Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program.
David A Kalmbach, Philip Cheng, Anthony N Reffi, Jason C Ong, Leslie M Swanson, Colin A Espie, Grace M Seymour, Mika Hirata, Olivia Walch, D'Angela S Pitts, Thomas Roth, Christopher L Drake
SLEEP Advances 2023 DOI: 10.1093/sleepadvances/zpad031 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a proof-of-concept trial Peer reviewed |
|---|---|
| Sample size | 12 |
| Population | Pregnant women with DSM-5 insomnia disorder |
| Intervention | Perinatal Understanding of Mindful Awareness for Sleep (PUMAS) |
| Duration | Eight weekly assessments: pretreatment, six sessions, and posttreatment |
| Topics | Meditation Depression |
| Keywords | Mbi Pumas Mechanism Pregnancy Rumination Stress Worry |
| Citations | 16 |
| Registration | NCT04443959 |
| Key findings | Reducing nocturnal cognitive arousal and sleep effort may serve as mechanisms for alleviating insomnia and depression through a mindfulness-based insomnia therapy for pregnant women. |
Abstract
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. Secondary analysis from a proof-of-concept trial of 12 pregnant women with DSM-5 insomnia disorder who were treated with Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness framework. Data were collected across eight weekly assessments: pretreatment, six sessions, and posttreatment. Measures included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC), and the Glasgow sleep effort scale (GSES). We used linear mixed modeling to test cognitive arousal and sleep effort as concurrent and prospective predictors of insomnia and depression. Most patients reported high cognitive arousal before PUMAS (75.0%), which decreased to 8.3% after treatment. All insomnia remitters reported low cognitive arousal after treatment, whereas half of nonremitters continued reporting high cognitive arousal. Both nocturnal cognitive arousal and sleep effort were associated with same-week changes in insomnia throughout treatment, and sleep effort yielded a prospective effect on insomnia. Lower levels of nocturnal cognitive arousal and sleep effort prospectively predicted reductions in depression. The present study offers preliminary evidence that reducing sleep effort and nocturnal cognitive arousal may serve as key mechanisms for alleviating insomnia and depression via mindfulness-based insomnia therapy. ClinicalTrials.gov ID: NCT04443959.
Comparable studies
Other non-randomized and open-label trials on depression, most cited first.
Citations in the library
Cited by 2
- Treating insomnia during pregnancy improves bedtime procrastination, rumination, anxiety, and positive affect: a randomized controlled trial of cognitive-behavioral and mindfulness-based therapies for prenatal insomnia. SLEEP Advances 2026
- Solution-focused brief therapy combined with mindfulness-based stress reduction to alleviate claustrophobia during MR imaging. Medicine July 11, 2025
Cites 8
- Mindfulness Interventions Annual Review of Psychology September 30, 2016
- A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia Sleep August 29, 2014
- Perinatal Understanding of Mindful Awareness for Sleep (PUMAS): A single-arm proof-of-concept clinical trial of a mindfulness-based intervention for DSM-5 insomnia disorder during pregnancy. Sleep Medicine August 1, 2023
- Mindfulness as an Adjunct or Alternative to CBT-I. Sleep Medicine Clinics March 2023
- Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep Health March 4, 2020
and 3 more in the library