UCSF

Objective

To evaluate the feasibility and efficacy of a home-based cognitive-behavioral training program for sleep during late pregnancy.

Methods

A nonrandomized quasiexperimental sample of nulliparous women who received the intervention during pregnancy (n=25) was compared with two control groups (n=76 and n=48) from other intervention studies at similar postintervention time points: approximately 1 month before childbirth and 1-2 months after childbirth. The home-based Sleep Enhancement Training System for Pregnancy consisted of 4 weeks of sound-enhanced audio relaxation programs, readings, and daily sleep diaries. Both control groups received dietary recommendations for improving sleep. Sleep duration (total sleep time) and sleep disruption (wake after sleep onset) were measured using wrist actigraphy for a minimum of 48 hours on consecutive weekdays.

Results

The intervention group had significantly longer sleep duration and less sleep disruption than both control groups, particularly at the postpartum assessment. Intervention participants slept an average of 430 (95% confidence interval [CI] 397-464) minutes during pregnancy compared with 420 (95% CI 403-438) and 417 (95% CI 395-439) minutes for the two control groups. At the postpartum assessment, the intervention group slept 446 (95% CI 415-478) minutes compared with 390 (95% CI 373-408) and 370 (95% CI 348-393) minutes for those in the control groups. In terms of sleep disruption, women in the intervention group had 16.1% (95% CI 11.9-20.2%) wake after sleep onset during pregnancy, whereas women in the control groups had 13.4% (95% CI 11.2-15.5%) and 20.4% (95% CI 17.7-23.0%). Postpartum, the intervention group had 20.3% (95% CI 16.4-24.1%) wake after sleep onset compared with 26.6% (95% CI 24.5-28.8%) and 28.7% (95% CI 26.0-31.5%) among women in the control groups. Participant feedback about the intervention was generally positive, although intervention adherence was variable.

Conclusion

This study provides evidence of the feasibility and efficacy of the Sleep Enhancement Training System for Pregnancy intervention for enhancing sleep that typically worsens during late pregnancy and after childbirth.