Sleep, Mama, Sleep: Understanding Postpartum Insomnia

My daughter was born after a labor that had some twists and turns like most labors do.  She was born about 36 hours after my first organized contractions.  I was over the moon to meet my daughter!  I recall napping for maybe an hour or so after she was able to nurse for the first time and when I finally had some quiet time without disruption.  That first afternoon and the first night, she nursed nearly continuously.  I was elated – riding that initial postpartum high, and didn’t mind that she was so taken with nursing.  The next day, I couldn’t stop staring at her and indeed, didn’t close my eyes much at all.  The second night I was feeling more emotionally raw.  I was filled with gratitude for my team of support, and felt this overwhelming surge of emotion about how hard it had been, how strong I had been, how transformed I felt.  I was existing in this heightened state of emotion, awareness, and in a state of timelessness.  I was still not getting any sleep.

I remember that somewhere around day 3 or 4, I was in a fair amount of pain with postpartum discomforts (and would later learn I had some complications and an infection), and recall having no appetite.  Oh.  And despite being a lactation consultant, I too had nipple pain and damage.  I called in a colleague to help me resolve it.

I remember feeling that I had moments where my brain would just shut down if someone was talking to me.  By the third day and night and the fourth, I was seeing my hungry baby’s rooting mouth whenever I tried to close my eyes. It was a bit of an overwhelming hallucinatory image – not unlike the way an image lingers on a monitor if it was frozen too long.  It was at that point that I realized I had slept 4 hours in as many days.   I was experiencing a postpartum high gone wrong.

I was suffering from postpartum insomnia.   On that fourth day, my dear friend and Birthways practitioner Elizabeth came to give me a bedside massage and aromatherapy treatment and sent me off to sleep immediately afterward for what would be the first chunk of normal sleep since earlier that week when labor had begun.  From that night on, I was able to prioritize blocks of nighttime sleep even as I exclusively nursed my baby.  I got treatment for my postpartum complications and thanks to the help of my doulas and midwives, recovered for the most part.  Unfortunately, there were other stressors for me that year, including putting my house on the market when my daughter was 6 weeks old.  I made all the mistakes I tell other moms not to.  I would later turn to treatment for what was a developing depression over the next months.

I wouldn’t have described myself as struggling with mood at that time, but certainly, loss of sleep for so many days was having a significant impact on my thought processes. Was I caring for and connecting with my baby? Quite sweetly.  Thinking clearly?  Not so much.  Getting anxious about things like my baby not having a bowel movement?  Definitely.  Feeling a little like I was losing my mind?   A bit.   Getting sleep was a game changer.

My postpartum insomnia may have been an early indicator of a hormone imbalance that would be a part of the postpartum mood puzzle.  Or the events of the birth, my infection, and the first days may have set me up to be vulnerable.  Was my lost sleep a symptom or a cause?  I’m sharing my own story, but I’ve seen this unfold for so many women under similar or different circumstances.  Each story has its own profile but commonly, there is pain and inflammation, and a lost opportunity for a block of sleep on that first night.  I have seen women struggle and I also have seen great outcomes when mothers got immediate support and intervention to break the cycle.

What Causes Postpartum Insomnia

The inability to sleep for the first 12 hours after giving birth is normal.   The postpartum high allows us to be vigilant to care for our vulnerable newborns.  As a midwife and birth attendant, it’s always amazing to see a mother who is so fatigued at 8cm that she is sure she can’t go on, get a burst of energy to push out her baby with such strength and energy.  Moms continue to be, more often than not, alert and euphoric in the hours that follow.  We need this mobilization of energy stores and it serves a purpose.  The increased alertness that comes with the rushing endorphins and catecholomines helps us to tend to our newborns and, perhaps, maybe to fend off a predator (or errant family visitor as the case may be).

But when this high continues, it can be a red flag.   In my work with postpartum families, I first start with a call for immediate intervention to break the cycle.  Without restorative sleep, this situation feeds on itself and cortisol levels can continue to elevate, making sleep more difficult and stressing an already inflamed and over-worked system.  Cortisol interferes with oxytocin, the hormone that promotes healing, bonding and breastfeeding.  And overextending our adrenal system not only depletes us in the moment, but can take its toll down the road. (Look for future blogs on how postpartum stress might be implicated in long-term adrenal dysfunction).

Impacts of Sleep Loss

Researchers have found that being deprived of sleep has both immediate and long-term consequences.

After missing sleep for 24 hours, the brain reacts and not too happily.

Micro-sleeps.  Those moments when I felt I had abruptly checked out?  I had.  Researchers have found that the brain goes into disordered and very brief sleep cycles post deprivation that can last up to 30  seconds.  Sudden moments when we lose full consciousness & sight.  Not the safest way to function.

Cognitive changes. Brain fog, diminished coping, less emotional regulation and unclear thinking processes result when we don’t get restorative sleep as nature intended.  Hallucinations are commonly reported as well and mine were mild visual experiences that can fall into this explainable category.   See below for a bit more on this.

Positive emotion and connection.  Poor sleep quality is associated with low positive emotion and higher experiences of negative emotion.  Depression and mood disturbances can develop when our brains are seeing the world in this way and we start to ‘buy it’.  It can be helpful to see that the thoughts we have when sleep deprived are thoughts we don’t need to identify with.  For instance, all new moms can feel confident one minute and then have a crash of confidence the next.  If they can see these as thoughts and feelings that come and go, it becomes less of who they are and more impermanent.  All thoughts, but particularly sleep deprived ones, aren’t too reliable!

Another unique characteristic of sleep deprivation, researchers have found, is that we lose the ability to both express positive emotion and to read it accurately from others.  So a new mom who is sleep deprived is more vulnerable to thinking her baby isn’t content or worrying that something is wrong.

What to do?

Breaking the cycle immediately is critical.  We’ll be posting an upcoming blog on some tips for helping a new mother settle into sleep.  Call us for a support plan specific to your needs.

Get immediate help if you or your loved one is experiencing confusion, agitation, paranoia, or disturbing or intrusive thoughts.  The rarest of the postpartum mood disorders, but the most dangerous, is postpartum psychosis and it tends to have an early onset in the first days after birth, and insomnia is a symptom.   Also note that insomnia accompanied by racing thoughts can be symptoms of a mania or hypomania onset for someone with bipolar disorder.  Contact your health care team or perinatal mental health experts for immediate evaluation and assistance.