Reduce Insomnia and Rumination in Pregnant Women with Mindfulness
By John M. de Castro, Ph.D.
“practicing mindfulness during the day, ideally for 20 minutes, . . The idea is to create a reflex to more easily bring forth a sense of relaxation. That way, it’s easier to evoke the relaxation response at night when you can’t sleep.” – Herbert Benson
Pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and insomnia are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. Sleep disturbance including insomnia is also common affecting around 75% of pregnant women. The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Insomnia has been linked to an increased risk of giving birth to a baby that’s too large or too small for its age, longer labor, and higher likelihood of a cesarean section.
Hence, it is clear that there is a need for methods to treat depression, anxiety, and insomnia during pregnancy. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety, depression, and sleep normally and to relieve maternal anxiety and depression during pregnancy. In addition, mindfulness is known to reduce worry and rumination which can also lead to restlessness and sleep disturbance. So, it would make sense to study the relationship of mindfulness during the pregnancy to depression, rumination, and insomnia.
In today’s Research News article “Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190270/ ) Kalmbach and colleagues recruited pregnant women in their third trimester and had them complete measures of mindfulness, rumination, insomnia, and depression. These data were subjected to multivariate linear regression analysis.
They found that women who were high in mindfulness had significantly lower levels of rumination, insomnia, and depression. Women who were high in rumination had significantly lower levels of mindfulness and higher levels of insomnia, and depression. Employing multivariate modelling they found that mindfulness and rumination separately and independently were related to insomnia and that mindfulness and rumination separately and independently were related to depression.
These results were correlational and as such causation cannot be determined. But previous research has demonstrated that mindfulness training reduces rumination, insomnia, and depression. So, the relationships observed here are likely due to causal relationships among the variables. It appears that mindfulness and rumination work in opposite directions. Mindfulness helps pregnant women sleep better and helps relieve depression while rumination does the opposite of interfering with sleep and increasing depression.
Interestingly, mindfulness and rumination affect sleep and depression independently but are negatively related such that mindfulness decreases rumination while rumination lowers mindfulness. Mindfulness is an asset to pregnant women while worry produces problems. This suggests that pregnant women should be trained in mindfulness and also trained to reduce worry. Both of these goals can be accomplished with Mindfulness-Based Cognitive Therapy (MBCT). Future research should investigate this possibility.
So, reduce insomnia and rumination in pregnant women with mindfulness.
“It seems important to develop mindfulness to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).” – M. Marques
CMCS – Center for Mindfulness and Contemplative Studies
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Kalmbach, D. A., Roth, T., Cheng, P., Ong, J. C., Rosenbaum, E., & Drake, C. L. (2020). Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep health, 6(2), 185–191. https://doi.org/10.1016/j.sleh.2019.11.011
Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external experiences in the present moment. Responding to stress mindfully may protect against stress-related perinatal complications such as insomnia and depression. The present study described the association between everyday mindfulness and nocturnal rumination, and examined whether these trait characteristics were independently related to perinatal insomnia and depression.
Cross-sectional and secondary analysis of existing data from 65 pregnant women recruited from a multisite hospital in Metro Detroit, MI, USA. Subjects completed online surveys including the Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Presleep Arousal Scale, and the revised Cognitive and Affective Mindfulness Scale.
Over half (53.8%) of women screened positive for clinical insomnia and 12.3% screened positive for major depression. Women high in mindfulness, relative to those low in mindfulness, reported less nocturnal rumination (Cohen’s d=1.16), insomnia symptoms (Cohen’s d=1.24), and depressive symptoms (Cohen’s d=1.35). Multivariate linear regression revealed that both mindfulness (β=−.24, p=.03) and rumination (β=.38, p<.01) were independently associated with insomnia. Similarly, a multivariate model showed that mindfulness (β=−.41, p<.001) and rumination (β=.35, p<.01) were independently associated with depression.
Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications.