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Benedetto L, Peña F, Rivas M, Ferreira A, Torterolo P. The Integration of the Maternal Care with Sleep During the Postpartum Period. Sleep Med Clin 2023; 18:499-509. [PMID: 38501522 DOI: 10.1016/j.jsmc.2023.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Our entire life occurs in a constant alternation between wakefulness and sleep. The impossibility of living without sleep implies that any behavior must adapt to the need for sleep, and maternal behavior does not escape from this determination. Additionally, maternal behavior in mammals is a highly motivated behavior, essential for the survival of the offspring. Thus, the mother has to adapt her physiology of sleep to the constant demands of the pups, where each species will have different strategies to merge these two physiological needs. However, all studied female mammals will experience sleep disturbances at some point of the postpartum period.
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Affiliation(s)
- Luciana Benedetto
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | - Florencia Peña
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Mayda Rivas
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Annabel Ferreira
- Sección de Fisiología y Nutrición, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Pablo Torterolo
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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2
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Horwitz A, Bar-Shachar Y, Ran-Peled D, Finkelstein O, Ben-Zion H, Bar-Kalifa E, Meiri G, Tikotzky L. Sleep of mothers, fathers, and infants: a longitudinal study from pregnancy through 12 months. Sleep 2023; 46:zsad029. [PMID: 36788476 DOI: 10.1093/sleep/zsad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
STUDY OBJECTIVES This study assessed and compared mothers' and fathers' sleep trajectories from pregnancy and throughout the first year of the infant's life. We also examined associations between maternal, paternal, and infant sleep. METHODS Two hundred and thirty-two couples were recruited for the study during pregnancy. Data were collected during pregnancy and at 4, 8, and 12 months postpartum. Maternal, paternal, and infant sleep were monitored at home for seven nights, using actigraphy, sleep diaries, and the Insomnia Severity Index (ISI). RESULTS Mothers showed more impaired sleep quality than fathers, at all assessments, whereas fathers had shorter sleep duration. Based on the ISI, about 70% of mothers and 50% of fathers showed at least subclinical insomnia at the different assessments. Trajectory analyses (controlling for feeding method and sleeping arrangements) demonstrated a significant deterioration in diary-based and actigraphy sleep quality for both parents, from pregnancy to 4 months. Both parents and infants had an increase in sleep quality from 4 to 12 months, though some parental sleep variables showed a quadratic pattern with a decrease in sleep quality at 8 months. Statistically significant triadic associations at the different assessments were found between mothers', fathers', and infants' sleep. Maternal and infant sleep measures were more strongly correlated than paternal and infant sleep. CONCLUSIONS The findings highlight the importance of considering the family context of sleep, by demonstrating similarities and differences in the changes that sleep undergoes in new mothers and fathers and by showing how sleep is interrelated between all family members.
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Affiliation(s)
- Avel Horwitz
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Bar-Shachar
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dar Ran-Peled
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Omer Finkelstein
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hamutal Ben-Zion
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eran Bar-Kalifa
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Meiri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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3
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Duhart JM, Buchler JR, Inami S, Kennedy KJ, Jenny BP, Afonso DJS, Koh K. Modulation and neural correlates of postmating sleep plasticity in Drosophila females. Curr Biol 2023; 33:2702-2716.e3. [PMID: 37352854 PMCID: PMC10527417 DOI: 10.1016/j.cub.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 06/25/2023]
Abstract
Sleep is essential, but animals may forgo sleep to engage in other critical behaviors, such as feeding and reproduction. Previous studies have shown that female flies exhibit decreased sleep after mating, but our understanding of the process is limited. Here, we report that postmating nighttime sleep loss is modulated by diet and sleep deprivation, demonstrating a complex interaction among sleep, reproduction, and diet. We also find that female-specific pC1 neurons and sleep-promoting dorsal fan-shaped body (dFB) neurons are required for postmating sleep plasticity. Activating pC1 neurons leads to sleep suppression on standard fly culture media but has little sleep effect on sucrose-only food. Published connectome data suggest indirect, inhibitory connections among pC1 subtypes. Using calcium imaging, we show that activating the pC1e subtype inhibits dFB neurons. We propose that pC1 and dFB neurons integrate the mating status, food context, and sleep drive to modulate postmating sleep plasticity.
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Affiliation(s)
- José M Duhart
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Laboratorio de Genética del Comportamiento, Fundación Instituto Leloir-IIBBA-CONICET, Buenos Aires C1405BWE, Argentina; Universidad Nacional de Quilmes, Quilmes B1876BXD, Argentina.
| | - Joseph R Buchler
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Sho Inami
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kyle J Kennedy
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - B Peter Jenny
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Dinis J S Afonso
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kyunghee Koh
- Department of Neuroscience, the Farber Institute for Neurosciences, and Synaptic Biology Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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4
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Zimmerman D, Bartick M, Feldman-Winter L, Ball HL. ABM Clinical Protocol #37: Physiological Infant Care-Managing Nighttime Breastfeeding in Young Infants. Breastfeed Med 2023; 18:159-168. [PMID: 36927076 PMCID: PMC10083892 DOI: 10.1089/bfm.2023.29236.abm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).
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Affiliation(s)
- Deena Zimmerman
- Maternal-Child and Adolescent Division, Public Health Service, Israel Ministry of Health, Jerusalem, Israel
| | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Helen L Ball
- Durham Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
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5
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Duhart JM, Inami S, Koh K. Many faces of sleep regulation: beyond the time of day and prior wake time. FEBS J 2023; 290:931-950. [PMID: 34908236 PMCID: PMC9198110 DOI: 10.1111/febs.16320] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 12/19/2022]
Abstract
The two-process model of sleep regulation posits two main processes regulating sleep: the circadian process controlled by the circadian clock and the homeostatic process that depends on the history of sleep and wakefulness. The model has provided a dominant conceptual framework for sleep research since its publication ~ 40 years ago. The time of day and prior wake time are the primary factors affecting the circadian and homeostatic processes, respectively. However, it is critical to consider other factors influencing sleep. Since sleep is incompatible with other behaviors, it is affected by the need for essential behaviors such as eating, foraging, mating, caring for offspring, and avoiding predators. Sleep is also affected by sensory inputs, sickness, increased need for memory consolidation after learning, and other factors. Here, we review multiple factors influencing sleep and discuss recent insights into the mechanisms balancing competing needs.
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Affiliation(s)
- José Manuel Duhart
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia PA
- These authors contributed equally
- Present address: Fundación Instituto Leloir, Instituto de Investigaciones Bioquímicas de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Sho Inami
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia PA
- These authors contributed equally
| | - Kyunghee Koh
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia PA
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6
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Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, Chen F. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13:1053210. [DOI: 10.3389/fphar.2022.1053210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.
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7
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Astbury L, Bennett C, Pinnington DM, Bei B. Does breastfeeding influence sleep? A longitudinal study across the first two postpartum years. Birth 2022; 49:540-548. [PMID: 35191089 PMCID: PMC9546104 DOI: 10.1111/birt.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between breastfeeding and sleep of the gestational parent is poorly understood. This longitudinal study investigated how breastfeeding is associated with total nighttime sleep duration and sleep efficiency (percentage of total sleep time in bed) in nulliparous participants over the first two postpartum years. METHODS Nulliparous participants (N = 155, Mage = 33.45, SDage = 3.50) self-reported patterns of breastfeeding via telephone interviews and sleep via self-report at 1.5, 3, 6, 12 and 24 months postpartum. Data were analyzed using mixed-effects models, with breastfeeding variables as predictors and sleep variables as outcomes, controlling for relevant covariates. RESULTS Neither the presence of breastfeeding nor the percentage of human milk in infants' total diets was significantly associated with participants' sleep duration or sleep quality (P-values > 0.08). This finding held after controlling for the number of nighttime feeds (P-values > 0.11). However, greater numbers of nighttime feeds, regardless of feeding content, were strongly associated with shorter sleep duration and poor sleep efficiency (P-values < 0.05). On average, with each additional nighttime feed, nocturnal sleep duration decreased by 6.6-8.4 minutes, and sleep efficiency decreased by 2.88%-3.02%. CONCLUSIONS Data from this study showed that breastfeeding per se was not associated with shorter or poor nocturnal sleep, but the number of nighttime feeds was. Sharing nighttime infant care amongst different carers in the household could help reduce postpartum sleep disturbance and ameliorate its negative impact on wellbeing.
