Postpartum Depression Treatment: Sleep
“New parenthood in America is experienced as, above all else, an exercise in sleep deprivation.” Barbara Katz Rothman (1989)
If there’s one common denominator for pregnant and postpartum women and their partners, it is sleep deprivation. In fact, sleep is one of the top concerns for most new mothers and fathers, and sleep disturbance has long been associated with Perinatal Mood & Anxiety Disorders (PMADs). Learning about sleep strategies and treatment can make a huge impact on a postpartum family’s adjustment and well-being.
Postpartum Sleep Deprivation
Sleep troubles usually begin in pregnancy, with sleep becoming more disturbed as a woman’s body grows, making it uncomfortable to sleep (and forcing her to visit the restroom all night long). During labor, women are pushed to extreme physical limits, and sleep in the hospital is usually interrupted and poor. All of this sets the stage for highly disturbed sleep in the postpartum period. I hear it from new parents all the time, “I never understood just how tired I could be.” Between 2-3 hour feeding schedules, other children, and just plain life, new mothers (and fathers) are usually more sleep deprived than they realize; and that sleep loss can take a serious mental and physical toll.
What makes sleep so challenging?
Even without middle-of-the-night feedings, sleep can be a challenge for new parents. Many mothers whose infants sleep through the night wake up to “check” on them, or they listen for and hear every sound, preventing them from much needed deep sleep. Older children and partners can also disrupt a mother’s sleep. In fact, studies have found that, despite overwhelming signals from their minds and bodies to rest, many new mothers readily give up sleep in favor of keeping their infants from crying or being uncomfortable, protecting an older child’s activities, and protecting a working partner’s sleep. Some even view sleep as “optional.” Though most women know that they feel better physically and mentally—with better focus, thinking, and ability to relate to family members—sleep tends to be one thing we moms don’t protect. And dads can be just as affected by all of these sleep challenges.
The Toll of Sleep Deprivation
This pattern of giving up sleep can take a heavy toll, and new parents need to “wake up” and realize the price you will pay. Sleep is the body’s way of restoring health and well-being. Sleep loss is associated with poor attention and decision-making, poor performance on routine tasks, more mistakes, diabetes, obesity, and a host of emotional symptoms like depression, anxiety, mood swings, irritability, anger, frustration, and poor coping skills. At its extreme, sleep deprivation can actually induce psychotic symptoms!
5 hours of uninterrupted sleep every 24 hours is a physiological imperative for healthy functioning in a normal adult. It’s easy to see, therefore, that a mother who does not get 5 hours of uninterrupted sleep will further her sleep deficit and has a high likelihood of developing physical and mental health symptoms as a result.
Even medical and mental health practitioners may minimize the importance of sleep. Sure, sleep is often recommended as part of many pregnancy and postpartum wellness routines, but telling a new parent to “get more sleep” just doesn’t cut it! Providers need to take it a step further and help families learn strategies to improve sleep. In fact, it’s time we see sleep for what it really is–a fundamental cause of PMADs–and treat it as such. In many cases, sleep treatment is the treatment families need. Either way, improving sleep will have a positive impact on a mother and her family.
Perinatal Sleep Strategies
The following strategies have been shown to improve sleep quality and quantity. Try one or a few and see what it can do for you!
1) Make sleep a priority. If you want to be a happy, healthy mom or dad, then you need sleep! Too many parents know that sleep is important but fail to make it a priority. As a 4-time PPD survivor and longtime insomnia sufferer, I know how hard it can be to force yourself to go to bed right when you finally have a few free minutes! But believe me, the price you will pay is not worth the sleep loss. Set up a sleep hygiene routine, including frequent naps and a bedtime goal with time to wind down, and stick to it as much as possible. I repeat, “Make sleep a priority!”
2) Establish a sleep plan in pregnancy. Know that you are going to be more tired than you’ve ever been. Get used to the idea of having others help you get naps, take a feeding at night (if your baby takes a bottle), or even keep the baby and bring her to you only to eat. Also, try to get as much sleep as possible before the baby comes. The more prepared you are going in, the better your chances of staying on top of the sleep loss.
3) Enlist the entire family. We’ve already established that sleep is a family concern. There are many ways families can help one another sleep better. Parents, take turns helping each other sleep through the night. Work on getting your older children into their own beds so they aren’t disrupting the family’s sleep. Let grandparents or other family members help you get naps or take over for a night once in a while.
4) Treat Insomnia. Insomnia is a common occurrence in pregnancy and postpartum, and treating the insomnia can alleviate symptoms of depression and anxiety dramatically. Learn and apply strategies that help you fall asleep and stay asleep better (read “Sleep Better, Cope Better: 6 Causes & Cures for Insomnia”). If these strategies aren’t helping, speak to your healthcare provider about insomnia treatment options.
5) Learn & Use Strategies to Improve Infant Sleep. Sometimes it’s more about the baby than you. Some babies just sleep better than others. Colicky babies can be the toughest to deal with, crying for hours and waking all night long (trust me, I’ve had one!). Newborns are usually on their own schedule, but once they reach 4-6 months, you can start getting them on a sleep schedule that works better for all of you. Books, websites, and talking with friends or other support systems can give you ideas to help your baby (and therefore, you) sleep better.
6) Try Sleep Therapy. There are many thought and behavior-based methods that can significantly improve sleep. Finding a psychologist or therapist who provides sleep therapy, especially cognitive-behavioral therapy, can be very helpful, especially if your sleep troubles are related to too much thinking! (Read about Cognitive-Behavioral Theory)
7) About Sleep-Aids: Many new parents use a sleep-aid to help them settle down at night and sleep while the baby sleeps (when the opportunity presents itself). There are many types of sleep aids, from over-the-counter to prescription strength, which can be helpful. Natural sleep aids like Melatonin can also help temporarily. However, natural or not, these sleep aids can have varying side effects, and some can be addictive. It’s therefore important to discuss sleep aids with your medical provider to keep you safe and well.
8) Order a Sleep Disorder Assessment. Sometimes the problem isn’t as simple as having to wake up all night to feed the baby. Sometimes, there’s an underlying sleep disorder than can be causing trouble (like sleep apnea). Talk with your doctor, who can order a sleep study or refer you to a sleep specialist.
I know how challenging it can be to get enough sleep when you’ve got a baby to care for. But, take sleep seriously, learn sleep-promoting strategies and practice them, and you will be able to improve your energy, functioning, emotional state, and even your postpartum depression treatment. It won’t be like this forever—trust me! Eventually your children will sleep better and so will you!
Related Articles and Posts:
American Academy of Sleep Medicine: http://yoursleep.aasmnet.org/topic.aspx?id=40
 Runquist, J.J. (2007). Persevering Through Postpartum Fatigue. JOGNN 36, 28-37.