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.
David A Kalmbach, Anthony N Reffi, Philip Cheng, Parisa R Kaliush, Matthew B Jennings, Heba A Afaneh, Amanda Yu, Miriam Jaziri, Christopher L Drake
SLEEP Advances 2026 DOI: 10.1093/sleepadvances/zpag050 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 64 |
| Population | Pregnant women with clinical insomnia |
| Interventions | Cognitive-behavioral therapy for insomnia (CBTI) Perinatal Understanding of Mindful Awareness for Sleep (PUMAS) Sleep hygiene education |
| Measures | Bedtime Procrastination Scale (BPS), Daytime Insomnia Symptom Response Scale, Generalized Anxiety Disorder-7 (GAD-7), Positive and Negative Affect Schedule, Expanded Form-Modified (PANAS), Five Facet Mindfulness Questionnaire (FFMQ) |
| Topics | Meditation Anxiety |
| Keywords | Cbti Pumas Cognitive arousal Maternal Rumination Sleep |
| Registration | NCT04445805 |
| Key findings | CBTI and PUMAS produced large reductions in bedtime procrastination (Cohen's ds ≥ 1.02) and medium-to-large increases in positive affect (Cohen's ds ≥ .60). In a subsample with anxiety symptoms, both produced large anxiolytic effects (Cohen's ds ≥ .92). PUMAS reduced insomnia-focused rumination relative to sleep hygiene education (Cohen's d = .71), whereas CBTI did not. No significant effects on negative affect or mindfulness were observed. |
Abstract
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 trial (RCT) explored the effectiveness of CBTI and PUMAS on bedtime procrastination, insomnia-focused rumination, anxiety, affect, and mindfulness. Secondary analysis of a single-site, three-arm RCT of N = 64 pregnant women with clinical insomnia who were randomized to CBTI, PUMAS, or sleep hygiene education (SHE). Outcomes included the bedtime procrastination scale (BPS), daytime insomnia symptom response scale, generalized anxiety disorder-7, positive and negative affect schedule, expanded form-modified (PANAS positive and negative affect), and five facet mindfulness questionnaire (FFMQ). Patients provided treatment feedback. CBTI and PUMAS were associated with large reductions in BPS (Cohen's ds ≥ 1.02) and medium-to-large effects on PANAS positive affect (Cohen's ds ≥ .60). In a subsample of patients with anxiety symptoms, CBTI and PUMAS produced large anxiolytic effects (Cohen's ds ≥ .92). PUMAS reduced insomnia-focused rumination relative to SHE (Cohen's d = .71), whereas CBTI did not. We observed no significant effects on negative affect or FFMQ. Patients identified behavioral sleep strategies, meditation, and honoring pregnancy as particularly helpful. CBTI and PUMAS yield clinical gains beyond the primary target of insomnia. These findings highlight the benefits of improving sleep quality for the betterment of overall maternal wellbeing, thereby strengthening consideration of CBTI and PUMAS as first-line treatments for prenatal insomnia. Improving Negative Stressful Perseverations in Insomnia to Revitalize Expectant Moms (INSPIRE). https://clinicaltrials.gov/study/NCT04445805, National Library of Medicine ClinicalTrials.gov Registry: NCT04445805.
Comparable studies
Other randomized controlled trials on anxiety, most cited first.
Citations in the library
Cites 10
- A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia Sleep August 29, 2014
- Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program. SLEEP Advances 2023
- 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
- Preliminary evidence of psychological improvements and increased maternal-fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder. Journal of Sleep Research February 1, 2024
- Mindfulness-based therapy for insomnia alleviates insomnia, depression, and cognitive arousal in treatment-resistant insomnia: A single-arm telemedicine trial Frontiers in Sleep March 8, 2023
and 5 more in the library