The Role of Circadian Rhythms in Postpartum Sleep and Mood.

Women often experience sleep disturbances and worsening sleep quality throughout pregnancy and postpartum. Circadian rhythms are closely linked to sleep problems and mood disorders. This systematic review provides a summary of studies of circadian rhythms and associated sleep problems and maternal distress, among postpartum women. Articles were idenitfied through a systematic literature search. Circadian rhythm disturbances were strongly correlated with depression, social factors and mothers`s exposure to light postpartum. Future research should include larger, prospective studies as well as randomized controlled trials for measuring effect of circadian rhythm interventions on postpartum mental health outcomes.

Personality and Perinatal Maternal Insomnia: A Study Across Childbirth.

Personality may influence sleep in perinatal women. A follow-up study was conducted among 3,752 pregnant, then postpartum women at Akershus University Hospital, Norway. The Big Five personality dimensions were measured by the Mini-International Personality Item Pool in week 17 of pregnancy. Insomnia was measured by the Bergen Insomnia Scale in pregnancy week 32 and 8 weeks postpartum, along with self-reported sleep times. The Edinburgh Postnatal Depression Scale measured depression, and the Hopkins Symptom Checklist measured anxiety. Adjusted for current anxiety, depression, and demographic variables, the personality traits Neuroticism and Agreeableness were associated with insomnia in pregnancy. No personality traits were associated with postpartum insomnia. Extraversion was associated with longer postpartum sleep duration and better sleep efficiency, and Agreeableness with shorter sleep duration.

Trajectories of maternal sleep problems before and after childbirth: a longitudinal population-based study.

BACKGROUND: Sleep problems are common during pregnancy and in the postnatal period, but there is still a lack of longitudinal population-based studies assessing the quantity and quality of sleep in these women. The aim of the current study was to examine the natural development and stability of insomnia and short sleep duration in women from pregnancy to two years postpartum. METHODS: This was a longitudinal cohort study (the Akershus Birth Cohort Study) of 1480 healthy women, who completed three comprehensive health surveys, at week 32 of pregnancy, week 8 postpartum and year 2 postpartum. The survey was composed of the following validated questionnaires: the Bergen Insomnia Scale, the Pittsburgh Sleep Quality Index and the Edinburgh Postnatal Depression Scale. Differences in sleep characteristics between the three assessment points were compared using Analyses of Variance with repeated measures, and logistic regression analyses were used to examine the stability of sleep variables. RESULTS: One thousand four hundred and eighty women completed all three surveys, and the mean age at birth was 30.7 (+/-4.9). The prevalence of insomnia remained stable at 60 % at the first two time periods, and remained high at 41 % at year 2 postpartum. The mean sleep duration at the three time periods was 7 h 16 min, 6 h 31 min, and 6 h 52 min, respectively. Concurrent maternal depression could not explain the stability of sleep problems from during and immediately after pregnancy, to sleep problems 2 years postpartum. CONCLUSION: Both insomnia and short sleep duration were found to be very common both before and after pregnancy.

Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study.

BACKGROUND: Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression. METHODS: A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms. RESULTS: After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia. LIMITATIONS: Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study. CONCLUSIONS: Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.

Insomnia and depressive symptoms in late pregnancy: a population-based study.

A population-based questionnaire study of 2,816 women was conducted in week 32 of pregnancy to estimate the prevalence of and risk factors for insomnia and depressive symptoms. The Bergen Insomnia Scale (BIS) measured insomnia. The Edinburgh Postnatal Depression Scale (EPDS) measured depressive symptoms. The prevalence of insomnia (DSM-IV-TR criteria) was 61.9%, and mean BIS score 17.5 (SD = 10.5), significantly higher than among the general population. The prevalence of depressive symptoms (EPDS ≥ 10) was 14.6%. Depressive symptoms were strongly associated with insomnia during late pregnancy, especially with sleep durations <5 or >10 hours, sleep efficiency <75%, daytime impairment, and long sleep onset latency. Pelvic girdle pain and lower back pain was associated with insomnia, but not with depressive symptoms.