My baby is sleeping, why can’t I? – 5 culprits of postpartum insomnia

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It’s 11pm, the house is quiet, my partner is snoring, and the baby is….ASLEEP! Now to just drift off….hmmm why do I suddenly feel so awake? What time is it? Drat it’s 11:45pm now. I really need to get some sleep before the little chomper is hungry again. Ok focus on deep, steady breaths. Don’t think about anything. I wonder how the rest of tonight will be. Maybe she’ll actually sleep. Maybe she’s already awake. I should check on her. Nope sleeping. Phew. Gah how is it 12:17am already? If I don’t fall asleep now, I’m doomed to only 3 hours if I’m lucky. Ugh why am I thinking about that? All that’s required of me right this moment is to sleep…. I wonder where the communication breakdown is in my brain… Yikes it’s 1am! Well now it’s pointless to fall asleep since I’m just going to be woken in 20 minutes. But 20-minute catnaps are sometimes super refreshing right? I just have to calm my brain and fall…. (waaahhhh; baby crying in the distance)… Shit. Well at least there are still a few hours until morning.

Does any of this sound familiar? (Ok maybe I’m the only one nerdy enough to actually think about why my brain’s communication system isn’t working). I hate to say it, but for me this internal dialogue went on for MONTHS. In the small intervals of time when my second baby actually did sleep significant stretches at night, I would just lie awake and…. think about why I wasn’t sleeping. Begging, craving, demanding myself to just fall asleep. Of course to no avail. I could not believe that in such a sleep deprived state I still couldn’t muster even an hour of peaceful slumber. It frustrated me to no end. And the more I worried about how little sleep I was getting, the less sleep I got.

A Rite of Passage

It seems to be a rite of passage that new moms are walking zombies for the first few months of a new baby. It is not surprising that your sleep is seriously disturbed, since your little one needs to feed every 2 to 4 hours around the clock.

As a result, it is so easy to chalk your extreme fatigue up to just being part of the new mom package. This too shall pass. But, like with many other personal hygiene matters that tend to slip under the radar with a new baby in the picture, moms tend to put on a brave face and completely disregard their own wellbeing during this postpartum period. This is not advisable considering the numerous factors other than a hungry baby that may be contributing to your highly disrupted sleep.

Factors such as:

Iron Deficiency

The iron demands of pregnancy, blood loss during delivery, infections that often occur perinatally (endometritis, UTIs, mastitis), and thyroid dysfunction, can all leave new moms in an anemic state. The sluggish feeling of iron deficiency can all too easily be passed off for “I just haven’t slept well the past few nights” during the early postpartum period. But what it can equate to is a lack of energy to “burn off” during the day and therefore ill-timed build of up sleep debt. Or, more frequent naps during the day or an earlier bedtime/wake time, and thus a disruption of your natural circadian rhythm.

If you suspect your iron might be low, it might be worth having your levels checked and looking into a supplement – such an easy boost in energy.

Hormone Changes

Following delivery of the placenta, new moms experience a rapid and significant drop in progesterone and estrogen levels, and accompanying increases in oxytocin and prolactin. Prolactin secretion also fluctuates markedly with lactation. And melatonin (an important sleep-wake regulator) release is altered, probably due to nighttime light exposure during infant care and reduced daytime light from all that daytime napping (ha!). All of these hormones – as well as growth hormone, cortisol, and thyroid-stimulating hormone – are mediated through a set circadian secretion, just like sleep.

But with such notable changes in hormone levels following the birth of a baby, it is no wonder that sleep timing and quality for mom can be greatly impacted.

Altered circadian rhythm

Sleep timing is optimal when your homeostatic sleep drive matches your circadian sleep rhythm. What this really means is that you will get the best sleep if you are noticeably tired at approximately the same time every day/night. But when you have a new baby, your homeostatic drive to sleep gets put on the back burner. Your circadian rhythm also experiences many disruptions as a result of frequent night wakings and (hopefully) regular daytime naps. And/or a ridiculously early bedtime in an attempt to make up at least some lost sleep.

What this equates to is that when you do sleep, the restorative quality of that rest is diminished. You are intrinsically misaligned (nice, huh?).

Anxiety

Particularly for first time mothers, anxiety can be high in the first weeks and months with a newborn. Fear for the baby’s safety, worries and challenges surrounding feeding, re-identifying personally in the “new mom” role – all of these adjustments can lead to increased cortisol secretion and resulting feelings of anxiety postpartum. And anxiety and sleep simply don’t mix.

Changes in sleep architecture

A few studies have actually revealed that postpartum moms experience less stage 1 and 2 NREM sleep and more stage 3 NREM and REM sleep overall. These changes appear to be mediated by the hormone prolactin and may be a response to the sleep debt that accrues rapidly during the postpartum period.

It may seem, then, that everything is trying to weasel its way between the relationship you have with your pillow. And almost all the resources out there focus on improving your sleep by improving your infant’s (this site included). But in many cases, focusing on you is, quite literally, half the battle.

