Postpartum Anxiety And Sleep Problems

During the postpartum period, many new mothers experience heightened anxiety due to the significant life change brought about by motherhood. While these feelings often ease over time, some new mothers may experience postpartum anxiety accompanied by sleep problems, requiring professional intervention. As postpartum anxiety and sleep problems are intertwined, it is important to recognise the signs for the well-being of both the mother and baby. 

What is postpartum anxiety?

Anxiety is your body’s natural response to perceived threats or danger. It is a normal and adaptive reaction that helps individuals recognise and respond to potential risks or stressful situations.¹ When faced with a perceived threat, the body’s “fight or flight” response is triggered, leading to physiological changes such as increased heart rate, rapid breathing, or heightened alertness. These physiological changes help prepare you to either confront the threat (fight) or flee from the threat (flight).¹

While anxiety is a natural response, it can become problematic when it is excessive or disproportionate to the perceived threat. Anxiety disorders are a group of mental health conditions characterised by intense and excessive fear, worry, or nervousness that is out of proportion to the actual threat posed. This condition can make it challenging for people to feel relaxed or calm, even when there is no immediate danger or threat. 

Anxiety that a new mother develops during the first year of childbirth is called postpartum anxiety and typically affects 10-20% of females assigned at birth (AFAB).^2,3 If you have postpartum anxiety, you may experience intense and excessive worry, or nervousness related to the well-being of the baby, yourself, or other aspects of life.^2,3

Understanding different types of postpartum anxiety 

If you have postpartum anxiety you may experience symptoms associated with one or more different types of anxiety disorders, each with their unique symptoms and triggers.³

Key sub-types of anxiety disorders include:

• Generalised anxiety disorder (GAD): is a long-term condition that is characterised by excessive worry about everyday events, situations, and activities
• Panic disorder: involves frequent panic attacks in which a person experiences sudden episodes of intense fear and discomfort accompanied by physical symptoms such as rapid heartbeat, sweating, chest pain, and shortness of breath
• Social anxiety disorder: involves an intense fear of social situations or performance situations, where people may fear judgement, embarrassment, or humiliation
• Obsessive-compulsive disorder (OCD): involves a person having intrusive thoughts or obsessions, and having an intense need to perform certain behaviours or rituals to alleviate anxiety or perceived threat of harm
• Post-traumatic stress disorder (PTSD): develops in response to a traumatic event. The person may experience symptoms such as flashbacks, nightmares, hypervigilance, and avoidance of reminders of the traumatic event 

Sleep problems in postpartum anxiety 

Sleep problems frequently accompany postpartum anxiety. The excessive worry or fear experienced by people with an anxiety disorder can make it harder to fall asleep and/or maintain sleep throughout the night. As a result, this can contribute to sleep deprivation and poor sleep quality, which can exacerbate anxiety symptoms, creating a cycle involving both sleep problems and anxiety disorders.^4,5 

Different types of sleep problems 

Sleep problems are common among those with anxiety disorders. Serious sleep issues like insomnia or nightmares have been incorporated into some anxiety disorder definitions, such as generalised anxiety disorder or post-traumatic stress disorder.⁶

If you experience sleep problems during the postpartum period, this may arise from difficulties adjusting to being a parent, sudden hormonal changes, or providing constant care for the baby.⁷ 

Sleep problems associated with postpartum anxiety include:

• Insomnia: refers to the difficulty of either falling or maintaining sleep
• Sleep fragmentation: refers to frequent awakenings during the night, disrupting sleep. These awakenings may occur due to meeting the needs of the baby, such as feeding
• Poor sleep quality: refers to waking up and feeling unrefreshed despite having some sleep
• Daytime sleepiness: refers to excessive daytime sleepiness and fatigue throughout the day due to disrupted sleep during the night
• Anxiety-related sleep problems: symptoms of anxiety can exacerbate sleep problems by causing racing thoughts, worries, or fears that interfere with the ability to relax and fall asleep 

Importance of addressing postpartum anxiety and sleep problems 

Addressing postpartum anxiety and sleep problems is crucial for several reasons:^8,9

Maternal well-being and infant care

Both postpartum anxiety and sleep problems can significantly impact maternal mental health and overall well-being. Untreated anxiety and sleep disturbances can lead to chronic stress, exhaustion, and a decreased ability to cope with daily challenges. This can affect the mother’s ability to respond to their baby’s needs, impacting bonding, feeding, and nurturing responses.

