New Mothers Benefit from a Course on Sleep

TORONTO, Dec. 4 -- For sleep-deprived new mothers, some planning and training may translate into nearly an extra hour of welcome shuteye, according to a small study here.

Fifteen women given an educational-behavioral sleep intervention early in their first postpartum period slept 57 minutes longer at night than controls while their babies slept 46 minutes longer, said Robyn Stremler, R.N., Ph.D., of the University of Toronto here, and colleagues, in the Dec. 1 issue of the journal SLEEP.

The pilot study randomized 30 women in a hospital's postpartum unit to an extensive intervention consisting of a 45-minute meeting with a nurse to discuss sleep information and strategies, an 11-page booklet on the same topic, and weekly phone calls for problem solving and reinforcement. The 15 controls received only basic information from the same nurse during a 10-minute meeting and a one-page pamphlet on sleep hygiene and infant sleep.

When sleep was measured by actigraphy at six weeks, women in the intervention group slept significantly longer at night (433 versus 376 minutes, difference 95% confidence interval 6 to 106 minutes, P=0.03). And, fewer intervention group mothers rated their sleep as a problem (33% versus 73%, P=0.03).

Infants with mothers in the sleep intervention group woke significantly less at night (7.9 versus 12.3 awakenings, difference 4.4, 95% CI 1.4 to 7.6, P=0.006) and longer maximum nighttime sleep periods (217 versus 171 minutes, difference 46 minutes, 95% CI 5 to 88 minutes, P=0.03).

The findings have clinical significance, Dr. Stremler and colleagues said, since women often experience sleep deprivation, sleep fragmentation, and significant fatigue during the postpartum period and infant sleep problems may persist into childhood if not treated.

However, little information on sleep is provided to or available for new mothers, they said.

"Usual care for postpartum women is to receive no additional information regarding maternal and infant sleep, either in the hospital or through contact with public health or primary care providers after discharge," the authors wrote.

"The most readily available information for parents related to sleep, either from health care professionals, reading materials, or online information focuses not on promotion of maternal or infant sleep in the early postpartum, but on treating the older infant who should be sleeping through the entire night," they added.

Women in the study were predominantly 30 years of age or older (83%), Caucasian (77%), married or with a partner (100%), university educated (93%), breastfeeding at enrollment (100%), and many had a cesarean delivery (47%).

Only women with a healthy singleton baby born at gestational age of at least 37 weeks, who were first-time mothers and were planning to provide fulltime care to their infant for at least the first six weeks after discharge were included.

During the sleep intervention, women talked one-on-one with a nurse about sleep issues and strategies tailored to work within or overcome implementation barriers and to fit their beliefs, interests, and lifestyle. The 11-page booklet elaborated on the information discussed. Topics covered in both included maternal sleep hygiene; strategies for increasing maternal sleep; maternal relaxation techniques, such as progressive muscle relaxation and deep breathing; acknowledgement of the challenges of parenting and sleep deprivation; and information on infant sleep structure, cues, sleep promotion, and self-soothing.

Comparing questionnaires and sleep diaries from mothers in the intervention to those of the control group at six weeks, the investigators found these changes, none of them significant:

• Lower General Sleep Disturbance Scale scores (37.0 versus 45.9, difference -8.9, 95% CI -21.3 to 3.5, P=0.15),
• Slightly lower Edinburgh Postnatal Depression Scale scores (4.4 versus 5.9 on a scale of 30, difference -1.5, 95% CI -3.9 to 0.8, P=0.19),
• Slightly lower State-Trait Anxiety Inventory state subscale scores (27.1 versus 29.1, difference -2.0, 95% CI -7.8 to 3.8, P=0.49),
• More sleep overall in 24 hours (497 versus 462 minutes, difference 35 minutes, 95% CI -44 to 114, P=0.38), and
• Lower Fatigue Visual Analog Scale scores morning and evening, respectively (difference -11.9, 95% CI -26.3 to 2.4, P=0.10, and difference -4.7, 95% CI -15.1 to 5.7, P=0.36).

For infants whose mothers were in the intervention compared to control group, the researchers reported these nonsignificant changes :

• Slightly more total nocturnal sleep (468 versus 448 minutes, difference 20 minutes, 95% CI -16 to 56, P=0.26),
• Less daytime sleep (231 versus 276 minutes, difference -45 minutes, 95% CI -93 to 4, P=0.07), and
• Actually less total sleep in 24 hours (697 versus 728 minutes, difference -31, 95% CI -96 to 33, P=0.33).

Women reported getting sleep information from other sources, but the distribution was similar between groups.

The investigators said the study was limited by having both groups receive their information from the same nurse. If extra sleep information beyond the protocol was given to the control group, "it would only be expected to dilute any difference between groups, not exaggerate it," they wrote.

Evaluation of the intervention in a larger, more diverse sample will be needed for the findings to be incorporated into clinical practice, Dr. Stremler and colleagues said.

"Because maternal and infant sleep in the early postpartum period are affected by a number of factors," they wrote, "it seems important to maintain multiple strategies in future sleep intervention studies."

Meanwhile, Dr. Stremler suggested that women who have trouble sleeping early in their postpartum period should discuss this with their primary care doctor, who can determine whether a visit to a sleep specialist is necessary.