Treating perinatal insomnia and rumination to reduce postpartum depression symptoms: A randomized control trial of digital cognitive-behavioral therapy for insomnia

2018 Focused Projects Grant for Junior Investigators

David Kalbach, PhD
Henry Ford Health System

Key Project Outcome

Over half of women have difficulty with insomnia during pregnancy. Unfortunately, insomnia is
linked to several perinatal complications including maternal depression, suicidal thoughts and
behaviors, and preterm birth. As sleep medications are not proven safe nor effective during pregnancy, pregnant women have very limited options for insomnia treatment. However, recent data suggest that cognitive and behavioral therapies can help pregnant women improve their sleep.

Leveraging digital technology has the potential to provide access to safe insomnia treatment for millions of pregnant women. In our randomized controlled trial, 91 pregnant women were randomized to fully automated internet-based cognitive behavioral therapy for insomnia (CBTI) or sleep education control. After treatment, women who underwent CBTI were nearly 3 times as likely to have significant reductions in their insomnia symptoms and slept nearly an hour longer at night relative to those in the control group. Although treatment ended during pregnancy, CBTI benefited maternal sleep after childbirth such that women who received CBTI slept 40 minutes longer at night and were less likely to have difficulty staying asleep in early postpartum as compared with women in the control condition.

Taken together, our trial findings show that insomnia therapy is a viable and safe option for pregnant women struggling with insomnia and may even offer some protection against sleep-interfering factors common to early postpartum. Continued research is needed to better tailor insomnia therapy to meet the unique and changing needs of women as they progress through pregnancy and early parenting. Moreover, greater treatment emphasis on reducing maternal stress and cognitive arousal (e.g., rumination, worry) may enhance insomnia treatment outcomes for new and expecting mothers.

Journal Articles


Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination

A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women


Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity


Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy