1070 Interdisciplinary Approach to Maternal Sleep. (12th April 2019)

• Record Type: Journal Article
• Authors: Dhaliwal, Sammy S; Gregorio, Nicholas R; Lewin, Daniel S
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A428
• Page End: A428
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz069.1067
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Perinatal depression affects ~20% of women; persistent insomnia can be one of several debilitating symptoms. Contributors to postpartum sleep disruption include infant sleep, temperament, and feeding patterns, negative cognitions, mood and anxiety symptoms, and other comorbid sleep disorders. An assessment battery with validated measures of these factors is being piloted within a Perinatal Sleep Service co-located within an academic children's hospital. The assessment identifies Cognitive Behavioral Therapy (CBT) interventions that align with presenting complaints to create patient-centered sessions. Insomnia profiles distinguished by this assessment include chronic-stable, incident-perinatal, and postpartum-mood-related insomnia. Report of Case: A 21-year-old Latina single-mother of a 23-month-old male was referred for severe sleep deprivation and persistent postpartum depression. Significant history includes psychiatric hospitalization 6-weeks postpartum for thoughts of suicide and infanticide. Initial screening identified persistent insomnia and passive thoughts of suicide and infanticide. The patient revealed that cultural considerations, namely her "fuerza, " or strength, kept her from sharing this previously. Focus shifted to risk assessment and safety planning. She endorsed an average sleep duration of ~4 hours/night. Sleep deprivation increased impulsivity, which likely contributed to spontaneous thoughts around harm. Her presenting concerns around sleep onset and insufficient duration were addressed by querying social support, immediate barriers to sleep, and constructing plans for toddler care to minimize nighttime interruptions. Her insomnia was treated using (a) sleep restriction and stimulus control, (b) relaxation/biofeedback for physiologic symptoms, (c) psychoeducation to normalize nighttime awakenings and reinforce sleep hygiene aligning with childcare, and (d) cognitive restructuring: reappraising her negative thoughts once awake. CBT-I encouraged exploration of cultural norms affecting symptom endorsement and therapeutic goals, together treating her anxiety and depression. She reported trouble swallowing medication (24% adherent), chewing prescribed morning and evening doses of buproprion (175mg BID), prompting pill swallowing training and coordination with her prescribing physician to promote adherence. Conclusion: CBT-I over 6 sessions, with ecological/multicultural considerations, improved the patient's presenting concerns. Buproprion was discontinued due to its activating effect, increasing sleep onset latency when given at night. The multi-dimensional assessment approach, while in development, rapidly provided treatment goals and priorities. Her depression and insomnia remission demonstrates the importance of interdisciplinary approaches to maternal care.