Insomnia in the Postpartum Period

I have had insomnia since a few days after my son's birth. Have other women experienced this and what can I do about it? I stopped nursing in order to take medications to help, because it's so bad. I have not slept at all tonight. Help I'm really not happy about this!



Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Dear Christina,

Insomnia is one of the "complications" of the postpartum period. Although the exact nature is not understood, it has physical, emotional and hormonal roots.

This is one of major markers for postpartum depression but of course it can and does occur in women without this condition. Some women I've seen have responded to Unisom, an over the counter sleep aid and Vitamin B6. Some also need to take Wellbutrin which seems to be well tolerated and useful for this.

Although it depends upon your situation, sleeping with your baby has been known to help but I suppose sleeping away from the baby may help just as many.

I've enclosed some abstracts for you to see as well.

Quillin SI.
Infant and mother sleep patterns during 4th postpartum week.
Issues in Comprehensive Pediatric Nursing. 20(2):115-23, 1997 Apr-Jun.
Using modified Barnard and Eyres (1979) Sleep/Activity Records, 44 mothers recorded diurnal sleep and awake times for themselves and their infants during the 4th week postpartum. Independent two-way analyses of variance, using a two-factor design (3a x 2b), compared data from each mother and each infant. Independent variables were (a) parity groups (mothers feeding their first, second, or third infant) and (b) feeding method (breast vs. bottle). A statistically significant difference (alpha = .05) was apparent between breast-fed and bottle-fed babies regarding the number of awakenings and the hours of night sleep, with breast-fed babies awakening more and sleeping less at night. But there was no statistically significant difference in the hours of total sleep diurnally. Mothers exhibited corresponding differences in sleep patterns, with a statistically significant increase in night waking for breast-feeding mothers. Infants in this study averaged 14.6 hr of sleep in 24 hr, which is in contrast to the 15.5 to 17.3 hr of sleep commonly reported in nursing texts based on studies from the 1960s.

Swain AM. O'Hara MW. Starr KR. Gorman LL.
A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women.
Obstetrics & Gynecology. 90(3):381-6, 1997 Sep.
OBJECTIVE: To compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables.
METHODS: For the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions.
RESULTS: Postpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect for "time awake" at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss.
CONCLUSION: Women must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.

Arpels JC.
The female brain hypoestrogenic continuum from the premenstrual syndrome to menopause. A hypothesis and review of supporting data. \[Review\] \[87 refs\]
Journal of Reproductive Medicine. 41(9):633-9, 1996 Sep.
OBJECTIVE: To propose a theory to help unify the symptoms of premenstrual syndrome (PMS), postpartum blues and depression, the perimenopausal transition and menopause.
STUDY DESIGN: A review of supporting data is used to explain the possible neuroendocrine mechanism upon which the hypothesis is based.
CONCLUSION: The brain in women has been shown to be an estrogen target organ. Common symptoms are shared by women complaining of PMS, postpartum blues, the perimenopausal transition and menopause: depression, sleep disturbance, irritability, anxiety and panic, memory and cognitive dysfunction and a decreased sense of well-being. The antiestrogens progesterone, progestin and tamoxifen may also elicit these same symptoms. It is proposed that whenever brain estrogen levels fall below the minimum brain estrogen requirement, for whatever reason and at whatever age, brain center dysfunction may ensue. \[References: 87\]

Waters MA. Lee KA.
Differences between primigravidae and multigravidae mothers in sleep disturbances, fatigue, and functional status.
Journal of Nurse-Midwifery. 41(5):364-7, 1996 Sep-Oct.
The purpose of this study was to describe the differences between primigravidae and multigravidae women in their experience of sleep efficiency, fatigue and vitality, and level of functioning in the third trimester of pregnancy and the first month postpartum. A secondary analysis of a descriptive, longitudinal study was done. A convenience sample of 31 pregnant women was used to test the hypothesis that multigravidae would have significantly higher levels of functioning in the household, increased fatigue, and decreased sleep efficiency and vitality than primigravidae at both phases of the study. Results indicate, however, that primigravidae experienced significantly more disturbed sleep, with sleep efficiency falling from 89.79% in the third trimester to 77.25% postpartum. Multigravidae had only a minor reduction in sleep efficiency from 86.76% in the third trimester to 83.99% postpartum. Although there was no statistically significant difference in level of vitality, primigravidae experienced more fatigue (73.58 +/- 15.22) than multigravidae (64.35 +/- 18.96) at 1 month postpartum. These results suggest that maternal role "acquisition," experienced by primigravidae, results in more fatigue and sleep disruption than does maternal role "expansion." The significant decrease in sleep efficiency and increase in fatigue in primigravidae after delivery indicate that health care professionals need to provide anticipatory guidance to primigravidae to help smooth the transition from pregnancy to motherhood.

Stowe ZN. Nemeroff CB.
Women at risk for postpartum-onset major depression. \[Review\] \[76 refs\]
American Journal of Obstetrics & Gynecology. 173(2):639-45, 1995 Aug.
There is considerable evidence that the childbearing years represent a time when women are highly vulnerable to developing mood disorders. Prospective, cross-sectional, and retrospective studies have demonstrated that more than 10% of new adult mothers will experience a major depressive episode during the first postpartum year. Changes in the health care delivery system will result in increased pressure on the obstetrician/gynecologist to identify and treat women with postpartum-onset depression. Despite shortcomings in the available literature, prospective studies have identified risk factors for developing postpartum depression. Furthermore, the clear overlap between the normal sequelae of childbirth and the symptoms of major depression, including alterations in sleep, energy, libido, appetite, and body weight, underscores the need to develop guidelines for early identification. We furnish a brief overview of postpartum mood disorders with a primary focus on the antenatal and postnatal risk factors for developing postpartum depression. Based on the extent literature and our clinical experience, a set of recommendations for early identification and treatment is provided. \[References: 76\]
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