Beyond the Baby Blues: How Postpartum Sleep Impacts Mental Health

The following is a guest post from sleep scientist and Co-Founder of Baby Sleep Science, Erin Flynn-Evans, PhD on this incredibly important topic for parent mental health.

The first weeks and months with a newborn are exciting and memorable, but getting to know your baby and learning how to parent can also be quite stressful. Newborns seem to sleep all the time, yet it takes a tremendous amount of time, effort, and energy to care for a new baby. Even experienced parents can get overwhelmed from time to time, but for some parents, the postpartum period can come with deeper issues in the form of postpartum depression (PPD) and anxiety (PPA). While these conditions affect mental health, they also intertwine with another aspect of well-being: sleep. In this blog, we'll delve into the relationship between postpartum depression, anxiety, and sleep, and provide you with recommendations to help you cope while navigating this challenging time.

The Science

Postpartum depression and anxiety are mental health disorders that can occur after childbirth, affecting approximately 10-20% of new mothers (Shorey et al. 2018, Liu et al. 2022) and around 10% of new fathers (Rao et al. 2020). While anyone can experience PPD and PPA, it is more common among people who have a history of depression, families with low socioeconomic status, and those with limited social support (Wang et al. 2021). Symptoms of PPD and PPA may include feelings of sadness, hopelessness, irritability, and difficulty bonding with your baby.

Sleep loss can exacerbate the symptoms of PPD and PPA, making everything feel harder. Most people need seven or more hours of sleep each night for optimal health and well-being (Watson et al. 2015). When sleep is persistently disrupted, mental health can suffer (Alvaro et al. 2013). Conversely, depression and anxiety can also lead to sleep disruption. As any new parent knows, sleep is often disrupted during the postpartum period due to the demands of caring for a baby. Babies require frequent feedings throughout the day and night to support their growth and development. They are also not born with a mature circadian rhythm and may take several weeks or months to develop a consolidated bout of sleep during the night (Wong et al. 2022). For parents, this means that sleep can become fragmented, with frequent awakenings to feed or tend to the baby's needs.

How do postpartum depression and anxiety link to sleep?

Many studies have found a significant relationship between sleep disturbance and postpartum depression and anxiety (Bhati and Richards 2015, Okun 2016; Posmontier et al. 2008). Poor sleep quality in the postpartum period has been consistently linked to the severity of depressive symptoms (Park et al., 2013). There is also a bidirectional relationship between sleep and postpartum mental disorders (Lawson et al. 2015). Put simply, this means poor sleep can exacerbate symptoms of PPD and PPA, while the presence of these disorders can further disrupt sleep patterns. In addition, the longer poor sleep persists, the longer depressive symptoms occur, with some new mothers still experiencing PPD and sleep disruption at 7 months (Lewis et al. 2018). 

On a positive note, improving sleep for parents has been shown to improve symptoms of PPD and PPA. There are a few different paths to better sleep during the postpartum period. Several studies have found that working to improve an infant’s sleep can improve maternal sleep quality, thereby reducing depressive and anxiety symptoms (Symon et al. 2012, Kempler et al. 2016). Similarly, other studies have found that helping mothers improve their sleep, without changing their baby’s sleep can also reduce PPD and PPA symptoms (Sharma et al. 2023). The takeaway here is that improving your sleep can reduce the severity of PPD and PPA.

What can you do if you are feeling more than occasional stress and anxiety and/or sleep disturbance after your baby is born?

Seek Professional Help

If sleep disturbances persist or exacerbate symptoms of PPD or PPA, seeking professional help is important. Your healthcare provider can help create personalized interventions to help you manage your symptoms.

Optimize Your Sleep Environment

New parents often spend a lot of time making sure that their baby’s nursery is optimized for sleep, but adults benefit from a great sleep environment too! Ensure you have comfortable bedding, make sure the room is dark (use blackout curtains if you need them), make sure it’s quiet (use white noise if needed), and a comfortable temperature. 

Establish a Sleep Routine for Your Baby and Yourself

Implementing a consistent bedtime routine signals to the body that it's time to wind down. This may involve activities such as bathing your baby, reading a book, doing a baby massage, or practicing relaxation techniques for both you and your baby.