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Affiliation(s)
- Laura Astbury
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Christie Bennett
- Department of Nutrition and Dietetics and FoodBe Active Eat Sleep (BASE) FacilitySchool of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Donna M. Pinnington
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Centre for Women’s Mental HealthDepartment of PsychiatryUniversity of MelbourneRoyal Women’s HospitalMelbourneVictoriaAustralia
| | - Bei Bei
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Centre for Women’s Mental HealthDepartment of PsychiatryUniversity of MelbourneRoyal Women’s HospitalMelbourneVictoriaAustralia
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8
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Verma S, Rajaratnam SMW, Davey M, Wiley JF, Bei B. Cognitive Behavioural Therapy and Light Dark Therapy for Maternal Postpartum Insomnia Symptoms: Protocol of a Parallel-Group Randomised Controlled Efficacy Trial. Front Glob Womens Health 2021; 1:591677. [PMID: 34816165 PMCID: PMC8593939 DOI: 10.3389/fgwh.2020.591677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Symptoms of insomnia are common in new mothers and have been associated with a range of negative maternal and child outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioural Therapy (CBT) and Light Dark Therapy (LDT) represent two promising interventions for insomnia symptoms and associated daytime consequences such as fatigue. This randomised controlled trial examines whether CBT and LDT improve maternal insomnia symptoms as the primary outcome and maternal sleep disturbance, mood, fatigue, and sleepiness as secondary outcomes. This protocol paper outlines the development, design, and implementation of the trial. Methods: Participants are an Australian community-sample of 90 first-time mothers who are 4-12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores ≥ 8). Exclusion criteria include current severe sleep/psychiatric disorders, unsettled infant sleep behaviour, sleep-affecting medication use, and photosensitivity. Eligible women are randomised into a CBT (strategies targeting sleep, worries, fatigue, and relaxation), LDT, or a treatment-as-usual control condition. Interventions are therapist-assisted and personalised through two telephone calls and include a series of automated intervention emails delivered over 6 weeks. Primary and secondary outcomes are assessed at four time points: baseline, intervention mid-point, post-intervention, and 1-month post-intervention. Discussion: If found effective, these interventions could represent efficacious, safe, and inexpensive treatments for improving postpartum insomnia and mitigate its negative impact on maternal well-being. Interventions tested are highly scalable and can be integrated into postpartum care and made available to the broader community. ANZCTR trial registration: Accessible at: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000842268.
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Affiliation(s)
- Sumedha Verma
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Shantha M W Rajaratnam
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Margot Davey
- Melbourne Children's Sleep Unit, Monash Medical Centre, Clayton South, VIC, Australia
| | - Joshua F Wiley
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Bei Bei
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.,Department of Psychiatry, Centre for Women's Mental Health, Royal Women's Hospital, University of Melbourne, Parkville, VIC, Australia
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9
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Tikotzky L, Bar-Shachar Y, Volkovich E, Meiri G, Bar-Kalifa E. A longitudinal study of the links between maternal and infant nocturnal wakefulness. Sleep Health 2021; 8:31-38. [PMID: 34702683 DOI: 10.1016/j.sleh.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVES To examine the longitudinal links between maternal and infant nocturnal wakefulness by employing a trajectory-based approach, and to assess whether the strength of these links differs as a function of sleep assessment method (actigraphy vs. self-report) and sleeping arrangements. METHODS Maternal and infant nocturnal wakefulness were assessed with actigraphy and sleep diaries at home for 5 nights, at 3 (N = 191), 6 (N = 178), 12 (N = 155), and 18 (N = 135) months postpartum. Outcome measures included the number of night-wakings (NW) and the length of nocturnal wakefulness (WASO). RESULTS Strong associations between maternal and infant nocturnal wakefulness (controlling for nighttime breastfeeding) were found for NW and WASO. Trajectory analyses demonstrated that the strength of these relations decreased linearly from 3 to 18 months. Furthermore, the findings showed that the links between maternal and infant NW and WASO were stronger for maternal reports than for actigraphy. No consistent differences were found in the strength of the relations between maternal and infant NW and WASO as a function of sleeping arrangements (ie, room-sharing vs. solitary-sleeping families). CONCLUSIONS The results suggest that infant and maternal sleep are strongly intertwined, especially during the first 6 months. The decline in the synchronization between maternal and infant nocturnal wakefulness through infant development may be attributed to the growing ability of infants to self-soothe during the night. The findings emphasize the need to study sleep within a family context.
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Affiliation(s)
- Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yael Bar-Shachar
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Volkovich
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Meiri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eran Bar-Kalifa
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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10
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Gordon LK, Mason KA, Mepham E, Sharkey KM. A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression. Sleep Health 2021; 7:353-361. [PMID: 33640360 PMCID: PMC9665349 DOI: 10.1016/j.sleh.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied. METHODS In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum. RESULTS Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness. CONCLUSIONS In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.
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Affiliation(s)
- Lily K Gordon
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA
| | - Katherine A Mason
- Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Emily Mepham
- Sleep for Science Research Laboratory, Providence, Rhode Island, USA
| | - Katherine M Sharkey
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA; Rhode Island Hospital, Divison of Pulmonary, Critical Care, and Sleep Medicine, Providence, Rhode Island, USA.
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11
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Spaeth AM, Khetarpal R, Yu D, Pien GW, Herring SJ. Determinants of postpartum sleep duration and sleep efficiency in minority women. Sleep 2021; 44:5998103. [PMID: 33220056 DOI: 10.1093/sleep/zsaa246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES To examine demographic, psychosocial, and behavioral determinants of postpartum sleep duration and sleep efficiency among a cohort of black and Latina women. METHODS Data were from 148 women (67% black, 32% Latina) at 5 months postpartum, recruited from an academic medical center in Philadelphia. Relevant demographic, psychosocial and behavioral predictors were assessed via questionnaire. Nocturnal sleep was objectively measured for 1 week using wrist actigraphy. Sleep duration was examined as a continuous variable and in categories (<7 versus ≥7 h per night); sleep efficiency was examined as a continuous variable. Independent multiple linear regression models were built to evaluate significant determinants of sleep. RESULTS Adjusted models revealed that breastfeeding, having a bedtime after midnight, and being employed were associated with shorter sleep duration (-25-33 min, all p < 0.05). Multiparity, being unmarried, being employed, breastfeeding, having a bedtime after midnight, bedsharing, and responding to infant awakenings by getting up immediately rather than waiting a few minutes to see if the infant fell back asleep, were all significant determinants of sleeping <7 h per night (OR varying: 2.29-4.59, all p < 0.05). Bedsharing was the only variable identified from the multiple regression model that associated with poorer sleep efficiency (-3.8%, p < 0.05). CONCLUSIONS Findings may inform interventions for improving postpartum sleep in socioeconomically disadvantaged, racial/ethnic minority postpartum women.
