By improving infant sleep, maternal mental health may find a way forward
By Sharon Brandwein
Before we continue, we feel it’s important to remind mothers that postpartum depression is quite common, and you are certainly not alone. If you’re feeling sad, fearful, unmotivated, or having trouble sleeping, we urge you to reach out to your doctor or a loved one who can help you get the help you need.
Sleep is restorative and essential. Without it, we would be unprepared to handle the mundane workings of our lives and ill-equipped to face its many challenges.
Unfortunately, for new parents, sleep deprivation is often the rule, not the exception, and disproportionately so for new mothers as they often bear the brunt of active nocturnal care.
Over time, prolonged sleep deficits can exact a heavy toll on new parents. And when the price of long-term sleep deficits leads to depression and anxiety, everyone around them will feel the ripple effect.
Luckily, the news is not all gloom and doom, as research shows that by improving infant sleep, maternal mental health can find a way forward.
Why is sleep so important?
Our bodies and brains require plenty of sleep to perform at their peak. On the surface, we’re closing our eyes for hours at a time and waking up refreshed and ready for another day.
Behind the scenes, however, sleep goes far beyond restoring our energy. When we sleep, our bodies are hard at work in active repair mode, and various biological processes occur.
While we sleep, our bodies and our brain are busy:
- Forming memories
- Processing and sorting information from our day
- Releasing hormones needed for growth and repair as well as crucial proteins needed to fight illness and disease effectively
How parenthood changes sleep
Research shows that anywhere from 28% to 57% of infants six and 12 months old do not sleep through the night. Meanwhile, according to the CDC, adults should get anywhere between seven to nine hours of ZZZs per night. And while that may be possible in most cases, any new parent can tell you that getting that full allotment is just a pipe dream. And there’s the rub.
The results of one sleep study from 2019—featuring over 2,000 female and 2,000 male participants, respectively—indicate that new parents experience an all-time low in both satisfaction and duration of sleep during the first three months following childbirth.
Taking a closer look at the data from that same study also revealed that infant sleep patterns have a more profound effect on mothers. While fathers lost an average of 13 minutes of sleep per night, mothers lost over an hour of sleep each night.
Jackie Kamrowski, Certified Pediatric Sleep Consultant and founder of Little Dandelion Sleep Consulting, illuminates the issue further. “Mothers are the primary caregiver as they often nurse [the] baby,” she says. While fathers can prepare a bottle of pumped breast milk or formula, they often work, resulting in them usually taking the “baby shift” at the start of the night. The mother often takes the “baby shift” for most of the night wakings (as they usually get some maternity leave).”
Not that this is a battle of the sexes, but Kamrowski goes on to say that “babies in the newborn phase will soothe faster with mom over dad as they already know mom from being in her womb.”
Furthermore, the adverse effects on parental sleep are more pronounced in first-time parents than with experienced parents and similarly more pronounced in breastfeeding mothers compared with bottle-feeding mothers.
Did you know?
If that weren’t enough to keep parents up at night, here’s another eye-opener. Parents don’t reach pre-pregnancy sleep satisfaction and duration until around six years after the birth of their first child. 😲
When does it start to get better?
Unfortunately, many new parents will find that sleep only begins to normalize somewhere around three to six months postpartum. But while that may feel like a light at the end of the tunnel, it can feel like forever when you’re dealing with chronic sleep deprivation.
Not surprisingly, this coincides with the time that their babies begin to produce melatonin. Also called the sleep hormone, melatonin is mainly responsible for our sleep-wake cycle. It’s a prerequisite to falling asleep.
With their newfound ability to distinguish between day and night, babies will often sleep for longer periods. This undoubtedly gives parents a much-needed (and well-deserved) break.
It’s also worth noting that three to six months is just a rough estimate and every baby is different. Don’t worry too much if your baby doesn’t follow this timeline to a tee.
The factors influencing fatigue of postpartum mamas
New parents may both struggle with their baby’s erratic sleep patterns. But there are a few considerations at play that tend to tip the balance for mothers.
For starters, hormonal changes compound the mother’s lack of sleep. Some studies show that a drop in progesterone—a hormone that plays a key role in maintaining the early stages of pregnancy, and one that improves mood and sleep—postpartum can alter her REM sleep and her mood. (REM sleep is the deepest, most restorative stage of sleep.)
Other studies showed that the decrease in postpartum REM sleep and mood was more deeply correlated to increased wake times than it was to hormonal changes. Either way, when significant drops in estrogen and progesterone levels are coupled with erratic infant sleep patterns, that could be a recipe for disaster as far as mama’s sleep is concerned.
If all of the above weren’t enough, mothers also tend to bear the brunt of active nocturnal care; those who breastfeed will likely experience more significant changes in their sleep due to more frequent wakings of their infant.
