Understanding Postpartum Insomnia: A Guide for Parents
All bleary-eyed mothers have suffered the torture of disrupted circadian rhythms and disturbed sleep patterns and know that the postpartum period is really tough. For some parents, the constant awakenings and grueling three- or four-hourly feeding schedules can potentially turn sleeplessness into clinical insomnia. It’s important to know when to seek help.
How Sleep Changes During Pregnancy
Pregnancy-associated insomnia does not start after the delivery. One study found that 86% of the pregnant women involved in the study experienced poor quality sleep.1 Unfortunately, a woman’s sleep patterns can be affected as early as the first trimester.
As the pregnancy progresses, sleep disturbances often increase. By the third trimester 97% of women reported sleep disorders.1 Diaphragmatic pressure increases as a result of fetal development, causing abdominal discomfort. Women develop back pain and suffer leg cramps; restless leg syndrome becomes more intense; pressure on the bladder often causes multiple visits to the toilet at night; and hormonal changes further disrupt circadian rhythms.1 Increased estrogen, for example, causes the upper nasal passages to narrow, which can exacerbate snoring.2
Circadian Disruption After Pregnancy
After delivery, the new-born’s sleep rhythms bring a new dimension to sleep disruption. New mothers often complain that they’re sleep-deprived but the problem is not sleep deprivation per se, but the disruption of the mother’s circadian rhythm during the first few months of the baby’s life.
During our evolution, we internalized the 24-hour cycle of our rotating planet in the form of circadian rhythms. These circadian rhythms drive the daily patterns of our physiology and behaviour. A person’s circadian rhythm is synchronized to the external environment, primarily by the light-dark cycle, and controlled via molecular clocks located in the hypothalamus. Disruption of circadian rhythms can have detrimental consequences for human health, especially mental health.3
Ultradian Versus Circadian Rhythms
A baby’s circadian clock starts developing in the womb, and matures postpartum.4 Unlike adults, who have established circadian rhythms, babies sleep whenever they need to, which is most of the time during the first few weeks. Their sleeping rhythms are ultradian. An ultradian cycle is a recurring cycle within a 24-hour period, while a circadian cycle is one that takes place over 24 hours.
Babies have sleep-wake cycles between two and three hours long, and these cycles repeat several times during a twenty-four hour period. Due to immature hypothalamic neurodevelopment, which is the centre of circadian rhythm and sleep-wake regulation, newborns don’t distinguish between day and night in terms of sleep time.5 For adults who are used to being awake during the day and asleep at night, this blurring of day and night can be mental and emotional torture.
Hyperarousal in the Parents of Newborns
The optimal thing parents can do during the first few weeks is to adapt their sleeping patterns to their baby’s, in other words make peace with the fact that they’re going to follow an ultradian rhythm instead of a circadian rhythm. This is easier said than done, of course. External work and life pressures can make this adaptation very difficult. Plus, adults do not normally have ultradian cycles, so raising a new-born messes with adult biology.
Many parents who have to suffer the constant disruption of their circadian rhythms start feeling anxious about being woken up. The anxiety causes hyperarousal, which, in turn, exacerbates insomnia. Add to that our evolutionary tendency to be hypervigilant during postpartum, and it is no wonder the parents of new-borns battle to sleep.
Practical Sleep Tips for the Postpartum Period
If you have a newborn and have a hard time sleeping, these practical tips might come in handy.
Try not to fret about not getting enough sleep. Fretting makes insomnia worse because it causes hyper-arousal, which interferes with your sleep drive.
Sleep when you get a chance and adapt to your baby’s cycles. Put everything else on the back burner if you can. The weeks after birth are about surviving. Napping in the middle of the day is allowed, even recommended!
Sleep walking, sleep hallucinations, exploding head syndrome, hypnagogic jerks and sleep paralysis are all normal occurrences during postpartum. However, if you are concerned about any of these, speak to your doctor.
Let your baby sleep whenever he or she wants to. If you keep babies awake when they need to sleep, their bodies may go into hyperarousal.
Resist the natural urge to pick your baby up unless the child is clearly awake or crying. Picking up babies too soon can interfere with the maturation of their circadian patterns. Sometimes babies make movements that suggest they are awake, but they aren’t, so observe them before picking them up. Mothers’ night-time responses to their infants may affect crucial developments in the sleep-wake rhythm.5
The Link Between Insomnia and Perinatal Depressive Symptoms
If you don’t find relief with these tips, it could be beneficial to monitor yourself carefully for symptoms of depression. We always recommend that you speak to your doctor about your concerns. A 2019 meta-analysis of nine studies, which involved 1992 women, found that because insomnia during the perinatal period is associated with depressive symptoms so it's essential that pregnant women should be screened for both insomnia and depression.6 In fact, not just mothers suffer from insomnia. A 2020 study found that insomnia and poor sleep problems are frequent amongst all family members in the weeks before and after the birth of a new baby.7
Consider Cognitive Behavioral Therapy
If you feel that your things are getting out of hand, either for you or your family members, fill in our questionnaire. The questionnaire takes you through a series of diagnostic sleep questions, which will give you insight into your insomnia.
The Dawn Health sleep app uses cognitive behavioral therapy for insomnia (CBT-I), an evidence-based approach that treats insomnia by identifying and changing habits and thinking patterns that prevent you from falling asleep [
Tafşkiran, N. (2011) “Pregnancy and sleep quality”, Journal of Turkish Society of Obstetrics and Gynecology, 8 (3), pp. 181-7.
Helmi, A. et al. (1975). “The effect of oestrogen on the nasal respiratory mucosa: An experimental histopathological and histochemical study”, The Journal of Laryngology & Otology, 89(12), pp. 1229-1241. Doi: 10.1017/S0022215100081597.
Walker, W.H. et al. (2021) “Disrupted circadian rhythms and mental health”, Handbook of Clinical Neurology, 179, 259-270. https://doi.org/10.1016/B978-0-12-819975-6.00016-9
Escobar, C. et al. (2021) “Development of the circadian system and relevance of periodic signals for neonatal development”, Handbook of Clinical Neurology, 179, pp. 249-258. https://doi.org/10.1016/B978-0-12-819975-6.00015-7
Kuroda, M. et al. (2021) “Influence of mothers’ nighttime responses on the sleep–wake rhythm of 1-month-old infants”, Sci Rep., 11, article no. 24363. https://doi.org/10.1038/s41598-021-03717-7
Emamian, F. et al. (2019) “Link between insomnia and perinatal depressive symptoms: A meta-analysis”, Journal of Sleep Research, 28 (6). https://doi.org/10.1111/jsr.12858
Baglioni, C. et al. (2020) “Insomnia and poor sleep quality during peripartum: a family issue with potential long term consequences on mental health”, The Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2020.1854718
Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.