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Affiliation(s)
- Andrea M Spaeth
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ
| | - Risha Khetarpal
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA
| | - Daohai Yu
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Grace W Pien
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sharon J Herring
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA.,Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.,Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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12
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Kikuchi S, Nishihara K, Horiuchi S, Eto H. The influence of feeding method on a mother's circadian rhythm and on the development of her infant's circadian rest-activity rhythm. Early Hum Dev 2020; 145:105046. [PMID: 32353647 DOI: 10.1016/j.earlhumdev.2020.105046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
An infant's circadian sleep-wake rhythm is established during the first three months after birth. It is crucial to identify how entrainment factors, such as maternal behavioural influences, feeding conditions, and others, contribute to the infant's obtaining circadian rhythm. This study examined the influence of feeding method on the mother's rhythm and on the development of her infant's circadian rest-activity rhythm. The subjects were 24 healthy primiparas (mean age, 29.8) and their full-term infants. We retrospectively divided the subjects into two groups based on feeding method (breastfeeding, 17; mixed-feeding, 7). Actographic recordings for the infants and their mothers were made over 3-5 consecutive days during the 2nd-3rd week, the 6th week, and the 12th week. First, we calculated the mean values of the autocorrelograms from the autocorrelation coefficients and calculated their statistical significance to see their rhythmicity for all the mothers and their infants at each of the periods. Second, we evaluated the mean values of the autocorrelograms to see statistical differences between the feeding methods. For the breastfed infants, the mean values of the autocorrelograms at 24-h for the 6th week were significant. However, the mean values for the mixed-fed infants were unclear. At the 12th week, the mean values of the autocorrelograms at 24-h for both groups of infants were significant. The mean value for the breastfeeding mothers at 24-h was significantly larger than that for the mixed-feeding mothers. In conclusion, the breastfeeding mothers contributed more to their infants achieving circadian rhythm than did the mixed-feeding mothers.
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Affiliation(s)
| | - Kyoko Nishihara
- Sleep Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; The Institute for Science of Labour, Tokyo, Japan.
| | - Shigeko Horiuchi
- Department of Nursing, Maternal Infant Nursing and Midwifery, St. Luke's International University, Tokyo, Japan
| | - Hiromi Eto
- Nagasaki University, Institute of Biomedical Sciences, Nagasaki, Japan
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The Mother-Infant Sleep Nexus: Night-Time Experiences in Early Infancy and Later Outcomes. THE MOTHER-INFANT NEXUS IN ANTHROPOLOGY 2020. [DOI: 10.1007/978-3-030-27393-4_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ayers AM, Allan ATL, Howlett C, Tordiffe ASW, Williams KS, Williams ST, Hill RA. Illuminating movement? Nocturnal activity patterns in chacma baboons. J Zool (1987) 2019. [DOI: 10.1111/jzo.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. M. Ayers
- Department of Anthropology Durham University Durham UK
- Primate and Predator Project Lajuma Research Centre Makhado South Africa
| | - A. T. L. Allan
- Department of Anthropology Durham University Durham UK
- Primate and Predator Project Lajuma Research Centre Makhado South Africa
| | - C. Howlett
- Department of Anthropology Durham University Durham UK
- Primate and Predator Project Lajuma Research Centre Makhado South Africa
- School of Anthropology and Conservation The University of Kent Canterbury Kent UK
| | - A. S. W. Tordiffe
- Department of Paraclinical Sciences Faculty of Veterinary Science University of Pretoria Onderstepoort South Africa
| | - K. S. Williams
- Department of Anthropology Durham University Durham UK
- Primate and Predator Project Lajuma Research Centre Makhado South Africa
| | - S. T. Williams
- Department of Anthropology Durham University Durham UK
- Primate and Predator Project Lajuma Research Centre Makhado South Africa
- Department of Zoology University of Venda Thohoyandou South Africa
- Institute for Globally Distributed Open Research and Education (IGDORE) Thohoyandou South Africa
| | - R. A. Hill
- Department of Anthropology Durham University Durham UK
- Primate and Predator Project Lajuma Research Centre Makhado South Africa
- Department of Zoology University of Venda Thohoyandou South Africa
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Nagari M, Gera A, Jonsson S, Bloch G. Bumble Bee Workers Give Up Sleep to Care for Offspring that Are Not Their Own. Curr Biol 2019; 29:3488-3493.e4. [DOI: 10.1016/j.cub.2019.07.091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/09/2019] [Accepted: 07/31/2019] [Indexed: 01/26/2023]
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Considering Sleep, Mood, and Stress in a Family Context: A Preliminary Study. Clocks Sleep 2019; 1:259-272. [PMID: 33089168 PMCID: PMC7445857 DOI: 10.3390/clockssleep1020022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background: During the first years of life, parental sleep strongly depends on child’s sleep quality. Poor parental sleep may relate to increased stress and negative mood. However, there is a lack of sleep studies focusing on all family members. This study aimed to investigate the relationship between sleep, mood, and stress in mothers, fathers and children. Methods: Data were obtained from 65 parental couples and 65 children (2 to 36 months). Data on sleep for all family members and stress of parents were completed by both mothers and fathers through questionnaires and sleep diaries. Results: Toddlers’ positive mood before nocturnal sleep was significantly associated with reduced wake times after sleep onset. Mothers reported worse sleep quality compared to fathers. Shorter sleep onset latency in fathers and better sleep efficiency in mothers were linked with better self-reported mood upon awakening. In mothers, but not in fathers, poor sleep quality was associated with higher perceived stress. Conclusion: Results suggest bidirectional relationships between sleep and mood in children, mothers and fathers. Moreover, results evidence poorer sleep in mothers, compared to fathers, which was linked with increased parenting stress. This gender gap should be further considered in studies with larger samples and in clinical contexts.
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Okun ML. Sleep Disturbances and Modulations in Inflammation: Implications for Pregnancy Health. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019; 13:e12451. [PMID: 31737088 PMCID: PMC6857810 DOI: 10.1111/spc3.12451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
When a woman becomes pregnant, there is a vast series of physiological, vascular, and psychological changes. Among the most commonly reported changes are those involving sleep. Pregnant women report that their ability to maintain sleep and acquire continuous refreshing sleep is impaired during the perinatal period as compared to the non-pregnant period. A growing literature supports the hypothesis that disturbed sleep (which comes in many forms) during the perinatal period is associated with an increased risk of adverse maternal, delivery, and infant outcomes. Among the suggested biological pathways linking sleep and adverse outcomes are disturbances in the immune and hormonal systems. The following paper will discuss (1) the various sleep processes that are commonly disturbed during the perinatal period and the methods used to collect sleep data; (2) the evidence linking sleep to adverse outcomes; and (3) how one specific biological pathway, the immune system, likely mediates these associations. The goal of this paper is to clarify the role that sleep disturbance has during pregnancy.
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Determinants of Insomnia among Mothers during Postpartum Period in Northwest Ethiopia. SLEEP DISORDERS 2019; 2019:3157637. [PMID: 31057976 PMCID: PMC6463557 DOI: 10.1155/2019/3157637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/23/2019] [Accepted: 03/06/2019] [Indexed: 12/16/2022]
Abstract
Objective Postpartum period is a state of instability that may be accompanied by mood liability, anxiety, insomnia, and neuropsychiatric disturbance in women. This neuropsychiatric disturbance has a negative influence on the child's psychological and physical development. Our aim was to see the level of sleep difficulties among postpartum mothers in three obstetric care settings in Ethiopia. Method Institutional based cross-sectional study was conducted at one referral hospital and two health centers. A total of 988 postpartum mothers had been interviewed for sleep difficulties by using Athens Insomnia Scale (AIS). Adjusted Odd Ratio (AOR) and 95% Confidence Interval (CI) were used and P-value <0.05 was used for indicating significant variables. Result The prevalence of sleep difficulty between four to six weeks of postpartum period was 21.8% (215/988). Marital status of divorced/widowed/separated [AOR= 2.29, 95% CI (1.40, 6.08)], no educational opportunity [AOR= 2.35, 95% CI (1.57, 3.51)], having poor social support [AOR=2.82, 95% CI (1.63, 4.88)], alcohol use [AOR=1.58, 95% CI (1.13, 2.22)], history of depression [AOR=1.93, 95% CI (1.13, 3.31)], and who has poor support from husband [AOR=1.94, 95% CI (1.18, 3.18)] had association with sleep difficulty. Conclusion There is a high magnitude of sleep difficulties during four to six weeks of postpartum period in postpartum mothers and they are associated with many preventable risk factors.
