Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force “Sleep and Women,” the Italian Marcè Society and international experts task force for perinatal mental health

Abstract

Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms “insomnia” and “perinatal period” or “pregnancy” or “post partum” or “lactation” or “breastfeeding” and “evaluation” and “treatment.” Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy.

Potential genetic and epigenetic mechanisms in insomnia: A systematic review

“…These data are consistent with evidence coming from clinical studies and underlining the potential role of insomnia in mental and medical disorders including the peri-partum period (Fang et al, 2019;Hertenstein et al, 2019;Javaheri & Redline, 2017;Palagini, Biber, & Riemann, 2014;Palagini, Bramante, et al, 2022;Palagini, Gemignani, et al, 2014;Palagini, Hertenstein, et al, 2022;Shamim et al, 2019;Silva et al, 2022).…”

Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta‐analysis

“…It is possible that insomnia, disturbed sleep, and poor sleep quality may lead to a condition of sleep loss across pregnancy and postpartum favouring overactivation of the stress system (Palagini et al, 2014). The overload of stress and inflammatory systems has in fact already been hypothesised as a factor possibly correlated with a negative pregnancy outcome including maternal psychopathology which is linked to increased suicidal risk (Emamian et al, 2019; Palagini et al, 2014; Palagini et al, 2022; Swanson et al, 2020). Insomnia has also been related to cognitive and emotional factors favouring suicidal risk including hopelessness and rumination, to the impairment of executive decision‐making process and a tendency to impulsivity, emotional reactivity, and aggressive behaviours (McCall & Black, 2013).…”

How to deal with sleep problems during heatwaves: practical recommendations from the European Insomnia Network

“…Peripartum is a critical period for women, which involves several physiological, emotional, and behavioural changes. Women's sleep during pregnancy and post-partum is altered by anatomical, endocrinological, physiological, psychological, behavioural, socioeconomic and cultural factors (Baglioni et al, 2020b;Palagini et al, 2022).…”

“…Peripartum is a critical period for women, which involves several physiological, emotional, and behavioural changes. Women's sleep during pregnancy and post‐partum is altered by anatomical, endocrinological, physiological, psychological, behavioural, socioeconomic and cultural factors (Baglioni et al, 2020b; Palagini et al, 2022). It is beyond the scope of this review to carefully describe sleep changes and interactions between sleep and bodily functions during pregnancy and in the first months after childbirth.…”