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CompletedNCT03301727Updated Sep 14, 2018

Sleeping for Two: RCT of CBT-Insomnia in Pregnancy

An interventional study of Cognitive-Behavioural Therapy for Insomnia (CBT-I) in Insomnia and Sleep Disturbance, sponsored by University of Calgary. Completed at 2 sites in Canada. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2018-09-14.

Sponsored by University of Calgary · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
54
Allocation
Randomized
Ages
18 Years and older
Sex
Female
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Study summary

Cognitive-behavioural therapy for insomnia (CBT-I) has been shown to be an effective treatment for insomnia in multiple populations, including women during pregnancy and postpartum. Online CBT-I has also been shown to be effective and comparable to in-person CBT-I, and shows promise as an accessible treatment alternative to in-person CBT-I for pregnant women experiencing insomnia. As the harmful consequences of insomnia or sleep disturbances have been well documented during late pregnancy, this randomized-controlled trial will compare the efficacy of both in-person and online CBT-I on pregnant women with insomnia to a wait-list control group.

Read the detailed description

The primary aim of the current project is to evaluate the impact of a 6-week in-person CBT-I, versus online CBT-I, versus a wait-list in reducing symptoms of insomnia (assessed subjectively by self-report and objectively with actigraphy) experienced in pregnancy. The investigators hypothesize that participants who receive a 6-week program of either in-person CBT-I or online CBT-I (versus a wait-list) will report fewer insomnia symptoms and have improved objectively assessed sleep measured at one-week post-treatment. Based on previous research findings, the investigators do not expect that there will be a difference between in-person CBT-I and online CBT-I administration.

The secondary aim is to investigate if CBT-I versus a wait-list will reduce symptoms of depression at one-week post-treatment. The investigators hypothesize that participants who receive in-person CBT-I and online CBT-I (versus a wait-list) will report fewer depressive symptoms measured at one-week post-treatment.

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Conditions studied

  • Insomnia
  • Sleep Disturbance
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Who can participate

Ages eligible
18 Years and older
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • Age: 18 years or greater
  • Gestation: 12 - 30 weeks
  • Identifying as experiencing sleep disturbances
  • Language: English-intermediate or above
  • Have access to internet

Exclusion criteria

Exclusion Criteria:

  • Experiencing symptoms of sleep disorders other than insomnia
  • Currently taking prescribed medications for sleep problems
  • History of untreated, serious psychiatric illness
  • Substance-use during pregnancy
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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
54 participants (actual)

Study arms

  • Active comparator
    In-person CBT-I Treatment

    Participants receive 6 in-person weekly 1.5-hour sessions of cognitive-behavioural therapy for insomnia (CBT-I) for pregnant women, supervised by a registered, licensed clinical psychologist.

    Other: Cognitive-Behavioural Therapy for Insomnia (CBT-I)

  • Active comparator
    Online CBT-I Treatment

    Participants receive 6 online weekly 1.5-hour sessions of cognitive-behavioural therapy for insomnia (CBT-I) for pregnant women, supervised by a registered, licensed clinical psychologist.

    Other: Cognitive-Behavioural Therapy for Insomnia (CBT-I)

  • Other
    Wait-list Control

    Participants are placed on a wait-list for 6 weeks before receiving either in-person or online 6 weekly 1.5-hour sessions of cognitive-behavioural therapy for insomnia (CBT-I) for pregnant women, supervised by a registered, licensed clinical psychologist.

    Other: Cognitive-Behavioural Therapy for Insomnia (CBT-I)

Interventions

  • OtherCognitive-Behavioural Therapy for Insomnia (CBT-I)

    Cognitive-Behavioural Therapy for Insomnia (CBT-I) is an evidence-based psycho-therapeutic intervention, combining cognitive and behavioural principles to provide psycho-education concerning contributing thoughts to sleep problem maintenance, and behavioural technique instruction to reduce sleep onset latency and promote effective sleep maintenance.