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Wilkerson AK, Uhde TW. Perinatal Sleep Problems: Causes, Complications, and Management. Obstet Gynecol Clin North Am 2019; 45:483-494. [PMID: 30092923 DOI: 10.1016/j.ogc.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Changes in sleep are ubiquitous in the perinatal period and it is important to be able to determine when these changes are significant enough to indicate sleep deficiency associated with increased risk for poor maternal and infant outcomes. Guidelines for identifying sleep deficiency include insomnia symptoms, excessively shortened sleep duration, and perception of insufficient or nonrestful sleep. Causes and complicating factors related to such sleep problems have been well-documented and are used to tailor behavioral and pharmacologic treatments for women who are pregnant or in the early postpartum period.
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Affiliation(s)
- Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425, USA.
| | - Thomas W Uhde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425, USA
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Christian LM, Kowalsky JM, Mitchell AM, Porter K. Associations of postpartum sleep, stress, and depressive symptoms with LPS-stimulated cytokine production among African American and White women. J Neuroimmunol 2018; 316:98-106. [PMID: 29406850 PMCID: PMC5806133 DOI: 10.1016/j.jneuroim.2017.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postpartum is a period of unique psychosocial stress characterized by sleep disturbance, risk for depressed mood, and heightened parenting stress. However, data on effects of these exposures on inflammatory immune function are limited. METHODS This study examined associations among sleep, psychosocial stress (i.e., parenting stress, general perceived stress), mood (i.e., depressive symptoms), serum cytokine levels, and LPS-stimulated proinflammatory cytokine production among 69 women (32 African American, 37 White) assessed at 7-10weeks postpartum. RESULTS No associations between behavioral measures and serum cytokine levels were observed among women of either race. In African American women, but not Whites, poorer sleep quality, greater parenting stress, and greater depressive symptoms were associated with greater LPS-stimulated IL-6 and IL-8 production (ps≤0.05). Also in African Americans, greater general perceived stress was associated with greater IL-8 production, and greater depressive symptoms with greater stimulated TNF-α production (ps≤0.05). Simple mediation models highlighted the bidirectional relationship between stress and sleep in relation to inflammation among African American women. CONCLUSIONS Significant effects of both stress/distress and poor sleep quality on proinflammatory cytokine production during postpartum were observed uniquely among African American women. These data are consistent with an allostatic load model which predicts that conditions of chronic stress impart vulnerability to dysregulated responses to novel stressor exposures. The bidirectional nature of the stress-sleep relationship has clinical relevance. Studies examining whether interventions focused on one or both of these psychological factors during postpartum is beneficial for inflammatory profiles would be informative. In addition, examination of these models in relation to maternal health at postpartum, including delivery related wounds and other infections, is warranted.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
| | | | - Amanda M Mitchell
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States
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21
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Sivadas N, Radhakrishnan A, Aswathy B, Kumar VM, Gulia KK. Dynamic changes in sleep pattern during post-partum in normal pregnancy in rat model. Behav Brain Res 2017; 320:264-274. [DOI: 10.1016/j.bbr.2016.11.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 11/25/2022]
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Hill PD, Aldag JC, Chatterton RT, Zinaman M. Psychological Distress and Milk Volume in Lactating Mothers. West J Nurs Res 2016; 27:676-93; discussion 694-700. [PMID: 16157942 DOI: 10.1177/0193945905277154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this article is twofold: (a) to compare psychological distress as measured via self-reported perceived stress, sleep, and fatigue levels in lactating mothers of a term infant and mothers of a preterm infant and(b) to determine whether the addition of psychological distress to a previous model predicts milk volume at Postpartum Week 6 by gestation group. The convenience sample of 95 mothers of a preterm infant (31 weeks) and 98 mothers of a term infant completed the Perceived Stress Visual Analogue Scale, Richards-Campbell Sleep Questionnaire, and the Fatigue Visual Analog Scale. Stress, sleep difficulty, and fatigue levels decreased during the 6-week study period for mothers of a term but not for mothers of a preterm infant. Perceived stress, sleep difficulty, and fatigue during the first 6 weeks postpartum were not related to milk volume; thus, the mother’s perceived psychological distress had no apparent effect on lactation.
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Affiliation(s)
- Pamela D Hill
- College of Nursing, University of Illinois at Chicago, USA
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Sharkey KM, Iko IN, Machan JT, Thompson-Westra J, Pearlstein TB. Infant sleep and feeding patterns are associated with maternal sleep, stress, and depressed mood in women with a history of major depressive disorder (MDD). Arch Womens Ment Health 2016; 19:209-18. [PMID: 26228760 PMCID: PMC4781668 DOI: 10.1007/s00737-015-0557-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/08/2015] [Indexed: 01/22/2023]
Abstract
Our goal was to examine associations of infant sleep and feeding patterns with maternal sleep and mood among women at risk for postpartum depression. Participants were 30 women (age ± SD = 28.3 ± 5.1 years) with a history of MDD (but not in a mood episode at enrollment) who completed daily sleep diaries, wore wrist actigraphs to estimate sleep, and had their mood assessed with the Hamilton Depression Rating Scale (HAM-D-17) during four separate weeks of the perinatal period (33 weeks pregnancy and weeks 2, 6, and 16 postpartum). They logged their infants' sleep and feeding behaviors daily and reported postnatal stress on the Childcare Stress Inventory (CSI) at week 16. Mothers' actigraphically estimated sleep showed associations with infant sleep and feeding patterns only at postpartum week 2. Shorter duration of the longest infant-sleep bout was associated with shorter maternal sleep duration (p = .02) and lower sleep efficiency (p = .04), and maternal sleep efficiency was negatively associated with the number of infant-sleep bouts (p = .008) and duration of infant feeding (p = .008). Neither infant sleep nor feeding was associated with maternal sleep at 6 or 16 weeks, but more disturbed infant sleep and more frequent feeding at 6 weeks were associated with higher HAM-D scores at 6 and 16 weeks and higher CSI scores. Sleep in the mother-infant dyad is most tightly linked in the early postpartum weeks, but mothers continue to experience disturbed sleep and infant sleep and feeding behaviors continue to be associated with mothers' depressive symptoms and stress ratings as long as 16 weeks postpartum. These data imply that interventions designed to improve maternal sleep and postpartum mood should include both mothers and infants because improving infant sleep alone is not likely to improve maternal sleep, and poor infant sleep is linked to postpartum depression and stress.
