14 May 2015

WOMEN & SLEEP: Adventures in Sleep for the Pregnant Woman, Postpartum Edition

See Also:
Adventures in Sleep
for the Pregnant Woman, Part One:
The First Trimester

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Adventures in Sleep
for the Pregnant Woman, Part Two:
The Second Trimester

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Adventures in Sleep
for the Pregnant Woman, Part Three:
The Third Trimester
So you think you can sleep now that junior is born?

Not likely. Three things can prevent a new mama from enjoying sound sleep for quite a few more months:

1. Nighttime Awakenings
2. Postpartum Discomfort
3. Postpartum Insomnia

Let's take a closer look.

Baby needs nursing at 2 am. Most new parents "get" that, on an intellectual level. However, on a deeper level, they may grossly underestimate just how much these nighttime feedings and snuggles will cut into their sleep time and how long this period of sleeplessness can last.

Newborn babies may take anywhere from three to nine months to settle into their sleep architecture. Most people aren't prepared to endure yet enough nine months of poor sleep after having just gone through nine months previously dealing with sleep problems.

Getting insufficient sleep does take its toll on new parents, both physically and emotionally. It's important to take this sleep deprivation seriously; while making lighthearted jokes about not getting enough sleep is common in our culture, the fact is that anyone with ongoing sleep deprivation is setting themselves up for all kinds of health and safety issues.

The National Sleep Foundation points to the following as the risks one assumes by not getting enough sleep:

1. Increased risk of car accidents caused by impaired judgment or drowsy driving
2. Increase in body mass index — after the baby, an increased appetite can be due to the needs of nursing, which uses calories, but if you are continuing to eat more calories than you burn and feel hungry all the time despite adequate calories, this can be caused by hormonal imbalances due to sleep deprivation
3. Increased risk for cardiovascular problems and for developing diabetes
4. Increased risk for long-term depression, substance abuse and mood disorders
5. Cognitive declines and reduced ability to manage executive functions like decision-making
6. Higher risk for illness

Solutions? Obviously the answer is to get your sleep, but how to achieve this may be tricky, especially for single, working mother households. But napping whenever possible is always a good option (especially while baby is sleeping). Hiring someone like a doula to help with nighttime awakenings or to be there for you and baby in the afternoon while you nap can make all the difference. Your spouse, best friend, or relative can also be good for handling feedings and simple babysitting so you can get the rest you need.

If you are at work, ask for napping opportunities during the day while you get through this stage of your new family life.

Finally, while the baby monitor has become the ubiquitous tool for 21st century parents who wish to check in on their babies, it can also be a trouble-some sleep thief. A mother can hear a crying baby from far, far away; it's hard-wired in her brain to do so, and some recent scientific studies back this up. If you are nearing the stage when junior may be just crying for comfort but not for hunger, it may be time to turn off the monitor video and sound and just get some sleep, perhaps moving toward the "crying it out" stage that many pediatricians advocate for teaching infants self-soothing. 

Postpartum discomfort mirrors many of the same prenatal problems a mother encountered prior to labor and delivery. There's the insistence on continued reflux, nighttime leg cramps, hormone changes that sweep over you and leave you feeling nauseated, tenderness in the breasts or the pelvic region due to surgical procedures or natural tearing from delivery. You may be weaning yourself off painkillers after a major abdominal surgery, or you may be passing large blood clots because you are trying to do too much in the early weeks after childbirth.

Solutions? In a nutshell, take care of your aches and pains with the help of your physician, and practice good sleep hygiene. Treat yourself to warm baths, even warm milk at bedtime. Eat healthy foods, try to exercise at a level that is appropriate to your postnatal condition (mothers experiencing Cesarean births will have different requirements from those who delivered vaginally), practice relaxation techniques such as yogic breathing or listening to soft music. All efforts to achieve relaxation also tend to assuage aches and pains and give you a better sense of overall well-being. Keep in mind that the more sleep you get, the less you will be bothered by transitory or residual pain in the postnatal term. Pain perception increases when sleep is insufficient.


Postpartum Insomnia may occur along the spectrum of Postpartum Depression (PPD) or the so-called "baby blues." It's quite common to experience emotional shifts following childbirth. Hormone changes lead to mood swings, fatigue and problems sleeping at night. Insufficient sleep then leads to memory problems, brain "fog," emotional sensitivity, even the desire to stop being a new mother. Whether the insomnia following childbirth is caused by PPD, or whether the PPD is caused by insufficient sleep is less important: what's critical here is that it can be serious and needs treatment.

Solutions? Get support at home for tasks that can be handed off to others (like spouses, relatives, neighbors, friends, or for-hire doula services). Use that time to sleep and recharge yourself. Take a morning off; even a couple of hours to yourself can be immensely rejuvenating. If depressive symptoms continue, don't hesitate to seek help from your doctor. PPD is not a sign of weakness or something to be ashamed of; much of it is caused by unstable hormone peaks and valleys and can be addressed with therapy, medication, or a combination of both. Your baby needs you to be a whole mother, and that includes emotional stability in the definition of "whole."

Final thought:
Getting good sleep isn't a luxury for the few. It shouldn't be a checkmark on one's bucket list of things you'd like to encounter some day, but as an all-out priority in your life. Not sleeping compromises both the health of you and your child. It is worth doing everything in your power to ensure you relieve yourself of the problems that sleep deprivation can bring.