Hospital-based behavioral intervention promotes better sleep in high-risk pregnant women

A study shows that a hospital-based behavioral intervention protocol including components of sleep hygiene and cognitive behavioral therapy successfully improved sleep in women who were hospitalized for a high-risk pregnancy.

Results show that women in the intervention group had significantly lower sleep disturbance scores than controls. They also had fewer symptoms that can interfere with sleep such as pain or nervousness.

"We know getting adequate sleep is difficult in hospital settings, and hospitals try various strategies to reduce noise, but our strategies place the patient in more control of her room and environment for sleep," said lead author and principal investigator Kathyrn Lee, RN, CBSM, PhD, professor emerita in the Department of Family Health Care Nursing at the University of California, San Francisco.

The study results are published in the Dec. 15 issue of the Journal of Clinical Sleep Medicine.

Many pregnant women experience disturbed sleep, especially if they are hospitalized for a high-risk pregnancy. Stress and fear, coupled with the bright lights and loud noises of the hospital, can contribute to sleep disturbances.

The study by Lee and colleague Caryl L. Gay, PhD, involved 25 high-risk pregnant women whose sleep measures were compared during one week of hospitalization before and after implementation of a Sleep Improvement Protocol for Antepartum Patients. Participants were on average 30 weeks pregnant and 33 years old.

The intervention group received usual care and written information about sleep hygiene, a set of tips and strategies to help people develop healthy habits that promote better sleep. Cognitive behavioral strategies for dealing with stress and worry were tailored to the hospitalized antepartum population. Emphasis was placed on prioritizing time for sleep for patient health and well-being.

Women in the intervention group also received a sleep kit to help promote a sleep-friendly bedroom environment. Kits included a fan, white noise machine, eye mask and earplugs.

"Women were eager to participate, very accepting of our strategies, and loved items in the kit," said Lee. "They said they would utilize the materials and information we provided when they went home. This could work for other types of patients, and hospital volunteers can easily assemble these sleep kits."

Sleep was assessed using the Pittsburgh Sleep Quality Index, a daily sleep diary, and the General Sleep Disturbance Scale. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale. Both groups reported in their sleep diaries that the most frequent reason for awakenings during the night was monitoring by the nursing staff, followed by noise in the hallway.

According to the authors, study results suggest that health care providers should teach about healthy sleep hygiene behaviors early in pregnancy during routine prenatal visits.

"Some women reported only sleeping 5 hours a night at home before coming into the hospital," said Lee. "A pregnant woman should be making sleep a priority."

The American Academy of Sleep Medicine recommends that adults should sleep 7 or more hours per night on a regular basis to promote optimal health.