A study published in "SLEEP Advances" depicted that integrating mindfulness with behavioral sleep techniques in pregnant women can effectively address both cognitive arousal and sleep effort by promoting a peaceful mindset during the night when sleep-promoting behaviors are at their peak. David A Kalmbach et al. aimed to investigate whether reducing nocturnal cognitive arousal and sleep effort could serve as treatment mechanisms for improving depression and insomnia in pregnant women through the application of a mindfulness sleep program.

This secondary analysis from a proof-of-concept trial involved twelve pregnant females diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder, who underwent treatment using Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), an approach that integrates behavioral sleep strategies into a mindfulness framework. Collection of data was done over eight weekly evaluations, including pre-treatment, 6 sessions during intervention, and post-intervention evaluations.

The evaluation criteria encompassed the Glasgow Sleep Effort Scale (GSES), Edinburgh Postnatal Depression Scale (EPDS), the pre-sleep arousal scale’s cognitive factor (PSASC), and the Insomnia Severity Index (ISI). Linear mixed modeling was employed to examine cognitive arousal and sleep effort as prospective and concurrent predictors of both depression and insomnia outcomes.

Before undergoing PUMAS treatment, a majority of patients (75.0%) reported experiencing high cognitive arousal, but this significantly declined to 8.3% following the intervention. Among those who experienced remission from insomnia, all reported reduced cognitive arousal post-treatment, whereas half of those who did not experience remission continued to report high cognitive arousal.

During the treatment, both nocturnal cognitive arousal and efforts to sleep were linked to changes in insomnia within the same week. Furthermore, it was found that efforts to sleep had a predictive impact on insomnia. Reduced levels of nighttime cognitive arousal and attempts to improve sleep were indicative of forthcoming reductions in depression. Hence, mitigating cognitive arousal and sleep-related efforts leads to the relief of insomnia and depression in pregnant women diagnosed with DSM-5 insomnia disorder who are undergoing treatment with a mindfulness-based sleep program.