And there’s plenty of research to support the fact that during the first six months postpartum, it’s the mothers who experience a significant increase in wake after sleep onset (or interrupted sleep) and a palpable decrease in sleep efficiency. More often than not, mothers can expect fatigue and lack of energy to stick around for a few months.
Recognize the signs of PPD
It should come as no surprise that infant sleep problems are directly linked to maternal mental health, and poor sleep is the tie that binds them. Postnatal depression is moderate to severe depression in mothers that typically occurs within three months of giving birth. It is estimated that as much as 13% of women experience PPD.
Symptoms of postpartum depression include:
- Excessive worry
- Feeling sad for long periods
- A lack of desire to do things you once loved
- Lack of motivation
- Difficulty falling asleep
- Difficulty getting out of bed
- Irritability, anger, rage
- Fear of being left alone with your baby
“[A] lack of sleep is difficult for most people but extremely hard after having a baby, Kamrowski says. “Significant hormonal changes, physical and emotional exhaustion and sleep deprivation combined can all result in postpartum depression or postpartum anxiety.”
To further illustrate this point, multiple community-based studies have shown a direct correlation between infant sleep problems and maternal depression. While one study clearly shows the link between the two, another study showed that the persistence of infant sleep problems could be harmful to both mother and child over the long term.
Specifically, if sleep issues persist and follow the child into the preschool years, the child is more likely to have behavioral problems, and the mother may have higher maternal depression scores.
It’s worth noting that sleep issues and depression often run in circular patterns. Poor sleep triggers depression and vice versa. However, this particular study by Hiscock and Wake showed that maternal depressive symptoms resulted from infant sleep problems rather than the cause.
Infant sleep and maternal depression are bidirectional
While it’s clear that infant sleep can affect maternal mental health, it’s important to note that infant sleep and maternal depression have a bidirectional relationship.
This means that while frequent night wakings leave the mother vulnerable to depression, maternal depression is associated with sleep disturbances in early infancy. What’s more, sleep issues for infants can continue through age three.
How bad is long-term sleep deprivation for new parents?
The reality of having a newborn in the house is not just that parents lose minutes or hours of precious sleep. It’s also that parents often experience lower quality sleep. Whatever little shut-eye they get is likely to be entirely out of sync with their body’s circadian rhythm.
Did you know?
When parents (or anyone for that matter) only sleeps in short stretches like one or two hours at a time, there’s no way they can ever make it into REM sleep—the deepest, most restorative stage of sleep.
As we noted earlier, new parents can expect their sleep to normalize somewhere around the three to the six-month mark. But while that may feel like a light at the end of the tunnel, it can feel like forever when you’re dealing with chronic sleep deprivation.
Over the short term, sleep deprivation can not only lead to irritability and a short fuse, but it can also affect your mood, judgment, and cognition. Over the long term, sleep deprivation can lead to serious mental health issues such as depression, anxiety, and psychosis. Physical health issues include obesity, diabetes, and cardiovascular disease.
Common signs of sleep deprivation
- Daytime fatigue
- Excessive sleepiness
- Changes in mood or behavior
- Weight gain
- Cognitive impairment
- Poor memory function
Sleep deprivation and parental burnout
Burnout is a stage of physical, emotional, and mental exhaustion. From that definition alone, it’s easy to see how infant sleep patterns can lead to parental burnout.
In addition to high stress levels, sleep-deprived parents are also likely to be more irritable and unprepared for dealing with the physical and emotional demands that often come with newborns and babies.
Kamrowski notes, “It’s really difficult to take care of yourself when you’re sleep-deprived and even harder to take care of a baby. When we don’t have enough sleep, we have a hard time controlling our emotions, which can have a big impact on our mental health.”
Sleep intervention to improve maternal mental health
Infant sleep problems and postnatal depression are certainly not uncommon. But there is some good news. There’s growing evidence supporting the theory that parents can turn the tide regarding maternal mental health by improving their infant’s sleep.
One study conducted by Huckleberry Labs found that sleep interventions effectively moved the needle for parents with non-normal levels of depression, anxiety, and stress.
The findings were as follows:
- 77.78% moved from non-normal levels of depression to within normal ranges
- 88.89% moved from a non-normal level of anxiety into the normal range
- 87.5% moved from non-normal levels of stress into the normal range
How to help your baby sleep better
While Huckleberry’s research was largely focused on its client base and its specific AI-based solutions, there is something to be gleaned here—sleep intervention for infants ultimately led to a decrease in infant sleep problems. And, by extension, a reduction in maternal depression.
Outside intervention, however, is not the only way forward; parents can do plenty to help their baby sleep better and longer, And it might be as simple as a few simple tweaks to their sleep routines. Here are some interventions you can try on your own.
1. Create a solid bedtime routine early on and stick to it
Studies show that consistent bedtime routines promote longer sleep duration and better quality sleep. Think about activities like dimming the lights, giving your baby a warm bath before bedtime, and playing some soothing music. Ideally, begin winding down before your baby is overtired.
