aims to determine the relationship between pregnant women's sleep characteristics and depressive symptoms.
Methods:
A hospital-based, cross-sectional study was conducted. Pregnant women were selected from the population by using the an improbable random sampling method. This study sample included 436 pregnant women who met the study's inclusion criteria. To collect data, this study used an information form that was developed by the researcher after reviewing relevant literature, the Women's Health Initiative Insomnia Rating Scale (WHIIRS), and the Beck Depression Inventory (BDI). The researchers used face-to-face interviews method to collect data from the participants, pregnant women who were examined in the polyclinic.
Results:
This study found that 36% of participating pregnant women reported insomnia, and 38.1% experienced depressive symptoms. It also determined that participants who had problems with insomnia, who experienced a change in sleep habits, and who did not wake up feeling rested experienced depressive symptoms 1.64, 2.79, and 2.59 times more than those who didn't have these problems, respectively. who experienced a decrease in sleep, who experienced an increase in sleep, and who did not wake up feeling rested experienced depressive symptoms 1.61, 3.22, 3.53, and 2.59 times more, respectively, than those who did not have insomnia, who did not experience a change in sleep habits in pregnancy, and who woke up feeling rested, respectively.
Conclusion:
This study determined that there is a relationship between insomnia and depressive symptoms and that pregnant women experiencing insomnia presented with more depressive symptoms.
... As pregnancy progresses, selfreported sleep quality worsens, with decreases in reported sleep duration and sleep efficiency 3 . In addition, over 40% of pregnant women endorse insomnia in the first trimester, and this increases to over 60% by the third trimester 4 . Polysomnographic data from the third trimester has also shown increased wake after sleep onset and decreased rapid eye movement (REM) sleep compared to non-pregnant women 5 . ...
Later sleep timing, circadian preference, and circadian rhythm timing predict worse outcomes across multiple domains, including mood disorders, substance use, impulse control, and cognitive function. Disturbed sleep is common among pregnant and postpartum women. We examined whether sleep timing during third trimester of pregnancy predicted postpartum symptoms of mania, depression, and obsessive-compulsive disorder (OCD). Fifty-one women with a previous, but not active, episode of unipolar or bipolar depression had symptoms evaluated and sleep recorded with wrist actigraphy at 33 weeks of gestation and 2, 6, and 16 weeks postpartum. Circadian phase was measured in a subset of women using salivary dim light melatonin onset (DLMO). We divided the sample into “early sleep” and “late sleep” groups using average sleep onset time at 33 weeks of gestation, defined by the median-split time of 11:27 p.m. The “late sleep” group reported significantly more manic and depressive symptoms at postpartum week 2. Longer phase angle between DLMO and sleep onset at 33 weeks was associated with more manic symptoms at postpartum week 2 and more obsessive-compulsive symptoms at week 6. Delayed sleep timing in this sample of at-risk women was associated with more symptoms of mania, depression, and OCD in the postpartum period. Sleep timing may be a modifiable risk factor for postpartum depression.
... Mindell ve arkadaşları (2015) da araştırmamıza benzer olarak gebelerin %57'sinde uykusuzluk semptomları olduğunu belirtmiştir (24). Roman-Galvez ve arkadaşlarının (2018) kohort çalışmasında gebelerin birinci trimestirde %44,2'sinin, ikinci trimestirinde %46,3 ve üçüncü trimesterinde %63,7'sinin uykusuzluk sorunu yaşadıklarını bulmuştur (25). Bulgumuz Mindell ve arkadaşları ile Roman-Galvez ve arkadaşlarının bulgusu ile benzerlik göstermektedir. ...
... First, physiological changes related to pregnancy and birth-giving (e.g., hormonal changes, fetus growth, increased risk for sleep disordered breathing and restless legs syndrome), and postpartum nighttime infant care are common factors that reduce/disrupt sleep opportunity [4]. Second, by the third trimester, approximately 60% of women experience significant insomnia symptoms with persistent difficulties in initiating and maintaining sleep [5,6]. Further, for about half of the women with probable insomnia during pregnancy, symptom of insomnia persist into at least two years postpartum [6]. ...
Background:
Poor sleep, including symptoms of insomnia are common during pregnancy and postpartum periods. Poor sleep during the perinatal period is linked to impaired daytime functioning, mood disturbance, and risk for chronic insomnia. Cognitive behavioural therapy (CBT) is consistently shown to be efficacious in treating insomnia, but it is largely inaccessible to new mothers, and surprisingly, not part of current perinatal care. This study aims to evaluate the feasibility and efficacy of a scalable CBT-based intervention for better sleep quality.
Methods:
In this single-blind randomised controlled trial, eligible nulliparous women are randomised in a 1:1 ratio to either the intervention (CBT) or active control (healthy diet) condition. The interventions are provided from the third trimester till 6 months postpartum. The primary outcome is maternal sleep quality and secondary outcomes are maternal sleep-related impairment, mood, health-related quality of life, relationship satisfaction, and mother-infant-relationship, all assessed using validated instruments at 30- (baseline) and 35 weeks gestation (pregnancy endpoint), and 1.5, 3, and 6 months (postpartum endpoint) after childbirth, with follow-up assessments conducted at 1-year and 2-year postpartum.