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Affiliation(s)
- Katherine M. Sharkey
- Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Sleep for Science Research Laboratory, Providence, RI, USA
| | - Ijeoma N. Iko
- Alpert Medical School of Brown University, Providence, RI, USA,Sleep for Science Research Laboratory, Providence, RI, USA
| | - Jason T. Machan
- Departments of Orthopaedics and Surgery, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Teri B. Pearlstein
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Women’s Medicine Collaborative, a Lifespan Partner, Providence, RI, USA
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Zambrano DN, Mindell JA, Reyes NR, Hart CN, Herring SJ. "It's Not All About My Baby's Sleep": A Qualitative Study of Factors Influencing Low-Income African American Mothers' Sleep Quality. Behav Sleep Med 2016; 14:489-500. [PMID: 26488388 PMCID: PMC4840086 DOI: 10.1080/15402002.2015.1028063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Low-income African American mothers are at particular risk for poor postpartum sleep. This study sought to understand facilitators and barriers that exist to getting a good night's sleep among these high-risk mothers. Semistructured interviews with 18 low-income African Americans (3-6 months postpartum) were conducted. Most mothers described their own sleep quality to be poor, despite the fact that their babies' sleep improved substantially from the newborn period. Mothers kept themselves awake due to their own internal worry and anxiety, along with external factors that were largely independent of babies' sleep, including work and school commitments and the home environment. For the few mothers with good sleep quality, time management and family support were strong facilitators. Findings lay the groundwork for sleep improvement interventions.
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Affiliation(s)
| | - Jodi A. Mindell
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA
| | - Naomi R. Reyes
- Center for Obesity Research and Education, Departments of Medicine and Public Health, Temple University, Philadelphia, PA
| | - Chantelle N. Hart
- Center for Obesity Research and Education, Departments of Medicine and Public Health, Temple University, Philadelphia, PA
| | - Sharon J. Herring
- Center for Obesity Research and Education, Departments of Medicine and Public Health, Temple University, Philadelphia, PA,Address correspondence and reprint requests to: Sharon J. Herring, MD, MPH, Center for Obesity Research and Education, Temple University School of Medicine, 3223 N. Broad Street, Suite 175, Philadelphia, PA 19140. Telephone: 917-941-8509. Fax: 215-707-6475.
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Mindell JA, Sadeh A, Kwon R, Goh DYT. Relationship Between Child and Maternal Sleep: A Developmental and Cross-Cultural Comparison. J Pediatr Psychol 2015; 40:689-96. [DOI: 10.1093/jpepsy/jsv008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/18/2015] [Indexed: 11/13/2022] Open
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Tikotzky L, Sadeh A, Volkovich E, Manber R, Meiri G, Shahar G. VII. INFANT SLEEP DEVELOPMENT FROM 3 TO 6 MONTHS POSTPARTUM: LINKS WITH MATERNAL SLEEP AND PATERNAL INVOLVEMENT. Monogr Soc Res Child Dev 2015; 80:107-24. [DOI: 10.1111/mono.12147] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Liat Tikotzky
- Department of Psychology; Ben-Gurion University of the Negev
| | - Avi Sadeh
- School of Psychological Sciences; Tel-Aviv University
| | - Ella Volkovich
- Department of Psychology; Ben-Gurion University of the Negev
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences; Stanford University
| | - Gal Meiri
- Soroka University Medical Center and Faculty of Health Sciences; Ben-Gurion University of the Negev
| | - Golan Shahar
- Department of Psychology; Ben-Gurion University of the Negev
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Thomas KA, Burr RL, Spieker S, Lee J, Chen J. Mother-infant circadian rhythm: development of individual patterns and dyadic synchrony. Early Hum Dev 2014; 90:885-90. [PMID: 25463836 PMCID: PMC4312214 DOI: 10.1016/j.earlhumdev.2014.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/23/2014] [Accepted: 09/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mutual circadian rhythm is an early and essential component in the development of maternal-infant physiological synchrony. AIMS The aim of this to examine the longitudinal pattern of maternal-infant circadian rhythm and rhythm synchrony as measured by rhythm parameters. STUDY DESIGN In-home dyadic actigraphy monitoring at infant age 4, 8, and 12 weeks. SUBJECTS Forty-three healthy mother-infant pairs. OUTCOME MEASURES Circadian parameters derived from cosinor and non-parametric analysis including mesor, magnitude, acrophase, L5 and M10 midpoints (midpoint of lowest 5 and highest 10h of activity), amplitude, interdaily stability (IS), and intradaily variability (IV). RESULTS Mothers experienced early disruption of circadian rhythm, with re-establishment of rhythm over time. Significant time effects were noted in increasing maternal magnitude, amplitude, and IS and decreasing IV (p<.001). Infants demonstrated a developmental trajectory of circadian pattern with significant time effects for increasing mesor, magnitude, amplitude, L5, IS, and IV (p<.001). By 12 weeks, infant phase advancement was evidenced by mean acrophase and M10 midpoint occurring 60 and 43 min (respectively) earlier than at 4 weeks. While maternal acrophase remained consistent over time, infants became increasingly phase advanced relative to mother and mean infant acrophase at 12 weeks occurred 60 min before mother. Mother-infant synchrony was evidenced in increasing correspondence of acrophase at 12 weeks (r=0.704), L5 (r=0.453) and M10 (r=0.479) midpoints. CONCLUSIONS Development of mother-infant synchrony reflects shared elements of circadian rhythm.
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Affiliation(s)
- Karen A. Thomas
- Department of Family and Child Nursing University of Washington Seattle, WA 98195-7262
| | - Robert L. Burr
- Department of Biobehavioral Nursing and Health Systems University of Washington Seattle, WA 98195-7266
| | - Susan Spieker
- Barnard Center for Infant Mental Health & Development Department of Family and Child Nursing University of Washington Seattle, WA 98195-7262
| | - Jungeun Lee
- Department of Family and Child Nursing University of Washington Seattle, WA 98195-7262
| | - Jessica Chen
- Department of Psychology University of Washington Seattle, WA 98195-1525
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Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity. Arch Womens Ment Health 2013; 16:539-47. [PMID: 23733081 PMCID: PMC5308064 DOI: 10.1007/s00737-013-0356-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
Women are at increased risk of developing mood disorders during the postpartum period, and poor postpartum sleep may be a modifiable risk factor for the development of depression. This longitudinal study investigated the relationship between sleep variables and postpartum depression symptoms using wrist actigraphy and self-report surveys. Twenty-five healthy primiparous women were recruited from their outpatient obstetricians' offices from July 2009 through March 2010. Subjects wore wrist actigraphs for 1 week during the third trimester of pregnancy and again during the 2nd, 6th, 10th, and 14th weeks postpartum while completing sleep logs and sleep surveys. Subjective assessments of mood were collected at the end of each actigraph week. Subjective sleep assessments were strongly predictive of depression severity scores as measured by the Edinburgh Postnatal Depression Scale (EPDS) across all weeks (p < 0.001). Actigraphic measures of sleep maintenance, such as sleep fragmentation, sleep efficiency, and wake time after sleep onset, were also significantly correlated with EPDS scores postpartum. However, there was no relationship between nocturnal sleep duration and EPDS scores. This study provides additional evidence that poor sleep maintenance as measured by wrist actigraphy, rather than lesser amounts of sleep, is associated with EPDS scores during the postpartum period and that subjective assessments of sleep may be more accurate predictors of postpartum depression symptoms than wrist actigraphy. It also supports the hypothesis that disrupted sleep may contribute to the development and extent of postpartum depression symptoms.
