PND & Sleep

The cyclical relationship between postnatal depression and sleep deprivation

What is postnatal depression and its symptoms?

More than just the ‘baby blues’, postnatal depression constitutes feelings of hopelessness, overwhelming anxiety, and an inability to perform daily tasks, including the proper care of a newborn. Symptoms include some or all of the following:

• feeling sad, low in mood or tearful much of the time
• feeling agitated or irritable towards your partner, baby or other children
• loss of interest in the world around you and no longer enjoying things that used to give you pleasure (like you “cannot be bothered”)
• lack of energy and feeling tired all the time
• trouble sleeping at night – you may be awake even when your baby is sleeping
• feeling very sleepy during the day
• problems concentrating and making decisions
• loss of appetite or overeating (comfort eating)
• negative thoughts such as feeling you are not a good enough mother, you are unable to look after your baby or your baby does not love you
• feelings of guilt, hopelessness and self-blame
• feeling anxious that something bad may happen to your baby
• problems bonding with your baby, no sense of enjoyment in being with them

Feeling teary, down and a little anxious is completely normal post-birth, but these feelings usually pass after a couple of weeks. If symptoms last for more than a couple of weeks, it’s likely that you could be developing postnatal depression. It’s incredibly common, with 1 in 8 women suffering in the year after giving birth, but, no wonder, most likely to develop during the first 6 months when infant sleep is at its most fragmented.

While there are many contributing factors, poor sleep quality is now recognised as a significant cause of postnatal depression and anxiety. It can lead to issues with baby bonding, which can impact on a child’s development, so it’s vital for both Mum and baby that support and treatment is put in place.

Does sleep deprivation cause postnatal depression?

Sleep deprivation can start during pregnancy, with many women reporting lower sleep quality since before the birth of their child. Women who suffer from poor sleep during pregnancy are more likely to suffer from postnatal depression.

Fragmented sleep is normal, especially during the first 6 months when infant night time feedings are at their most frequent. The relationship between PND and lack of sleep is bidirectional, with each increasing the risk of each other.

Sleep interventions are a priority when suffering with PND in order to break the cycle and start improving the symptoms of each.

The best way to do this is to get help and support wherever possible, and maximise on sleep wherever you can including daytime napping. Let everything else go and put your sleep, and health, first. It is also important to understand how to help maximise your baby’s sleep too.

Sleep tips for mums and babies

Get a head start by prioritising sleep during pregnancy, especially if you are already considered high-risk for PND through other factors.

Practice good sleep hygiene for both of you. This can include:

• Having a fixed bedtime and morning wake up time – it can be tempting to sleep in till mid-morning, or stay up late watching tv waiting for the next feed, but it can disrupt your body clock and cause further sleep deprivation in the long run.
• Lighting is key – give you and your baby lots of access to light in the morning and throughout the day, contrasting with dimming the lights in the evening to start winding everyone down in readiness for sleep
• Follow a nightly routine – for your baby this can include, feeding, clean sleep suit, nappy change and white noise. Similar sleep cues can help for adults to, as well as brushing your teeth, and any relaxation techniques you find useful such as reading, scents, meditation etc.
• Limit electronics after dark – keep exposure to devices to a minimum once you’re in night time mode, and instead pass the time during night feeds with audio books and podcasts instead of watching tv or phone scrolling.
• Optimise your sleep environment – make sure your baby’s sleep space is safe, your own is comfortable, the room temperature is cool (around 18-20 degrees) and light is blocked out wherever possible.

Although babies wake frequently for feeds in the early months, and sleep consolidation is unlikely to happen before 4-6 months of age, you can still try to structure feeds to maximise sleep. Strategies such as frequent daytime with good-quality feeds (not snacking), evening cluster feeding and/or introducing a dream feed, and sticking to ‘sleepy feeds’ at night can all help with reducing sleep deprivation. From around 3-4 months, you can also start to think about sleep associations, and whether feeding and sleep has become habitual either at sleep onset, or through the night.

Identify and manage any other common baby sleep interferences such as giving remedies and baby massage for wind/gut issues, be aware of the symptoms and addressing reflux/allergies as early on as possible, and managing birth trauma through interventions such as cranial osteopathy.

Research suggests that protecting one 4-5 hour stretch of consolidated night time sleep is necessary and effective in improving risks of PND. Protecting this uninterrupted period of sleep can be achieved by parents taking shifts, or getting external help from a family member, friend or a professional such a night nanny or maternity nurse.

Keep all other sleep disturbances to a minimum to encourage maximum sleep in between feedings, such as blackout blinds, white noise to mask erroneous noises, keeping pets out of the bedroom and ensuring siblings sleep routines and boundaries are secured well ahead of the new baby arriving. The ‘off duty’ parent can use ear plus and/or sleep in a different room to ensure the best sleep quality.