Discussion:
This study has the potential to address the need for an evidence-based, non-pharmacological sleep intervention tailored for the pregnancy and postpartum periods. The intervention is designed to maximise reach and minimise cost, with the potential to scale up and incorporate in routine perinatal care. With outcomes measured at 8 time points, from the third trimester of pregnancy to 2-year postpartum, this study has the potential to examine both short- and long-term impact on maternal sleep and wellbeing.
Trial registration:
ACTRN12616001462471 ; retrospectively registered on 19/10/2016.
... Total sleep time appears to be the lowest one month after birth, but it can remain as low still at two months postpartum [39], [99]. In previous studies, these attributes were measured via subjective self-report questionnaires or short-term objective actigraphy [5], [16], [31], [100]. ...
Sleep is a composite of physiological and behavioral processes that undergo substantial changes during and after pregnancy. These changes might lead to sleep disorders and adverse pregnancy outcomes. Several studies have investigated this issue; however, they were restricted to subjective measurements or short-term actigraphy methods. This is insufficient for a longitudinal maternal sleep quality evaluation. A longitudinal study a) requires a long-term data collection approach to acquire data from everyday routines of mothers and b) demands a sleep quality assessment method exploiting a large volume of multivariate data to assess sleep adaptations and overall sleep quality. In this paper, we present an Internet-of-Things based long-term monitoring system to perform an objective sleep quality assessment. We conduct longitudinal monitoring where 20 pregnant mothers are remotely monitored for six months of pregnancy and one month postpartum. To evaluate sleep quality adaptations, we a) extract several sleep attributes and study their variations during the monitoring and b) propose a semi-supervised machine learning approach to create a personalized sleep model for each subject. The model provides an abnormality score which allows an explicit representation of the sleep quality in a clinical routine, reflecting possible sleep quality degradation with respect to her own data. Sleep data of 13 participants (out of 20) are included in our analysis, as their data are adequate for the study, including 172.15 ± 33.29 days of sleep data per person. Our fine-grained objective measurements indicate the sleep duration and sleep efficiency are deteriorated in pregnancy and notably in postpartum. In comparison to the mid of the second trimester, the sleep model indicates the increase of sleep abnormality at the end of pregnancy (2.87 times) and postpartum (5.62 times). We also show the model enables individualized and effective care for sleep disturbances during pregnancy, as compared to a baseline method.
... 2 Questionnaire-based estimates of prevalence of insomnia during pregnancy range between 40% and 60%. [3][4][5] This is significant because 50% of women with probable insomnia during pregnancy continue to have symptoms at 2 years postpartum 4 and because insomnia is associated with comorbidities. 6 Cognitive behavioral therapy for insomnia is a nonpharmacologic insomnia-focused psychotherapy, whose strong empirical support lead to its designation as the first-line treatment for insomnia by the American College of Physicians. ...
OBJECTIVE
To evaluate the effectiveness of cognitive behavioral therapy for insomnia during pregnancy.
METHODS
Randomized, unmasked, 3-site controlled trial. Participants were randomly allocated to cognitive behavioral therapy for insomnia (a first-line, empirically supported psychosocial intervention that addresses sleep-related behaviors and cognitions) or a control intervention consisting of imagery exercises that paired patient-identified distressing nighttime experiences with patient-identified neutral images. Participants were eligible if they met diagnostic criteria for insomnia disorder and were between 18 and 32 weeks of gestation. Patients were ineligible if they met diagnostic criteria for major psychiatric disorders, including depression, or were receiving nonstudy treatments that could affect sleep (or both). The primary outcome was the Insomnia Severity Index score, a validated brief questionnaire, with scores between 14 and 21 representing clinically meaningful insomnia of moderate severity, scores higher than 21 representing severe insomnia, and scores less than 8 representing no insomnia. Secondary outcomes included remission of insomnia (Insomnia Severity Index score less than 8), objectively measured and self-reported time awake (ie, total wake time), and the Edinburgh Postnatal Depression Scale score. All outcomes were measured weekly. Analysis included 48 participants who did not complete treatment. We estimated that 184 women would be required to have 80% power, with a two-tailed test, to detect a moderate Cohen's d effect size (.5) with α=.05.
RESULTS
Between May 2013 and April 2017, 194 pregnant women were randomized and 149 completed treatment; 179 with available baseline data (92%) were ultimately analyzed, 89 in the cognitive therapy group and 90 in the control group. Women assigned to cognitive behavioral therapy for insomnia experienced significantly greater reductions in insomnia severity (scores decreased from 15.4±4.3 to 8.0±5.2 in the cognitive behavioral therapy group vs from 15.9±4.4 to 11.2±4.9 in the control therapy group [P<.001, d=0.5]). Remission of insomnia (to an Insomnia Severity Index score less than 8) disorder was attained by 64% of women in the cognitive behavioral therapy for insomnia group vs 52% in the control group. Women receiving cognitive behavioral therapy for insomnia experienced faster remission of insomnia disorder, with a median of 31 days vs 48 days in the control therapy (P<.001). Cognitive behavioral therapy for insomnia led to significantly greater reduction in self-reported but not objective total wake time and a small but significantly greater decline in Edinburgh Postnatal Depression Scale scores vs the control group.
CONCLUSION
Cognitive behavioral therapy for insomnia is an effective nonpharmacologic treatment for insomnia during pregnancy.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT01846585.
