Your Guide To Postpartum Insomnia

You expected to be exhausted in the first days and weeks of having a newborn, though nothing can really prepare you for how tiring it is to be woken up every hour or two, every day, for weeks on end. However, if you can’t catch a little sleep when the baby is sleeping — despite being exhausted — you may be dealing with postpartum insomnia. We spoke to three of the best doctors with expertise in sleep medicine and perinatal well-being to help decode the mechanisms behind true postpartum insomnia — what it is, what causes it, and how you can start getting the rest you want and need, including when and how to seek treatment.

What is postpartum insomnia?

“There is no ‘official’ definition for postpartum insomnia,” explains Dr. Leslie Swanson, associate professor of psychiatry at the Sleep and Circadian Research Laboratory at the University of Michigan. However, women experiencing insomnia during the postpartum period is incredibly common. “We consider someone to be experiencing postpartum insomnia if they are within the postpartum period and are experiencing symptoms of insomnia,” Swanson adds, explaining that classic insomnia symptoms — which are the same for postpartum insomnia and insomnia that occurs outside of the postpartum period — include:

• Difficulty falling asleep
• Difficulty staying asleep
• Experiencing early morning awakenings accompanied by impairments in daytime functioning

“To meet diagnostic criteria for insomnia disorder, these difficulties must occur at least 3 nights per week for 3 or more months, and must also cause distress or daytime impairment,” explains Dr. Alexandra Woods, outpatient therapist and supervising psychologist at The Motherhood Center of New York. “Importantly, someone with insomnia struggles to sleep despite adequate opportunity for sleep. This means that sleep disruptions due to a crying baby are not considered insomnia.”

In the very first few weeks home with your baby, it may be really hard to tell if you indeed have postpartum insomnia or simply are exhausted from the normal demands of newborn care. But if your baby is sleeping in longer stretches and you find yourself struggling to fall or stay asleep, you may have insomnia. “It’s estimated that about a third of women experience significant insomnia symptoms at 6 months postpartum,” says Woods. If you’re experiencing postpartum insomnia, or suspect that you are, you should know that you are not alone. Insomnia is common during the postpartum period, says Swanson, adding that “estimates suggest rates as high as 20-60%” of women experience it.

Signs that a person is experiencing postpartum insomnia

So what exactly is the difference between the very normal — if brutal — exhaustion that comes along with caring for a newborn baby and actual, treatable postpartum insomnia? If you know and expect that sleep disruptions are a normal part of the postpartum period, what sort of sleeplessness is not normal? “New parents are often able to fall asleep or return to sleep quickly when they have the opportunity to sleep because they are sleep deprived by having to care for their baby,” Swanson says. “Trouble falling asleep, returning to sleep or waking too early when the baby is asleep (or being cared for by someone else) lasting more than a few weeks can signal insomnia.”

In addition to struggling with night sleep, Woods adds that “women with postpartum insomnia often suffer daytime consequences of sleep deprivation that are visible to others.” Signs of postpartum insomnia that Woods says to watch for include:

• Fatigue
• Difficulty with concentration
• Mood changes
• Excessive daytime sleepiness
• Anxiety about sleep

It’s important to note that postpartum insomnia has a “strong link with postpartum depression, which may also involve irritability, depressed mood, slowed thinking and poor focus, and mood swings,” adds Dr. Kelly Waters, a sleep medicine physician at Corewell Health. “Chronic sleep loss perpetuates these symptoms. Studies have demonstrated 20-30% incidence of persistent sleep loss complaints postpartum, and postpartum depression incidence is approximately 10-20%.”

What causes postpartum insomnia?

Although experts still don’t know exactly what causes postpartum insomnia, “we do know that women are at much higher risk for insomnia than men,” Swanson says. “Insomnia is most commonly triggered by a life stressor, which in the case of postpartum insomnia, is often the arrival of a new infant.” Often, she explains, new parents change their routines to restructure them around the sleep loss that they’re experiencing. Unfortunately, the changes themselves may end up perpetuate the insomnia, even after new parents adjust to the stress of caring for a newborn. “Such behaviors include spending long periods of time in bed ‘trying to sleep’ when frustrated or anxious, and having a variable bed and/or wake time (because the new parent is timing their sleep to their infant, who doesn’t yet have a stable sleep-wake pattern),” Swanson says. “I also hear from many of my postpartum patients that the only uninterrupted time they have to think or plan is when they get into bed at night, and doing this kind of mental activity in bed can lead to strong associations between the bed and wakeful thinking instead of sleep.”

It’s also possible that the hormone drops that follow delivery could have something to do with postpartum insomnia, but it has “not been well-studied,” Swanson says. “So far, we don’t really know the exact role that hormonal change in the postpartum period may play in insomnia. That said, hormones that impact the body clock change rapidly in the postpartum period, and they could be a factor that influences insomnia risk during this time.”

Like so many postpartum challenges, postpartum insomnia is likely related to all of the things that you’re going through in this transitional moment — physically, mentally, and hormonally. “The risk of developing insomnia appears to be a combination of hormonal changes, factored in with baseline stressors, quality of sleep through pregnancy, and underlying health, sleep, and mental health status. The postpartum period is a focused timeframe overlapping many of these factors,” Waters explains.