2. Keep sleep and wake times consistent
Consistent sleep and wake times are among the most important things we can do to regulate our body’s internal clock or circadian rhythm, and babies are no different. Once your baby hits the three-month mark where they begin producing melatonin, it’s important to capitalize on that process and boost it by keeping your baby on a consistent sleep schedule.
3. Put your baby down when they are drowsy but still awake
Putting your baby in their bed while drowsy but still awake helps reinforce the connection between their bed and sleep, so make this a part of their bedtime routine. Keep in mind to always place your little one on their back with no toys or blankets around them.
4. Keep things calm and limit your interaction
When your baby wakes up throughout the night, keeping things low-key is important Whether you’re changing a diaper or offering a nighttime feeding, try to use dim lights, hushed tones, and a calm approach. This will reinforce that it is time to sleep, not time to play.
How to prioritize your mental health as a parent
While new parents must focus on the health and well-being of their newborns, it’s incredibly important to keep an eye on your own mental health and well-being. Here are a few tips for prioritizing your postpartum mental health.
1. Create a maternal wellness plan
Maternal wellness is all about taking care of yourself and your baby. But when your baby needs you 24/7 and things like schedules and sleep go topsy-turvy, it can be challenging to prioritize your own mental health.
But, you can get ahead of your mental health by creating a maternal wellness plan before your child’s birth. Doing so may be as simple as writing down your postpartum priorities and desires and communicating them with your partner or a small group of loved ones. These folks can help you keep things on track.
2. Set realistic expectations
Every parent has an idealized version of how things will play out once they bring their new baby home. In a perfect world, everyone sleeps through the night, your baby has an even temperament, and you and your partner can resume your life right where they left off. In reality, babies are unlikely to sleep through the night, the focus is squarely on them, and nothing is as it used to be.
For that reason, the best thing new parents can do is to set realistic expectations. If you approach the situation knowing that you’re going to get less sleep, fewer showers, and things will feel upside down for a while, it will likely make things easier for everyone. It’s important to realize that this is the state of affairs for every new parent (you’re not alone), and this too shall pass.
3. Ask your partner to be your PPD spotter
More often than not, when someone is in the throes of depression or anxiety, it’s hard for them to see the forest for the trees. When you’re on the inside, it’s easy to push down your feelings while you wait for a better tomorrow. However, someone on the outside looking in can more easily spot those signs and red flags.
So before the arrival of your little one, you may want to talk to your partner and enlist their help as a PPD spotter of sorts. (This could even be a part of your maternal wellness plan). While it’s important that your partner remains vigilant, it may be a good idea to have a plan to navigate the issue should it arise.
4. Seek professional guidance if necessary
If you’re experiencing any symptoms of anxiety or depression, please seek help immediately and speak to your healthcare provider. You can also call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP for support.
The bottom line
Over time, infant sleep issues can lead to parental burnout and maternal depression. The good news is researchers and pediatricians intimately familiar with the unique challenges new parents (and specifically, new mothers) face have made great strides toward addressing these issues. If this one study shows that we can improve maternal mental health by improving infant sleep, there’s hope on the horizon.
- How Sleep Works. Sleep.org.
- Uninterrupted Infant Sleep and Maternal Mood. Pubmed. 2018. Uninterrupted Infant Sleep, Development, and Maternal Mood
- Mother’s progesterone postpartum can alter REM sleep. Academic Oup. 2000. REM Sleep and Mood State in Childbearing Women: Sleepy or Weepy?
- Drops in estrogen and progesterone levels. Pubmed. 2015. Sleep and Women’s Health
- Breastfed babies wake more frequently. Pubmed. 2013. Breastfeeding and infant sleep patterns: an Australian population study
- Thirteen percent of women experience postpartum depression. Pubmed. 2001. Predictors of postpartum depression: an update
- Link between infant sleep problems and maternal depression. Pubmed. 2001. Infant sleep problems and postnatal depression: a community-based study
- Long-term effect of infant sleep problems. Pubmed. 2003. Outcomes of infant sleep problems: a longitudinal study of sleep, behavior, and maternal well-being
- Maternal depressive symptoms were a result of infant sleep problems. Pubmed. 2003. Outcomes of infant sleep problems: a longitudinal study of sleep, behavior, and maternal well-being
- Infant sleep and maternal depression have a bidirectional relationship. NIH. 2014. Eye of the beholder? Maternal mental health and the quality of infant sleep
- Physical health issues from sleep deprivation. NIH. Sleep Deprivation and Deficiency
- Postnatal depression can impair cognitive development. NIH. 1997. Effects of postnatal depression on infant development
- Behavioral intervention for infant sleep reduced maternal depression. NIH. 2002. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood