Factors Associated with Clinically Significant Insomnia Among Pregnant Low-Income Latinas

Abstract

Background: Poor sleep, common during pregnancy, is associated with negative health risks. The study aimed to identify predictors of clinically significant insomnia among pregnant Latinas. Methods: A total of 1289 pregnant Latinas recruited from obstetric clinics completed the Insomnia Severity Index (ISI) and questions about demographics and sleep. Results: Clinically significant insomnia (ISI ‡ 10) was present among 17% of participants. Significant correlates of clinically significant insomnia were higher scores on the Edinburgh Postnatal Depression Scale (EPDS) after removing the sleep item (47% of women with EPDS ‡ 9 and 9% with EPDS < 9), completing measures in English (rather than Spanish: 26% versus 13%), and income but not pregnancy week, age, highest education level, or marital status. The highest percentage of clinically significant insomnia (59%) was experienced by women with EPDS ‡ 9 who completed measures in English. The lowest percentage of clinically significant insomnia (6.2%) was experienced by women with EPDS < 9 who completed measures in Spanish. Conclusions: In this sample of low-income, mostly Spanish-speaking pregnant Latinas, rates of clinically significant insomnia appear to be higher than rates among nonpregnant Latinas. Rates of clinically significant insomnia are particularly high among Latinas with elevated depressive symptom severity, a known risk for insomnia. Acculturation, as indicated by completing measures in English, may be another risk specific to Latinas, possibly owing to loss of some ethnicity-specific protective factors (e.g., social support, strong family ties, and group identity). It will be important to directly test this explanation in future research.

Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms

“…Links between subjective sleep and negative mood were previously found in nonpregnant samples (Alvaro et al 2013;Manber and Chambers 2009), as well as among pregnant (Manber et al 2013;Skouteris et al 2008;Skouteris et al 2009a) and postpartum (Goyal et al 2009;Wolfson et al 2003) women. However, links between objective sleep disturbances and the two measures of emotional distress in the present study were not significant.…”

“…Pregnancy is characterized by substantial changes in sleep patterns, such as increased frequency of insomnia symptoms, including night-wakings, daytime fatigue, and in some cases, also difficulties falling asleep and waking up too early in the morning (Manber et al 2013;Mindell and Jacobson 2000;Skouteris et al 2009a;Tsai et al 2012). Although most of the studies in this field are based on self-reported measures of sleep, studies that used objective sleep measures, such as actigraphy and polysomnography (PSG), support these findings and suggest that in comparison to nonpregnant women, pregnant women have lower sleep efficiency, more frequent night-wakings and longer night-wakings and spend more time in light sleep and less time in deep sleep and REM sleep (Hertz et al 1992;Wilson et al 2011).…”

“…Research on pregnant women's mental health in relation to sleep consistently demonstrates that self-reported poor sleep of pregnant women is concurrently and prospectively associated with higher depressive symptoms during pregnancy (Manber et al 2013;Skouteris et al 2008;Skouteris et al 2009a;Swanson et al 2011). In contrast, relatively few studies examined, in addition to the subjective links, the links between objective measures of sleep and mood during pregnancy.…”

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women

“…She may experience increased levels of stress and distress. 44,91 All of these influences may disrupt sleep. However, we contend that an emphasis regarding sleep concerns should be placed on the first 20 w gestation.…”

“…Swanson et al 42 reported that 45% of pregnant women scored above the threshold value, and Fernandez-Alonso et al 43 identified more than 73% in late pregnancy. Manber and colleagues, 44 however, reported that only 17% of Latina women, across all trimesters, met criteria for insomnia (≥ 10) and that there was no difference across trimesters.…”