... Various factors that have been reported to contribute to the high rate of insomnia during the 3 rd trimester include general discomfort (including backache), urinary frequency, and spontaneous awakenings or restless sleep. Foetal movements, heartburn, obesity, leg discomfort and fatigue are among other reasons [21][22][23]. ...
Objectives:
To estimate the prevalence of insomnia and examine the association between social isolation and insomnia among pregnant women.
Methods:
This cross-sectional study was part of the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017. Pregnant women were recruited at obstetric clinics and hospitals in Miyagi Prefecture, Japan. We analyzed 17,586 women who completed the questionnaires and were allowed to transcribe medical records. Insomnia was defined as the Athens Insomnia Scale score of ≥6. The Lubben Social Network Scale-abbreviated version was used to assess social isolation (defined as scores <12), and its subscales were used to assess marginal family ties and marginal friendship ties. Multiple logistic regression analyses were conducted to examine the association between social isolation and insomnia during pregnancy, adjusting for age, parity, prepregnancy body mass index, feelings toward pregnancy, education, income, work status, morning sickness, and psychological distress. Multiple logistic regression analyses were also conducted for marginal family ties and marginal friendship ties.
Results:
The prevalence of insomnia in the second trimester was 37.3%. Women who were socially isolated were more likely to have insomnia than women who were socially integrated: the multivariate-adjusted odds ratio (OR) was 1.26 (95% confidence interval [CI], 1.16-1.36). Marginal family ties and marginal friendship ties were also associated with increased risks of insomnia: the multivariate-adjusted ORs were 1.40 (95% CI, 1.25-1.56) and 1.15 (95% CI, 1.07-1.24), respectively.
Conclusions:
Social isolation from family and friends was associated with increased risks of insomnia among pregnant women.
Sleep disruption is common during pregnancy, particularly in later stages of gestation, and is related to the hormonal and physiological changes that are experienced. Although pregnancy often exacerbates pre-existing sleep disturbance, it can also cause emergence of new ones. Clinical sleep disorders and behavioral practices can alter the structure and/or duration of typical sleep patterns, which in turn can impact the wellbeing of the maternal-fetal dyad. Sleep is also influenced by circadian rhythms, for example shift work results in circadian misalignment with some shift workers experiencing insomnia symptoms and poor sleep quality. Notably, shift work as an extreme example of circadian misalignment has been reported to impact fertility and early pregnancy loss. There are robust data regarding associations between sleep—particularly sleep-disordered breathing—and maternal outcomes such as gestational hypertension/pre-eclampsia and gestational diabetes, although less is known about how maternal sleep affects fetal wellbeing.
Background
Insomnia is the most common sleep disorder affecting sleep quality and quality of life among women during the perinatal period. The aim of the study is to study the frequency of insomnia and sleep quality among perinatal women and their effect on quality of life: 131 participants; 64 perinatal and 67 control groups from the outpatient clinics of Suez Canal University Hospital, Ismailia, Egypt. DSM-5 criteria were used to diagnose insomnia. Sleep quality was assessed using PSQI, and SF-36 questionnaire was used for assessment of health-related quality of life.
Results
Insomnia was statistically significant higher among the perinatal group than the control; 28.1% and 10.4%, respectively ( P < 0.05). The perinatal women had poor sleep quality as compared with the control group with a higher mean global PSQI score; 8.02 ± 2.97 and 4.97 ± 2.45, respectively ( P < 0.05). The quality of life in the perinatal group was lower than the control group with scores of 54.96 ± 14.63 versus 62.34 ± 14.63, respectively.
Conclusions
Insomnia and poor sleep quality are found in higher frequency in perinatal women than their counterpart control. The study also showed a significant impact of these changes on maternal HRQoL.
During pregnancy, a life stage during which there are significant hormonal, anatomic, physiological, and psychological changes, women experience unique challenges with sleep. Pregnancy can exacerbate preexisting sleep problems as well as cause the emergence of new ones. The impact of sleep deficiency – which includes insufficient sleep, poorly timed sleep, and clinical sleep disorders – is observed not only on the individual but also on the offspring, with potentially long-lasting implications.KeywordsPittsburgh Sleep Quality Index (PSQI)Unrefreshed sleepSleep in mid-pregnancySleep-disordered breathing (SDB)RLS during pregnancyInsufficient Sleep
Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms “insomnia” and “perinatal period” or “pregnancy” or “post partum” or “lactation” or “breastfeeding” and “evaluation” and “treatment.” Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy.
Objective
The aims of this study were to examine the incidence and correlates of insomnia and its impact on health-related quality of life among Chinese pregnant women.
Method
A cross-sectional study was performed from November 2018 to April 2019 in a university-affiliated general hospital in Guangzhou, China. Seven hundred and seventeen pregnant women completed the 36-item Short-Form Health Survey (SF-36), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), and the obstetric and sociodemographic data sheet.
Findings
24.3% of the pregnant women suffered from insomnia. Compared with women without insomnia, those with insomnia had a significantly lower health-related quality of life during pregnancy. Maternal age, educational level, occupation, economic status, insurance coverage, gestational age, the woman’s relationship with her mother-in-law and anxiety were significantly associated with insomnia among pregnant women.
Conclusion
The incidence of insomnia among pregnant women is high, and insomnia is negatively correlated with health-related quality of life. Appropriate measures and practical therapeutic programmes should be provided to prevent the adverse effects of insomnia in pregnant women with advanced maternal age, lower education, lower economic status, unemployment, lack of insurance coverage, unsatisfied with their relationships with their mothers-in-law, and suffering from anxiety symptoms, especially in the third trimester.