Mother and newborn relationship

Addressing postpartum anxiety and sleep problems is essential for fostering a positive mother-infant relationship. These symptoms can enhance the mother’s emotional availability and responsiveness, promoting secure attachment and healthy development in infants.

Long-term mental health

Untreated postpartum anxiety and sleep problems can increase the risk of developing long-term mental health disorders, such as depression or chronic anxiety. Early intervention and support can help prevent these issues from escalating and promote long-term mental well-being for both the mother and her family.

Symptoms and causes 

What are the symptoms of postpartum anxiety?

Anxiety serves as a protective function and is your body’s natural way of responding to danger or threats. It is important to note that experiencing some worry during the postpartum period is normal. It is when symptoms start to interfere with daily functioning, that it may indicate postpartum anxiety.

Symptoms of postpartum anxiety can include physical, emotional, and behavioural symptoms:

Physical symptoms 

• Muscle tension
• Headaches
• Fatigue or exhaustion
• Sleep problems
• Stomach problems (such as nausea or digestive issues)
• Shortness of breath or difficulty breathing
• Racing heart or heart palpitations 

Emotional symptoms

• Restlessness or agitation
• Difficulty concentrating or forgetfulness
• Avoidance of certain situations or activities
• Increased need for reassurance or checking behaviours (such as repeatedly checking on the baby)
• Irritability

Behavioural symptoms 

• Excessive worry or fear, especially about the baby’s well-being 
• Irritability or mood swings
• Feelings of dread or impending doom
• Difficulty relaxing or experiencing pleasure
• Intrusive thoughts or fears related to harm coming to the baby or oneself
• Difficulty bonding with the baby or experiencing joy in motherhood

Symptoms of sleep problems 

Symptoms of sleep problems can include:

• Difficulty falling asleep
• Frequent awakenings
• Mood disturbances 
• Poor concentration, memory, or decision-making
• Fatigue 
• Being awake for long periods at night 

What are the main causes of postpartum anxiety and sleep problems?

The exact causes of postpartum anxiety and sleep problems are not fully understood. It has been suggested they may arise from a combination of biological, psychological, and environmental factors.^4,6

• Hormonal changes: a decrease in hormone levels, particularly the drop in progesterone after birth, can impact brain chemistry and contribute to mood disturbances, including anxiety and sleep problems
• Genetics: A family history of anxiety disorders, sleep disorders, or other mental health conditions may increase the risk of developing postpartum anxiety and sleep problems. Genetic factors can predispose individuals to heightened sensitivity to stress and anxiety
• Stressful life events: Significant life changes, such as becoming a parent, sleep deprivation, financial stress, or relationship difficulties, can trigger or exacerbate anxiety symptoms in the postpartum period
• Personal history: Women with a history of anxiety disorders or sleep problems, such as generalised anxiety disorder or insomnia, are at increased risk of developing postpartum anxiety and sleep problems. Pregnancy and childbirth may serve as triggers for the recurrence or exacerbation of pre-existing anxiety or sleep symptoms
• Perinatal complications: Complications during pregnancy, childbirth, or the postpartum period, such as preterm birth, medical complications, or difficulties breastfeeding, can contribute to heightened stress, anxiety, and sleep problems in new mothers

Treatment and management 

How are postpartum anxiety and sleep problems treated?

Cognitive-behavioural therapy (CBT)

It is considered the gold standard treatment for people experiencing anxiety disorders. It involves speaking to a healthcare professional such as a psychologist, psychiatrist, or mental health nurse. CBT works by helping people identify and challenge irrational thoughts and fears, develop coping strategies, and learn relaxation techniques to manage anxiety and sleep problems effectively.

