A mindfulness-based sleep program for pregnant women with insomnia appears to work by reducing nighttime cognitive arousal and the effort invested in trying to sleep. In a small trial of 12 pregnant women with insomnia disorder, 75% reported high cognitive arousal before treatment, dropping to 8.3% after treatment. All women whose insomnia remitted had low cognitive arousal afterward, while half of non-remitters still had high arousal. Lower cognitive arousal and less sleep effort predicted same-week improvements in insomnia and later reductions in depression. The findings suggest that quieting a racing mind and decreasing sleep effort are key mechanisms through which mindfulness-based insomnia therapy alleviates both insomnia and depression during pregnancy.
A proof-of-concept trial of a treatment combining mindfulness with behavioral sleep strategies (PUMAS) for pregnant women with insomnia found large reductions in insomnia, depression, and cognitive arousal. Among 12 participants with insomnia disorder (five also had depression), 83.3% achieved insomnia remission after six telemedicine sessions. All five depressed patients remitted from depression. Nocturnal cognitive arousal, perinatal-focused rumination, and sleep effort all showed large improvements. Patients rated sleep restriction and guided meditations as most helpful and were highly satisfied with the telemedicine format and meditation app.