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Women and Infants Mental Health Program

Sleep & Circadian Rhythms across the Life Cycle

Current research suggests there is a relationship between sleep disturbance and mood symptoms such as depression. The WIMH Program research efforts focus on the impact of sleep disturbance on mental health outcomes of pregnant women, infant outcomes, effective treatment for sleep disturbance during pregnancy and the postpartum period,  validation of screening tools for sleep-disordered breathing in pregnancy, and prevalence of sleep disruption in pregnant women.  

Much of our research involves The Sleep and Chronophysiology Lab

Research Activity:

Interventions, Treatments, and Complimentary Alternative Medicine

Utility of Positive Airway Pressure in Women with Pre-eclampsia

This study is designed to find out if blood pressure in women with hypertension or pre-eclampsia can be reduced by the standard treatment for sleep apnea, positive airway pressure (PAP). We would like to find out whether it is only helpful in reducing blood pressure if sleep apnea is present or it is helpful even if sleep apnea is not present. We will also determine whether using PAP during pregnancy is associated with better infant outcomes (such as longer pregnancies, improved birth weight, improved infant well-being and fewer admissions to the Neonatal Intensive Care Unit).

Principal Investigator:
Louise O’Brien

An Open Pilot of Cognitive-Behavioral Therapy for Insomnia in Women with Postpartum Depression

Women in the postpartum period often experience symptoms of depression as well as significant sleep disturbance.  This study aimed to determine the preliminary efficacy of a modified version of cognitive-behavioral therapy for insomnia (CBT-I) on improving mood and sleep and decreasing daytime fatigue in postpartum women with insomnia and depression in an open pilot study. This study also explored the feasibility of the CBT-I treatment model. Twelve postpartum women who met criteria for major depression and sleep disturbance participated in five weekly individual treatment sessions.  Results suggest that,

  • There is evidence to support the feasibility of this treatment in that all but one participant completed all 5 treatment sessions, and the women who did not complete only missed the last session.
  • Women reported a significant reduction in depression symptoms according to self-report survey scores before treatment compared to after treatment.
  • Women experienced improvements in sleep quality and a reduction in insomnia symptoms. Although total sleep time increased by only 40 minutes, women reported an increase in sleep consolidation, or reduced time taken to fall asleep and better quality sleep.
  • Women also report less physical and mental fatigue during the day and increased activity and motivation.

Investigators:
Leslie Swanson, PhD. (PI), Heather Flynn, Jennifer Adams, Roseanne Armitage and Todd Arnedt

Publication:
Manuscript in press at Behavioral Sleep Medicine

Other Research

Sleep, Mood and Pregnancy Outcomes in Postpartum Women and their Infants

Depression occurring around the time of pregnancy is quite common and can lead to problems in functioning within the family.  One of the most common problems linked to depression is sleep disruption for both the mother and her baby.  Treatment for depression has been found to help most people by improving many of their symptoms of depression.  However, treatment does not work fully for all women, and sleep problems may continue even when other symptoms are treated. Therefore, the purpose of this study was to examine whether sleep disruption in the mom and infant is related to depression treatment response, as well as to look at the relationship between sleep patterns in the mothers and their babies.  Participants completed interviews at the beginning and end of treatment.  The interviews included measures of depression, stress, social and treatment issues.  Information about baby’s birth such as birth weight and age at birth was also collected. Sleep and biological rhythms were measured in the home environment during the last trimester of pregnancy and in the first 6 months after delivery.  Sleep, light exposure and rest were recorded from a light and motion sensor device called an actigraph and participants were asked to track their sleep and wake patterns using a sleep log.

Findings:
Total sleep time, sleep latency, sleep efficiency, and number and duration of sleep episodes were computed for nocturnal and daytime sleep in each 24-hour block. The high-risk infants took longer to fall asleep, had lower sleep efficiencies, and had more sleep bouts in the nocturnal sleep period than did low-risk infants. These effects persisted at 6 months postpartum. Maternal depression is associated with significant sleep disturbance in infancy at 2 weeks postpartum that continues through 24 weeks.

Investigators:
Heather A. Flynn (PI), Sheila M Marcus, M.D., and Roseanne Armitage, Ph.D.

Publication:
Armitage R; Flynn H; Hoffmann R; Vazquez D; Lopez J; Marcus S. (2009) Early developmental changes in sleep in infants: the impact of maternal depression. SLEEP, 32(5), 693-696.

Selected Publications

Swanson, L. M., Pickett, S. M., Flynn, H., & Armitage, R. (2011). Relationships among
depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. Journal of Women’s Health, 20(4), 333-338.

Swanson, L. M., Flynn, H. A., Wilburn, K, Marcus, S., &Armitage, R. (2010). Maternal
mood and sleep in children of women at risk for perinatal depression. Archives of
Women’s Mental Health, 13(6), 331-334.

Armitage, R., Flynn, H., Hoffmann, R., Vazquez, D., Lopez, J.,& Marcus, 5. (2009). Early developmental changes in sleep in infants: The impact of maternal depression. Sleep: Journal of Sleep and Sleep Disorders Research, 32(5),693-696.