Insomnia, Fatigue, and Depression: The Trifecta That Postpartum Moms Can’t Easily Escape

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SleepPostpartum 2

It’s 3 a.m. and I’m nursing my new baby, my fifth child. I’ve been up for hours, worrying about her, feeding and changing her, and then gently laying her down and tiptoeing back to bed. But when I hit the sheets, I lay there, eyes wide open, stressing, obsessing, and feeling lower than normal. Two hours pass. She’s up again and I’ve missed my little sleep window. Morning comes, and I don’t know how to make it through the day. Is it postpartum depression? Exhaustion? Insomnia? Which do I start with? They are all one, a perfect and terrible postpartum trifecta, plaguing moms everywhere with too many responsibilities, not enough help, and sometimes without the medical support they need. 

Now, a new study is looking at the impact the three have on each other, together, which hasn’t been investigated before. The article published in Women & Health on Nov. 2, takes the question one step further — how do the three impact the maternal role (1)?

They conclude that women are spending more energy performing daily living tasks in the postpartum period, suffering from insomnia due to baby care, and depressive symptoms affected their motherhood role, therefore, by 32.6 percent. They concluded there is a “moderately significant” relationship between the three, calling for more support for coping with insomnia along with depression.

“Postpartum life is talked about but what I’m finding with clients is that they are still not prepared for the insomnia and fatigue which can lead to depression in some. Postpartum Depression can be from the lack of sleep, hormonal changes, the fact that your whole world and identity changed in an instant and other factors,” says Abbey Sangmeister, therapist, founder of Evolving Whole, Professional and Parental Burnout Coach. “With more conversations during pregnancy and with parents being open to sharing their stories, I am hopeful there will be a shift to support new moms.” She says postpartum fatigue is a whole new game compared to other times in our lives where we are fatigued, mainly because there’s no break in sight.

“The difference for mothers is that another life is solely leaning on them for nourishment, connection, and comfort which does not end after a moment or night. The weight of this responsibility with fatigue can lead to depression,” she says.

Insomnia has also been linked with major depressive disorder, and researchers are calling for “novel” treatments to help people in that cycle as well. Other studies have explored how pregnant women can benefit from Cognitive Behavior Therapy for short term insomnia (such as a baby who isn’t sleeping for those first few months). 

Postpartum insomnia might seem confusing to moms and others supporting them as to why they can’t “sleep when the baby sleeps.” Sangmeister explains: “There are times when a mom is able to get sleep but is so tired that they can’t turn their brain off or allow their body to rest. The adrenaline kicks in and keeps them in go mode. The less sleep a mom gets the more tired and sometimes the less she is able to relax to sleep. This can lead to depression, feeling inadequate or not enough.”

 She has some concrete tips that have worked with moms she’s helped through her coaching business. These include:

  • Getting more support to do the other things that need to be done around the home
  • Making sure a mom is nourished with healthy foods that support healing, limiting caffeine and staying well hydrated. 
  • Moms and parents can work on regulating their nervous system; this would be great to practice during pregnancy to build the skill but if not to learn in the present moment. “One great way, I like to teach clients when they are doing skin to skin time to soak in the present moment and focus on their and their baby’s breath. It is a great way to focus on attachment while regulating self.”
  • Be assertive, clear, open and honest about their needs during this time. No one’s experience is identical and others may assume they know what you need to be direct and clear. Do not be afraid to ask for support. 
  • Parents rest and not worry about some of the other chores around the house. “The saying: rest when baby is resting is great advice. If you can’t sleep, curl up with a book, do breathing exercises, or journal your thoughts.”
  • Having a therapist and/or coach who specializes in postpartum care is a great way to have support and an outlet to process feelings and emotions. “Begin your work with them during pregnancy so you have rapport and have sessions set up during postpartum. If you haven’t done that, that is ok. Start today.”
  • Get fresh air especially in the morning hours as this will help your body attune to the circadian cycle. 

Of course, many of these are easier said than done due to financial, time, and support constraints. Perinatal and parenting advocates are calling for systemic change through supports such as affordable childcare to free up money for these supports, paid and longer leaves, and more follow up mental and physical healthcare for mothers. 

“Society needs to create more support for new parents. Friends and family are usually excited the first few days but parents need more support for at least the first year as there are so many changes happening to the family and the baby is growing rapidly,” Sangmeister says. “There is a failure in postpartum care for moms.”  

What Happened to One Mother Who Struggled With Postpartum Sleep

A client of mine did not expect as many challenges with her newborn. The feeding cycle of the baby was a challenge with an undiagnosed tongue tie and struggles with nursing. Her pediatrician suggested one thing while her intuition was telling her something else. Since this was her first child she went with what the pediatrician suggested even though it was a fight to wake the baby to feed them. This created a lack of sleep for the mother which made her feel inadequate and emotional. When she could sleep, she struggled to fall asleep because she knew soon she’d need to wake right away.

This mama didn’t have the right resources in the hospital with a poor lactation counselor who ignored her requests for support and needs. She also felt torn about getting rest and getting movement in. Seeing many women “bouncing back” but also knowing that it’s best for the body to rest and heal, she struggled with cognitive dissonance. I had worked with this client for years so I was able to help her process her thoughts and feelings so she could listen to her intuition and be solution focused.

When she guided herself with her intuition and trusted her motherly instincts, she was able to get more sleep, regulate her nervous system and tap into the strengths she had in the past that got her through other challenges. We also worked on being more assertive and clear about what her needs and asks were from other family members. Our sessions also included time to work on nervous system regulation through breathing, meditations, and movement exercises.

  • 1. Jale Ozdemir & Sadiye Ozcan (2023) Do postpartum insomnia, fatigue and depression affect the maternal role of primiparous women?, Women & Health, DOI: 10.1080/03630242.2023.2276150

Alexandra Frost

Alexandra Frost

Alexandra Frost is a Cincinnati-based freelance journalist, content marketing writer, copywriter, and editor focusing on health and wellness, parenting, real estate, business, education, and lifestyle. Away from the keyboard, Alex is also mom to her four sons under age 7, who keep things chaotic, fun, and interesting. For over a decade she has been helping publications and companies connect with readers and bring high-quality information and research to them in a relatable voice.  She has been published in the Washington Post, Huffington Post, Glamour, Shape, Today's Parent, Reader's Digest, Parents, Women's Health, and Insider.

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