Support groups

Joining a support group for new mothers or those experiencing postpartum anxiety and sleep problems can provide peer support, validation, and encouragement. Connecting with others who are going through similar experiences can reduce feelings of isolation and help people feel understood.

Lifestyle changes

Making healthy lifestyle changes can also help manage postpartum anxiety and sleep problems. This may include prioritising self-care activities such as regular exercise, adequate sleep, nutritious eating, and practising relaxation techniques such as mindfulness or deep breathing exercises.

Medication

In some cases, medication may be prescribed to help manage severe symptoms of postpartum anxiety or sleep problems. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for anxiety. Sleeping tablets such as zolpidem may be prescribed to help treat sleep problems such as insomnia. It is essential to discuss the potential risks and benefits of medication with your healthcare provider, especially if breastfeeding.

How to improve sleep quality during the postpartum period

Improving sleep problems may involve following these simple recommendations and strategies to promote your ability to fall and maintain sleep:

• Sleeping (or napping) with your baby
• Keeping a consistent sleep schedule 
• Creating a relaxing bedtime routine
• Practicing relaxation techniques before bedtime
• Practicing good sleep hygiene
• Limiting caffeine and alcohol intake, especially hours leading to bedtime
• Prioritising good sleep environments such as keeping your room dark, and quiet, using blackout curtains, using earplugs to limit distractions 

FAQs

How do I know if I have postpartum anxiety?

Distinguishing between normal levels of worry and postpartum anxiety can be challenging. While it's common to experience some degree of worry and anxiety after giving birth, postpartum anxiety occurs during the first year following childbirth. Symptoms of postpartum anxiety may include constant worrying about the baby's health, difficulty relaxing or sleeping, feeling on edge or restless, and experiencing physical symptoms such as muscle tension or rapid heartbeat.

If you're experiencing persistent anxiety symptoms after giving birth, it's essential to seek support from a healthcare provider who can assess your symptoms and provide appropriate guidance and treatment.

How are postpartum anxiety and sleep problems diagnosed?

A comprehensive diagnostic assessment by a healthcare provider may include a discussion of symptoms, medical history, and any recent life stressors or changes. Your provider may also conduct screening tools or questionnaires to evaluate the severity of anxiety symptoms and sleep disturbances.

Additionally, they may perform physical examinations or order laboratory tests to rule out any underlying medical conditions contributing to sleep problems. Working with a mental health professional, such as a psychologist or psychiatrist, may also be beneficial for a thorough evaluation and diagnosis.

What is the prognosis for postpartum anxiety and sleep problems?

The prognosis for postpartum anxiety and sleep problems varies depending on the severity of symptoms and the individual's response to treatment. With appropriate support and intervention, many women experience improvement in their symptoms over time.

However, untreated postpartum anxiety and sleep problems can have significant implications for maternal mental health, infant care, and long-term well-being. Early recognition, diagnosis, and intervention are essential for improving outcomes and promoting recovery.

How to prevent postpartum anxiety and sleep problems?

While it may not be possible to prevent postpartum anxiety and sleep problems, there are steps that new mothers can take to reduce their risk and promote better mental health and sleep quality such as:

• practising relaxation techniques
• seeking support from loved ones
• establishing a consistent sleep schedule
• and optimising the sleep environment

Also, minimising stressors and seek professional help if needed. Staying informed about postpartum mental health issues can also be beneficial. By taking proactive steps, new mothers can promote better overall well-being during the postpartum period. 

Summary

Postpartum anxiety is relatively common during the first year following childbirth and often goes hand-in-hand with sleep problems during the postpartum period. The exact causes of postpartum anxiety and sleep problems are not fully understood although may arise from a combination of biological, psychological, and environmental factors.

Addressing postpartum anxiety and sleep problems can be managed through therapy, lifestyle changes, and medication. Hence, promoting positive mother-infant relationships to prevent long-term mental health issues.