What to Do When You Can’t Sleep When the Baby Sleeps

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We know sleep is important to good health and mental well-being, but what can you do when you go through a life transition that inherently threatens sleep quality? Disruptions to the quantity and quality of sleep are heightened during the perinatal period, the timeframe throughout pregnancy and postpartum.

One in five women will experience mental health complications during the perinatal period, and three in four will experience sleep issues such as insomnia, poor sleep quality, or disrupted sleep. To this end, mental health and sleep have a strong bidirectional relationship. This means that throughout pregnancy and postpartum, mothers with more severe mental health symptoms report greater sleep disturbances, and mothers with worse sleep are more likely to experience mental health complications.

Pregnancy and Sleep

While there has long been a connection between prenatal sleep and the risk for perinatal mental health disorders, researchers recently learned that women who experience sleep disturbance in their second and third trimesters of pregnancy have a threefold increase in the risk of postpartum depressive symptoms. Symptoms were highest amongst Black or African-American participants.

Postpartum and Sleep

Postpartum sleep has also been associated with several important health factors, including an increased risk for postpartum mental health disorders, lower quality of life, and worse general wellness for the postpartum mother, infant, and family. A review of the literature specifically demonstrated a strong relationship between postpartum sleep disturbances and postpartum depression.

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Support and Intervention

Screening: Although it has been well-substantiated that poor sleep quality during pregnancy is associated with an increased risk for postpartum depression, prenatal sleep issues often go undetected because sleep disturbances may be seen as typical, and prenatal appointments can be brief. However, research demonstrating the increased risk for mothers to experience mental health complications when they have sleep disturbances during pregnancy should not be ignored. Routinely administered screening measures that ask about sleep could identify otherwise lower-risk pregnant individuals who may benefit from prevention efforts. If you are pregnant and struggling with sleep, whether your provider asks or not, bring this topic up for discussion during your prenatal visits.

Protect Sleep: New parents should create a postpartum plan to protect their sleep. This typically looks like splitting the nighttime into shifts. For example, one parent might take the first shift (e.g., 8 p.m. to 2 a.m.) while the other takes the second shift (2 a.m. to 8 a.m.). This will require the parent on the second shift to go to bed as early as possible to optimize their protected sleep window. If they're lactating, they should attempt to pump or breastfeed before sleeping and only wake up if they need to pump or feed again during their sleep window. This plan might also require temporary sleep arrangements to reduce the risk of sleep disruptions (e.g., sleeping in a different room and sleeping with earplugs or a sound machine). Not only will this promote physical healing in the parent who gave birth, it will also prevent or reduce symptoms of mental health disorders in both parents.

Therapy: There is research support for the effectiveness of a specific modality of cognitive behavioral therapy for insomnia (CBT-I) in reducing sleep issues as well as decreasing the risk for postpartum depression. CBT-I is a short-term treatment approach that combines behavioral interventions to promote good sleep hygiene (e.g., implementing healthy sleep habits and creating an optimal sleep environment) and relaxation training, cognitive interventions to modify negative sleep-related thoughts and worries, and psychoeducation about sleep health.

Key Takeaway: Sleep may be one of the few modifiable risk factors for perinatal depression that is relatively easy to detect and treat. Sleep interventions are a potentially low-cost, effective, non-medication strategy to prevent and treat mental health disorders during pregnancy and postpartum.

To find a therapist near you, visit the Psychology Today Therapy Directory.