Introduction

One of life’s most profound moments is bringing a new life into this world. This can be such a deep and wonderful joy for new parents. However, it is not without challenges that are important to address. Postpartum depression (PPD) affects many new parents and mothers worldwide. It can create darkness in what should be a bright and joyous occasion, creating an even more laborious transition into parenthood. PPD in itself is a challenge that can be arduous to tackle, but another adversary that new parents and mothers have to grapple with is sleep deprivation. Sleep is central to well-being and quality of life, and is often found to be quite elusive in the peripartum period. This adds extra struggle in this time, where rest can be a rejuvenation not solely for the physical but for the mental. This article will explore the relationship between PPD and sleep, and how this can have a deep impact on new parents. We hope this guide will be useful for those navigating these issues as a source of understanding.

Understanding postpartum depression

Diagnosis and symptoms

Postpartum depression (PPD) is a mood disorder that can affect new parents after childbirth, including after miscarriage and stillbirth. For those affected, persistent feelings of anxiety, sadness, despair and exhaustion can permeate daily life and reduce your ability to take care of yourself or others to the best of your ability.¹ If the presence of this disorder is under suspicion, diagnosis of PPD can be performed by a healthcare professional using many criteria, including those outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10/ICD-11).^2,3 These are prominent journals used to diagnose mental health conditions. Any questionnaire or criteria will cover a wide range of symptoms you may recognise in yourself and are summarised as such:

• Mood disturbances: Persistent feelings of sadness, hopelessness, or emptiness. You may also suffer from severe mood swings. This may present as excessive crying or difficult bonding with the baby⁴
• Cognitive and behavioral changes: Difficulty concentrating, making decisions, or recalling things. You may find yourself withdrawing from family and friends and having a loss of interest or pleasure in activities you would usually find interest in⁴
• Physical symptoms: Changes in appetite or weight, sleep disturbances (this may be insomnia or excessive sleep) and possible overwhelming fatigue or loss of energy⁴
• Psychological symptoms: Feelings of worthlessness, guilt, or inadequacy may shadow your day, and intense irritability or anger. In even more serious circumstances, thoughts of self-harm or harming the baby can impact individuals⁴

It is important to address that the experiences of some of these symptoms can be common after childbirth because of hormonal changes and the challenges of new parenthood. However, if these symptoms persist for more than two weeks or greatly impact your daily functioning, it may be an indication of PPD. It is paramount to look inward or outward to new parents who may show signs or symptoms of PPD, for early intervention and support. Please seek help from a health care professional (e.g. doctor, therapist, nurse) for assistance in diagnosis and treatment, if suspicion arises.

Factors contributing to the development of postpartum depression

Many factors can contribute to the development of postpartum depression and make it more likely to experience this disorder:

• Hormonal changes: Hormonal fluctuations postpartum, in particular oestrogen and progesterone, can contribute to developing mood disturbances and PPD^5,6
• Psychological factors: Previous history of depression, anxiety, or other mental health issues can increase the risk. Also, stressful life events, such as a difficult pregnancy or traumatic birth experience, can contribute^7,8
• Social support: Lack of support from family, friends, or a partner can make it more challenging to cope with the demands of new parenthood and increase the risk of PPD^7,8
• Physical health: Sleep deprivation, pain from childbirth, and other physical health issues can exacerbate depressive symptoms and contribute to the development of PPD^8,9

Sleep and the postpartum period

Sleep remains a central pillar of our overall health and well-being. It is a foundational requirement for optimising our physical, emotional and cognitive functions, so we feel our best in daily life.¹⁰ For new parents, sleep can be even more crucial to meet the demands of parenthood, especially at such an early stage. Sufficient sleep is essential for energy restoration,t healing, and maintaining a good emotional and mental balance.¹¹

The sleeping requirements of new parents undergo significant changes following the birth of their child. While every individual may require different sleep durations, new parents especially are susceptible to fragmented sleep patterns because of the demands of caring for a newborn.¹² The general recommendation by sleep medicine experts is an aim of 7-9 hours of sleep a night, but the reality of parenting is often in conflict with this guideline, leading to sleep deprivation.¹³ 

Effects of sleep deprivation on physical and mental health

Being sleep deprived can not only be a matter of energy depletion but can also have a profound influence on physical and mental health. In the postpartum period, inadequate sleep can exacerbate the challenge of recovering from childbirth.¹² Physically, this can lead to increased fatigue, reduced rate of healing, and reduced immune function.¹⁴ Mentally, sleep deprivation can lead to mood disturbances, cognitive impairments and increased stress, making it an even harder challenge to cope with the demands of parenthood at this early stage.¹⁴

Relationship between sleep and mood regulation

Sleep and mood are linked intricately. Sleep has a pivotal role in mental health and emotional well-being.¹⁵ Sufficient sleep supports optimal brain function and increases emotional resilience and stress management skills.¹⁵ If sleep demands are consistently unmet, it can lead to mood instability, increased irritability and heightened emotional reactivity.¹⁶ 

For those impacted by postpartum depression (PPD), sleep disturbances can further exacerbate mood imbalances and contribute to the onset or worsening of depressive symptoms.¹⁷ It is therefore of the utmost importance to address this issue in those affected and understand the relationship between PPD and sleep disturbances. 

