Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 11;3(1):zpac006.
doi: 10.1093/sleepadvances/zpac006. eCollection 2022.

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection

David A Kalmbach  1   2 , Philip Cheng  1 , Andrea Roth  3 , Thomas Roth  1 , Leslie M Swanson  4 , Louise M O'Brien  5 , David M Fresco  4 , Nicholas C Harb  1 , Andrea S Cuamatzi-Castelan  1 , Anthony N Reffi  1 , Christopher L Drake  1
Affiliations

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection

David A Kalmbach et al. Sleep Adv. .

Abstract

Study objectives: The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal.

Methods: Ninety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale's Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale.

Results: DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13.

Conclusions: Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.

Keywords: Epworth Sleepiness Scale; ICSD-3; Insomnia Severity Index; Pittsburgh Sleep Quality Index; Presleep Arousal Scale; daytime sleepiness; perinatal.

PubMed Disclaimer

References

    1. Sedov ID, et al. . Insomnia symptoms during pregnancy: a meta-analysis. J Sleep Res. 2021;30(1):e13207. - PubMed
    1. Salari N, et al. . A systematic review and meta-analysis of prevalence of insomnia in the third trimester of pregnancy. BMC Pregnancy Childbirth 2021;21(1):1–8. - PMC - PubMed
    1. Quin N, et al. . Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum. Sleep 2022;45(2). doi:10.1093/sleep/zsab293 - DOI - PMC - PubMed
    1. Kalmbach DA, et al. . Insomnia, short sleep, and snoring in mid-to-late pregnancy: disparities related to poverty, race, and obesity. Nature Sci Sleep. 2019;11:301–315. - PMC - PubMed
    1. Dørheim SK, et al. . Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study. PLoS One. 2014;9(4):e94674. - PMC - PubMed