⏱ 3 min read
Sleep disruption was associated with anxiety, obsessive beliefs, obsessive-compulsive symptoms and depression among women assessed during pregnancy and after birth, according to an analysis of data from 231 participants.
The findings point to sleep as an important factor to consider during the perinatal period. However, the study found relationships between symptoms rather than proving that poor sleep causes mental health problems.
Sleep changed across pregnancy and after birth
Participants were assessed at 20 weeks pregnant, 34 weeks pregnant, six weeks postnatal and six months postnatal. The analysis included measures of insomnia symptoms, subjective sleep duration, coping skills, anxiety, obsessive beliefs, obsessive-compulsive symptoms and depression.
Insomnia symptoms were highest at 34 weeks of pregnancy and lowest at six weeks after birth. Sleep duration decreased during pregnancy and increased postpartum, although it remained lower at six months postnatal than at the first assessment.
At the first timepoint, 27% of participants were reported to have clinically significant insomnia symptoms. The results also reported anxiety symptoms in 28% and moderate-or-above obsessive-compulsive symptoms in 23% of participants, while 7% reported clinically significant depressive symptoms.
How sleep and mental health symptoms were connected
At baseline, more insomnia symptoms were associated with shorter sleep, lower coping and higher levels of anxiety, obsessive beliefs, obsessive-compulsive symptoms and depression.
Shorter sleep was associated with higher anxiety, obsessive beliefs and obsessive-compulsive symptoms, but not with higher depressive symptoms. Coping skills showed the opposite pattern: lower coping was associated with higher anxiety, obsessive beliefs, obsessive-compulsive symptoms and depression.
The researchers also examined whether coping changed the relationship between sleep and mental health symptoms. Among participants with lower coping, shorter sleep was linked with higher anxiety and depression, while insomnia was linked with higher depression. These relationships were not seen among participants with higher coping.
What the study can—and cannot—show
Shorter sleep duration predicted later increases in anxiety and obsessive beliefs in the analysis. The reported coefficients were B = -0.63 for anxiety and B = -2.17 for obsessive beliefs, with both findings reported as statistically significant.
However, anxiety and related symptoms did not predict later sleep disruption. Insomnia symptoms also did not predict later change in any outcome within mothers. The authors described anxiety, depression and obsessive symptoms as closely intertwined, with each associated with disturbed sleep.
These results do not establish that sleep disruption causes anxiety, obsessive beliefs, obsessive-compulsive symptoms or depression. The study was based on associations and prediction within an observational dataset, so other factors may also contribute.
Why the findings may not apply to everyone
The analysis used two-level multilevel linear regression models, with the four timepoints nested within participants. Age and parity were included as covariates, and the researchers considered lagged effects and possible bidirectionality.
There were important limitations. The sample was largely white, high income and highly educated, and participants were recruited at two sites in the United States through provider referrals, other studies and social media adverts. The original recruitment also selected participants with either high or low scores on an Obsessional Beliefs Questionnaire, excluding women with scores in the middle range.
The article also notes limited recruitment details, limited covariate adjustment, and the use of insomnia symptoms as the main way of operationalizing sleep disturbance. Coping was measured using selected items from the Perceived Stress Scale rather than a broader coping assessment.
Why sleep may be worth discussing in perinatal care
The findings suggest that sleep deserves attention alongside anxiety, depression and obsessive-compulsive symptoms during pregnancy and after birth. The article notes that effective non-pharmacological treatments for perinatal insomnia already exist and suggests that behavioral sleep interventions could be offered more broadly to expectant mothers.
For clinicians and families, the main message is not that every sleep problem signals a mental health condition. Rather, persistent sleep disruption and emotional symptoms may be relevant together, particularly when coping feels limited. Further research in more diverse populations is needed to clarify how these symptoms influence one another.
AI tools were used to assist with the preparation of this article.
Leave a Reply