When women give birth they realise that their sleep is going to be badly affected by their babies’ awakening and demands for feeds, diaper change etc. What they don’t realise is that for some women, sleep deprivation has a profound impact both on them as well as their families. It can even lead to anxiety and depression in some cases.
Sleep deprivation starts during the first trimester of the pregnancy, when the growing uterus competes with the bladder for space within the pelvis. Besides getting up to go to the toilet more frequently, some women even have to wake up to throw up due to nausea. For others, this may be triggered by fatigue caused by early-pregnancy hormones. These women, describe feeling so wiped out at the end of the day that all they want to do is to crawl into bed and sleep.
The second trimester typically provides some reprieve. But by the third trimester, women are again having poor quality sleep due to the growing belly and frequent foetal movements. Towards the last few weeks before delivery, the baby’s head which has now descended into the pelvic space is once again compressing the bladder, causing the expectant mother to frequent the toilet in the night. Sleep studies have shown that the disruptions to sleep in pregnant women in their third trimester do indeed qualify as a sleep disorder.
When the baby finally arrives, a whole different set of factors conspire to steal sleep from the poor mother. Firstly, there are the interruptions from the infant, who wakes up every 2 to 3 hours for a feed. This has to be followed by burping the baby and, in many instances, changing the diaper since Mother Nature has given humans something called a gastro-colic reflex, which means that when the stomach expands after a meal, there is then a reflex to empty one’s bowels. While it is good for regulating baby’s poops, it is certainly not so delightful when it happens in the middle of the night.
Combine this with the many months it takes before the baby finally establishes a routine and sleeps through the night, and what we have is a potential mental health crisis quietly taking place in many homes after a new baby arrives. Most women manage to weather this crisis successfully, with catching whatever sleep they can whenever they can, or by tapping on relatives, paid help or even friends to provide that crucial practical support during these months. But if there are other factors involved, an estimated 10 to 15% of women go on to develop a diagnosable Mood or Anxiety disorder.
Most of the women I see usually present the symptoms by the second month post-delivery. By then, all the euphoria of the arrival of the little one has evaporated, and life has settled into a haze of endless cycle of feeding, soothing, diaper-changing, bathing and putting baby to bed. By this time, mothers start noticing that they have difficulty finding words to express themselves, experience memory lapses, trouble concentrating, feel irritable anxious, and lack energy and zest. They are extremely sensitive, get angry easily and find it hard to calm down.
How then does one distinguish between sleep deprivation, and clinically-significant anxiety and depressive disorders?
One of the red flags for me would be if a woman cannot sleep even when her baby is sleeping.
Other than symptoms like sleep, appetite and energy levels in pregnant women and those in the postpartum period, I usually look out for other more distinguishing symptoms. One of the red flags for me would be if a woman cannot sleep even when her baby is sleeping. She usually describes feeling exhausted, yet having a very active mind. Some women describe thinking of a hundred and one things that still need to be done, or plan for, or worry about. Others say that everything seems like a priority and that it is hard to stop the thoughts from repeating or continuing. As a result, they often feel as if there is a feeling of vague dread that they have, as if something bad may happen at any time. This leads to further poor sleep, creating a vicious cycle.
A clinically depressed mother on the other hand, finds it hard to enjoy almost everything. Even seeing her baby doesn’t bring her joy. As if life isn’t confusing enough, some women have both anxiety and depression combined in varying degrees. Some symptoms of anxiety include:
- Feelings of dread or tension
- Difficulty controlling worries
- Seeing negative outcomes much more easily
- Muscle tension
Again, there is a risk of a vicious cycle starting: depression leads to changes in sleep duration and quality which in turn makes the depression worse. If it persists for at least two weeks, it’s time to consider seeking professional help.
A trained professional familiar with seeing perinatal women would be able to tease apart what is sleep deprivation and what might be a clinically-significant mood or anxiety disorder. Besides how sleep is affected, we also ask about whether or not her function has affected, and if possible involve her family members too in the assessment and support. Her individual stressors (which are unique to each woman) and strengths will also be assessed as part of coming up with a management plan. What is important though, is not suffering in silence. There are always avenues for help.
- NUH Women’s Emotional Health Service 67722037
- KKWCH Mental Wellness Service
Spouses and family members can also help in their own ways
- Listen without judgement
- Don’t react to sensitivity or irritability as far as possible
- Be encouraging to her that she is doing the best she can
- Help in practical ways that she finds helpful
- Reduce unwanted visitors
- Encourage her to seek help if you are worried
The contributor is the Director of the Women’s Emotional Heath Service at the National University Hospital.