How Do You Treat Postpartum Insomnia?

DISCLAIMER: All content and information on this blog is for informational and educational purposes only, does not constitute medical advice, is not intended to diagnose or treat, and does not establish any kind of client relationship. 

Postpartum insomnia is a common problem for new parents. It involves trouble falling asleep, staying asleep, or both. Birthing parents and breast/chestfeeding parents are more likely to be affected than their partner. The problem can start during pregnancy or after birth.

What are the symptoms of postpartum insomnia?

Postpartum insomnia symptoms mirror regular insomnia symptoms and include:

• Taking a long time (20-30+ minutes) to fall asleep, even though you feel tired or know you haven’t gotten enough sleep recently

• Waking often (not because the baby is crying), even if you can go back to sleep relatively easily

• Waking up before you want to, i.e. before your alarm goes off or before the baby wakes you up

• Taking a long time (20-30+ minutes) or not being able to fall back asleep if you wake up in the middle of the night, early in the morning, or in the middle of a nap

• Not feeling rested when you wake up, even after getting a good stretch of sleep

• Changes in mood or behavior that are due to chronic poor sleep such as:
  • Irritability or postpartum rage
  • Fatigue or daytime sleepiness
  • Difficulty concentrating or problems with memory
  • Mood swings, feelings of anxiety or depression

Is it normal to have insomnia after childbirth?

It is important to distinguish between insomnia and sleep deprivation/disrupted sleep. 

ALL new parents experience disrupted sleep and some degree of sleep deprivation. This is because newborns have to be fed every few hours. Therefore, it’s very difficult or impossible to get a normal nighttime stretch of sleep during the first few weeks or months. This is especially true for a breast/chestfeeding parent.

So even though a new parent may be able to get enough total hours of sleep in a day, it is only a few hours at a time. Obviously, this is not as restorative as one longer stretch of sleep! More importantly, tt can still cause the same problems as not getting enough sleep!

Very fussy or colicky babies make it even more difficult for new parents to get enough sleep. This can result in significant and ongoing sleep deprivation. 

=> So not getting enough sleep simply because the baby is waking you up or keeping you up because they are crying, need to be fed, or have to be held/rocked to sleep is NOT insomnia.

=> Insomnia is when you have the opportunity to sleep – when the baby is sleeping, when your partner offers to take over, or when you have someone available to watch the baby for you – but you STILL can’t fall asleep or stay asleep.

So what causes insomnia after birth?

Stress and anxiety is a very common cause of insomnia. Stress can impact birthing and non-birthing parents simply due to the adjustment of bringing a new baby home. It’s stressful learning how to care for the baby or how to care for the baby AND an older child.

For some parents, it goes beyond typical new-baby stress and they develop postpartum anxiety. These parents may struggle to sleep due to intrusive thoughts that are upsetting or scary, or from ruminating about all their worries.

Both birthing and non-birthing parents may experience changes to their circadian rhythm (day/night pattern) and their sleep drive (the natural “pressure” or tired sensation that helps you to fall asleep around the same time each night). This is due to generally disrupted sleep and constantly changing sleep times. It is also affected by increased daytime sleep (all the naps!), and suppressed melatonin secretion from nighttime light exposure during overnight feedings. 

Birthing parents and breast/chestfeeding parents are also impacted by physical complications and hormonal changes from childbirth and/or milk production. These can cause insomnia on their own or indirectly by creating more stress. These may include:

• Iron deficiency or anemia (more common with excessive blood loss after delivery)
• Pain from incisions (c-section or episiotomy), vaginal tears, cracked nipples, etc.
• Postpartum infections (mastitis, UTIs, endometritis)
• Thyroid changes

Will postpartum insomnia go away?

