Oh my gosh, is she breathing? I can’t tell if she’s breathing. Put your hand out to check….Okay, good, she’s breathing. But what if she stops? Don’t go to sleep. You better stay up just in case. Wait, is it too hot in here? It might be too hot. What if that makes her stop breathing? Better go turn the air conditioning on. Oh no, what was that sound?

As a mom with both perinatal and postpartum anxiety, my experience having a baby made me feel like I could never, ever let my guard down for a second.

I constantly and obsessively worried about everything that could go wrong with my baby. I even spent my entire pregnancy having nightmares about losing her and I’d wake up drenched in a cold sweat every single night.

Naturally, those worries only intensified after she was born and my inner monologue often fixated on making sure I stayed awake 24/7 to watch her. 

While many people have heard of postpartum depression, Postpartum Support International explains that there are actually an entire host of maternal mental health disorders that can affect pregnant and postpartum individuals.

Perinatal mood and anxiety disorders (PMADs) can encompass anything from postpartum depression to postpartum anxiety to more severe disorders like postpartum psychosis. 

Postpartum Support International also explains that up to 20% of people who have recently delivered a baby can experience increased anxiety and depression. Those numbers—and the sheer number of maternal mental health disorders that can arise—can be frightening, but at the root of all the different maternal mental health changes that can happen with parenting, there’s also one solution that can help with all of them: sleep. 

Does less sleep lead to postpartum depression?

Disrupted sleep plays a large role in both the development of and the exacerbation of postpartum depression (PPD).

According to the Sleep Foundation, sleep deprivation can make the symptoms of postpartum depression more severe and is even linked to serious complications, like suicidal ideations, in some people with PPD.

The organization also notes that women with poor sleep quality are three times more likely to experience postpartum depression than those who report quality sleep. 

That’s not to say that just having your sleep disrupted by a hungry baby will automatically lead to PPD, however. What’s more likely, doctors theorize, is that some of the severe hormonal fluctuations that happen in postpartum can affect both a woman’s sleep and increase the risk for PPD, creating a vicious cycle.

It may be possible that people who are more affected by extreme hormonal fluctuations are also more susceptible to developing PPD in the first place—but then those same hormone changes can also disrupt their sleep, making PPD worse. 

What are the symptoms of postpartum depression?

Dr. Chitra Akileswaran MD, MBA, a board-certified OB-GYN, and Cradlewise’s medical advisor, says, “If you’re having trouble moving through the day, feel like you want to hide under a rock, or can’t interact with loved ones, those would all be warning signs for a mood issue.”

Read Dr. Chitra’s insights on What your doctor doesn’t tell you about the postpartum period. Your healthcare provider can also give you screening tools like the Edinburgh Postpartum Depression Scale to get a sense of how you score.

The Office on Women’s Health explains that some emotional changes are normal in the first two weeks after giving birth. But if you are experiencing persistent feelings as outlined below after the first few weeks, you should call your doctor to be assessed for PPD:

• Sadness, hopelessness, or overwhelm
• Crying in increased amounts and for reasons you’re not sure about
• Any thoughts of hurting yourself or your baby
• Not feeling like you can bond with your baby
• Eating too much or not enough
• Sleep disruptions
• Memory problems
• Not being able to make decisions 
• Loss of interest in things that you normally enjoy
• Isolating yourself

What are the characteristics of sleep deprivation vs. postpartum depression?

Some symptoms of sleep deprivation can mimic PPD, such as feeling foggy when you’re awake, distracted, or forgetful.

However, the primary way to tell the difference between PPD and sleep deprivation is how long your feelings last. If you feel completely like yourself after a good night of sleep, it’s possible you had temporary impacts from sleep deprivation.

But feelings of hopelessness, irritability, anxiety or not feeling like yourself that last, even after you’ve caught up on sleep, are more likely to be symptoms of a possible perinatal mood disorder. 

How can you sleep better with postpartum depression?

If your doctor diagnoses you with a PMAD, your first priority should be treating the disorder.

Remember, in order to raise your baby the best way you can, you need to be the healthiest version of yourself too. The good news is that in addressing your PMAD, you will often improve your sleep, too. Part of the problem with maternal mental health mood disorders is that even when your baby is sleeping, you often are not, so treating your disorder will help improve your sleep. 

Treatment for PMAD will depend on what type of disorder you have, how severe your symptoms are, and if you have any other medical conditions as well.

Your doctor can either work with you to devise an individual treatment plan or refer you to a mental health practitioner who has more experience in working with maternal mental health disorders. In general, treatment for PPD can include an antidepressant or anti-anxiety medication (like an SSRI), counseling or therapy, or a combination of the two. 

Alternative therapies such as exercise, acupuncture, nature therapy, and even journaling can all help treat PPD as well—and help you sleep better. 

How to set your baby (and you) up for sleep success

After you have addressed your PMAD with treatment—and keep in mind, it can take weeks or even months for treatment to work, especially if you’re using medication—it’s a good idea to look over both you and your baby’s new sleep habits to see if anything can be improved.

After all, you’re both new to learning how to sleep in your new roles, so it just makes sense that a tune-up could be helpful. 

The Sleep Foundation recommends the following tips for ensuring sleep success for new parents and babies:

• Assess your sleep environment. Make sure your sleep environment is calming, with light-blocking measures, and no screens that could impact sleep. 
• Avoid screens two hours before bedtime.
• Avoid stimulants like caffeine in the afternoon hours or before you plan to sleep.
• Avoid alcohol, as it can disrupt sleep.
• Use a white noise machine or a fan in your sleep space.
• Get natural light first thing in the morning to help reset your circadian rhythm. 
• Exchange sleep with a partner if you have one, and if not, consider hiring a night doula or nurse to help you.
• Explore putting your baby on a sleep schedule. Not all babies will stick to a schedule and it may take some time, but a sleep schedule could help you both get more quality sleep.

Don’t forget, new technology can boost our mental state, even “supplementing the ‘village’ we once had,” said Dr. Chitra. “Most families don’t have live-in relatives for on-demand childcare, unlike other countries where there may be more multi-generational homes. Here, we’re left to our own devices—literally—so you need the devices that help you make it work.”

So whether you’re using Cradlewise, an okay-to-wake light, or feeding apps, technology can support you in your parenting journey.

The key thing to understand about sleep and maternal mental health is that the two are closely intertwined—much like all of parenting, right? But if you are experiencing symptoms of postpartum depression or anxiety, getting treatment for your own health is the first step to improving sleep.

Once your PMAD is treated, your sleep should improve too, which will help the whole family feel better. 

Sources:

1. Maternal mental health disorders. Postpartum Support International. “Perinatal Mental Health Disorders.“
2. Sleep deprivation and symptoms of postpartum depression. 2023. Sleep Foundation. “Sleep Deprivation and Postpartum Depression.“
3. Women’s poor sleep quality. 2011. MGH Center for Women’s Mental Health. “Postpartum Depression and Poor Sleep Quality Occur Together.“
4. Emotional changes after giving birth. Office on Women’s Health. “Postpartum depression.“
5. Alternative therapies for PPD. 2017. The University of Texas Southwestern Medical Center. “Treating postpartum depression with complementary or alternative medicine.“
6. Tips for ensuring sleep success. 2023. Sleep Foundation. “Postpartum Insomnia.“
7. How common is postpartum depression. 2019. March of Dimes. “Postpartum depression.“
8. Postpartum anxiety symptoms. Postpartum Support International. “Anxiety During Pregnancy & Postpartum.”