Sleep problems in pregnancy get treated as scenery. They are common, they are expected, and the standard response is that this is what pregnancy is like. A trial published in Sleep advances in 2026 looked at what happens when you treat them properly anyway, and found the benefits ran wider than sleep. [pubmed-sleep-jun-2026-source]
What the researchers did
Sixty-four pregnant women with clinical insomnia were randomly assigned to one of three arms: cognitive behavioural therapy for insomnia, a mindfulness-based programme designed for pregnancy called PUMAS, or sleep hygiene education as the comparison.
This particular paper is a secondary analysis. The trial’s main question was whether the treatments improved insomnia, which is reported elsewhere. What this analysis asks is what else moved: bedtime procrastination, rumination about sleep, anxiety, mood, and mindfulness.
What they found
Both active treatments produced large reductions in bedtime procrastination, the familiar business of staying up despite being tired and knowing better.
Both produced clear gains in positive affect: interest, enthusiasm, feeling engaged rather than flat. Notably, negative affect did not fall. Those are separate dimensions rather than opposite ends of one scale, and only one of them moved.
Among participants who had anxiety symptoms to begin with, both treatments produced large reductions in anxiety.
The one clean difference between the two treatments: the mindfulness programme reduced rumination about sleep, the lying-awake-thinking-about-not-sleeping loop, and standard CBT for insomnia did not. Neither improved general mindfulness skills as measured.
How much weight to give it
Sixty-four people across three groups is roughly twenty per arm, which is small. Everything reported here is a secondary outcome, and secondary outcomes in small trials are where chance findings gather. The effect sizes are large, but large effects estimated from small samples are also the least stable.
The comparison condition was sleep hygiene education, which is a fair active control, though it is also widely regarded as the weakest of the sleep interventions.
Treat the direction as informative and the magnitudes as provisional.
What this means in practice
Two things are worth taking from it.
Insomnia in pregnancy is a treatable problem rather than a feature of the territory, and the treatments are behavioural rather than pharmacological, which matters when medication options are limited.
And the gains people actually notice may not be the ones on the sleep questionnaire. Feeling engaged again, and stopping the nightly delay before bed, are the changes participants would describe if asked how they were doing.
Is bedtime procrastination part of your problem?
Tick anything true of most evenings in the last month.
0 of 6 ticked
The obstacle here is not physiological, which is why it responds to treatment. The usual first move is to relocate the time you are protecting rather than trying to suppress the urge: find a genuinely unclaimed half hour earlier in the day.
Worth separating "cannot sleep" from "will not go to bed", because they need different responses. Track which it is for a fortnight before deciding what to change.
If you are going to bed at a reasonable time and still not sleeping, the problem is in the sleep rather than in the delay before it.
The source
These findings are drawn from “Treating insomnia during pregnancy improves bedtime procrastination, rumination, anxiety, and positive affect: a randomized controlled trial of cognitive-behavioral and mindfulness-based therapies for prenatal insomnia” (Kalmbach DA, Reffi AN, Cheng P, et al., 2026), published in Sleep advances. Read the full study on PubMed.