Short-term or acute insomnia refers to sleep difficulties that only last a few days or weeks at a time. It usually occurs in response to a stressor (such as physical and/or emotional postpartum adjustment). This type of insomnia typically resolves when the stressor goes away or becomes less of a problem. Therefore, if you have only been experiencing insomnia for a short time or it isn’t happening too often, then there is a good chance it will go away as you heal physically and adjust to new routines.

Long-term or chronic insomnia refers to sleep difficulties that occur at least three times per week for three months or longer. This kind of insomnia generally indicates an underlying physical or psychological problem. Chronic insomnia is unlikely to go away until the underlying problem is treated.

How to treat postpartum insomnia

If you think you need help for postpartum insomnia, your treatment options will depend on what is causing your insomnia:

Physical – It is always best to meet with your doctor first to rule out common physical causes such as iron deficiency, thyroid changes, or a side effect of medications. If they believe you may have a sleep-related disorder such as sleep apnea or restless leg syndrome, they will refer you to a specialist for testing.

Psychological – If you are experiencing a postpartum mood disorder such as anxiety, depression, or PTSD, these can all contribute to insomnia in different ways. In this case, you will need to seek out behavioral health treatment. A therapist can help you to process your postpartum thoughts and feelings and identify the most effective coping skills to manage your mood and therefore improve sleep.

Medication may also be necessary. You can start by reaching out to your primary doctor or OB and they will refer you to a psychiatrist if needed. People generally feel the most benefit in a shorter amount of time when they combine therapy and medication for treatment.

Conditioned – Short-term sleep disturbances can lead people to cope in ways that cause them to develop habits and thinking patterns that unintentionally reinforce poor sleep. For example, drinking lots of caffeine, taking too many naps, or being worried about if you’ll be able to sleep tonight. This turns into a type of chronic insomnia.

Treatment for conditioned insomnia requires changing your environment and routines and re-training your brain out of those unhelpful thinking patterns. All this can be accomplished through something called CBT-I.

What is cognitive behavior therapy? And how does it help treat postpartum insomnia?

• Cognitive behavioral therapy (CBT) is a psychological treatment designed to address both the cognitions (thoughts) and behaviors that are contributing to mental health problems such as anxiety and depression. 
• Cognitive behavioral coaching is an adaptation using the same principles and techniques to help people work through other kinds of life challenges to be able to reach their goals for career, relationships, etc. 
• CBT-I is a form of cognitive behavioral therapy or coaching specifically for insomnia.  

Does CBT-I help treat postpartum insomnia?

Yes! If your doctor has ruled out or addressed any physical causes, cognitive behavioral therapy or coaching is a brief, structured, and scientifically proven approach to treating insomnia. It is equally effective as prescription sleep medication in the short-term, and more effective in the long-term. It’s more effective long-term because it addresses the root of the problem! It creates lasting change to your sleep (whereas sleep problems return when medication is discontinued). With CBT-I, you will learn to:

• Develop good general sleep hygiene and healthy habits that promote consistent, restful sleep

• Engage in stimulus control – re-establishing the bed=sleep connection so that your brain associates your bedroom and bed with calm, quiet, and rest

• Utilize cognitive restructuring to identify, challenge, and change any thoughts or beliefs that are contributing to your insomnia

• Identify and use effective coping skills to manage feelings of anxiety or stress, calm down after waking from a nightmare, or wind back down if something disrupts your sleep

CBT-I and similar cognitive behavioral approaches to insomnia are offered by behavioral sleep specialists, mental health therapists, general life coaches, and adult sleep coaches/consultants.

If you are experiencing significant postpartum mood issues, I recommend finding a therapist trained in CBT-I. He or she will be able to address other symptoms of anxiety, depression, PTSD, etc. and any deeper or more complicated psychological issues in addition to helping you improve your sleep.

Are you ready to end the insomnia and feel like a renewed momma?

Learn more about my therapy services for moms (including CBT-I) – available for moms residing in Colorado or Georgia.

Or click below to schedule a free 15-minute consultation call to talk more about how therapy can help you get more sleep!