Cognitive Behavioral Therapy for Perinatal Insomnia: Exploring Adherence, Perceived Usefulness of Intervention Components, and their Associations with Sleep Outcomes.

Objective: To explore the adherence and perceived usefulness of Cognitive Behavioral Therapy for Insomnia (CBT-I) components in the perinatal period and their association with sleep outcomes.

Methods: Seventy-six nulliparous individuals (age M = 33.07 SD ±3.10) from two randomized control trials who received CBT-I at three time points: late pregnancy (35 weeks' gestation), 1.5-3 months postpartum, and 6 months postpartum were analyzed. At each time point, participants self-reported perceived usefulness and adherence for each of the six CBT-I components, and completed the Insomnia Severity Index (ISI), PROMIS Sleep-Related Impairment (PROMIS-SRI), and Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16).

Results: All components were perceived as useful by most (74.3-97.1%) participants; adherence varied between components and across time. Cross-sectional multiple regression analyses showed that for "sleep hygiene", higher adherence was associated with lower DBAS-16 at 35 weeks' gestation (small effect). Higher adherence and usefulness to "managing sleep deprivation, sleepiness and fatigue" was associated with lower ISI at 6 months postpartum (small and medium effect size, respectively); higher perceived usefulness was associated with lower PROMIS-SRI at 6 months (small effect; all p-values < .05). There were no significant associations among adherence/usefulness and sleep at 2 months postpartum.

Conclusions: The overall high perceived usefulness of CBT-I components suggests a strong interest in engaging with perinatal sleep health information. Pregnancy may be a crucial time for delivering sleep strategies before facing caregiving duties and heightened postpartum sleep disruptions. These findings provide insights into how CBT-I components are perceived and applied during the perinatal period.