The link between sleep and mental health.
The connection between sleep and mental health is well-established by research, and any new mother can provide a wealth of personal stories showing how a lack of sleep affects her well-being. Understanding this link is especially crucial in the postpartum period, as the relationship between poor sleep quality and depression is bidirectional: poor sleep quality is a risk factor for the onset of depression, and depression is a risk factor for the onset of poor sleep quality.
Women dealing with postpartum mood and anxiety disorders often struggle with sleep. They might find it tough to fall asleep, wake up too early, and feel more tired during the day. On top of that, their sleep isn’t very restorative, with shorter and less restful REM cycles.
This creates a tough mix of both acute and chronic sleep deprivation, especially during a time when hormonal changes make them more vulnerable to depression.
Mothers showing signs of major depression at 4 and 8 weeks postpartum were much more likely to report that their baby cried frequently, woke them up multiple times during the night, and left them with less than six hours of sleep over the past week. They also felt their baby’s sleep patterns were making it hard for them to get a decent night’s rest. Reflecting these struggles, these mothers often felt exhausted and overwhelmed.
Baby sleep experts often rush in to offer ways to “fix the babies sleep” - focusing on changing the infant in order to remedy the situation. Infant sleep in America is a 325 million dollar industry. However, the research shows that babies are quite resistant to many of the behavior modifications these “experts” suggest. Although this is due to the developmental stage of the infant, it can leave parents feeling as though they are failing when these techniques don’t work for them, further perpetuating the problem. Not to mention poor support for new parents in the workplace, and strong, sometimes quite polarizing opinions on infant sleep on social media and mom groups, and the pressure of getting sleep, or the lack of it can becoming a black-hole of despair.
Thus it is clear that improving sleep improves the mental health and well-being of the birthing parent. But how do we achieve this goal?
First it is important to recognize that the responsibility to address the mental health and sleep struggles faced by new mothers does not fall on the shoulders of the mothers alone. It is absolutely crucial to have the support of others to promote the sleep and healing of new mothers. As summarized nicely in this commentary piece from Biological Psychiatry:
“To overcome these structural factors requires the buy-in of multiple stakeholders and takes time. There is no shortcut. There are at least 4 core principles to prescribing sleep: 1) Change the message so that women see self-care rather than self-sacrifice as the hallmark of a good mother; 2) Consolidate sleep and educate about the consequences of sleep deprivation; 3) Recruit help (to the extent possible) because newborn night feedings are best understood as a job for more than 1 person; and 4) Encourage a flexible approach to breastfeeding.” - Prescribing Sleep: An Overlooked Treatment for Postpartum Depression.
Another study which looked at the impact of support on maternal sleep found that greater paternal involvement in infant care predicted greater sleep consolidation for both mothers and infants at 6 months. This is because infants often align their sleep patterns with their mother’s circadian rhythms. So by focusing on supporting the mother and helping her get the sleep she needs, the baby will eventually adjust as well.
In Prescribing Sleep the authors go on to say: “The effective treatment of PPD requires us to call in the cavalry—fathers, partners, family members, anyone who can help protect moms’ sleep—and prioritize women’s health as a family and societal necessity.” And I couldn’t agree more. Night nurses and postpartum doulas are also a good option for overnight support - and some offer sliding scale or payment plan options to make their services more affordable. Some doulas even receive grant money they can specifically use to cover their services for those who may otherwise be unable to afford them.
If you're still wondering how much improving sleep can truly enhance mental health, consider this: during the phase 3 trial of the medication Brexanolone for treating postpartum depression, the treatment group saw their depression scores improve by 17 points, while the control group (who received a placebo) improved by 13 points. Both groups experienced a significant drop in their depression levels, moving from moderate/severe to none/mild.
So, how is this possible? One likely factor is that both groups were admitted to an inpatient treatment center for three nights and had to stop breastfeeding for a week. It's reasonable to assume that the quality sleep they got in this supportive environment played a crucial role in their remarkable improvements. Sleep is medicine.
To truly reduce or prevent postpartum mood and anxiety disorders, we need to focus on removing the barriers that disrupt sleep—both at home and in the workplace—rather than trying to change the baby or the mother. By tackling these obstacles head-on, we can create a supportive environment that enhances well-being and deepens the bond between mother and child.
Other countries recognize the vital link between sleep and mental health, which is why Australia has launched a community-level sleep program to support new families. This program trains nurses to educate families on effective sleep strategies, emphasizing the importance of understanding babies’ needs instead of attempting to change their behavior. The Australian government has made significant investments in public resources, ensuring families have access to the support they need. When standard services fall short, insurance covers additional options like home visits, daytime programs, and even sleep schools where families can stay for up to four nights. In these schools, sleep experts provide personalized advice and support.
This holistic approach not only empowers the entire family but also has been shown to significantly reduce feelings of depression in mothers for up to two years.
In summary, the interplay between sleep and mental health is a critical concern for new mothers, with poor sleep exacerbating feelings of depression and vice versa. The significant impact of sleep deprivation on mood and the challenges it poses for bonding with the baby highlights the need for comprehensive support. Social policies are needed to make an impact on a large scale and improve the well-being of families. In the meantime, it’s important to prioritize your sleep, utilize effective sleep-hygiene strategies, recruit help from those in your support system and seek professional help for postpartum mood and anxiety disorders.
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