SLEEPJ
May 8, 2026
Heba A Afaneh, David A Kalmbach, Philip Cheng et al.
Abstract Introduction Insomnia affects half of pregnant women and increases risk for depression. Identifying effective treatments for co-occurring insomnia and depression during pregnancy remains a critical priority. Cognitive-behavioral therapy for insomnia (CBTI) improves sleep quality but has limited impact on depression—an effect attributed to persistent cognitive arousal (worry and...
SLEEP Advances
2026
David A Kalmbach, Anthony N Reffi, Philip Cheng et al.
Insomnia is common in pregnancy and is associated with maladaptive sleep behaviors and poor emotion regulation. Cognitive-behavioral therapy for insomnia (CBTI) and Perinatal Understanding of Mindful Awareness for Sleep (PUMAS) are effective interventions for alleviating prenatal insomnia. However, clinical benefits outside the primary target of sleep remain unclear. This randomized controlled...
Journal of Clinical Sleep Medicine
September 1, 2025
Anthony N Reffi, David A Kalmbach, Philip Cheng et al.
Study objectives: Patients with acute trauma are vulnerable to suicidality following hospitalization. Research suggests nightmares and insomnia may interact to potentiate suicidality, possibly due to nightmares worsening co-occurring insomnia. Nightmares and insomnia are common stress reactions to acute trauma and might compound suicide risk within acutely traumatized patients. We tested the...
Sleep
May 1, 2025
Mika Hirata, Heba A Afaneh, Ishana Kapoor et al.
Perinatal women are highly vulnerable to insomnia and depression. High cognitive arousal (e.g., worry, rumination) at night is a key risk factor for developing insomnia and depression during this period. However, mindfulness skills have been proposed to reduce risk for negative health outcomes by protecting individuals against the harmful effects of cognitive arousal. This prospective study...
European Journal of Psychotraumatology
October 8, 2024
Anthony N Reffi, Philip Cheng, David A Kalmbach et al.
ABSTRACT Background: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD. Objective: We tested trauma type (interpersonal...
Journal of Sleep Research
February 1, 2024
David A Kalmbach, Anthony N Reffi, Jason C Ong et al.
9 citations
Treating insomnia during pregnancy improves sleep and depressed mood. However, given well-established links between poor sleep and a broad spectrum of adverse maternal outcomes, the benefits of insomnia care may reach beyond sleep and depression. The present study evaluated the preliminary efficacy of 'Perinatal Understanding of Mindful Awareness for Sleep' (PUMAS)-a mindfulness sleep programme...
Sleep Medicine
August 1, 2023
David A Kalmbach, Philip Cheng, Anthony N Reffi et al.
15 citations
Cognitive-behavioral therapy is effective for prenatal insomnia, but unresolved cognitive arousal limits patient outcomes. Therapies aimed at reducing cognitive arousal may benefit pregnant women with insomnia. This proof-of-concept trial evaluated Perinatal Understanding of Mindful Awareness for Sleep (PUMAS, which combines mindfulness with behavioral sleep strategies) on insomnia, depression,...
Frontiers in Sleep
March 8, 2023
David A Kalmbach, P. Cheng, J. Ong et al.
Objectives Cognitive-behavioral therapy and pharmacotherapy are effective insomnia treatments, yet half of patients do not remit. Emerging evidence indicates refractory cognitive arousal is associated with poor insomnia treatment outcomes, giving rise to the concept that therapeutic approaches directly aimed at reducing cognitive arousal may benefit patients with a history of inadequate...
Sleep Medicine Clinics
March 2023
Jason C Ong, David A Kalmbach
Mindfulness-based interventions (MBIs) are programs that teach mindfulness concepts through guided meditation and self-regulation practices. MBIs have been found to improve sleep and reduce cognitive arousal, which are central to the development and perpetuation of insomnia. In this article, we review theoretic frameworks and clinical trial effectiveness data supporting MBIs for insomnia. Based...
SLEEP Advances
2023
David A Kalmbach, Philip Cheng, Anthony N Reffi et al.
16 citations
Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this treatment approach remain unclear. The present study examined nocturnal cognitive arousal and sleep effort as potential treatment mechanisms for alleviating insomnia and depression via a mindfulness sleep program for pregnant women....
Sleep Health
March 4, 2020
David A Kalmbach, Thomas Roth, P. Cheng et al.
BACKGROUND Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external...