0405 Cognitive Behavioral Therapy Is Effective For Insomnia During Pregnancy: A Randomized Controlled Trial In An Ethnically Diverse Sample

Abstract

Introduction: Poor sleep during pregnancy has deleterious effects, yet insomnia during pregnancy remains largely under‐recognized and under‐treated. Cognitive behavioral therapy for insomnia (CBTI) is effective in the general population, but its efficacy during pregnancy remains unknown. We present the results of an RCT of CBTI during pregnancy. Methods: Pregnant women (N=179) meeting DSM‐5 criteria for insomnia disorder, with duration criterion relaxed to one month, were randomized to five sessions of CBTI or an active control (CTRL) therapy, delivered weekly during pregnancy. Participants were excluded if they used medications that could impact sleep or mood. Mean age and gestation age upon entry were 33.0 (SD 5.1) years and 28.8 (SD 4.9) weeks respectively; 38.0% were Latina, 25.7% received treatment in Spanish. The Insomnia Severity Index (ISI) and the Edinburgh Postnatal Depression Scale were administered during baseline and weekly after treatment began. Results: Mixed effects models with continuous time revealed that, compared to women assigned to CTRL, those assigned to CBTI had a significantly greater reduction in ISI (p < .001). Among those who received at least one therapy session, insomnia severity in CBTI decreased from 15.4 (4.4) at baseline to 8.2 (5.2). Among those in CTRL the change was from 15.9 (4.3) to 11.4 (4.9). Cox proportional hazards model showed that, compared to CTRL, participants in the CBTI group had significantly shorter time to remission as defined by ISI<8 (median days to remission: 31 versus 48 days; p