Preventing postpartum insomnia: findings from a three-arm randomized-controlled trial of cognitive behavioral therapy for insomnia, a responsive bassinet, and sleep hygiene.

STUDY OBJECTIVES: Insomnia symptoms are common during the perinatal period and are linked to adverse outcomes. This single-blind three-arm randomized-controlled trial examined whether two interventions targeting different mechanisms prevent postpartum insomnia. METHODS: Participants were nulliparous females 26-32 weeks gestation with Insomnia Severity Index (ISI) scores ≥ 8, recruited in Australia and randomized 1:1:1 to: (1) a responsive bassinet (RB) designed to support infant sleep and reduce maternal sleep disruption until 6 months postpartum, (2) therapist-assisted cognitive behavioral therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (3) a sleep hygiene booklet (control; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome was ISI scores averaged T3-T5. Primary analyses were regressions controlling for baseline outcomes. RESULTS: One hundred and twenty-seven participants (age M ±â€…SD = 32.62 ±â€…3.49) were randomized (RB = 44, CBT-I = 42, CTRL = 41). Both interventions were feasible and well-accepted, with few related adverse events reported. Compared to CTRL, the average ISI across T3-T5 was lower for CBT-I (p = .014, effect size [ES] = 0.56, medium) but not RB (p = .270, ES = 0.25, small). Exploratory findings on maternal insomnia diagnosis, sleep disturbance, sleep-related impairment, beliefs and attitudes about sleep, depression, anxiety, as well as infant sleep outcomes were also presented. CONCLUSIONS: CBT-I but not RB reduced prenatal insomnia (very large effect) and prevented postpartum insomnia (medium effect). Further research is needed to examine the effects of both CBT-I and RB on other outcomes such as sleep-related well-being, postpartum depression, and maternal postpartum sleep duration. CLINICAL TRIAL REGISTRATION: The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.

Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep.

STUDY OBJECTIVES: Supportive coparenting between couples has been shown to have positive effects on the dyadic relationship, child development, and parental and child sleep. This study aimed to investigate the association between paternal involvement in nighttime childcare and child and maternal sleep, while exploring relationship satisfaction and maternal competence about child sleep as mediators. METHODS: The sample consisted of 290 mothers (mean age ± standard deviation = 34.8 ± 4.1) with children (50.7% male) aged 6-36 (mean ± standard deviation = 22.7 ± 8.6) months. Participants reported their paternal involvement in nighttime childcare and completed the following questionnaires: Brief Infant Sleep Questionnaire-Revised, Dyadic Adjustment Scale-4 items, and the Insomnia Severity Index. Path analysis was conducted to examine the impact of paternal involvement on child and maternal sleep through relationship satisfaction and maternal competence. RESULTS: Among the sample, 74.8% responded that paternal participation in nighttime childcare was less than 25%. Path analysis showed that paternal involvement had a significant direct effect on maternal insomnia (ß = -.15, P < .05) but not on child sleep. Direct pathways from paternal involvement to relationship satisfaction (ß = .17), from relationship satisfaction to maternal competence (ß = .19), from maternal competence to child's sleep (ß = -.57), and from child sleep to maternal insomnia (ß = .48) were significant (P < .01). Relationship satisfaction mediated the associations between paternal involvement and child (ß = -.08, P < .05) and maternal (ß = -.04, P < .05) sleep. CONCLUSIONS: Paternal nighttime childcare involvement was low in South Korea. The results highlight the importance of considering paternal supportive participation and relationship satisfaction in future research on child and maternal sleep. CITATION: Song J, Jang E, Astbury L, Bei B, Suh S. Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep. J Clin Sleep Med. 2024;20(8):1241-1250.

Treating postpartum insomnia: a three arm randomised controlled trial of cognitive behavioural therapy and light dark therapy.

