Postpartum Insomnia

Insomnia is a common problem for pregnant women, especially during their third trimester. Some studies estimate roughly three-quarters of women experience insomnia symptoms during the later stages of their pregnancy. These symptoms include difficulty with both falling and remaining asleep, as well as nighttime awakenings. Unfortunately, these sleep disturbances often continue after the woman has given birth, and some sleep even less during the first few postpartum weeks than they do during pregnancy.

Postpartum sleep issues may also stem from changes to the mother’s sleep schedule. The first six weeks after delivery can be particularly trying. Studies have found the average new mother receives about six hours of sleep each night during this period.

What Causes Postpartum Insomnia?

Insomnia is a sleep disorder that is believed to affect 10-30% of adults. It is defined as persistent difficulty with sleep onset, maintenance, consolidation, or quality. Insomnia occurs despite enough time allotted for sleep each night or a comfortable sleep area, and it leads to excessive daytime sleepiness and other impairments when the person is awake.

If these symptoms occur at least three times per week and persist for at least three months, a person may receive a diagnosis of chronic insomnia. The condition is known as short-term insomnia if less than 3 months duration.

Sleep disruption, inadequate sleep, and insomnia symptoms are all common during pregnancy. Most mothers also face new sleep challenges after giving birth. Newborns wake up frequently and require feedings throughout the day and night. These demands often force mothers to adjust their sleep schedules and, in many cases, sleep less at night.

Additionally, women undergo hormonal changes during the postpartum period. These include a decrease in the production of progesterone, a female sex hormone with sleep-inducing properties, and changes in levels of melatonin, which the body produces in the evening to promote sleepiness and relaxation. These adjustments can affect the woman’s circadian rhythm, which regulates not only sleep but also mood, appetite, and other bodily functions.

Postpartum depression, or perinatal depression, can be another obstacle to sleep. This disorder affecting new mothers can cause extreme sadness, anxiety, and fatigue. Approximately one in eight pregnant women will experience postpartum depression. Difficulty falling asleep and excessive sleeping are two common symptoms of this condition. Insomnia may be a catalyst or a symptom of postpartum depression. One study found new mothers who sleep poorly are more than three times as likely to experience depression than those with good sleep quality.

Postpartum sleep disturbances can be a serious matter. They not only have a negative effect on the mother but also potentially their infant and partner. Researchers have suggested a link between a mother’s behavioral health and the psychosocial development of their child. Furthermore, studies have shown women who experience chronic insomnia after giving birth are at higher risk of developing postpartum pain.

Tips for Treating Insomnia and Improving Postpartum Sleep

While measures for treating insomnia depend on a person’s health and medical history, people may experience a reduction of symptoms through cognitive behavioral therapy for insomnia (CBT-I). This type of therapy, which is normally offered by a licensed health care professional, involves identifying problematic or inaccurate thoughts and beliefs about sleep and replacing them with healthier attitudes. Specific components of cognitive-behavioral therapy may include:

• Sleep education: By learning more about how sleep works and what we can do to get more rest each night, people with insomnia and other sleep disturbances can address their difficulties from a more informed perspective. Maintaining a sleep diary promotes awareness of sleep patterns.
• Sleep hygiene: The term sleep hygiene refers to practices that improve sleep, such as following a daytime routine that promotes restfulness at night and maintaining a comfortable, healthy sleep environment. Bedroom temperature and light levels, caffeine and alcohol intake, meal times, and exercise all play a role in sleep hygiene.

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• Stimulus control: Some people develop anxieties about sleeping after dealing with insomnia and other night time disturbances, and they need to be reconditioned in order to sleep more soundly. Stimulus control stresses the importance of only using a bed for sleep and sex, getting out of bed on nights when it’s difficult to fall asleep, and setting an alarm for the same wakeup time every day of the week.
• Sleep restriction and compression: Based on the patient’s sleep diary, a CBT-I practitioner may recommend curtailing the amount of time they spend in bed each night.
• Relaxation: Controlled breathing, meditation, and other relaxation techniques may help people unwind in the evening and fall back asleep if they wake up during the night

New mothers should always speak to a doctor before taking prescription or over-the-counter sleep medications or anti-depressants and inquire about concerns for their own health and their infant’s.

Beyond insomnia treatment methods, new mothers who have trouble sleeping can try one of the following techniques for getting some added shuteye while caring for a newborn.

• Rearrange your sleep schedule: As any new parent will attest, many newborns have erratic sleep schedules. Sleeping when their baby sleeps, both at night and during naps, can help mothers acclimate to their little one’s snooze schedule and get an adequate amount of sleep each day/night. Keep in mind that newborns may sleep up to 17 hours a day, so mothers will be awake much of the time their child is asleep.
• Share the workload: Mothers who raise their child with a partner can alternate responsibilities for taking care of their infant. This may cultivate more time to sleep. Single mothers may have relatives or friends who can assist with childcare duties.
• Go for a morning walk: After a sleepless night carrying for their infant, mothers can recharge a bit by taking a stroll that morning. Exposure to natural sunlight can realign the circadian rhythm, which is normally calibrated with the rise and fall of the sun. Moderate exercise can also help them sleep more soundly the following night.
• Don’t consume alcohol: There are two important reasons why new mothers may want to avoid drinking alcohol. First, abstaining from alcohol is considered the safest option for breastfeeding mothers. Second, drinking can actually decrease sleep quality. Although alcohol has sedative properties and can induce faster sleep onset, people often experience sleep fragmentation later in the night.

If you notice sleep issues after giving birth, don’t hesitate to contact your doctor or another licensed physician. Minor sleep struggles can snowball into more serious problems.

You may want to seek help or schedule a visit with your doctor if one or more of the following occurs:

• Snoring: Some pregnant women develop sleep apnea, a disorder characterized by heavy snoring and repeated choking episodes (airway obstruction) during the night.  This may persist in the postpartum period.
• Recurring sleep onset or sleep maintenance problems: If you’re continually having a hard time falling and/or staying asleep after your infant wakes up during the night, this could indicate insomnia or another sleep disorder.
• Symptoms of postpartum depression: These include not only insomnia but also feelings of hopelessness and a lack of motivation to take care of yourself.
• Involuntary sleeping: Nodding off when you don’t plan to fall asleep can put your newborn at risk, especially if you are holding or breastfeeding the child.
• Reduced reaction times: Responding more slowly to certain situations, such as driving or dropping an object, are possible indications you aren’t getting enough sleep.

The Office on Women’s Health – a subdivision of the U.S. Department of Health and Human Services – maintains a helpline for women experiencing postpartum depression and other mental health disorders. This number can be reached at 1-800-994-9662 between 9 am and 6 pm Eastern Standard Time, Monday to Friday.