SHINE: Sleep Health In Perinatal Care

The Healthy Sleep program uses therapist-assisted self-help Cognitive Behavioural Therapy for Insomnia (CBT-I) to address maladaptive sleep-related cognitions and behaviors, which play key roles in the maintenance of poor sleep during the perinatal periods. Content is adapted from our previous intervention (Bei et al., 2021, https://doi.org/10.1017/S0033291721001860), and aims to address 3 types of perinatal sleep complaints identified in the literature: (1) symptoms of insomnia, (2) pregnancy and infant-related sleep disturbance, and (3) daytime impairments (e.g., sleepiness, fatigue). Feedback on intervention content, format, readability, visual appeal, mode of delivery was sought and incorporated from a Community Reference Group. The following evidence-based therapeutic components are included: (1) General skills to increase resilience to sleep challenges: sleep hygiene, addressing unhelpful thoughts and beliefs about sleep, relaxation, and managing night-time worries. (2) Identifying and managing insomnia symptoms (e.g., stimulus control, time-in-bed restriction), and when to seek professional help. (3) Fostering realistic expectations and normalise some sleep loss via early education on sleep patterns of new parents and infants. (4) Mindfulness-based strategies targeting physical discomfort, pain, and cognitive arousal. (5) Age-appropriate and evidence-based infant sleep/settling skills to reduce awakenings and increase maternal sense of control. (6) Prioritising one’s own sleep and rest. (7) Smart naps based on circadian principles. (8) Managing sleepiness/fatigue. (9) Enlisting support. (10) Avoiding supine going-to-sleep position in pregnancy to reduce risk for late stillbirth. Content of the intervention is delivered via the following means, combined: - A 60-min standardised telephone or telehealth session is delivered by a trained researcher at program entrance, within 2 weeks of enrolment in pregnancy, to (a) introduce core components (factors contributing to sleep, managing insomnia and sleep deprivation, addressing unhelpful thoughts/beliefs about sleep), (b) discuss personalised strategies using intervention materials (additional components that are relevant to each individual will be added, such as sleep restriction, managing nighttime worries, managing physical discomfort), and (c) motivate adherence and sustainable behavioural change. Only key components and those relevant to the individual (i.e., not all components) will be delivered in this session. - Up to 3 optional mini-consultations via phone or telehealth (~15 minutes) before childbirth if required; - 1 mini-consultation via phone or telehealth (~ 30 minutes) when the newborn is 3 months. - Partner or another person who will also be involved in caring for the newborn is encouraged to attend at least one of the above consultations. - Multimedia intervention materials (including written text, images, audio, and videos) are delivered digitally via email at enrolment, 5 weeks after enrolment, and 2 weeks, 1.5 months, 3 months, and 6 months postpartum. These electronic materials are timed according to probable sleep challenges at each stage of the perinatal period (e.g., managing insomnia, physical discomfort, and expectation of postpartum sleep at late pregnancy, managing daytime sleepiness during early postpartum). Each electronically delivered module is designed to be succinct and easy to read on a computer, tablet, or phone, and will take no more than 10 minutes to read. Content accessing information such as email opening rate will be captured to assess compliance. - Participants who require additional support applying intervention materials can request brief email or telephone clarification from our team. - All sessions will be audio recorded for assessing treatment fidelity.