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Stremler R, Hodnett E, Kenton L, Lee K, Weiss S, Weston J, Willan A. Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: multisite randomised controlled trial. BMJ 2013; 346:f1164. [PMID: 23516146 PMCID: PMC3603553 DOI: 10.1136/bmj.f1164] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a behavioural-educational sleep intervention delivered in the early postpartum in improving maternal and infant sleep. DESIGN Randomised controlled trial. SETTING Postpartum units of two university affiliated hospitals. PARTICIPANTS 246 primiparous women and their infants randomised while in hospital with an internet based randomisation service to intervention (n=123) or usual care (n=123) groups. INTERVENTIONS The behavioural-educational sleep intervention included a 45-60 minute meeting with a nurse to discuss sleep information and strategies to promote maternal and infant sleep, a 20 page booklet with the content discussed, and phone contacts at one, two, and four weeks postpartum to reinforce information, provide support, and problem solve. The usual care group received calls at weeks one, two, and four to maintain contact without provision of advice. MAIN OUTCOME MEASURES Primary outcome was maternal nocturnal (9 pm to 9 am) sleep (minutes) and secondary outcome was longest stretch of infant nocturnal sleep (minutes) measured at six and 12 weeks postpartum by actigraphy. Other outcomes measured at six and 12 weeks were number of maternal and infant night time awakenings by actigraphy, fatigue visual analogue scale, general sleep disturbance scale, and Edinburgh postnatal depression scale. Rates of exclusive breast feeding were measured at 12 weeks postpartum only. RESULTS All women who completed any outcome measures at six or 12 weeks were included in analysis. Sleep outcomes were completed at one or both of six and 12 weeks postpartum for 215 of 246 (87%) women (110/123 intervention and 105/123 usual care). Longitudinal mixed effects model analyses indicated no significant differences between the groups on any of the outcomes. The estimated mean difference in maternal nocturnal sleep between the intervention and usual care groups was 5.97 minutes (95% confidence interval -7.55 to 19.5 minutes, P=0.39). No differences in any outcomes were noted based on the specific nurse delivering the intervention or the number of phone contacts received. CONCLUSION A behavioural-educational intervention delivered in the early postpartum, in hospital, and in the first weeks at home, was ineffective in improving maternal and infant sleep or other health outcomes in the first months postpartum. TRIAL REGISTRATION ISRCT No 13501166.
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Affiliation(s)
- Robyn Stremler
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
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Abstract
Insomnia is one of the most common sleep disorders, which is characterized by nocturnal symptoms of difficulties initiating and/or maintaining sleep, and by daytime symptoms that impair occupational, social, or other areas of functioning. Insomnia disorder can exist alone or in conjunction with comorbid medical and/or psychiatric conditions. The incidence of insomnia is higher in women and can increase during certain junctures of a woman's life (e.g., pregnancy, postpartum, and menopause). This article will focus on an overview of cognitive behavioral therapy for insomnia, evidence of effectiveness for this treatment when insomnia disorder is experienced alone or in parallel with a comorbidity, and a review with promising data on the use of cognitive behavioral therapy for insomnia when present during postpartum and menopause.
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Affiliation(s)
- Allison T Siebern
- Stanford University School of Medicine, Sleep Medicine Center, Redwood City, California 94063, USA.
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31
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Tsai SY, Thomas KA. Sleep disturbances and depressive symptoms in healthy postpartum women: A pilot study. Res Nurs Health 2012; 35:314-23. [DOI: 10.1002/nur.21469] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 11/10/2022]
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Abstract
Family systems are dynamic, with reciprocal interactions among family members. When children have sleep problems, they often awaken a parent, affecting parent sleep and subsequent parent daytime functioning. Child sleep patterns can also be disrupted by parent cognitions related to the child's sleep, as well as when parents are experiencing external stressors (eg, work or marital problems). This article focuses on sleep in a family context, reviewing the relationship between sleep among children and their parents from infancy to adolescence. Sleep in the family when a child has a chronic illness or development disorder is also reviewed.
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Affiliation(s)
- Lisa J. Meltzer
- Assistant Professor of Pediatrics, Division of Pediatric Behavioral Health, National Jewish Health, Denver, CO
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Abstract
Factors contributing to maternal sleep when infants are 4 to 10 weeks of age were examined. Twenty-four-hour sleep-wake diaries collected from 37 mother-infant dyads in the home environment were summarized to describe total, longest, and mean sleep period; synchrony of maternal and infant sleep; and feeding frequency and duration. Regression and post hoc analysis of variance were used to examine factors contributing to maternal and infant sleep. Maternal sleep is driven by infant sleep and feeding pattern. The minimum and maximum numbers of infant sleep episodes per day were 6 and 15, respectively, and mean infant total sleep was 13.47 hours (SD 1.73). Mean maternal total sleep was 7.18 hours (SD 1.51), with half of the mothers reporting less than 7 hours of sleep per 24 hours. Mean number of infant feedings was 11.14 (SD 3.27), with 11 infants (29.7%) receiving 13 or more feedings per 24 hours; minimum and maximum times per feeding were 15 and 41.7 minutes, respectively. Male infants had more sleep episodes, shorter sleep periods, and less sleep than females, and these gender differences resulted in shorter and more fragmented sleep for mothers. Findings suggest there is continued need for interventions to improve maternal sleep following childbearing.
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Affiliation(s)
- Karen A Thomas
- Department of Family and Child Nursing, University of Washington, Seattle, WA 98195-7262, USA.
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Normative longitudinal maternal sleep: the first 4 postpartum months. Am J Obstet Gynecol 2010; 203:465.e1-7. [PMID: 20719289 DOI: 10.1016/j.ajog.2010.06.057] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 05/04/2010] [Accepted: 06/21/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the normative course of maternal sleep during the first 4 months postpartum. STUDY DESIGN Sleep was objectively measured using continuous wrist actigraphy. This was a longitudinal, field-based assessment of nocturnal sleep during postpartum weeks 2 through 16. Fifty mothers participated during postpartum weeks 2 through 13; 24 participated during postpartum weeks 9 through 16. RESULTS Maternal nocturnal sleep time was 7.2 (SD ± 0.95) hours and did not change significantly across postpartum weeks 2 through 16. Maternal sleep efficiency did improve across weeks 2 (79.7%; SD ± 5.5) through 16 (90.2%; SD ± 3.5) as a function of decreased sleep fragmentation across weeks 2 (21.7; SD ± 5.2) through 16 (12.8; SD ± 3.3). CONCLUSION Though postpartum mothers' total sleep time was higher than expected during the initial postpartum months, this sleep was highly fragmented (similar to fragmenting sleep disorders) and inefficient. This profile of disturbed sleep should be considered in intervention designs and family leave policies.
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Tsai SY, Barnard KE, Lentz MJ, Thomas KA. Mother-Infant Activity Synchrony as a Correlate of the Emergence of Circadian Rhythm. Biol Res Nurs 2010; 13:80-8. [DOI: 10.1177/1099800410378889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Entrainment to the day—night cycle is critical for infant sleep and social development. Synchronization of infant circadian systems with the social 24-hr day may require maternal activity signals as an entraining cue. This descriptive and exploratory research examines the activity level and circadian pattern in mothers and infants. Method: Twenty-two healthy mothers and their infants (postnatal age 49.8 ± 17.1 days) wore actigraph monitors for seven days. Daytime (06:00—21:59) and nighttime (22:00—05:59) activity levels and circadian parameters of rest—activity patterns (i.e., mesor, amplitude, acrophase, and 24-hr cosinor fit) were calculated. Results: Mothers and infants were significantly more active during the day than at night. The goodness-of-fit index for the model (R2) indicates that circadian rhythm accounted for a mean of 29 ± 10% and 12 ± 8% of the variability in maternal and infant activity, respectively. Acrophase of activity occurred at 15:46 ± 1:07 for the mothers and 15:20 ± 1:21 for the infants. The mean within-dyad correlation of activity counts was r = .46 ± .11, and the within-dyad correlation was associated with the amplitude (r = .66, p < .01) and 24-hr cosinor fit of infant activity (r = .67, p < .01). Conclusions: Our findings suggest maternal rhythms as a possible exogenous influence on shaping an infant’s emerging rhythms and synchronizing them with the external light—dark cycle. Strong pattern synchrony between maternal and infant activity may support infant circadian entrainment and enhance a regular 24-hr sleep—wake schedule during the early postnatal weeks.
