Desperate for sleep
New parents reminisce about pre-baby days where a full
night's sleep was the norm rather than a luxury, and practically
salivate at the sight of their beckoning beds. Cherin Abdelaal
Selim and Shelley Zintl reveal there is light at the end of the
tired tunnel.
Got a newborn? Welcome to the world of postpartum fatigue
(PPF). PPF describes the exhaustion and reduced capacity to perform
physical and mental activities that new parents experience in the
postnatal period. PPF is more than just sleepiness; it is a
combination of being physically tired, mentally overwhelmed, and
emotionally exhausted.
What causes PPF?
Pregnant women are commonly afflicted with sleep-stealing problems
such as nausea, heartburn, night-time bathroom trips, and
difficulty finding a comfortable resting position.
Birth, even a straightforward delivery, is
an exhausting exercise. Particularly difficult births, and
complications resulting in intensive intervention, take a
significant physiological toll on a woman's body. Iron deficiency
and anemia, which pregnant women and new mums are at greater risk
of developing, also contribute to fatigue.
In addition to the physiological effects
of pregnancy and birth, women can also become fatigued due to
psychological or emotional factors. During pregnancy women often
spend a lot of time planning for the birth and imagining how their
child will enter the world. When actual birth experiences fall
short of expectations, women often feel disappointment, grief, or
anger - emotions that can be psychologically taxing.
Hormonal changes can wreak havoc with our
ability to sleep well. For example, towards the end of pregnancy
and immediately following childbirth, women experience a drop in
their progesterone levels. Progesterone is known to have mild
sedative effects so reduced levels can impact on sleeping. Changes
in melatonin levels (the sleep-inducing hormone) are also common in
the three months following childbirth.
A few generations ago, women stayed in
hospital for a week or so after giving birth and were encouraged to
rest and recover. "Rooming-out", where babies were taken to a
nursery at night to allow mothers to sleep uninterrupted, was also
the norm. These days, postpartum hospital stays tend to be short,
and many women are heading home with their new babies just a few
hours after giving birth. For those that do stay in hospital, the
atmosphere is not usually conducive for sleep. While we now
recognise the importance of "rooming-in" for bonding and the
establishment of breastfeeding, mothers are no longer given the
opportunity to rest and recover to the same extent before going
home with their newborn babies.
Most adults, in ideal circumstances, will
sleep for 7-9 hours per night. Sleep is divided into two phases:
Rapid eye movement (REM) sleep and non rapid eye movement (NREM)
sleep. During REM sleep, the brain is very active, while the body
is essentially paralysed (presumably to prevent us acting out our
dreams). REM sleep is often described as the time when our brain
sorts through and "files" information that we have processed and
learned throughout the day. REM sleep is thought to be responsible
for ensuring optimal cognitive and memory function.
During NREM sleep, our brain is relatively
inactive while our body is busy undergoing necessary repairs and
restoration. NREM sleep can be further categorized into four
stages: Stage 1 is a very light sleep which represents the
transition from wakefulness to sleep, and stages 2-4 are
progressively deeper levels of sleep. An average adult will cycle
completely through these sleep phases approximately every 90
minutes, usually beginning with a significant chunk of NREM sleep
(our body's priority for survival) then moving into REM sleep.
Because a baby's sleep cycle is much shorter than an adult's, it is
very typical for mothers to be woken before they have had
sufficient (if any) REM sleep. When baby's needs have been met,
mothers will go back to sleep and the sleep cycle begins again (it
does not pick up where it left off). This means that even if
mothers manage to get the same quantity of sleep they had pre-baby
(which most do not), this sleep is likely to be fragmented and
significantly deficient in REM sleep.
Caring for a new baby also means
significant lifestyle changes. Where once a woman was able to
meticulously plan her day, she may now feel overwhelmed by the
sheer number of jobs she needs to complete within a shortened
amount of time. The unpredictability a newborn brings can leave the
new mother feeling on edge and living her day reactively, according
to the ever-changing needs of her baby. This sudden lack of control
can be very emotionally draining.
Furthermore, not all babies are alike, and some
are much harder to care for than others. For example, babies with
difficult temperaments, developmental problems, or physical
complications such as reflux, will all demand more care and
attention. As well as experiencing more disrupted sleep, mums may
also be emotionally fatigued by worry about their baby's health and
development.
What are the effects of postpartum fatigue?
The effects of PPF may include:
* Emotional changes: Low mood, crying, and irritability.
* Cognitive impairment: Difficulty concentrating or completing
complex mental tasks, poor memory.
