2010, 2015) leading to stress system allostatic “overload” which may account for adverse pregnancy outcomes including peripartum psychopatology (Palagini et al. These factors may fuel the cycle of hyperarousal in insomnia with hyperactivation of stress and inflammatory systems (Riemann et al. Then, maladaptive sleep behaviors together with other sleep disorders such as sleep disorders breathing (SDB) and restless leg syndrome (RLS) which are frequently experienced during the last trimester of pregnancy may perpetuate insomnia in pregnancy (Kalmbach et al. 2014 Balserak and Lee 2017 Kay-Stacey and Attarian 2017 Pengo et al. 2015), hormonal and physical factors may predispose pregnant women to develop insomnia in response to pregnancy related emotional distress (Palagini et al. According to the “3-P” model of insomnia with predisposing, precipitating, and perpetuating factors relevant to the development and maintenance of insomnia (Riemann et al. Vulnerability to insomnia is greatly heightened during the perinatal period with racial disparity to endorse the insomnia symptoms (Swanson et al. In particular, insomnia may affect more that 50% of the pregnant women reaching until the 80% of women during the third trimester (Swanson et al. Most common problems during all three trimesters include short sleep duration, poor sleep quality, conditions of sleep loss, and insomnia (Palagini et al. 2014 Balserak and Lee 2017 Kay-Stacey and Attarian 2017 Baglioni et al. ![]() 2017) with 75–98%, of during the third trimester of pregnancy (Palagini et al. With the physical and hormonal adaptations in pregnancy, changes in sleep are reported by 66 to 97% of women (Balserak and Lee 2017 Kay-Stacey et al. Women’s sleep during pregnancy and post-partum is altered by anatomical, endocrinology, physiological, psychological, behavioral, socioeconomic, and cultural factors (Pengo et al. 2019) and sleep is commonly impaired during peripartum (Palagini et al. Consistently, sleep problems are recognized as a major risk factor for mental and physical health problems (Palagini et al. Sleep is an important regulatory psychophysiological behavior in life, influencing mood, emotion, and impulse behaviors, which are key mediators of stress adjustments so commonly needed in the perinatal period (Baglioni et al. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. ![]() According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. ![]() The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms “insomnia” and “perinatal period” or “pregnancy” or “post partum” or “lactation” or “breastfeeding” and “evaluation” and “treatment.” Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. ![]() The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology.
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