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Affiliation(s)
- Shao-Yu Tsai
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan,
| | - Kathryn E. Barnard
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Martha J. Lentz
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA
| | - Karen A. Thomas
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
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Hunter LP, Rychnovsky JD, Yount SM. A selective review of maternal sleep characteristics in the postpartum period. J Obstet Gynecol Neonatal Nurs 2009; 38:60-8. [PMID: 19208049 DOI: 10.1111/j.1552-6909.2008.00309.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the current knowledge of postpartum women's sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers. DATA SOURCES A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance. STUDY SELECTION A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum women's sleep and implications for health care providers. DATA EXTRACTION Literature was reviewed and organized into groups with similar characteristics. DATA SYNTHESIS An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women. CONCLUSIONS Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns.
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Affiliation(s)
- Lauren P Hunter
- School of Nursing, San Diego State University, San Diego, CA 92182-4158, USA.
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Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Subjective and objective sleep among depressed and non-depressed postnatal women. Acta Psychiatr Scand 2009; 119:128-36. [PMID: 18822089 DOI: 10.1111/j.1600-0447.2008.01272.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women sleep less in the postnatal period and it has been suggested that mothers diagnosed with depression alternatively could be suffering from the effects of chronic sleep deprivation. METHOD From a population-based study, we recruited 42 women, of whom 21 scored >or=10 on the Edinburgh Postnatal Depression Scale. Sleep was registered by the Pittsburgh Sleep Quality Index (PSQI), sleep diaries and actigraphy 2 months after delivery. RESULTS There were significant differences in subjective sleep measured retrospectively by the PSQI between depressed and non-depressed women. In contrast, there were no significant differences in sleep measured prospectively by sleep diaries and actigraphy. Both depressed and non-depressed women had impaired sleep efficiency (82%) and were awake for about 1.5 h during the night. Primipara had worse sleep, measured by actigraphy, compared with multipara. CONCLUSION Measured objectively and prospectively, women with depression did not have worse sleep than non-depressed women.
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Affiliation(s)
- S K Dørheim
- Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, Bergen, Norway.
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38
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Cho EJ. Subjective Sleep Quality in Depressed and Non-Depressed Mothers During the Late Postpartum Period. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2009. [DOI: 10.4069/kjwhn.2009.15.2.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
OBJECTIVES This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum. METHODS As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers. Infant feeding type (breast milk or formula) was determined from parent diaries. Sleep was measured objectively using wrist actigraphy and subjectively using diaries. Lee's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance. RESULTS Parents of infants who were breastfed in the evening and/or at night slept an average of 40-45 minutes more than parents of infants given formula. Parents of infants given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night. CONCLUSIONS Parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work.
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Affiliation(s)
- Therese Doan
- Department of Family Health Care Nursing, School of Nursing, University of California at San Francisco, CA 94143, USA
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40
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YAMAZAKI A. Family synchronizers: Predictors of sleep?wake rhythm for Japanese first-time mothers. Sleep Biol Rhythms 2007. [DOI: 10.1111/j.1479-8425.2007.00274.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee SY, Lee KA. Early postpartum sleep and fatigue for mothers after cesarean delivery compared with vaginal delivery: an exploratory study. J Perinat Neonatal Nurs 2007; 21:109-13. [PMID: 17505230 DOI: 10.1097/01.jpn.0000270627.73993.b0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to describe sleep and fatigue during the first week of postpartum recovery, and compare women after cesarean delivery with women after vaginal delivery while their infants were hospitalized in the intensive care unit (ICU). METHODS This cross-sectional descriptive exploratory study involved 21 postpartum Chinese American mothers (6 after cesarean delivery and 15 after vaginal delivery). Three types of data were collected: (1) mothers' demographic data; (2) objective sleep that included total sleep time (TST) and wake after sleep onset (WASO) measured using wrist actigraphy, and (3) subjective sleep quality (General Sleep Disturbance Scale) and fatigue severity (Numerical Rating Scale-Fatigue). RESULTS All of the mothers experienced poor sleep while their 3- to 5-day-old infants were in the ICU. After cesarean birth, mothers averaged only about 4 hours TST with 34% WASO while still hospitalized, compared with 6.5 hours TST with 14% WASO for mothers after vaginal birth monitored in their home after hospital discharge. CONCLUSION Sleep disturbances and fatigue need to be further investigated to better understand the relationship between type of delivery and maternal health outcomes. Despite infant care provided in ICUs, these new mothers could benefit from interventions to promote their own sleep, particularly when also recovering from cesarean delivery.
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Affiliation(s)
- Shih-Yu Lee
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA 30302, USA.
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Abstract
OBJECTIVES This study describes the patterns of sleep disturbance and depressive symptoms in a sample of childbearing women from the third trimester through the postpartum period. The relationship between sleep and depressive symptoms is also examined. A secondary aim of this study was to examine the relationship between self-report measures of sleep and depressive symptoms between women with depressive symptoms in comparison with women with minimal or no depressive symptoms in the third trimester and in the third month postpartum. METHODS This longitudinal, descriptive study followed 124 primiparous women from their last month of pregnancy through 3 months postpartum. Questionnaires on sleep and depressive symptoms were completed during the third trimester (Time 1), 1 month postpartum (Time 2), 2 months postpartum (Time 3), and during the third month postpartum (Time 4). Sleep measures in a subset of women with depressive symptoms were compared with those of women with minimal or no symptoms at Time 1 and Time 4. RESULTS AND CONCLUSIONS Sleep disturbance and depressive symptoms were associated at Time 1 and Time 4. For new mothers, a complaint of trouble falling asleep (delayed sleep onset latency) may be the most relevant screening question in relation to their risk for postpartum depression.
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Affiliation(s)
- Deepika Goyal
- Department of Family Health Care Nursing, University of California, San Francisco, CA 94143, USA
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Abstract
OBJECTIVE The purpose of this qualitative study was to learn from 20 mothers about their experience of sleep during pregnancy and the immediate months of becoming a new mother. The study was part of a larger randomized clinical trial on an intervention to improve sleep and well-being among new mothers. METHODS Semistructured, audiotaped interviews were conducted in which women were asked to describe the continuum of the sleep experience across the pregnancy and early postpartum and to describe strategies they found helpful as they established sleep patterns with their infant. Narrative analysis was used to interpret their stories, and data were managed with Atlas.ti qualitative software. RESULTS AND CONCLUSIONS Sleep disturbances were common to all of the mothers, and sleep became a negotiated behavior as they adjusted to the mothering role. All of the mothers were surprised at the level of disturbance and exhaustion they experienced. Strategies included enlistment of partners to facilitate naps, development of a "sleep consciousness," and bed-sharing. Mercer's stages of becoming a mother are used to describe the process of incorporating sleep changes into their lives.
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Affiliation(s)
- Holly Powell Kennedy
- Department of Family Health Care Nursing, University of California, San Francisco CA 94143, USA.
