What are the chances that two psychiatrists who work together here at Playa Vista Mental Health and both specialize in women’s mental health have babies within a few weeks of one another? We decided we couldn’t miss out on this opportunity to discuss something that is on both of our minds: sleep!
Sleep Difficulty
There are a lot of emotions that come with bringing home a new baby and so many worries that parents may have. All of these feelings can be magnified when the baby struggles to sleep for an uninterrupted period, leading to sleep-deprived parents. Most people feel that they need at least four hours of consecutive sleep in order to feel rested in the morning. As psychiatrists, we know that lack of sleep can contribute to and/or worsen postpartum depression (PPD) and anxiety.
What is PPD?
Postpartum depression is defined as a depressive episode with an onset in pregnancy or within four weeks of delivery. The criteria for a depressive episode states that five of the following nine symptoms must be present in a two week period and must represent a change in previous functioning as well as present daily or nearly everyday: depressed mood, loss of interest or pleasure, change in weight or appetite, insomnia or hypersomnia, psychomotor retardation or agitation, loss of energy or fatigue, worthlessness or guilt, impaired concentration or indecisiveness, and/or recurrent thoughts of death or suicidal ideation or attempt.
Women with postpartum anxiety often have PPD as well, although there can be times where women can present with symptoms of generalized anxiety disorder (GAD) or obsessive compulsive disorder (OCD) alone.
Sleep and PPD
Role of sleep with PPD (risk factor for peripartum mental illness)
Most studies observe that about 15% of women experience postpartum depression. For the majority of women who present with postpartum depression, the postpartum episode is not the first ever episode of depression and instead represents a recurrence.
According to one study, (described here) women with PPD were significantly more likely to experience a greater amount of nighttime infant awakenings compared to women without PPD. The authors conclude that clinicians must address measures to improve sleep quality in depressed mothers in order to decrease the severity of depressive symptoms, and educate mothers about good sleep hygiene.
Recommendations during the postpartum period include catching up on lost sleep with naps throughout the week and setting some time aside in the mornings for the mother and newborn to go on a walk as this will improve the mother and child’s circadian rhythms.
Mothers are encouraged to talk about their sleeping habits and any issues they may be experiencing with their doctors, just like they frequently discuss their infant’s sleeping traits and patterns with their pediatricians.
Post 3: Treatment Modalities for PPD
Treatment modalities
There are many modalities of treatment to target PPD. We know that the use of SSRI’s (selective serotonin reuptake inhibitors) are very effective, but we feel strongly that they should be used alongside other modalities of treatment that are non pharmacologic (and in some cases these other interventions can be used without the use of an SSRI).
We strongly recommend these tools for healthy sleeping habits:
- Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
- Set a bedtime that is early enough for you to get at least 7 hours of sleep.
- Don’t go to bed unless you are sleepy.
- If you don’t fall asleep after 20 minutes, get out of bed.
- Establish a relaxing bedtime routine.
- Use your bed only for sleep and sex.
- Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
- Limit exposure to bright light in the evenings.
- Turn off electronic devices at least 30 minutes before bedtime.
- Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
- Exercise regularly and maintain a healthy diet.
- Avoid consuming caffeine in the late afternoon or evening.
- Avoid consuming alcohol before bedtime.
- Reduce your fluid intake before bedtime.
Personal note from Dr. Fein:
As a mother of three children, I can tell you that I definitely value my sleep. Since giving birth to my oldest child, I have always prioritized consistent sleep routines. This consistency has helped my six and four year old stay on schedule and get the amount of sleep they need (about ten hours per night).
It has not always been smooth-sailing, as my oldest daughter was born with a condition called laryngomalacia, which caused her to wake up frequently throughout the night. Every hour or two, she would find herself in a position that caused difficulty breathing and she would wake herself. I will never forget those sleepless nights and how difficult it was to wake up at 6am and start my day as a resident physician. Luckily, she grew out of it and we both were able to catch up on some much needed ZZZs.
When I first heard about the snoo, it immediately caught my attention. I know that even healthy babies often wake every 2-3 hours throughout the night, and figured that if I could extend that time with the snoo, it would make my days much easier. After trying it out with my youngest child, I was blown away by the improvement in sleep. It also allowed me to sleep even more as I was able to put my baby down drowsy but awake (I didn’t believe it was possible after my first two kids).
Improved sleep greatly helps maternal bonding, which has been linked to a host of positive child characteristics and outcomes in domains such as independence, social responsibility, self-confidence, self-esteem, and aggression.