Keep Your Baby Close

Sharing a room with your baby can make it easier to provide nighttime feedings. Reducing the distance that you have to travel to reach your baby can also help you fall asleep faster.

Divide the Night Between Parents

For two-parent households, it can be very helpful to split up nighttime parenting duties so that both parents have an opportunity for a predictable consolidated bout of sleep. In this situation, one parent might respond to the baby for night waking between 9 pm and 2 am, while the other parent might take the shift from 2 am until 7 am. If this isn’t possible, then it can be helpful for one parent to get up with the baby in the morning so that the parent responding overnight can get more sleep.

Work on Improving Your Baby’s Sleep

It is normal for newborns to wake up to eat overnight, but there are things that parents can do to accelerate the consolidation of nighttime sleep, such as maintaining a regular morning wake time and light exposure and keeping it dark at night. If a medically typical baby is waking frequently at age six months or older, then it is ok to do some sort of sleep training to help a baby fall learn to fall asleep quickly and stay asleep for longer stretches (Note that sleep training doesn’t just mean “cry it out.” There are many approaches to sleep training that involve staying nearby to provide constant support).

Conclusion

Navigating the complexities of postpartum depression, anxiety, and sleep can be challenging for new parents, but understanding the relationship between sleep and mental health is the first step in improving the symptoms of both conditions. 

References:

Shorey, S., Chee, C.Y.I., Ng, E.D., Chan, Y.H., San Tam, W.W. and Chong, Y.S., 2018. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of psychiatric research, 104, pp.235-248.

Rao, W.W., Zhu, X.M., Zong, Q.Q., Zhang, Q., Hall, B.J., Ungvari, G.S. and Xiang, Y.T., 2020. Prevalence of prenatal and postpartum depression in fathers: A comprehensive meta-analysis of observational surveys. Journal of affective disorders, 263, pp.491-499.

Liu, X., Wang, S. and Wang, G., 2022. Prevalence and risk factors of postpartum depression in women: A systematic review and meta‐analysis. Journal of clinical nursing, 31(19-20), pp.2665-2677.

Wang, Z., Liu, J., Shuai, H., Cai, Z., Fu, X., Liu, Y., Xiao, X., Zhang, W., Krabbendam, E., Liu, S. and Liu, Z., 2021. Mapping global prevalence of depression among postpartum women. Translational psychiatry, 11(1), p.543.

Wong, S.D., Wright Jr, K.P., Spencer, R.L., Vetter, C., Hicks, L.M., Jenni, O.G. and LeBourgeois, M.K., 2022. Development of the circadian system in early life: maternal and environmental factors. Journal of physiological anthropology, 41(1), p.22.

Consensus Conference Panel, Watson, N.F., Badr, M.S., Belenky, G., Bliwise, D.L., Buxton, O.M., Buysse, D., Dinges, D.F., Gangwisch, J., Grandner, M.A. and Kushida, C., 2015. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of Clinical Sleep Medicine, 11(6), pp.591-592.

Alvaro, P.K., Roberts, R.M. and Harris, J.K., 2013. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), pp.1059-1068.

Bhati, S., & Richards, K. (2015). A systematic review of the relationship between postpartum sleep disturbance and postpartum depression. Journal of Obstetric, Gynecologic & Neonatal Nursing, 44(3), 350-357.

Okun, M. L. (2016). Disturbed sleep and postpartum depression. Current Psychiatry Reports, 18, 1-7.

Posmontier, B. (2008). Sleep quality in women with and without postpartum depression. Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(6), 722-737.

Lewis, B.A., Gjerdingen, D., Schuver, K., Avery, M. and Marcus, B.H., 2018. The effect of sleep pattern changes on postpartum depressive symptoms. BMC women's health, 18, pp.1-7.

Park, E. M., Meltzer-Brody, S., & Stickgold, R. (2013). Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity. Archives of Women's Mental Health, 16, 539-547.

Lawson, A., Murphy, K. E., Sloan, E., Uleryk, E., & Dalfen, A. (2015). The relationship between sleep and postpartum mental disorders: A systematic review. Journal of Affective Disorders, 176, 65-77.

Sharma, V., Sharkey, K.M., Palagini, L., Mazmanian, D. and Thomson, M., 2023. Preventing recurrence of postpartum depression by regulating sleep. Expert Review of Neurotherapeutics, 23(8), pp.1-9.