Although many women report changes in their sleep during pregnancy, clinically significant insomnia is a not normal part of pregnancy and it can be treated using CBT-I. In this chapter, we provide an overview of the current research about sleep and insomnia during pregnancy, as well as considerations for assessment and treatment of insomnia during pregnancy. We also provide an outline of the adaptations to the CBT-I protocol for use during pregnancy.
We investigated whether infant temperament was predicted by level and change in maternal hostility, a putative transdiagnostic vulnerability for psychopathology, substance use, and insensitive parenting. A sample of women (N = 247) who were primarily young, low-income, and had varying levels of substance use prenatally (69 non-smokers, 81 tobacco only smokers, and 97 tobacco and marijuana smokers) reported their hostility in the third trimester of pregnancy and at 2-, 9-, and 16-months postpartum, and their toddler’s temperament and behavior problems at 16-months. Maternal hostility decreased from late pregnancy to 16-months postpartum. Relative to pregnant women who did not use substances, women who used both marijuana and tobacco prenatally reported higher levels of hostility while pregnant and exhibited less change in hostility over time. Toddlers who were exposed to higher levels of prenatal maternal hostility were more likely to be classified in temperament profiles that resemble either irritability or inhibition, identified via latent profile analysis. These two profiles were each associated with more behavior problems concurrently, though differed in their association with competence. Our results underscore the utility of transdiagnostic vulnerabilities in understanding the intergenerational transmission of psychopathology risk and are discussed in regards to the Research Domain Criteria (RDoC) framework.
Backgroud and purpose:
Almost every woman experiences discomforts during pregnancy. This study aimed to evaluate the efficacy of yoga on physiological and psychological discomforts and delivery outcomes in Chinese primiparas.
Materials and methods:
A randomized controlled trial was conducted. Participants in the control group (n = 32) received routine prenatal care, whereas participants in the intervention group (n = 32) received routine prenatal care and yoga exercise three times a week for 12 weeks. Outcomes evaluated included physiological discomforts, prenatal depression, anxiety, childbirth self-efficacy and delivery outcomes. Intention-to-treat analysis was conducted.
Results:
Yoga decreased the symptoms of physiological discomforts during pregnancy (F = 6.966, p = 0.010), promoted childbirth self-efficacy (F = 11.900, p = 0.001), increased the rate of vaginal delivery (χ2 = 4.267, p = 0.039), and shortened the length of the first (t = -2.612, p = 0.012), second (z = -3.313, p = 0.001) and third stages of labor (z = -3.137, p = 0.002).
Conclusion:
Yoga offers beneficial effects on physiological discomforts, childbirth self-efficacy and delivery outcomes in Chinese primiparas.
Reports of sleep disturbances are common during pregnancy, yet estimates of prevalence of insomnia symptoms during pregnancy vary widely. The goals of the current review were to summarize the existing data on prevalence of insomnia symptoms during pregnancy and to explore potential moderators, including trimester, gestational age, maternal age, symptoms of anxiety and symptoms of depression. A systematic search of PubMed, PsycInfo and Web of Science was conducted for articles published from inception up to June 2020. In total, 24 studies with a total of 15,564 participants were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 38.2%. Trimester was a significant moderator, such that prevalence of insomnia symptoms was higher in the third trimester (39.7%) compared to first (25.3%) and second (27.2%) trimesters. No other variables significantly moderated the prevalence of insomnia symptoms. The results of the current meta-analysis suggest that the prevalence of insomnia symptoms is higher during pregnancy, particularly in the third trimester. Future research should examine the efficacy and safety of insomnia treatments with this population.
Study objectives:
This systematic review aimed to examine the: 1) strength of associations between prenatal sleep (i.e., duration, quality, and insomnia) and psychological health (i.e., depression, anxiety, and stress); and 2) moderating influence of sociodemographic characteristics (i.e., maternal age, gestational age/trimester, parity, marital and socioeconomic status [SES]), body mass index (BMI), and meeting sleep recommendations.
Methods:
A systematic search was conducted using PubMed, PsycINFO, Web of Science, and CINHAL to identify studies with at least one sleep measure and a psychological health outcome. Effect sizes (ES) were calculated by associations between individual components of sleep and psychological health (e.g., sleep quality-depression).
Results:
Reviewed studies (N =32) included 14,648 participants and yielded 219 ES. ES for anxiety/stress were combined due to insufficient data to analyze individually. Average strengths of associations for sleep duration-depression (ES=.52) and -anxiety/stress (ES=.48), sleep quality-depression (ES=.55) and -anxiety/stress (ES=.58), and insomnia-depression (ES=.67) ranged from medium to large. Marital status, parity, BMI, and meeting sleep recommendations moderated sleep duration-depression and -anxiety/stress. SES, gestational age/trimester, parity, and BMI moderated sleep quality-depression and anxiety/stress associations.
Conclusions:
Poor sleep quality and depression are prevalent during pregnancy and may negatively impact maternal and fetal outcomes. Moderating effects suggest that pregnant women of different BMI status and gestational age differ in their sleep habits and depression and anxiety/stress levels. Findings highlight the need to better understand the impact of these associations on maternal-fetal outcomes to inform interventions to improve sleep and psychological health.
