Nicole Leistikow, assistant professor of psychiatry at the University of Maryland School of Medicine in the United States, talks about depression in the first months of motherhood
when one of mine pregnant patients started at feeling depressed during the third quarter, we both wondered: would it be time to start antidepressant? Despite her history of postpartum depression, she felt fine. But for three weeks she cried often and felt guilty, impatient, and less resilient.
THE depression during pregnancy it’s one of the biggest risk factors for postpartum depression, so it was time to take action. Before writing a recipe, however, I had another question: how is yours to sleep?
His answer: not good. She started waking up during the night as her body welcomed the growing baby. Her baby also started waking her up and she was having trouble falling back asleep. “Has your husband got up with him yet?” I asked her. “Nope,” she replied. She felt bad for asking.
Her husband was no slouch; he just wasn’t prioritized your sleep. When I framed sleep as an important intervention for her and the baby, she was able to talk to her husband, which resulted in dramatic improvement… the resolution of your depression.
“I’ve slept so much better since our last appointment,” she wrote. “I was able to get through most of my nocturnal awakenings. Marked improvement in my mood – didn’t get overwhelmed or sad as easily, felt less stressed and generally more myself.”
The research on the consequences of sleep disruption outside of pregnancy and postpartum is substantial and compelling: Acute sleep disruption can be disabling. That’s why we have time restrictions for jobs like flying planes, driving trucks and practicing medicine, where the consequences of not enough sleep can take a toll.
We also know that chronic sleep disruption takes years off your life, increasing your risk of diabetescardiovascular disease, stroke and cancer.
The risk of depression after pregnancy is high
During and especially after pregnancy, when a biological window of increased risk of depression opens, women experience acute and chronic sleep deprivation that lasts for weeks, months, and sometimes years, with a shrug, as if to say : “What can you do?”
Despite growing awareness and recommended universal screening for perinatal depression, most women, their families, and their doctors expect the perinatal brain to recover from mental illness during toxic sleep deprivation. We prescribe helpful interventions like therapy and medications, but we expect them to work a miracle if we think they can get the brain out from under the 10,000 pound elephant in the room.
Such an elephant is a night food for babies. If the mother is not depressed or if the baby starts sleeping every 4-6 hours, then standard interventions for postpartum depression will work, hopefully. However, if a mother is at high risk for postpartum depression, or is already depressed, and for some nefarious purpose one wishes to cause or maintain mental illness, a simple recipe for waking up every 1 hour to 3 hours during the night for weeks in the end that would be enough.
And the reverse experiment? Could restoring postpartum sleep cure severe postpartum depression?
A study on brexanolone, the first drug approved by the Food and Drug Administration (a US body similar to Anvisa) for postpartum depression, suggests yes. To participate in this double-blind, placebo-controlled study, severely depressed postpartum women had to stop breastfeeding for seven days and receive an intravenous infusion in a hospital setting.
Some women have taken brexanolone; others were given saline without the drug. Everyone must have had supportive families who figured out how to care for a child during the night. Brexanolone has rightfully made headlines by dramatically reducing rates of depression in 72% of women in just 60 hours and maintaining that effect for 30 days.
However, in the placebo group, in which severely depressed women were given nothing more than the opportunity to sleep and then go home to the family who had developed a strategy to feed the baby at night without the mother, 55% of the women felt better and stayed better 30 days later.
Could restoring sleep quickly and sustainably solve postpartum depression? My patients have proven the effectiveness of this remedy for years.
These are my tried and tested tips on how to increase sleep after childbirth. They are aimed at the postpartum period (the most difficult time to consolidate sleep), but also apply during pregnancy or waking up the baby.
Sharing children’s shifts benefits the whole family
If a partner or family member consistently takes responsibility for caring for the baby when he wakes up and allows the mother to sleep – so that she has a 4-5 hour sleep period plus another 2-3 hour sleep period before or after – this sleep consolidation can allow you to recover or avoid depression.
The partner can sleep 2-3 hours plus 4-5 hours of sleep and can also continue to function. Here’s how it might work: Let’s say your child goes to sleep at 8:30pm and wakes up every 2.5 hours. If the mum goes to sleep at 8.30pm and a partner feeds at 11pm, around 1.30am, when the baby wakes up again, the mum will have had five hours of sleep and can take over, allowing her partner to sleep from 11.30pm to 11pm until morning.
Taking turns allows another person to become adept at soothing the baby at night, which improves bonding.
Prioritize sleep over everything else
A common objection to suggestion no. 1: “I have so many things to do – the only time to do them is when the baby is sleeping!” Protecting postpartum sleep will require you to sacrifice something. I think, however, that when women experience the benefit that consolidated sleep brings, they are converted to the gospel of quality time as a non-depressed mother rather than amount of time living in the shadow of depression.
It’s worth leaving the dishes undone and the boxes unmarked. Your family wants you to feel like yourself again and not do more at the expense of suffering.
Use a sheltered bedroom
The subsequent objection to suggestion no. 1 is something like: “I wake up every time the baby wakes up, so I can feed him myself.” I recommend that the person “on duty” sleeps in the same room as the child, while the person “protected sleeper” hides out in a separate, quiet room.
After the shift is over, have your partner walk into the quiet room and turn on a monitor or leave the door open so that the next time your child wakes up, you can hear what time it’s “on.”
Be flexible about food
Use whichever combination of methods is most protective of your health and your ability to bond and connect with your baby. Depression makes connection difficult.
Tip no. 1 is not compatible with exclusive breastfeeding every time. Having a loving person take over a feeding or two does not damage the mother-baby bond. Postpartum depression yes. Use any combination of breastfeeding, pumping, and formula to protect you and your baby together.
For women who wake up with milk production arriving before 4-5 hours of established sleep, consider pumping upon awakening and then delay pumping another 30 minutes every third night.
Over time, you can train your body to give yourself a 4-5 hour break between disappointments. Add a pumping or feeding session during the day if you’re concerned about your total milk supply.
Protecting postpartum sleep is difficult
Give yourself and your family a chance to fail, learn and improve. Try different solutions for two weeks, then reevaluate and make changes.
Finally, we need to improve maternal sleep as a society. Surprisingly, maternal suicide is a leading cause of postpartum death in the United States, and postpartum depression is estimated to cost $32,000 per untreated mother-child pair. Night doulas, paid leave or other types of support for single parents cost much less. Can we afford not to make the investment?
Nicole Leistikow is an assistant professor of psychiatry at the University of Maryland School of Medicine and a reproductive psychiatrist at the University of Maryland Medical Center.
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Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
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