It can also be useful to pass on necessary household tasks such as preparing food, cleaning of bottles/pumps, caregiving of other children etc., to another adult, or carry out these tasks while the baby is awake, allowing time in the evening to sleep as soon as the baby is settled.

Lastly, foster parent-child bonding as much as you can during the day, and keep your baby close at night to ensure your baby is building a secure attachment with you. Not only will this fill the the potential void created by PND, it also promotes sleep because a baby that feels safe, loved and secure will always sleep better!

Postnatal depression & CBT

Amy Langshaw (Cognitive behaviour therapist for parents at Herts CBT) recommends a few steps that can help support you through PND. 

The last thing you may feel like doing is talking to someone about how you feel but I recommend this as the first step with someone you feel comfortable with. This can be your partner, a family member, friend, health visitor.

We can often be overwhelmed with negative thoughts and behaviours that feed that low mood. If you experience negative thoughts, you can try reframing them to find a more balanced thought. Is there another way of seeing this situation? What would you say to a friend in the same situation? If I were not feeling this way, how would I view the situation? Talking with a therapist can also help you identify these and support you in finding more balance in your day.

Depression can cloud your outlook on the day so that you miss positives moments and successes. Try writing down any achievements you have made in the day, however small they may seem. For example, putting on a clean top, having a shower, making a cup of tea, taking a short walk.

Try making a daily plan of activities which can help bring some structure to your day. This can be any of the following:

• Self-care – essential although easier said than done when you have a new baby. By reaching out to others you can get support in getting a balanced heathy diet rather than reaching for the snacks, finding ways to rest and sleep when you can.
• Exercise is another essential step but we’re not talking about a 5K run. Start with small simple steps, gentle movement at home, or short walks, something you can gradually build on.
• Mix with other mums, either friends or join groups for more support, try not to be alone at this time. If groups seem daunting then support such as Home Start UK offer support in the home for two hours a week with visits from a Family volunteer.
• Planning activities you have previously enjoyed. You may need extra support in creating this time for you so keep those expectations realistic. Such as a cup of tea and listening to the radio, having a dance around the kitchen, reading a favourite book, doing something creative.

If you would like to know how Cognitive Behaviour Therapy can help you in your parenting role, then please contact me to arrange a FREE discovery call.

Email: amy_langshaw@outlook.com

Instagram: @Amy.Langshaw

Linked in: Amy Langshaw

When to get help

If you think you, or someone you care about is suffering from postnatal depression, please remember that PND is an illness that needs addressing just like any other. It is vital to talk to a trusted friend or family member, schedule a GP appointment, or seek the support of mental health charities such as Mind or PANDAS.

Here at HushaBoo we can also offer sleep advice, or some nocturnal respite through support from one of our night nannies. Please get in touch for a free 15 minute assessment call to discuss how we can help. 

References

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2020, May). Depression among women. Centers for Disease Control and Prevention.

https://www.cdc.gov/reproductivehealth/depression/index.htm#Postpartum

Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. (2009). Sleep and depression in postpartum women: a population-based study. Sleep. 32(7):847-55.

Hiscock, H, Bayer JK, Hampton A, Ukoumunne OC and Wake M (2008). Long-term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial. Pediatrics. September122 (3) e621-e627.

Iranpour S, Kheirabadi GR, Esmaillzadeh A, Heidari-Beni M, Maracy MR (2016). Association between sleep quality and postpartum depression. J Res Med Sci. 7;21:110.

Okun M. L. (2015). Sleep and postpartum depression. Current opinion in psychiatry, 28(6), 490–496.

http://journals.lww.com/00001504-201511000-00017

Leistikow, N. & Smith, M. H. (2024). The role of sleep protection in preventing and treating postpartum depression. Seminars in Perinatology, 48(6)

https://doi.org/10.1016/j.semperi.2024.151947

McEvoy, K. M., Rayapati, D., Washington Cole, K. O., Erdly, C., Payne, J. L., & Osborne, L. M. (2019). Poor postpartum sleep quality predicts subsequent postpartum depressive symptoms in a high-risk sample. Journal of Clinical Sleep Medicine, 15(9), 1303–1310.

https://pubmed.ncbi.nlm.nih.gov/31538601/

Sweet, L., Arjyal, S., Kuller, J. A., & Dotters-Katz, S. (2020). A Review of Sleep Architecture and Sleep Changes During Pregnancy. Obstetrical & gynecological survey, 75(4), 253–262.

https://journals.lww.com/10.1097/OGX.0000000000000770

Tomfohr, L. M., Buliga, E., Letourneau, N. L., Campbell, T. S., & Giesbrecht, G. F. (2015). Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period. Sleep, 38(8), 1237–1245.

https://pubmed.ncbi.nlm.nih.gov/25845691/