After childbirth, women may develop symptoms of depression with the associated sleep disturbances. This study assessed the relationship between insomnia and both depression symptoms and blood estradiol levels in women during the early postpartum period. 84 patients were assessed 24–48 h after labor. The main assessment methods were the following psychometric scales: Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS) and Athens Insomnia Scale (AIS). Serum estradiol levels were measured using ELISA assay. Women who developed postpartum insomnia significantly more often reported insomnia during pregnancy (P = 0.001), were more likely to have suffered from depression in the past (P = 0.007) and had significantly higher BDI (P = 0.002) and EPDS (P = 0.048) scores. Our study demonstrated no significant association between Restless Legs Syndrome (RLS) during pregnancy and postpartum insomnia. The groups of women with and without postpartum RLS showed no significant differences in the incidence of postpartum insomnia. No significant differences in estradiol levels were observed in women with and without postpartum insomnia. The study showed the following factors to play a major role in development of postpartum insomnia: an increase in Beck Depression Inventory score, a history of depression and a history of insomnia during pregnancy.
Sleep problems are common during pregnancy and in the postnatal period, but there is still a lack of longitudinal population-based studies assessing the quantity and quality of sleep in these women. The aim of the current study was to examine the natural development and stability of insomnia and short sleep duration in women from pregnancy to two years postpartum.
This was a longitudinal cohort study (the Akershus Birth Cohort Study) of 1480 healthy women, who completed three comprehensive health surveys, at week 32 of pregnancy, week 8 postpartum and year 2 postpartum. The survey was composed of the following validated questionnaires: the Bergen Insomnia Scale, the Pittsburgh Sleep Quality Index and the Edinburgh Postnatal Depression Scale. Differences in sleep characteristics between the three assessment points were compared using Analyses of Variance with repeated measures, and logistic regression analyses were used to examine the stability of sleep variables.
One thousand four hundred and eighty women completed all three surveys, and the mean age at birth was 30.7 (+/-4.9). The prevalence of insomnia remained stable at 60 % at the first two time periods, and remained high at 41 % at year 2 postpartum. The mean sleep duration at the three time periods was 7 h 16 min, 6 h 31 min, and 6 h 52 min, respectively. Concurrent maternal depression could not explain the stability of sleep problems from during and immediately after pregnancy, to sleep problems 2 years postpartum.
Both insomnia and short sleep duration were found to be very common both before and after pregnancy.
Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes.
A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis.
Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH-4.0 (95 % CI 1.3-11.9), 1.5 (95 % CI 0.5-4.5), and 2.9 (95 % CI 1.0-8.2) and for undergoing CS-5.3 (95 % CI 1.7-16.3), 4.9 (95 % CI 1.8-13.1), and 5.1 (95 % CI 1.9-14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS.
Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.
In the search of the sleep substance, many studies have been addressed for different hormones, responsible for sleep-wake cycle regulation. In this article we mentioned the participation of steroid hormones, besides its role regulating sexual behavior, they influence importantly in the sleep process. One of the clearest relationships are that estrogen and progesterone have, that causing changes in sleep patterns associated with the hormonal cycles of women throughout life, from puberty to menopause and specific periods such as pregnancy and the menstrual cycle, including being responsible for some sleep disorders such as hypersomnia and insomnia. Another studied hormone is cortisol, a hormone released in stressful situations, when an individual must react to an extraordinary demand that threatens their survival, but also known as the hormone of awakening because the release peak occurs in the morning, although this may be altered in some sleep disorders like insomnia and mood disorders. Furthermore neurosteroids such as pregnanolone, allopregnanolone and pregnenolone are involved in the generation of slow wave sleep, the effect has been demonstrated in experimental animal studies. Thus we see that the sleep and the endocrine system saved a bidirectional relationship in which depends on each other to regulate different physiological processes including sleep.
A population-based questionnaire study of 2,816 women was conducted in week 32 of pregnancy to estimate the prevalence of and risk factors for insomnia and depressive symptoms. The Bergen Insomnia Scale (BIS) measured insomnia. The Edinburgh Postnatal Depression Scale (EPDS) measured depressive symptoms. The prevalence of insomnia (DSM-IV-TR criteria) was 61.9%, and mean BIS score 17.5 (SD = 10.5), significantly higher than among the general population. The prevalence of depressive symptoms (EPDS ≥ 10) was 14.6%. Depressive symptoms were strongly associated with insomnia during late pregnancy, especially with sleep durations <5 or >10 hours, sleep efficiency <75%, daytime impairment, and long sleep onset latency. Pelvic girdle pain and lower back pain was associated with insomnia, but not with depressive symptoms.
This study aims to investigate insomnia experienced by pregnant women and factors associated with it. This study was designed as hospital-based, descriptive, and cross-sectional research. The participants were 486 people chosen with nonprobability random sampling method. The data were collected through Women's Health Initiative Insomnia Rating Scale, Beck Depression Inventory, and Interview Form. Insomnia prevalence in women participating in this study was found 52.2%. The results of logistic regression analysis showed that the risk of insomnia was 2.03 times higher for those in the third trimester than those in the first and second trimesters, 2.19 times higher for those 20 years old and over than younger ones, and 2.63 times higher for those who had depression syndrome than those who did not. Insomnia in pregnant women who participated in this study was found to be at high rates.
To assess the presence of insomnia and sleepiness and related factors in the late third trimester of pregnancy.
