Cognitive behavioural therapy for perinatal insomnia: A systematic review on postpartum outcomes

Insomnia is highly prevalent in the perinatal period and is associated with postpartum depression (PPD) and adverse maternal and infant outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is an established treatment in the general population, with proven short- and long-term effects. Although research on perinatal insomnia is still emerging, several recent randomised controlled trials (RCTs) have tested its postpartum efficacy. This systematic review examined the evidence of CBT-I in treating postpartum insomnia and reducing PPD. Six databases were searched from their earliest available records to July 2024, yielding a total of 408 records. Eight trials met the inclusion criteria, which were methodologically appraised using the Cochrane Risk of Bias tool (RoB-2). Due to substantial clinical and methodological heterogeneity, a narrative synthesis was conducted. Across studies, CBT-I produced small to medium effects on insomnia outcomes during early and mid-postpartum, with larger effects emerging in late postpartum. Effects on depressive symptoms were inconsistent and generally small. Overall certainty of evidence was low due to high risk of bias, small sample sizes, heterogeneous control conditions, and limited reporting of key postpartum confounders (e.g., infant night waking, breastfeeding, pharmacological sleep aid use). CBT-I shows potential for improving postpartum insomnia, but current evidence is insufficient to support strong clinical recommendations. Larger, methodologically rigorous trials with postpartum-specific adaptations and diverse samples are needed.