Struggling to Sleep After Baby?

What Research Tells Shows Us About Improving Postpartum Sleep Quality

Written by Dr. Fiona Callender, ND

Sleep is important for overall health

Sleep is crucial for our overall health - both mental and physical. Those who get less sleep seem to be at risk for a number of other health conditions, including type 2 diabetes and hypertension. Though we often think about quantity - “can I get those 8 hours!?” - quality might actually be more important. Quality of sleep is a subjective measure that tells us how an individual perceives their sleep. Sleep quality can be broken down into sleep latency (how quickly we fall asleep), sleep disturbance, and sleep efficiency (how long we were asleep versus how long we were actually in bed). Studies have shown us that better sleep quality is linked to 20-40% reduced risk of all-cause mortality. That’s reduced risk of death for any reason. This is huge. 

That’s great and all, but I’m postpartum and I’m up ever couple of hours…

The postpartum period is a time of massive transition in terms of physical and emotional health, but also in terms of relationships, roles, lifestyle - you name it. More than 60% of people experience poor sleep quality in the postpartum period. Sleep duration changes are almost unavoidable in the early weeks. Infants of various ages, stages and health complications have different requirements through the night when it comes to sleep and feeding patterns. We know that infant sleep will directly impact mom’s sleep. Hormonal changes, body discomfort and pain lingering from delivery, are additional factors that may play a role. For most people, sleep begins to improve somewhere between 6 weeks to 7 months postpartum - often by 6 months this is improving in a meaningful way. Though poor sleep is often accepted as a given in the postpartum period, it’s worthwhile exploring ways to improve quality if we can, given the known consequences of poor sleep. 

But what if it’s more than being disrupted?

I often ask my patients, “do you still experience difficulty sleeping when you are relatively free of pain and discomfort, no one wakes you up, and you don’t have to go to the bathroom?” Essentially, if someone took care of baby and you were given space and time to sleep - could you? We want to make sure this is not insomnia - which has quite significant overlap with postpartum sleep disturbance. In a very simplified way to distinguish the two, insomnia involves trouble with sleep even when the opportunity and conditions to sleep are present. It’s worth talking to your care provider (including me!) if you are concerned about this.

How sleep impacts postpartum mood - the relationship may be bi-directional

Worsening or minimal improvement of sleep problems by 7 months seems to be associated with greater risk of depressive symptoms. Poor sleep quality has been shown to be a risk factor for developing postpartum mood disorders and postpartum depression.  The risk of developing depression may be up to three times as high in those who are experiencing poor sleep quality. We also know that low mood can be associated with sleep distrubance. It’s important to seek support for low mood. There are a number of ways your care providers can support you - including therapy, lifestyle, assessing for underlying causes/other conditions that contribute, and/or medication.

One of the most important things we can do is move

Navigating getting better sleep in the postpartum period can be very challenging and so dependent on your baby, your support, how you are healing from pregnancy and birth. One piece of the puzzle that will support overall health as well as sleep, is movement. 

Exercise improves sleep quality in adults. Turns out, it’s the same in postpartum. Like in the regular adult population, we want to shoot for 150 minutes per week of moderate to vigorous exercise. Meeting these guidelines is associated with a 60% reduced chance of being a “bad” sleeper. This number can seem daunting for new moms - especially depending on what part of the postpartum experience you are at. The good news is that even every additional 30 minutes of “light” activity per day has been shown to be associated with a 24% reduction in the risk of being a “bad sleeper.”

Though exercise can’t necessarily improve how long you sleep - especially with frequent wake ups to tend to baby - it can be supportive in improving that quality piece. Given this, studies have shown that exercise can reduce daytime fatigue and general feelings of fatigue.

Light activity might be: gentle walking, household chores/activities.

Moderate to vigorous might be: brisk walking, swimming, cycling, strength training etc. What is considered moderate will be dependent on the person. We want this kind of exercise to get your heart rate up a bit so if walking isn’t doing that, you might want to consider increasing your intensity a little!

Why do we think Exercise improves sleep?

This is probably related to a few overlapping factors. Though exercise may help sleep and sleep may improve mood, exercise in itself has been shown to improve mood. Better mood seems to improve sleep quality. It’s all a bit of a cycle. Exercise may also improve energy through improved efficiency in our cardiovascular system and bringing oxygen to our tissues as well as using energy more efficiently. Movement also increases dopamine - which has been linked to improved mood an energy. Like many things in health, consistency probably matters more than intensity.

TLDR; Top Take aways?

Even modest amounts of light activity per day can make a difference in sleep quality. Increasing exercise, as you are able to, can make a difference in how you feel the next day. It’s not easy to incorporate more movement, especially dependent on your home environment, your access to equipment and space, the needs of your baby, your own physical healing, and your support systems. Remember that any little bit might help. What you can manage at three weeks postpartum will be different from what you can manage at seven months postpartum. Progress will be gradual so try to meet yourself with grace.

If you need support with how you are feeling as you increase your exercise, it can be helpful to speak to a practitioner who can help guide you. I love working with my patients to find ways to increase their exercise in ways that don’t provoke symptoms or feel overwhelming. Whether you are pregnant and looking towards postpartum wanting to be prepared, or you are currently in the throws of postpartum sleep deprivation, I’m here for you.