Impact of sleep health education on sleep quality among mothers of infants under one year: a randomized controlled trial

Sleep disruption is highly prevalent across the full first postpartum year (0–12 months) and is associated with adverse mental, emotional, and functional outcomes. Brief sleep-health education is a low-cost strategy, but its effectiveness when delivered as passive, lecture-based education to mothers of infants across this entire period remains uncertain. This study evaluated a four-session sleep-health education program among mothers of infants younger than one year in Tabas, Iran. In this randomized controlled trial, 70 eligible mothers were allocated to intervention (n = 35) or control (n = 35) groups. The intervention comprised four weekly, two-hour lecture-based sessions. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) at baseline and immediately after completion of the four-week intervention. Higher PSQI scores indicate poorer sleep quality. Between-group effects were evaluated using analysis of covariance (ANCOVA) adjusted for baseline PSQI; change scores (ΔPSQI = post-intervention minus baseline) were also compared using Welch’s t-test because change-score variances were markedly unequal. The groups did not differ significantly in baseline PSQI (control: 10.02 ± 3.18; intervention: 9.34 ± 3.20; p = 0.373). At follow-up, mean PSQI was 8.37 ± 2.11 in the control group and 9.91 ± 3.15 in the intervention group (unadjusted p = 0.019). The intervention group showed a mean increase in PSQI of + 0.57 ± 1.07 (95% CI: 0.21 to 0.94; paired p = 0.003), whereas the control group showed a mean decrease of -1.66 ± 3.71 (95% CI: -2.93 to -0.38; paired p = 0.012). The between-group difference in ΔPSQI (intervention minus control) was + 2.23 points (95% CI: 0.91 to 3.55; Welch p = 0.0015). Baseline-adjusted ANCOVA likewise indicated a higher (worse) post-intervention PSQI in the intervention group (adjusted difference = 1.87 points; 95% CI: 0.81 to 2.93; p < 0.001). No unintended or adverse effects were reported. In this single-center trial, this specific four-session, lecture-based sleep-health education program did not improve maternal PSQI scores immediately after completion of the four-week intervention period and was associated with a less favorable sleep-quality trajectory than routine care. These findings should not be generalized to all sleep education. Postpartum sleep support may require more intensive, skills-based, and individualized behavioral approaches, such as cognitive behavioral therapy for insomnia (CBT-I), together with longer follow-up. IRCT20230724058906N2 (retrospectively registered on 2026.06.29).