Perinatal Insomnia and Mental Health: a Review of Recent Literature
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REPRODUCTIVE PSYCHIATRY AND WOMEN'S HEALTH (CN EPPERSON AND L HANTSOO, SECTION EDITORS)
Perinatal Insomnia and Mental Health: a Review of Recent Literature Leslie M. Swanson 1
&
David A. Kalmbach 2 & Greta B. Raglan 1 & Louise M. O’Brien 3
Accepted: 14 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The perinatal period is a time of high risk for insomnia and mental health conditions. The purpose of this review is to critically examine the most recent literature on perinatal insomnia, focusing on unique features of this period which may confer specific risk, associations with depression and anxiety, and emerging work on perinatal insomnia treatment. Recent Findings A majority of perinatal women experience insomnia, which may persist for years, and is associated with depression and anxiety. Novel risk factors include personality characteristics, nocturnal perinatal-focused rumination, and obesity. Mindfulness and physical activity may be protective. Cognitive-behavioral therapy for insomnia is an effective treatment. Summary Perinatal insomnia is exceedingly common, perhaps due to factors unique to this period. Although closely linked to perinatal mental health, more work is needed to establish causality. Future work is also needed to establish the role of racial disparities, tailor treatments, and determine whether insomnia treatment improves perinatal mental health. Keywords Insomnia . Perinatal . Mental health . Depression . Anxiety
Introduction Sleep disturbance during the perinatal period has historically been considered a normative feature of pregnancy and postpartum, dismissed as inconsequential by health care providers and unworthy of attention or treatment beyond reassurance. However, over the past two decades, an accumulating body of work has emerged to shed light on the problem of sleep disorders in the perinatal period, including the significant impact of these disorders on perinatal women and their offspring. Insomnia is broadly defined as difficulty with sleep onset or maintenance. The International Classification of Sleep
This article is part of the Topical Collection on Reproductive Psychiatry and Women’s Health * Leslie M. Swanson [email protected] 1
Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
2
Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA
3
Department of Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA
Disorders (ICSD) outlines the following diagnostic criteria for insomnia disorder: difficulty falling asleep, difficulty staying asleep, and/or difficulty with waking too early despite adequate opportunity and circumstances for sleep, accompanied by daytime consequences or impairment (e.g., fatigue, difficulty with concentration, mood changes, daytime sleepiness, worry about sleep), experienced at least three nights per week [1]. Insomnia disorder is further characterized within the ICSD by duration: short-term (less t
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