Sleep and Perinatal Depression

Clinically relevant depressive syndromes are estimated to occur in approximately 12% of women during pregnancy and the postpartum. Perinatal depression (PND) negatively impacts maternal self-care, nutrition, labor, and obstetric outcomes. Hormonal and physical modifications influence the circadian and homeostatic components of sleep regulation, leading to increased WASO, reduced TST, and a predominance of relatively more superficial NREM sleep, especially in the third trimester. Sleep-related breathing disorders, restless legs syndrome, insomnia, and circadian rhythm disorders also typically increase during pregnancy in predisposed women. Of note, sleep disturbances are significantly more frequent in depressed pregnant women and might be an early predictor of mental health deterioration in the perinatal period. Therefore, sleep monitoring during pregnancy might contribute to the early detection of risk for PND. While polysomnography should be reserved for severe or diagnostically uncertain cases, sleep actigraphy can be used extensively due to its minor cost and major comfort, especially during pregnancy. Preliminary findings from this growing field of research encourage nonpharmacological approaches to sleep disturbances including clear communication of sleep hygiene to preserve positive sleep patterns, safe and effective chronotherapeutic measures such as bright light therapy to target circadian rhythm disruption, and cognitive-behavioral therapy to address insomnia. The combination of these interventions with conventional treatment approaches for PND is likely to improve mood and associated sleep disturbances in affected women.