“During the perinatal period, biological factors such as hyper-arousal of the nervous system and hormonal changes may contribute to the development of insomnia,” Woods agrees. “New moms’ sleep is also fragmented to care for their babies throughout the night. Sometimes, women develop habits that help them to cope with this significant disruption to their sleep such as spending long periods of time in bed, daytime napping, reduced light exposure during the day, and disrupted physical activity patterns. The problem is that these behaviors then fuel insomnia over time.”

How long does postpartum insomnia last?

If you’re experiencing true postpartum insomnia, you shouldn’t just wait for it to go away on its own. “Untreated, it can persist for a long time, even years, which makes it important to seek treatment if you’ve been experiencing insomnia symptoms for a month or more,” Swanson urges. “Many women whom I see in clinic with grown children tell me that their insomnia began when their child was a baby.”

A true insomnia disorder can, if untreated, potentially “persist for years,” says Woods. It never hurts to seek help for insomnia, and to bring up any sleeping struggles with your health care provider. While it’s normal to be tired when you have a newborn, if you can’t sleep when you have the chance to sleep, it may be time to get a little help.

Seeking support for postpartum insomnia

The good news is that there are very effective therapies for insomnia. “Thankfully, good treatments are available for insomnia, and there is data to show that these treatments can be helpful in the postpartum period, too,” Swanson shares. If you are breastfeeding, you may be nervous about taking medications, but one of the most effective treatments for insomnia doesn’t involve medication at all. “Cognitive Behavioral Therapy for Insomnia (CBT-I) is an extremely effective, 8-12 week intervention that targets the factors that maintain insomnia,” says Woods. “While it’s not specifically designed for postpartum women, it can be modified to accommodate infant sleep problems and nighttime feedings that are so common in this stage of life.”

However, if therapy alone isn’t enough, your health care provider may suggest medication to support your well-being, too. “For more significant insomnia, or in concurrent postpartum depression, medication may help manage symptoms,” adds Waters. Any medication used for sleep should involve a discussion with the patient and other available caregivers to determine support system to decide on appropriate care.”

Tips for getting sleep in the early days & weeks of the postpartum period

When you have a newborn at home, it’s normal to be a little tired. “Sleep disruption and sleep deprivation related to caring for the baby is normal and not cause for alarm,” Swanson reminds us. However, there are ways to try to optimize the rest you can get, even in those exhausting early months of new parenthood. “It is very important to get a continuous block of sleep during nighttime hours, rather than fragmented or daytime sleep. Newborn babies, however, need to feed every 2-3 hours around the clock, including overnight,” says Woods, laying out the conundrum that every single new mother, ever, has faced. Here’s how Woods suggests parents maximize their night time sleep, even in those early days of new parenthood: “For babies who can take a bottle, we recommend that each parent or support person be responsible for half the night, or a 5-hour shift. For babies who do not take a bottle, we still recommend a shift-based schedule. For feedings during the breastfeeding mother’s time to sleep, she should not get out of bed and should awaken as little as possible. The other parent or support person should get the baby, change the baby if necessary, bring the baby to the mother’s bed and keep watch during the feeding so that the mother does not fall asleep and drop the baby. Once the feeding is over, the other parent or support person should take the baby, perform any changing or rocking, and settle the baby back to sleep.”

After Baby arrives, if you are having trouble falling asleep or staying asleep at night when it is your “turn” to sleep, there are some things you can do. “In general, we recommend that people do not ‘try’ to sleep, because sleep is not under our direct control,” Swanson says. If you are unable to sleep at night, Swanson and Woods both suggest the following:

• Go to another room if you can’t sleep (i.e. don’t lie in bed if you are having trouble sleeping)
• Do something quiet and relaxing in dim light
• Don’t return to the bed until you feel sleepy
• Avoid all technological devices that will emit light into your face starting one to two hours before bed and during the night
• Keep a consistent bed and wake time, 7 days per week
• Avoid, or limit, caffeine intake
• Maintain your usual daytime activity level
• Consider limiting daytime naps if you are having difficulty with nighttime sleep, as consolidated nighttime sleep is best
• Avoid alcohol after dinner
• Develop a pre-bedtime routine
• Try installing an orange-red lightbulb (available for a low cost at most hardware stores) for use when light is needed during the night (for example, while changing or feeding the baby) because “orange-red light does not impact the body clock in the same way as other wavelengths,” Swanson explains.
• Get exposure to natural light during the day by getting outside, especially in the morning but also throughout the day. “Even as little as 20 minutes in natural light can help set the body clock. If getting outside isn’t possible, it may be helpful to sit next to a window,” Swanson adds.

Postpartum insomnia is not something you simply have to power through. There are many steps you can take to get the rest you need, even in the very first days and weeks of your baby’s life. If your exhaustion persists, seek help from a trusted health care provider. You deserve to be well-rested.

Experts:

Dr. Leslie Swanson, associate professor of psychiatry at the Sleep and Circadian Research Laboratory at the University of Michigan

Dr. Alexandra Woods, outpatient therapist and supervising psychologist at The Motherhood Center of New York

Dr. Kelly Waters, a sleep medicine physician at Corewell Health