    Also known as: Cognitive-Behavioral Therapy for Insomnia (CBT-I)

05

What researchers measure

Primary outcomes

  1. Change in the Insomnia Severity Index

    The ISI is a 7-item questionnaire designed to identify cases of insomnia and evaluate treatment outcomes. The ISI assesses severity of sleep onset, sleep maintenance and early wakening problems, sleep dissatisfaction, and perceived distress caused by sleep problems. It was found to be a clinically useful tool in assessing changes in insomnia symptoms in insomnia treatment research.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  2. Change in the Pittsburgh Sleep Quality Index

    The PSQI instrument is used in assessing one's sleep quality during the previous month. It consists of 19 self-rated items and 5 questions rated by the roommate or bed partner. There are seven components of the PSQI and these are subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  3. Change in Actigraphy (Actiwatch II, Phillips, USA)

    Actigraphy monitoring provides objective sleep, combining measurements of: circadian rhythm amplitude, acrophase, mesor, sleep efficiency, sleep latency, total sleep time, and number and frequency of awakenings.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  4. Change in Sleep Logs

    Sleep logs provide self-reported subjective sleep, combining self-reports of: latency, total sleep time, and number and frequency of awakenings.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

Secondary outcomes

  1. Change in the Edinburgh Postpartum Depression Scale

    Symptoms of depression in pregnancy and the postpartum will be assessed by the EPDS. The EPDS consists of 10 items and is a reliable and valid tool for identifying symptoms of depression experienced in pregnancy and the postpartum.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

Other outcomes

  1. Change in the Multidimensional Fatigue Symptom Inventory - Short Form

    30-item short form version of MFSI was designed to assess manifestations of fatigue.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  2. Change in the Dysfunctional Beliefs and Attitudes about Sleep Questionnaire

    Cognitive scale of 16 items used for assessing problematic levels of unhelpful beliefs about sleep.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  3. Change in the Sleep Self-Efficacy Scale

    9-item scale used for measuring one's level of confidence in carrying out specific sleep-related behaviors.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  4. Change in the Sleep Hygiene Index

    13-item self-report items used for assessing presence of behaviors thought to compromise sleep hygiene.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  5. Change in the Pre-Sleep Arousal Scale

    16-item self-report measure assessing pre-sleep arousal.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  6. Change in the Glasgow Sleep Effort Scale

    Measure of sleep-related effort.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  7. Change in the Sleep-Related Behaviors Questionnaire

    Designed to assess use of safety behaviours to promote sleep and cope with tiredness.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  8. Change in the Epworth Sleepiness Scale

    8-item scale designed to assess the tendency to fall asleep in situations

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  9. Change in the Generalized Anxiety Disorder index

    Brief measure for assessing symptoms of generalized anxiety disorder.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  10. Change in the Couple Satisfaction Index

    16-item scale assessing participants' relationship satisfaction.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  11. Change in the Big Five Inventory

    44-items assessing personality.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  12. Change in the Extended Brief Infant Sleep Questionnaire

    24-items assessing infant sleep.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  13. Change in the Pregnancy-Specific Anxiety Measure

    4-items assessing anxiety during pregnancy.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  14. Change in the PROMIS Adult Version 1.0 Pain Interference Short Form 8a

    8-items assessing interference of pain in functioning.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

  15. Change in the PROMIS Adult Version 1.0 Pain Intensity Short Form 3a

    3-items assessing intensity of pain symptoms.

    Time frame: Change between 3 time-points: baseline, 8-week follow-up, 3-months postpartum follow-up

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Study locations

2 sites
  • University of Calgary
    Calgary, Alberta T2N 1N4, Canada
  • University of Manitoba
    Winnipeg, Manitoba R3T 2N2, Canada
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References and documents

Study documents

  • Protocol and statistical analysis plan · Sep 28, 2017

Documents are hosted by the registry — open the source record to download them.

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Registry details

Key details

Study ID
NCT03301727
Lead sponsor
University of Calgary
Collaborators
University of Manitoba
Responsible party
Sponsor
First posted
Oct 4, 2017
Start date
Nov 2016
Primary completion
Mar 2018
Completion
Mar 2018
Last update
Sep 14, 2018

Study contacts

Lianne Tomfohr-Madsen, PhD
principal investigator · University of Calgary
View the source record on ClinicalTrials.gov ↗

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