The bidirectional link between postpartum depression and sleep

A body of evidence has shown that poor sleep quality during the postpartum period is linked to an increased risk of developing PPD. One study found higher global scores on the Pittsburgh Sleep Quality Index (PSQI) - a widely used questionnaire that assesses sleep quality and disturbances over one month. Higher scores on the PSQI indicate poorer sleep quality. The study results showed an association with increased depressive symptoms.¹⁸ 

Longitudinal studies have also shown that poor sleep quality during the early postpartum period predicts the development of PPD later on.^19,20 Another study found that sleep disorders during pregnancy increased the odds of developing PPD.²¹ Also, inadequate sleep duration before pregnancy has been associated with higher scores on the Edinburgh Postnatal Depression Scale (EPDS) at 1 month postpartum.²² Fatigue, poor sleep quality, and resilience are also predictors of depressive symptoms in the postpartum period.²³

Conversely, several studies have shown that those with PPD experience poorer sleep quality compared to those without PPD. They have higher levels of sleep disturbances, including longer sleep latency (time taken to fall asleep), more wake episodes during the night, and reduced sleep efficiency (percentage of time spent asleep while in bed).^24,25 Furthermore, the severity of PPD symptoms is associated with worse sleep quality.^24,25 

It is important to note that the relationship between PPD and sleep is bidirectional. This means that poor sleep quality can contribute to the development and persistence of PPD symptoms, and PPD symptoms can also cause sleep disturbances.²⁶ It is therefore crucial that we try plenty of methods to break the cyclical nature of PPD and sleep disturbances.

Factors contributing to sleep disturbances postpartum

There are many possibilities as to why postpartum sleep disturbances occur. A few include:

• Hormonal fluctuations: Disrupted sleep patterns due to oestrogen and progesterone shifts which can cause insomnia and night sweats²⁷ 
• Physical discomforts: Pain from childbirth, perineal soreness, and breastfeeding issues can make sleep less comfortable^28.29
• Psychological factors: Anxiety and intrusive thoughts about the baby's well-being can make sleeping much more difficult^28,29
• Caregiving responsibilities: Nighttime feedings and frequent baby awakenings is a demands that can increase sleep fragmentation^28,29

Coping strategies and practical tips

There are ways to tackle sleep disturbances, and here we present a few that help you improve sleep and tackle postpartum depression.

Sleep management tips

• Lean on your support network: Friends, family, and support groups can be lifelines during this challenging time. Sharing feelings and experiences can lessen the emotional burden and help in managing sleep disturbances. They can also help share the workload, which provides an opportunity for rest and sleep
• Relaxation techniques: Try relaxation exercises like deep breathing that can help to nurture restful sleep³⁰
• Sleep hygiene: Create a supportive sleep environment; a dark, quiet, and comfortable space can increase sleep quality³¹
• Sync with the baby: Seize opportunities for rest by synchronising sleep schedules with the baby's routine
• Prioritise self-care: Even small acts like a warm bath or reading a book can make a significant difference in rejuvenating the mind and body³²

Seeking help and support

In this transitional period to becoming a new parent, it is important to trust your instincts. Your intuition can help recognise when sleep disturbances or feelings may signal a deeper issue. Don't hesitate to seek help from a professional. Early intervention can make a world of difference in managing your postpartum depression and sleep disturbances. Your doctor may present you with options such as therapy or medication.³³ It is important to collaborate with your doctors and healthcare professionals so that your needs are met and you can feel involved and empowered in your care, especially at a time when it can be difficult to feel that way. You are not alone on this journey. There are numerous resources, charities and support networks available to help assist and guide new parents experiencing PPD and sleep disturbances. Using Hub of Hope can be useful in seeking local mental health charities.

Summary

There is a deep and interwoven relationship between postpartum depression and sleep disturbances. Addressing sleep disturbances is essential in the management and support of PPD symptoms, as both can exacerbate each other, creating an arduous cycle for new parents. Prioritising sleep is crucial for well-being and rejuvenation during the postpartum period. It is not just a physical reset: it is about nurturing mental and emotional health, which plays a crucial role in the adjustment to parenthood. Please remember that you are not alone, and we hope this guide helped you on your way to a path of well-being, and that you felt seen and heard. Good luck.