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Abstract
Increases in neuronal activity of hypocretin (HCRT), a peptide involved in arousal, and in HCRT-1 receptor mRNA expression have recently been identified in association with lactation. HCRT is released within brain regions regulating maternal behaviour and it is possible that increased HCRT neurotransmission during lactation supports maternal care. The present study examined for the first time the behavioural effects of HCRT on lactating mice. At intermediate doses, intracerebroventricular (i.c.v.) injections of HCRT-1 (0.06 and 0.1 microg) elevated levels of licking and grooming of pups (but not self-grooming) and number of nursing bouts without affecting other behaviours. At the highest dose, HCRT-1 (0.3 microg, i.c.v) delayed latency to nurse, decreased nursing, increased time off nest, and decreased maternal aggression. Intraperitoneal injections of the HCRT-1 receptor antagonist, SB-334867, exhibited a general trend towards increasing time spent low-arched back nursing (P = 0.053) and decreasing licking and grooming of pups while high-arched back nursing (P = 0.052). This suggests that the endogenous release of HCRT, working independently or dependently with other neuromodulators, may be necessary for full maternal behaviour expression. Possible sites of HCRT action in enhancing and impairing maternal care were identified via examinations of c-Fos immunoreactivity in association with i.c.v. HCRT injections. Together, these finding support the idea of HCRT modulating maternal behaviour, with intermediate levels (0.06 and 0.1 microg) supporting (even augmenting) some behaviours, but with levels that are too high (0.3 microg HCRT, i.c.v.), maternal behaviour and aggression are suppressed.
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Affiliation(s)
- K L D'Anna
- Department of Zoology, University of Wisconsin, Madison, WI, USA.
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Yamazaki A, Lee KA, Kennedy HP, Weiss SJ. Sleep-Wake Cycles Social Rhythms, and Sleeping Arrangement During Japanese Childbearing Family Transition. J Obstet Gynecol Neonatal Nurs 2005; 34:342-8. [PMID: 15890833 DOI: 10.1177/0884217505276156] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine how sleep-wake cycles and social rhythms of Japanese parents are related to their sleeping arrangements before and after the birth of their first child. DESIGN Prospective longitudinal, time-series methods. SETTING Participants' homes in four geographical areas of Japan. PARTICIPANTS Convenience sample of 101 Japanese first-time parent couples who completed antepartum and postpartum questionnaires. MAIN OUTCOME MEASURES 24-hr sleep-wake rhythm from 7-day logs at 32 to 36 weeks gestation and 4 to 5 weeks postpartum and daily social rhythm from Monk's Social Rhythm Metric. RESULTS Mothers' total sleep time and activity level decreased after birth. Social rhythms became less regular for mothers and more consistent and regular for fathers. Although sleeping arrangement had no effect on parents' daily social rhythms, it had a significant effect on the 24-hr sleep-wake rhythm. Regularity of sleep-wake rhythms was more prominent for fathers sleeping with mother and baby than for fathers sleeping alone. CONCLUSIONS Couples having their first child face great changes in their sleep-wake cycles and social rhythms. Nurses can counsel expectant parents to think about their sleeping habits and social activities and assist them in making informed decisions about the best sleeping arrangement during transition to parenthood.
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Affiliation(s)
- Akemi Yamazaki
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, the University of Tokyo, Japan.
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46
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Abstract
Retrospective (questionnaire) and prospective (5-day diary) self-reports of sleep were obtained from 209 women during the 3rd trimester of pregnancy. On average, the women slept for 465 min, took around 20 min to get to sleep, and were awake for just over 30 min after initial sleep onset having woke 2.6 times on average. Sleep efficiency was around 89%. Significant differences were found between retrospective and prospective reports only on the number of minutes awake after sleep onset and on sleep efficiency. However, these differences were small. Retrospective and prospective reports were only moderately correlated. These results were not markedly different from values reported in much smaller, previous studies of pregnant women using polysomnography, suggesting that the self-reports were valid. The findings suggest that sleep parameters are not as adversely affected during the 3rd trimester of pregnancy as is generally believed.
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España RA, Berridge CW, Gammie SC. Diurnal levels of Fos immunoreactivity are elevated within hypocretin neurons in lactating mice. Peptides 2004; 25:1927-34. [PMID: 15501524 DOI: 10.1016/j.peptides.2004.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 05/27/2004] [Accepted: 06/02/2004] [Indexed: 10/26/2022]
Abstract
The hypocretins modulate arousal via actions across multiple terminal fields. Thus, alterations in hypocretin neurotransmission may contribute to altered sleep patterns observed during lactation. This study examined whether lactation is associated with alterations in the number of hypocretin neurons and in diurnal Fos-immunoreactivity within hypocretin neurons in female mice. Alterations in Fos-immunoreactivity were also examined within two hypocretin terminal regions; the medial preoptic area and the locus coeruleus. Fos-immunoreactivity was increased within hypocretin neurons and the medial preoptic area in lactating females. No differences were observed in the number of hypocretin neurons or in Fos-immunoreactivity within the locus coeruleus.
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Affiliation(s)
- Rodrigo A España
- Department of Psychology, University of Wisconsin, Madison, WI 53706, USA
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48
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Quillin SIM, Glenn LL. Interaction Between Feeding Method and Co‐Sleeping on Maternal‐Newborn Sleep. J Obstet Gynecol Neonatal Nurs 2004; 33:580-8. [PMID: 15495703 DOI: 10.1177/0884217504269013] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that breastfed newborns spend more time awake than bottle-fed newborns, breastfeeding mothers have more fragmented sleep than bottle-feeding mothers, and mother-newborn sleeping arrangements may affect the sleep/wake pattern of mother-newborn pairs. OBJECTIVE To address the unsolved question of whether there is an interaction between type of feeding and sleeping arrangements that affects postpartum sleep during the 4th postpartum week. DESIGN Correlational, two-way design using feeding method and location of newborn at night as independent variables, and sleep patterns as the dependent variables. SETTING Patient's home during 4th week after giving birth. PATIENTS/PARTICIPANTS First-time mothers and their newborns (n = 33). MAIN OUTCOME MEASURES Amount of total sleep, amount of night sleep, number of night awakenings, and number of sleep periods in 24 hours using a modified version of the self-report sleep instrument by Barnard and Eyres. RESULTS Breastfed newborns had less total sleep per day than bottle-fed newborns, and breastfeeding mothers had more sleep periods in 24 hours than bottle-feeding mothers. Breastfeeding mothers slept more than bottle-feeding mothers when co-sleeping, but bottle-feeding mothers' sleep was unaffected by location of newborn. Average total sleep for 4-week-old newborns was about 14 hours daily. CONCLUSIONS More sleep was obtained when breastfeeding mothers slept with the newborn. Methods or devices that allow breastfeeding mothers and newborns to sleep next to each other in complete safety need to be developed.
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Affiliation(s)
- Stephanie I M Quillin
- Department of Family and Community Nursing, College of Nursing, East Tennesse State University, Johnson City 37614-0676, USA.
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Nishihara K, Horiuchi S, Eto H, Uchida S, Honda M. Delta and theta power spectra of night sleep EEG are higher in breast-feeding mothers than in non-pregnant women. Neurosci Lett 2004; 368:216-20. [PMID: 15351452 DOI: 10.1016/j.neulet.2004.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 07/09/2004] [Accepted: 07/10/2004] [Indexed: 11/28/2022]
Abstract
The power spectra of night sleep EEGs of 12 breast-feeding 9-13 week postpartum mothers were analyzed and compared with those of 12 non-pregnant women. The power spectra in the delta and theta frequency range during NREM sleep for breast-feeding mothers were significantly higher than those for non-pregnant women. In addition, the all-night sleep patterns of the mothers were classified into two groups - interrupted sleep due to taking care of their infants and non-interrupted sleep - in order to observe the influence of partial sleep deprivation. The power spectra in the delta and theta frequency range were not significantly different between them. This result suggests that increased delta and theta power spectra during postpartum sleep do not result from partial sleep deprivation. The role of prolactin in breast-feeding mothers' sleep is also discussed.
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Affiliation(s)
- Kyoko Nishihara
- Department of Sleep Disorders Research, Tokyo Institute of Psychiatry, 2-1-8 Kamikitazawa, Setagaya-ku, Tokyo 156-8585, Japan.
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50
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Abstract
The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents' work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.
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Affiliation(s)
- Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA.
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