A total of 370 singleton gravids completed a general questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). In addition, maternal anthropometry was recorded upon survey.
Median [interquartile range] maternal age and gestational age upon survey was of 31 [7.0] years and 39 [1.8] weeks, respectively. A 73.5% of women displayed some degree of insomnia (Total ISI score 8-28) and 22.2% sleepiness (Total ESS score ≥10). Determined rho Spearman coefficients showed significant correlations between ISI scores and gestational age at survey and survey to birth interval (weeks) and between ESS scores and maternal weight and arm circumference at survey and neonatal birth weight. Multiple linear regression analysis found that smoking habit, higher blood pressure and shorter survey to birth interval (weeks) significantly predicted higher ISI scores, and hence a higher risk of insomnia. Employed status, increased arm circumference and neonatal weight predicted higher ESS scores (sleepiness).
Insomnia and sleepiness were prevalent in the late third trimester of pregnancy in which lifestyle factors and maternal and neonatal body composition were significant predictors.
To explore relationships among sleep disturbances, glucose tolerance, and pregnancy outcomes.
Four validated sleep questionnaires were administered to 169 pregnant women at the time of 50-g oral glucose tolerance testing (OGTT) during the second trimester. Pregnancy outcomes were analyzed in 108 women with normal glucose tolerance (NGT).
Of the participants, 41% had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >8); 64% had poor sleep quality; 25% snored frequently; 29% had increased risk of sleep-disordered breathing (SDB); 52% experienced short sleep (SS); 19% had both increased SDB risk and SS (SDB/SS); and 14% had daytime dysfunction. Reported sleep duration inversely correlated with glucose values from 50-g OGTT (r = -0.21, P < 0.01). Each hour of reduced sleep time was associated with a 4% increase in glucose levels. Increased likelihood of gestational diabetes mellitus (GDM) was found in subjects with increased SDB risk (odds ratio 3.0 [95% CI 1.2-7.4]), SS (2.4 [1.0-5.9]), SDB/SS (3.4 [1.3-8.7]), and frequent snoring (3.4 [1.3-8.8], after adjustment for BMI). Among NGT subjects, preterm delivery was more frequent in those with increased ESS (P = 0.02), poor sleep quality (P = 0.02), and SS (P = 0.03). Neonatal intensive care unit admissions were associated with increased ESS (P = 0.03), SDB/SS (P = 0.03), and daytime dysfunction (P < 0.01) in mothers.
Pregnant women experience significant sleep disturbances that are associated with increased risk of GDM and unfavorable pregnancy outcomes. Pregnant women with increased SDB risk, frequent snoring, and sleep duration of <7 h/night have increased risk of developing GDM.
To develop and validate a Spanish version of the Athens Insomnia Scale (AIS).
The AIS is designed to assess sleep difficulty and comprises eight items: the first five refer to the sleep disturbance and the last three to the daytime consequences. Either the full eight-item scale (AIS-8) or the brief form (AIS-5) can be administered. The adaptation used a back-translation design. The validation process was based on a sample of 323 participants (undergraduates, community sample and psychiatric outpatients), which completed the AIS and other questionnaires: anxiety (BAI), depression (BDI) and psychological well-being (GHQ-12) scales.
The internal consistency coefficients for both versions were above 0.80. The study of dimensionality revealed a single factor with high loadings and a percentage of explained variance above 50% in both versions. Test-retest reliability was above 0.70 (AIS-5) and over 0.80 (AIS-8) at a one-month interval. The correlation between the AIS and the previously mentioned scales was for both the AIS-5 and the AIS-8 above 0.40 and 0.50, respectively.
The psychometric properties of both versions of the Spanish form of the AIS demonstrate that the scale is a valid and reliable instrument for the assessment of insomnia in Spanish-speaking populations.
Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, "insomnia" refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.
Although incident snoring is common in pregnant women and has been proposed as a potential risk factor for adverse maternal-fetal outcomes, the development of sleep-disordered breathing during pregnancy has not been prospectively described.
Using the Apnea Symptom Score from the Multivariable Apnea Prediction Index and the Epworth Sleepiness Scale, we prospectively assessed symptoms of sleep-disordered breathing and daytime somnolence in 155 women to determine whether symptoms increased during pregnancy and the characteristics associated with increasing symptoms.
We found that sleep-disordered breathing symptoms (Apnea Symptom Score, 0.44 (SEM 0.58) vs 0.95 (0.09, P < .001) and the degree of daytime somnolence (Epworth Sleepiness Scale, 8.6 (0.3) vs 10.2 (0.4), P = .0003) increased significantly during pregnancy. Women with higher baseline body mass indexes and greater increases in neck circumference during pregnancy reported higher apnea symptom scores. Of the 155 subjects, 11.4% reported an increase in Apnea Symptom Score of 2 units or more, consistent with a clinically significant increase in symptoms; these women experienced a significantly greater increase in subjective sleepiness than other subjects (P = .03). Excessive daytime somnolence (Epworth Sleepiness Scale > 10) was prevalent throughout pregnancy (31.0%-45.5%).
Our data demonstrate that symptoms of sleep-disordered breathing increase during pregnancy and that more than 10% of our subjects may be at risk for developing sleep apnea during pregnancy. Excessive daytime somnolence was highly prevalent even early in pregnancy and became increasingly common as pregnancy progressed.
Objective:
To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other).
