If you ask most people what impacts postpartum depression and anxiety the most, they will likely say sleep. Because honestly, sleep (or the lack thereof) is a huge part of life with an infant, and it can be extremely difficult to deal with constantly disrupted sleep. But it might not be exactly the sleep factor you think that is most correlated with maternal depression and anxiety.
When I created my CEU holistic sleep course for lactation professionals and therapists last year (you can get that here, by the way), I did a deep dive into lots of the research surrounding postpartum health and sleep, and one finding I landed on was super interesting to me.
Increased depression and anxiety symptom scores are linked to problems of maternal sleep efficiency, or difficulty initiating and falling back to sleep, not to the length of the infant’s self-regulated sleep periods.
(Douglas & Hill, 2013)
Most of us believe that the number of times our baby wakes at night is the problem and the issue that we really need to address in order to improve mental health and overall well-being. It makes sense! But, what the research suggests is that it’s possible it’s not actually the number of night wakes at all that is linked to increased anxiety and depression symptoms among new mothers, but rather it’s sleep efficiency. The authors go on to say that “poor maternal sleep efficiency results from elevated sympathetic nervous system arousal, or anxiety, not the number of times the mother wakes to the baby’s signals during the night.”
Sleep efficiency might be more impactful than the number of times baby wakes at night
Sleep efficiency is the ability to fall back asleep once woken in the middle of the night. Many mothers are really struggling with their sleep efficiency, and this could have more of an impact on their mental health than the number of times their baby wakes at night. This is also logical! Imagine you have a baby that wakes every 2 hours. Now imagine that every time that baby returns to sleep, you are unable to return to sleep for 30 minutes to 2 hours. This would result in a lot of missed sleep throughout the night. Now, imagine you have that same, wakeful baby, but instead, you are able to return to sleep quite quickly each time they wake. Completely different experiences and sleep quality!
Why are mothers struggling with sleep efficiency?
There are many potential factors that contribute to difficulty with sleep efficiency. Here, I’ll list a few of the major ones that I think about:
- Underlying health issues or potential hormonal imbalances
- Nutritional deficiencies and blood sugar regulation issues
- Overstimulation and night-time blue light impacting melatonin production
- Anxiety
- Having to get up to respond to baby
What are some solutions to poor sleep efficiency?
To address the problem of poor maternal sleep efficiency, mothers have to look within and take care of their own health and lifestyle, areas that are often forgotten about in the busy season of new motherhood. The good news is that many changes can be made that cost nothing (or very little), but can make a big impact on sleep efficiency and overall quality of sleep.
- Eat nourishing foods and try not to skip meals. Especially in the postpartum period when nutritional needs are higher for healing and breastfeeding (if breastfeeding), it’s crucial that mothers are eating enough, and eating enough of the right nutrients. Additionally, eating enough protein and healthy fats is helpful in regulating blood sugar throughout the night, which is a common cause of decreased sleep efficiency. Some mothers may need to have a bedtime snack to maintain their blood sugar.
- Limiting screen time and any bright lights in the evening and at night can help improve sleep efficiency. Research shows that exposure to blue lights can negatively impact melatonin production for up to two hours. Many mothers are checking or scrolling their phones often in the night to track feeds and/or try to keep themselves awake as they feed their babies. Which brings me to the next point…
- Keep your baby closer. If it is possible for mothers to safely bedshare and nurse in a side-lying position, they do not have to worry about scrolling social media to keep themselves alert while they feed their baby. The beauty of this is that mothers who are able to bedshare and nurse in a side-lying position can sleep as they respond to their babies, so their nights may hardly be interrupted at all. If safe bedsharing is not possible for you, the closer you can keep your baby, the better (and the sooner you’ll be able to hear and respond to their feeding cues). Utilizing a separate surface cosleeping space, like a bedside bassinet, or just placing baby’s crib in the room close to the bed reduces the amount of time mothers have to spend out of bed, which can decrease sleep efficiency when it’s time to return to sleep.
As mentioned before, these free solutions can be incredible helpful for improving sleep efficiency, but if you are looking for more support, here are some of my favorite tools and services:
- Work with an integrative healthcare practitioner to assess health. Mothers often have underlying health issues, including possible hormonal imbalances, and working with an integrative healthcare practitioner who really understands postpartum health can be very helpful in getting mothers on the right track with their health and improving quality of sleep.
- The blue light blocking lamp from Bon Charge is my absolute favorite nighttime lighting source. It has multiple color settings, including red light, which makes it the perfect light for night-time diaper changes and feeding sessions so that mothers don’t have to use their phones, or other lights that emit sleep-impacting blue light. It’s also battery-operated and rechargeable, has zero light flicker, and emits zero EMF, so it is literally the perfect choice for a sleep space! You can save 15% with the code TAYLOR15.
- If you do not want to go all in on bedsharing, or are looking for an alternative to bedsharing, but want something a bit more convenient and easier than a crib, you have to check out this pack n play. We bought this for our second baby specifically because it’s non-toxic, but I soon learned it is the ultimate hack for parents who snuggle or feed their children to sleep. You can lower the pack n play to it’s lowest setting on the floor, and then the side completely zips open and closed, so you can lay next to the bed and nurse or snuggle your child (lots of parents can also fit directly in the bed if they scrunch up a bit), and then sneak away and zip the side back up once your child is asleep. If you are looking to transition from bedsharing to an independent sleep space, this is makes a great transition step!
There are ways to improve your own sleep without changing anything about the way your child sleeps. For more detailed information about how mothers can improve their own sleep without sleep training, make sure you grab this free resource. Sometimes, a child is waking excessively, and a bit more exploration needs to happen to determine the root cause of this and work to improve it. If you feel you need support with your child’s sleep rather than your own, grab one of my comprehensive eCourses, such as The Infant Sleep Foundations eCourse or the Toddler Sleep Foundations eCourse. If you’d prefer 1:1 support, you can book a call or support package.
Reference:
Douglas, P. S., & Hill, P. S. (2013). Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants. Journal of Developmental & Behavioral Pediatrics, 34(7), 497–507. https://doi.org/10.1097/dbp.0b013e31829cafa6