* Physical changes: Loss or increase of appetite, weight loss or
gain, unexplained physical complaints such as stomachache or
headache.
* Weakened immune system.
* Accident-proneness.
* Depression: Although research continues to be mixed, it is
generally thought that PPF may be both a cause and effect of
postnatal depression (PND). Because both conditions share a number
of features, such as low mood, tiredness, and irritability, it can
be hard to differentiate between them. If you are experiencing
fatigue that is particularly severe, or is not beginning to subside
over time, it is important to seek a professional
opinion.
How long will I feel like this?
Many first-time mothers eagerly await the six-week milestone
because they have been told that things get easier at this point.
However, most will agree that "easier" is a very relative term, and
fatigue can continue for much longer than this. Recent research
suggests that symptoms of fatigue become progressively worse over
the first six weeks after baby is born, but the actual period of
PPF is defined as the first 12 weeks of baby's life. For around 50%
of women, symptoms will persist to some degree for up to 18
months.
What can I do to minimise PPF?
* Get organised before baby is born. Tackle any little jobs that
need doing (or even better, delegate them to others!); put away
plenty of meals in the freezer; organise your home and baby's room
to enable you to find things quickly; pre-pay household bills if
you can afford it. Every step you take to reduce stress and
pressure following baby's birth will help.
* Sleep when baby sleeps. In particular, try to coincide your
sleeping with baby's longest stretch of sleep to allow yourself the
best opportunity to get through a full sleep cycle (including REM
sleep).
* Delegate tasks to family and friends to allow yourself more time
to rest.
* Eat a healthy, balanced diet and exercise moderately when you are
feeling up to it.
* If possible, enlist help with nighttime awakenings. The goal is
to allow you to have an extended period of uninterrupted sleep as
often as possible and practicable. For example, you may ask your
partner to do one of the night feeds if your baby takes a bottle,
or even ask your partner to bring baby to you for night feeds to
save you having to get up. If you are parenting alone, consider
asking a family member or friend to stay over once a week to tend
to your baby during the night. There are also a number of
professional agencies that provide a night-nanny service.
* Only do the basic household chores. If you've washed the dishes
and done a load of laundry, consider it a successful day.
* Have a trusted person take your older children on outings.
This will allow you some time to focus on yourself and your new
baby. If your baby has a sleep at this time, make sure you have a
rest too.
* Breastfeed lying down. Research shows that women who do this
experience less fatigue than those who feed sitting up.
* Learn about infant sleep and how to encourage good sleeping from
your baby as soon as possible. Although all babies differ, most
will be developmentally capable of sleeping for 5-8 consecutive
hours at night (in addition to 3-4 day sleeps) by around three
months. If you are having difficulties with your baby's sleeping
after six months of age, consider getting advice and support from
trusted family and friends, or a professional.
Although PPF is unpleasant, it is
temporary. Take advantage of whatever support you can get and take
care of yourself. Remember that babies do eventually turn into
teenagers who struggle to get out of bed before midday, so a full
night's sleep will once again be the norm for all. And, in that
strange irony of life, you will probably find yourself looking at
your teenager and reminiscing about the baby days, all memory of
fatigue forgotten.
Cherie Abdelaal Selim and Shelley Zintl run Child and Family
Psychology Services in Canterbury, a specialist consultancy
providing comprehensive assessment and treatment options for
babies, children, adolescents, and families. Their services include
sleep, behaviour, development, parenting, family relationships,
anxiety, and depression. For more information, visit www.childfamilypsychology.co.nz
References
* Hunter, LP, Rychnovsky, JD, and Yount, SM. "A Selective
Review of Maternal Sleep Characteristics in the Postpartum Period."
Journal of Obstetric, Gynecologic and Neonatal Nursing 38
(2009):60-68.
* Livingstone, K., et al. "Postpartum fatigue and driving: Relating
experiences, thoughts and opinions 12 weeks post-birth." The 4th
International Conference on Women's Issues in Transportation, 27-30
October 2009, Irvine and Newport Beach, California. Available
online at www.eprints.qut.edu.au/28609/
* Meltzer, LJ and Mindell, JA. "Relationship Between Child Sleep
Disturbances and Maternal Sleep, Mood, and Parenting Stress: A
Pilot Study." Journal of Family Psychology 21.1 (2007):
67-73.
* Mindell, JA. Sleeping through The Night. New York: HarperCollins
(2005).
As seen in OHbaby!
magazine Issue 10: 2010
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