Online prenatal trial in mindfulness sleep management (OPTIMISM): protocol for a pilot randomized controlled trial

Mindfulness as an Adjunct or Alternative to CBT-I

Mindfulness-based interventions (MBIs) are programs that teach mindfulness concepts through guided meditation and self-regulation practices. MBIs have been found to improve sleep and reduce cognitive arousal, which are central to the development and perpetuation of insomnia. In this article, we review theoretic frameworks and clinical trial effectiveness data supporting MBIs for insomnia. Based on this review, we provide suggestions for using MBIs as an adjunct or alternative treatment option to CBT-I with regard to how, when, and for whom. We conclude with an agenda for future directions that can clarify the use of mindfulness as a treatment option for insomnia.

Efficacy of Internet-based cognitive behavioral therapy on sleeping difficulties in menopausal women: A randomized controlled trial

Sleeping difficulties are the most significant cause of disability in menopausal women. Cognitive behavioral therapy (CBT) is the first line of management for sleeping difficulties and chronic insomnia.

PURPOSE

To evaluate the efficacy of an Internet-based CBT program on sleeping difficulties in menopausal women.

DESIGN

This was a randomized controlled trial. A total of 80 eligible menopausal women who fit the criteria of poor sleep quality were randomly and evenly assigned to the CBT intervention group or the control group.

TOOLS

The tools used for data collection were the demographic sheet, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and sleep diary. Internet-based CBT modules were administered to the intervention group. Six consecutive modules were held weekly for each participant. Sleep quality scores and insomnia index scores were considered the primary outcomes, while sleep diaries were the secondary outcomes. Self-administered questionnaires were given at baseline and 6 weeks after randomization.

FINDINGS

Internet-based CBT is effective in reducing sleeping difficulties, particularly sleep quality scores (-3.60 ± 2.76) and insomnia index scores (-5.10 ± 3.54) from baseline. Moreover, the program induced significant changes in sleep parameters, such as increased total sleep hours (t = 2.734, p = 0.008), increased sleep efficiency ≥85%, (t = 3.558, p = 0.001), and decreased sleep latency (t = 2.180, p = 0.033) compared with the control group.

CONCLUSION

The strong predictors of having very poor sleep quality were short duration since last menopause, severity of hot flashes, and short duration of sleep difficulties.

PRACTICE IMPLICATION

Internet-based CBT is a useful practical intervention for managing sleeping difficulties in menopausal women. The current study provides evidence on the efficacy and cost-effectiveness of Internet-based cognitive behavioral intervention; thus, we recommend this method as a practical and accessible intervention to improve sleep in menopausal women.

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.