Methods:
In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated).
Results:
Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders.
Conclusion:
Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.
Objective:
To examine if insomnia before and after childbirth predicts the development of postpartum bodily pain.
Methods:
This study is part of a longitudinal cohort study, the Akershus Birth Cohort Study, which targeted all women giving birth at Akershus University Hospital in Norway. The current sample is comprised of 1480 women who participated at all three time points, yielding a participation rate of 32% of the 4662 women who originally consented to participate. The Bergen Insomnia Scale (BIS) was used to measure insomnia and a latent profile analysis (LPA) was used to identify subsets of women who shared a similar pattern of responses on the BIS-scale across the three time points. Pain was measured using the bodily pain scale, derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and symptoms of depression were measured by the Edinburgh Postnatal Depression Scale (EPDS).
Results:
Using a latent profile analysis a three class model showed the best fit and identified one major group (55.6%) with a low BIS scores across all three time points, one group with intermediate BIS scores (32.9%), and a smaller group (11.5%) with higher BIS scores across all three times. The chronic high insomnia group had a 2.8-fold increased risk of reporting high levels of bodily pain. The chronic intermediate group was associated with a 2.2-fold increased risk of bodily pain at two years postpartum. Adjusting for demographics and lifestyle behaviors did not reduce any of the associations, while adjusting for depression significantly attenuated the associations. Additional adjustment for pain at eight weeks postpartum further reduced the magnitude of the associations, but both chronic intermediate insomnia and chronic high insomnia remained strongly associated with the onset of bodily pain in the fully adjusted models (RR=1.75, 95% CI: 1.37-2.23) and RR=1.63, 95% CI: 1.15-2.32, respectively).
Conclusions:
The high prevalence of insomnia among women during and after childbirth, in combination with the strong prospective association with impaired physical health, emphasizes the importance of adequately identifying, preventing and treating insomnia for this population.
Introduction:
Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms MATERIALS AND METHODS: A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory RESULTS: Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too early morning awakenings increased in late pregnancy compared to mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow-up. In late pregnancy depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy CONCLUSIONS: We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectional associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy. This article is protected by copyright. All rights reserved.
Sleep disorders, prevalent in industrialized countries, are associated with adverse health outcomes such as hypertension, diabetes, and obesity. Disturbed sleep during pregnancy is frequently overlooked by health care providers, yet recent studies suggest there is an association between sleep disorders and adverse pregnancy outcomes, including preeclampsia, elevated serum glucose, depression, prolonged labor, and cesarean birth. Growing evidence indicates that the recognition and management of prenatal sleep disorders may minimize adverse pregnancy outcomes and improve maternal and fetal well-being. This focused review of prenatal sleep disturbance literature suggests there are 3 main sleep disorders of interest: breathing-related sleep disorders (ie, habitual snoring and obstructive sleep apnea), restless legs syndrome, and insomnia. These sleep disorders are common in pregnancy and have maternal and fetal consequences if left untreated. This article describes sleep disorders of pregnancy, elucidates their relationship with maternal and neonatal outcomes, and presents current evidence regarding diagnostic and management strategies.
Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce.
To estimate the prevalence and patterns of sleep disturbances during pregnancy among healthy nulliparous women.
This was a prospective, cohort study of healthy nulliparous women, recruited between 6 and 20 weeks of gestation, who completed a baseline sleep survey at enrollment with follow-up in the third trimester. The survey was composed of the following validated sleep questionnaires: Berlin Questionnaire for Sleep Disordered Breathing, Epworth Sleepiness Scale, National Institutes of Health/International Restless Legs Syndrome Question Set, Women's Health Initiative Insomnia Rating Scale, and the Pittsburgh Sleep Quality Index. Differences in sleep characteristics between the baseline and third trimester were compared using the paired t test or McNemar test for continuous or categorical data, respectively.
One hundred eighty-nine women completed both baseline and follow-up sleep surveys. The mean gestational age was 13.8 (+/-3.8) and 30.0 (+/-2.2) weeks at the first and second surveys, respectively. Compared with the baseline assessment, mean sleep duration was significantly shorter (7.4 [+/-1.2] hours compared with 7.0 [+/-1.3] hours, P<.001), and the proportion of patients who reported frequent snoring (at least three nights per week) was significantly greater (11% compared with 16.4%, P=.03) in the third trimester. The percentage of patients who met diagnostic criteria for restless leg syndrome increased from 17.5% at recruitment to 31.2% in the third trimester (P=.001). Overall poor sleep quality, as defined by a Pittsburgh Sleep Quality Index score greater than 5, became significantly more common as pregnancy progressed (39.0% compared with 53.5%, P=.001).
Sleep disturbances are prevalent among healthy nulliparous women and increase significantly during pregnancy.
II.
To describe different sleep disorders and daytime sleepiness in a French population of randomly selected young women during pregnancy and to evaluate the frequency of these sleep disorders according to the three trimesters of pregnancy.
Cross-sectional design with retrospective survey of pre-pregnancy, symptoms and prospective survey of current symptoms. Mothers were interviewed during pregnancy with a questionnaire to evaluate their sleep before pregnancy and to assess alterations in their sleep according to the trimester.