Here are some sleep-positive tips for your postpartum self:

A calm and soothing pre-sleep routine

Do I sound like a broken record? I keep preaching this as the most important piece of the infant sleep puzzle. But it works in our kids for good reason. Winding down from your day, keeping things consistent, and sticking to a fairly regular schedule all work to cue your brain that sleep is soon to come.

Aim to go to bed at the same time each night – I know, not easy with the unpredictability of a newborn; this includes staying up to your regular bedtime even if you’re absolutely bagged. This will help to entrain your circadian rhythm.

And about 30 minutes before climbing into bed, go through the same sequences that prep yourself for a long and restful slumber (even if you know that you will soon be awoken). Have a warm drink, brush your teeth, get into pyjamas, read a book – anything that signals a calm finish to your day.

Oh and turn off the electronics. They are highly stimulating for your brain and also emit light (particularly blue light) that disrupts your circadian control centres.

Magnesium

This one was a surprise to me, but a significant proportion of the population is low on magnesium. Magnesium has far reaching effects throughout your body (in fact, it is used throughout the body for regular cellular function).

But as far as sleep goes, magnesium helps prepare your body and mind to relax. It does so by binding to various neurotransmitters and their receptors in the brain, including the inhibitory GABA receptors that signal neural networks to reduce their activity. It also regulates melatonin, that pivotal hormone in your sleep-wake cycles.

Magnesium is not directly required to make you fall asleep, but without it, your body and your brain cannot get into the restful state necessary for you to make the transition to sleep.

As a bonus, it also appears to improve sleep quality by calming the nervous system. How to get more magnesium? Eat food rich in the mineral, such as whole wheat, spinach, quinoa, nuts, black beans, edamame, tofu, and sesame seeds. And of course you can get magnesium supplements from any local health store.

Cognitive Behavioural Therapy for Insomnia (CBT-I)

Since so much of insomnia centres around a state of stress/anxiety (whether it be stress at work, or a big upcoming deadline, the heightened arousal you experience for your baby’s next waking, or simply the anxiety you feel as you watch the hours of the nighttime clock dwindle, meaning less and less sleep for you), the first line of treatment can often involve changing your mindset/patterns of thought.

CBT-I is a structured program for replacing thoughts or worries that might be keeping you up at night with habits that are going to help you nod off. It also targets your sleep hygiene to ensure you are not contributing to your own sleep loss throughout your daily activities (by drinking too much caffeine, for example, or eating too late in the evening). In this way, CBT-I treats the root of the problem, not just the symptoms.

Hypnosis, yoga nidra & deep breathing techniques

This is an extension of CBT-I; a way to replace your racing thoughts with a calm and sleep inducing relaxation. I have used all of these with varying degrees of success.

Hypnosis – particularly directed at pre- or peri-natal women – was highly beneficial at providing the cues to calm my mind and get back to a restful state with each waking. In my experience, it did not make me actually fall asleep, but was relaxing and empowering.

Yoga nidra is an incredible directed relaxation meditation, usually lasting about 20 to 30 minutes, and helps you to connect with every part of your body to let go of tension and breath into sleep. You can find lots of options online (I personally love this one) – choose the voice you like best!

Deep breathing techniques not only tap into your parasympathetic nervous system, but also give you something to focus on if you find it difficult to settle a racing mind. I find that adding a counting component – either counting out your inhalation, holding at the top, and exhalation, or, say, counting backward from 100 – helps me really settle into my breath.

Essential oils

A diffuser filling the room with some of your fave calming scents can work wonders for relaxation. Lavender is a particular powerhouse in the sleep department.

Medications

If severe, it may be recommended that you take a medical sleep aid to combat postpartum insomnia. As it is possible to become quite dependent on these aids, it is important that you speak to your health care provider before taking this route.

My postpartum insomnia got substantially better after the first six months of my daughter’s life. It still rears its ugly head pretty much whenever I attempt to sleep in a new place; however, I find that earplugs and white noise (a weird combo, I know), as well as some of the meditative techniques mentioned above can usually give me the little kick into dream land that I need.

What’s important to recognize is that postpartum insomnia should not be dismissed completely as an inevitable part of new mom-hood. Insomnia and sleep deprivation are significant risk factors for developing depressive symptoms or postpartum depression (PPD). And PPD increases sleep disturbances, thus sending you into a powerfully reinforcing spiral. But more on that in a future post….

So don’t just write yourself off. Don’t just suck it up. Take care of you. You and your baby will thank you for it.

Links:

Okun ML. (2015) Sleep and postpartum depression. Current Opinion in Psychiatry 28: 490-496.

Stremler R et al. (2017). Postpartum period and early motherhood. In: MH Kryger, T Roth, and WC Dement (eds.). Principles and Practices of Sleep Medicine 6th Edition, Elsevier Health Science, pp. 1547-1552 (And references therein.)

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