Clinical Research Sleep & Gestational Diabetes | CBTi Chronic Pain & Mental Health

I have been reviewing recent clinical sleep research with an eye to how it can be incorporated into clinical practice. I hope that you find some of these summaries also of practical use. 

Gestational Diabetes Mellitus

Diabetes mellitus complicates 6–7% of all pregnancies with 90% representing gestational diabetes mellitus [1]. Gestational diabetes mellitus is associated with an increased risk of preeclampsia, fetal macrosomia, birth trauma (e.g., shoulder dystocia), and neonatal metabolic complications [2] Women who are objectively assessed as short sleepers have poorer glucose regulation [3] and self-reported short sleepers (i.e., < 6 hours) have a 2-10% increased risk of gestational diabetes [4]. Therefore improving sleep quantity and quality is an important aim for this population.

Gan et al [5] continued the work of an earlier pilot study and examined the use of eye masks and ear plugs to improve sleep (e.g., objectively assessed as ≤6 hours) in a cohort of pregnant women (34-36 weeks gestation) compared to a similar group receiving sleep hygiene advice. The intervention period was 1 week (perhaps a bit short for changing the complex habit of poor sleep) and while both groups improved their sleep, those in the eyemask/earplug group increased by more and only this group also significantly improved the quality of their sleep. No significant changes in either group were noted regarding labour or neonatal outcomes.

Clinical TakeAway - With both groups improving, it reinforces that action (eyemask/earplug) and education (sleep hygiene) is probably a sensible clinical combination.


  1. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol. 2013;122:406–16. [PubMed] [Google Scholar]
  2. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48. [PMC free article] [PubMed] [Google Scholar]
  3. Twedt R, Bradley M, Deiseroth D, Althouse A, Facco F. Sleep Duration and Blood Glucose Control in Women With Gestational Diabetes Mellitus. Obstet Gynecol. 2015 Aug;126(2):326-331. doi: 10.1097/AOG.0000000000000959
  4. Qiu C, Enquobahrie D, Frederick IO, Abetew D, Williams MA. Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC Womens Health. 2010;10:17. [PMC free article] [PubMed] [Google Scholar]
  5. Gan F, Sooriappragasarao M, Sulaiman S, Razali N, Hong J, Tan P. Eye-mask and earplugs compared with sleep advice leaflet to improve night sleep duration in pregnancy: A randomized controlled trial. Sleep. 2023;46(12)doi:10.1093/sleep/zsad196

Cognitive Behavioural Therapy for Insomnia (CBTi)

The go-to, first-line intervention recommended for clients presenting with chronic insomnia is CBTi. It is low-cost, has no side effects or addictive aspects and can be provided by a range of trained health professionals. So a couple of questions then arise, how can we broaden access to this important treatment technique and what's next for CBTi?

In the next couple of newsletters, I am going to explore how we as allied health practitioners can assist in this process. Let's first look at sleep and pain, as pain is the most common presentation to our clinics.

Cognitive behavioral therapy for insomnia in patients with chronic pain – A systematic review and meta-analysis of randomized controlled trials

Pain and insomnia have a bidirectional relationship. That is, a poor night of sleep increases the pain experienced, and an increase in pain reduces the quality of sleep. However, there is a growing indication in research that; poor sleep is the stronger predictor of subsequent pain, that poor sleep contributes to the development of chronic pain and that improved sleep reduces the intensity of pain.

As most of us are treating chronic non-cancer pain in the clinic, this new systematic review and meta-analysis is critical in guiding our treatment of those with chronic pain and insomnia [1]. The authors of the systematic review investigated the effectiveness of CBTi on patient-reported sleep, pain, and other health outcomes (e.g., depressive symptoms, anxiety symptoms, and fatigue) in a cohort with comorbid insomnia and chronic, non-cancer pain. At post-treatment, significant treatment effects were found on global measures of sleep, pain, and depressive symptoms. Significant treatment effects for sleep after CBTi were maintained for up to 12 months. There was a probability of 81% and 71% respectively for having better sleep after CBTi at post-treatment and final follow-up and the probability of having less pain after CBTi at post-treatment and final follow-up was 58% and 57%.

Clinical TakeAway - CBTi was developed to treat clients with chronic insomnia without pharmacological intervention. However, with the bidirectional relationship between sleep and pain, it has been noted that improving sleep quality often brings about improvements in pain management. This SR indicates this improvement in pain is both immediate and longer-lasting in a large group of pain sufferers, making it an important consideration to explore and provide appropriate sleep-based education and intervention.


  1. Selvanathan J, Pham C, Nagappa M, et al. Cognitive behavioral therapy for insomnia in patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews. 2021/12/01/ 2021;60:101460. doi:

In the next blog I will examine what the research around CBTi recommends we do to improve the impact of CBTi using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model.

Appreciate you reading and your thoughts.