Comparative effectiveness of nonpharmacological interventions on postpartum maternal sleep quality: a systematic review and network meta-analysis

Authors: Nguyen Cai Thi Thuy, Chiu Hsiao-Yean, Lin-Lewry Marianne, Bei Bei, Tsai Shao-Yu, Kuo Shu-YuJournal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicinePublished: November 1, 2025DOI: 10.5664/jcsm.11814

Strong EvidenceSystematic Reviewn=1826 participants

Insomnia Pregnancy Discomfort

In Plain Language: sleep, explained

Poor sleep quality is prevalent among postpartum females and can impair maternal and family health. Nonpharmacological interventions are preferred approaches over pharmaceutical methods for improving postpartum sleep, though their comparative effects remain unclear. This study aimed to systematically compare and rank the effects of various nonpharmacological interventions on maternal sleep quality at different postpartum stages. A systematic review and network meta-analysis was conducted. Electronic databases were systematically searched from their inception to July 2024. Randomized controlled trials of nonpharmacological interventions for postpartum sleep were included. Random-effects network meta-analyses were adopted. In total, 19 randomized controlled trials involving 1,826 participants examined 13 nonpharmacological interventions for postpartum sleep quality. Foot reflexology demonstrated the largest effect size (standardized mean difference [SMD] = -3.5), followed by progressive muscle relaxation (SMD = -3.2) and massage (SMD = -2.0), compared to usual care during the first 3 months postpartum. Cognitive behavioral therapy for insomnia (SMD = -1.7) and light-dark therapy (SMD = -1.3) are effective during 4-12 months postpartum. Nonpharmacological interventions effectively improve postpartum sleep, with foot reflexology being the most effective in the early postpartum period and cognitive behavioral therapy for insomnia optimal for 4-12 months. Health professionals can incorporate these promising interventions into postpartum sleep care. Future research evaluating the direct comparisons of nonpharmacological interventions for postpartum sleep is warranted. Nguyen CTT, Chiu H-Y, Lin-Lewry M, Bei B, Tsai S-Y, Kuo S-Y. Comparative effectiveness of nonpharmacological interventions on postpartum maternal sleep quality: a systematic review and network meta-analysis. J Clin Sleep Med. 2025;21(11):1957-1967.

Key Findings: what this systematic review found about sleep

✓Foot reflexology demonstrated the largest effect size (SMD = -3.5) for improving postpartum maternal sleep quality among 13 nonpharmacological interventions examined.
✓A systematic review and network meta-analysis of 19 randomized controlled trials involving 1,826 participants identified nonpharmacological interventions as preferred approaches over pharmaceutical methods for improving postpartum sleep.
✓Poor sleep quality is prevalent among postpartum females and has the potential to impair both maternal and family health outcomes.

What This Means for You

If you're struggling with sleep in your first three months postpartum, foot reflexology showed the strongest evidence for improvement compared to other non-drug options, though more research on its long-term safety and effectiveness would be valuable.

What This Means for Practitioners

This systematic review provides strong evidence supporting foot reflexology as a first-line recommendation for postpartum sleep issues in early postpartum period, positioning it ahead of other nonpharmacological interventions.

Study Design: how this systematic review was run

Sample Size

1826 participants

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Sleep: common questions

What does this study say about sleep?

What did this study find?

Foot reflexology demonstrated the largest effect size (SMD = -3.5) for improving postpartum maternal sleep quality among 13 nonpharmacological interventions examined. A systematic review and network meta-analysis of 19 randomized controlled trials involving 1,826 participants identified nonpharmacological interventions as preferred approaches over pharmaceutical methods for improving postpartum sleep. Poor sleep quality is prevalent among postpartum females and has the potential to impair both maternal and family health outcomes.

How strong is this evidence?

This is a systematic review and we rate its evidence strong. It covers 1,826 participants. It was published in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. This study is indexed here for context; it did not test reflexology itself.