BACKGROUND: Insomnia symptoms are common during the postpartum period, yet interventions remain scarce. This trial aimed to simultaneously examine the efficacy of cognitive behavioural therapy (CBT) and light dark therapy (LDT), targeting different mechanisms, against treatment-as-usual (TAU), in reducing maternal postpartum insomnia symptoms. METHODS: This three-arm randomised controlled trial recruited from the general community in Australia. Nulliparous females 4-12 months postpartum with self-reported insomnia symptoms [Insomnia Severity Index (ISI) scores >7] were included; severe medical/psychiatric conditions were excluded. Participants were randomised 1:1:1 to CBT, LDT, or TAU stratified by ISI (< or ⩾14) and infant age (< or ⩾8 months). Participants and principal investigators were unblinded. Six-week interventions were delivered via digital materials and telephone. The primary outcome was insomnia symptoms (ISI), assessed pre-, midpoint-, post- (primary endpoint), and one-month post-intervention. Analyses were intention-to-treat using latent growth models. RESULTS: 114 participants (CBT = 39, LDT = 36, TAU = 39; Mage = 32.20 ± 4.62 years) were randomised. There were significantly greater reductions in ISI scores in CBT and LDT (effect sizes -2.01 and -1.52 respectively, p < 0.001) from baseline to post-intervention compared to TAU; improvements were maintained at follow-up. Similar effects were observed for self-reported sleep disturbance. There were greater reductions in fatigue in CBT (effect size = 0.85, p < 0.001) but not LDT (p = 0.11) compared to TAU. Changes in sleepiness, depression, and anxiety were non-significant compared to TAU (all p > 0.08). Four participants (11%) in the LDT group reported headaches, dizziness, or nausea; no others reported adverse events. CONCLUSIONS: Therapist-assisted CBT and LDT were feasible during the first postpartum year; data at post-intervention and 1-month follow-up support their safety and efficacy in reducing postpartum insomnia symptoms.

Does breastfeeding influence sleep? A longitudinal study across the first two postpartum years.

BACKGROUND: The association between breastfeeding and sleep of the gestational parent is poorly understood. This longitudinal study investigated how breastfeeding is associated with total nighttime sleep duration and sleep efficiency (percentage of total sleep time in bed) in nulliparous participants over the first two postpartum years. METHODS: Nulliparous participants (N = 155, Mage  = 33.45, SDage  = 3.50) self-reported patterns of breastfeeding via telephone interviews and sleep via self-report at 1.5, 3, 6, 12 and 24 months postpartum. Data were analyzed using mixed-effects models, with breastfeeding variables as predictors and sleep variables as outcomes, controlling for relevant covariates. RESULTS: Neither the presence of breastfeeding nor the percentage of human milk in infants' total diets was significantly associated with participants' sleep duration or sleep quality (P-values > 0.08). This finding held after controlling for the number of nighttime feeds (P-values > 0.11). However, greater numbers of nighttime feeds, regardless of feeding content, were strongly associated with shorter sleep duration and poor sleep efficiency (P-values < 0.05). On average, with each additional nighttime feed, nocturnal sleep duration decreased by 6.6-8.4 minutes, and sleep efficiency decreased by 2.88%-3.02%. CONCLUSIONS: Data from this study showed that breastfeeding per se was not associated with shorter or poor nocturnal sleep, but the number of nighttime feeds was. Sharing nighttime infant care amongst different carers in the household could help reduce postpartum sleep disturbance and ameliorate its negative impact on wellbeing.

Raspberry Pi nest cameras: An affordable tool for remote behavioral and conservation monitoring of bird nests.

Bespoke (custom-built) Raspberry Pi cameras are increasingly popular research tools in the fields of behavioral ecology and conservation, because of their comparative flexibility in programmable settings, ability to be paired with other sensors, and because they are typically cheaper than commercially built models.Here, we describe a novel, Raspberry Pi-based camera system that is fully portable and yet weatherproof-especially to humidity and salt spray. The camera was paired with a passive infrared sensor, to create a movement-triggered camera capable of recording videos over a 24-hr period. We describe an example deployment involving "retro-fitting" these cameras into artificial nest boxes on Praia Islet, Azores archipelago, Portugal, to monitor the behaviors and interspecific interactions of two sympatric species of storm-petrel (Monteiro's storm-petrel Hydrobates monteiroi and Madeiran storm-petrel Hydrobates castro) during their respective breeding seasons.Of the 138 deployments, 70% of all deployments were deemed to be "Successful" (Successful was defined as continuous footage being recorded for more than one hour without an interruption), which equated to 87% of the individual 30-s videos. The bespoke cameras proved to be easily portable between 54 different nests and reasonably weatherproof (~14% of deployments classed as "Partial" or "Failure" deployments were specifically due to the weather/humidity), and we make further trouble-shooting suggestions to mitigate additional weather-related failures.Here, we have shown that this system is fully portable and capable of coping with salt spray and humidity, and consequently, the camera-build methods and scripts could be applied easily to many different species that also utilize cavities, burrows, and artificial nests, and can potentially be adapted for other wildlife monitoring situations to provide novel insights into species-specific daily cycles of behaviors and interspecies interactions.