871 pregnant women completed the questionnaire. The rate of pregnant women with insomnia with non-refreshing sleep and frequent awakenings increases during the second and the third trimester reaching more than 75% of the women, essentially due to an urge to urinate, movements of the fetus, backache and restless legs syndrome. Snoring also increases throughout the pregnancy with more than 18% of them snoring every night. Conversely, more than 75% of the women complained of a decrease in their vigilance and a need to nap inreased during the pregnancy.
The subjective quality of sleep is disturbed as early as the first trimester of pregnancy and increases throughout the pregnancy, except for excessive daytime sleepiness which was more frequent during the first trimester.
To describe changes in women's sleep patterns from prepregnancy to postpartum.
Polysomnography was done in women's homes for 2 consecutive nights. Forty-five women were studied during the follicular and luteal phases of their menstrual cycles, and 33 conceived and were studied during each trimester of pregnancy. Twenty-nine were studied at 1 and 3 months postpartum.
Compared with prepregnant sleep characteristics, significant changes in sleep patterns were evident by 11-12 weeks' gestation, with a significant increase in total sleep time but less deep sleep and more awakening during sleep. By the third month postpartum, there was improvement in sleep characteristics; however, sleep efficiency remained significantly lower than baseline prepregnancy values.
Sleep disturbance was greatest during the first postpartum month, particularly for first-time mothers.
To provide documentation for the diagnostic validity of the Athens Insomnia Scale (AIS), a self-assessment psychometric tool which has previously shown high consistency, reliability and external validity for the evaluation of the intensity of sleep difficulty.
The AIS was administered to a total of 299 subjects (105 primary insomniacs, 100 psychiatric outpatients, 44 psychiatric inpatients and 50 nonpatient controls) who were also assessed for the ICD-10 diagnosis of "nonorganic insomnia" blindly in terms of the AIS scores.
176 subjects were identified as insomniacs and 123 as noninsomniacs. Logistic regression of AIS total score against the ICD-10 diagnosis of insomnia demonstrated that a score of 6 is the optimum cutoff based on the balance between sensitivity and specificity. When diagnosing individuals with a score of 6 or higher as insomniacs, the scale presents with 93% sensitivity and 85% specificity (90% overall correct case identification). For this cutoff score, in the general population, the scale has a positive predictive value (PPV) of 41% and a negative predictive value (NPV) of 99%. For the same cutoff score, among unselected psychiatric patients, the PPV was found to be 86% and the NPV 92%. Other cutoff scores can be also considered, however, depending on the importance of avoiding false positive or false negative results; for example, for a cutoff score of 10, the PPV in the general population reaches about 90% without the NPV becoming lower than 94%.
The AIS can be utilized in clinical practice and research, not only as an instrument to measure the intensity of sleep-related problems, but also as a screening tool in reliably establishing the diagnosis of insomnia.
To survey the effects of pregnancy on mothers' sleep.
Mothers were interviewed during and after pregnancy with a series of five questionnaires to assess alterations in their sleep. The first questionnaire covered the 3 months before becoming pregnant, the next three the trimesters of pregnancy and the last the 3 months after delivery. The study was carried out in a central hospital and the maternity care units in the nearby rural community. Altogether, 325 pregnant women completed all five questionnaires.
The total amounts of reported sleep and of nocturnal sleep increased significantly during the first trimester of pregnancy, began to decrease thereafter and were shortest during the 3 months after pregnancy. During late pregnancy expectant mothers over 30 years of age reported less sleep than those under 30. During the whole pregnancy, but increasingly toward the end of pregnancy, sleep became more restless and fragmentary and its subjective quality worsened, due at least partly to increased restless legs and nightly awakenings increasing with advancing pregnancy.
The subjective quality of sleep is disturbed as early as the first trimester of pregnancy, although total sleeping time increases. The amount of reported sleep begins to decrease in the second trimester. The frequency of reported sleep disturbances, such as restless legs syndrome and nocturnal awakenings, is maximum in the third trimester but is about normal within 3 months after delivery.
In a prospective study of 247 pregnant Chinese women, the prevalence of sleep disturbances across pregnancy has been assessed using a set of validated questionnaires including the Sleep and Health Questionnaire (SHQ) and the Epworth Sleepiness Scale (ESS). The frequency of self-reported snoring increased from 29.7% in the first trimester to 40.5% and 46.2% in the second and third trimesters, respectively, with an increase in the prevalence of moderate or severe snoring from 1% in the first trimester to 7.2% in the third trimester (P < 0.01). There was a higher frequency of moderate to severe snoring intensity among subjects with BMI >or=25 compared with those with BMI <25 kg/m(2) in the third trimester (20.8%vs 5.3%, P < 0.01). Subjective sleepiness, as determined by the ESS, increased significantly from 8.6 to 9.4 and 9.6 in the first, second and third trimesters, respectively.
Preventive activities in women
- A L Garcia-Franco
- L A Mir
- E B Munoz
- Iglesias Pineiro
- M J Solsona
- J O Teira
Garcia-Franco AL, Mir LA, Munoz EB, Iglesias Pineiro MJ, Solsona JO, Teira BG,
et al. Preventive activities in women. Aten Primaria 2012;44(Suppl 1):65-80.
Guidelines for perinatal care
American Academy of Pediatrics. Guidelines for perinatal care. 2012.
Postpartum and Newborn Care: A Guide for Essential Practice
- Who
- Pregnancy
- Childbirth
WHO. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for
Essential Practice. 3rd ed. Geneva: World Health Organization; 2015.