Sleep. This is the hottest topic of conversation among new and experienced parents. During pregnancy, especially in the third trimester, sleep patterns are likely already disrupted for obvious reasons! However, many mothers are not prepared for the experience of postpartum insomnia. Parents have the expectation that they will not have the restorative sleep they may be used to once baby is born but the bigger issue lies when mom cannot sleep even though baby is. Approximately 25-50% of mothers will experience postpartum insomnia and it can have an immediate onset after giving birth, lasting months if not addressed properly.
As an occupational therapist, I care about sleep as it is considered an activity of daily living (ADL), and a very meaningful activity when we look at an individuals ability to function in the way they want to, need to or are expected to. Sleep becomes one of the most meaningful activities for new mothers especially when it is already broken throughout the night to attend to the necessary co-occupations with baby such as feeding, diaper changes and helping baby get back to sleep. In between her participation in these co-occupations it is imperative a mother gets the sleep she needs to function through out the day. When postpartum insomnia occurs, it can permeate every aspect of a mother’s life and puts her at higher risk for experiencing postpartum depression and anxiety.
So, what can be done to encourage healthy sleep habits and hopefully counteract the affects of postpartum insomnia? I look at three components, the occupation, the person, and their environment.
The focus here is the activity of sleep. What are the current sleep patterns like? What are the approximate awake times throughout the night that are not baby related? Are there other occupations or ADLs such as toileting that are interrupting sleep? Awareness is empowering. Answering these questions and tracking the experiences can give a mother a greater sense of understanding and control over a situation that increases anxiety and feelings of helplessness.
Hormones - There are obvious biological changes a mother experiences after giving birth. The decreases and significant shifts in hormones can affect sleep patterns along with the development of night sweats.
These are factors that are out of our control and will settle over time but knowing that there is a biological reason for some sleep interruptions can help with acceptance.
Routines – Just as a bedtime routine is important for children, it is equally important for mothers. Having rituals or a routine that become associated with sleep are helpful. These can be as simple as brushing your teeth, washing your face, emptying your bladder, getting into clean pajamas, having a glass of water at the bedside, or reading at bedtime (although most moms don’t have the energy or attention span to read much when going through the newborn phase!!) Try going to bed early and attempt sleep when baby is sleeping as much as possible. The chores that are piling up can wait. The need for sleep trumps everything!
Habits – Have you ever picked up your phone/tablet or turned on the TV out of habit or boredom? Electronic use is one of the most habit-forming behaviours and requires active awareness to control the habitual use. I’m certainly not against electronics but like most things in life, I believe there is benefit in moderation. Current recommendations in research indicates turning electronic devices off an hour before bedtime and keeping it off throughout the night is key to maintaining your circadian rhythm which controls our sleep/wake cycles. As a new mom, how realistic is this though? Many moms will say they beat boredom, wandering minds, and loneliness in the middle of the night by going on social media, reading one parenting article after another, or online shopping on their device. The blue light that is emitted from our devices plays a significant role in sleep disruption and this is where an app that reduces blue light emission may be helpful if you find device use is needed from a connection perspective during night feeds that can feel isolating. Habitual device use becomes a problem when you are not able to sleep when baby is sleeping. Especially if you are going on a device when you can’t sleep to try to make yourself sleepy! This becomes a vicious cycle that can be hard to get out of.
Intake – Caffeine, alcohol and rich foods can all impact your sleep if consumed too close to bedtime. Being mindful of your intake and recognizing negative sleep associations with intake can give you more information on how to manage your experience with insomnia.
Get up - This may seem counter-intuitive when you are trying to get to sleep but the more you lay in bed staring at the ceiling listening to your partner enjoying the benefits of a good sleep and your sweet baby making all those wonderful sleep noises, your anxiety can build and build until it all becomes too much to handle. So, get up. Go to a different room, do something calming and restful then return to bed to attempt sleep again. This can be a much-needed reset.
Breath – There is a connection between insomnia and higher cortisol levels. Taking mindful whole-body breaths can help calm your nervous system and reduce your feelings of anxiety. I personally love doing umbrella breaths. As you inhale, imagine an umbrella opening. Feel the breath expand your chest, your back, and both sides of your rib cage while keeping your shoulders relaxed and away from your ears! On your exhale, imagine the umbrella closing. This type of breath engages the diaphragm, allows a full healthy breath and, as a bonus, helps your pelvic floor health!
Exercise – Building regular exercise into your day will have a beneficial impact on most aspects of your well being, especially sleep. This doesn’t mean you have to push your self to get back to the gym asap. Healthy postpartum exercise includes going for a short walk with your baby. Stay within your current ability level for endurance and strength.
Bedroom set up – Keeping your bedroom cooler by either opening a window or putting on a fan will help encourage sleep just as having a darkened room can also help. Ensuring that your sleep space is uncluttered with clean bedding will also be beneficial.
Outdoor Time – Not only does getting outside help encourage healthy sleep patterns, research shows an increased well-being when we spend at least two hours outdoors each week. In life’s big picture, two hours a week is likely manageable, and shouldn’t we make it a priority if its going to make us feel better mentally or encourage sleep?
Support People – Postpartum mothers need to surround themselves, as much as possible, with supportive, loving people. I understand this is not always a possibility, especially now in these days of Covid-19. But if you have people in your life who can help with night feeds, cuddles, and diaper changes then put them to work! This also goes for daytime naps. Do not be afraid to ask for help! You cannot be the supermom you are likely striving to be if you aren’t getting the sleep needed to function.
While incorporating any of these strategies, it is so important that you keep open lines of communication with your primary care provider. As mentioned above, postpartum insomnia has a significant link to postpartum depression and anxiety. Maintaining your mental and physical health as a mom is priority! Please do not think you have to suffer in silence. Know that you are not alone in this experience and reach out for help when needed. There may be a more medical oriented intervention or counselling required to help you overcome postpartum insomnia.