Managing Sleep Disorders during Pregnancy

Determinants of Poor Sleep Quality During the COVID-19 Pandemic Among Women Attending Antenatal Care Services at the Health Facilities of Debre Berhan Town, Ethiopia: An Institutional-Based Cross-Sectional Study

BACKGROUND

Women's ability to get sleep can be affected by pregnancy-related hormonal changes or other external stressful situations like the coronavirus disease 2019 (COVID-19).

OBJECTIVE

The objective of this study was to assess the proportion of poor sleep quality during the COVID-19 pandemic and its determinants among pregnant women attending antenatal care (ANC) services.

METHODS

An institutional-based cross-sectional study was conducted among 423 women attending ANC services at the health facilities in Debre Berhan Town, Ethiopia, from May to June 2020. A systematic random sampling technique was used to select the required samples. The tool consisted of questions that assessed (1) socio-demographic characteristics, obstetric and health care service-related characteristics; and media exposure to get information regarding COVID-19 infection; (2) To assess sleep quality; the Pittsburgh Sleep Quality Index (PSQI) was applied. And a global score of >5 indicates poor sleep quality, and a global score of ≤5 indicates good sleep quality.

RESULT

The overall prevalence of poor sleep quality was 62.8%, and was associated with pregnant women aged ≥46 years (AOR = 4.27), being in the third trimester (AOR = 2.51), being multigravida (AOR = 2.72), and having co-morbidity (AOR = 3.57).

CONCLUSION

The prevalence of poor sleep quality among pregnant women during the pandemic was found to be high. Advanced maternal age, third trimester pregnancy, being multigravida, and having comorbidity were determinants of poor sleep quality among pregnant women during the COVID-19 pandemic.

Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health

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.

Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns

Narcolepsy is a neurological disorder of the sleep-wake cycle characterized by excessive daytime sleepiness (EDS), cataplexy, nighttime sleep disturbances, and REM-sleep-related phenomena (sleep paralysis, hallucinations) that intrude into wakefulness. Dysfunction of the hypocretin/orexin system has been implicated as the underlying cause of narcolepsy with cataplexy. In most people with narcolepsy, symptom onset occurs between the ages of 10 and 35 years, but because the disorder is underrecognized and testing is complex, delays in diagnosis and treatment are common. Narcolepsy is treated with a combination of lifestyle modifications and medications that promote wakefulness and suppress cataplexy. Treatments are often effective in improving daytime functioning for individuals with narcolepsy, but side effects and/or lack of efficacy can result in suboptimal management of symptoms and, in many cases, significant residual impairment. Additionally, the psychosocial ramifications of narcolepsy are often neglected. Recently two new pharmacologic treatment options, solriamfetol and pitolisant, have been approved for adults, and the indication for sodium oxybate in narcolepsy has been expanded to include children. In recent years, there has been an uptick in patient-centered research, and promising new diagnostic and therapeutic options are in development. This paper summarizes current and prospective pharmacological therapies for treating both EDS and cataplexy, discusses concerns specific to children and reproductive-age women with narcolepsy, and reviews the negative impact of health-related stigma and efforts to address narcolepsy stigma.