Sleep and PPD – Post Partum Depression

Interview on Sleep and PPD-Post Partum Depression

Below is the second in a series of interviews aimed at providing insight on PPD by a number of different health and wellness professionals. We know that there are a variety of factors that contribute to the development of depression and anxiety following the birth of a baby (including hormone and chemical imbalances, nutrient depletion, sleep deprivation, lacking social support, marital conflict, a previous history of depression/ anxiety, and society’s expectations around motherhood, to name a few). My hope is that each perspective may offer a new understanding around ways to prevent, treat, and support issues related to PPD and other emotional vulnerabilities in motherhood.

Eileen Henry is an RIE Associate and mother of two excellent sleepers. She developed her sleep program, Compassionate Sleep Solutions, based on the (RIE) Resources for Infant Educarers philosophy of caring for the infant. This approach supports parents in caring for the needs of their child with respect, mindfulness and authenticity. She offers personalized sleep plans for expecting families and families with children birth to five years of age. She also offers private parent coaching and teaches RIE Parent/Infant classes in Boulder at Yomama Yoga. She is based in Boulder, Colorado

How often do you see women who are struggling with PPD or other emotional challenges after giving birth?
Since I am not a Dr. or a therapist I cannot make a diagnosis of depression or mood disorder. I do ask about an existing or past diagnosis of depression/mood disorder. Many of the families I work with on sleep have already been diagnosed and treated for depression. I find that these parents are highly successful because they already know how vital their sleep is to their mental and emotional health. I also offer parents the Edinburgh Postnatal Depression Scale (EPDS) if there has been no diagnosis. Sleep is 50% of our mental health. And with depression or any mood disorder the sleep must be regulated before any other treatment can be successful.

Do you feel these are common problems?

What are the symptoms that you notice?
One of the red flags for a parent is that the parent is not sleeping even after the baby’s sleep has regulated. If this continues I recommend that the parent seeks additional help from a therapist who specializes in mood instability. Other general symptoms are overwhelming feelings of sadness, lethargy, fatigue, and hopelessness. Or the mother may have a complete loss of interest in activities or others. But symptoms can also present in the form of anxiety and restlessness. If a parent feels anxiety and restlessness, and this is followed by a crash into sluggishness and an inability to function, this can be a sign that they need additional support from a therapist or psychiatrist who specializes in mood disorders. I always say, better safe than sorry. If you think you have a problem, or if a family member or friend thinks there is a problem… seek help sooner than later.

What, in your opinion, do you feel are the contributing factors to these symptoms?
Even in a typical person with a typical brain, sleep is 50% of our mental health. For those of us who have what I call “special needs” brains (Unipolar or Bipolar depression) sleep can make or break us. The natural sleep patterns of the infant are extremely disruptive to the adult brain. This coupled with the infants need for food in the night requires at least one parent to wake up long enough to see what the infant needs and then provide what the infant needs. In the beginning this can be every hour all night long.

In the work that you do, how are you able to support these moms who are struggling?
It depends on how old their baby is and what the food needs are in the night. One of the sleep packages I offer is called “Super Start”. If the pregnant mother has had a prior diagnosis of depression or suffered from pregnancy depression at any time during pregnancy she will need a plan going into those first few months of infancy. In these first months of life I am a believer that the infant brain benefits from co-sleeping. As long as dad has not been diagnosed with depression, the solution can be as simple as the co-sleeper going on dad’s side of the bed. Sometimes even a newborn awakens, grunts and gurgles and returns to sleep. If dad is there and can offer a warm hand of reassurance the infant often can and might just settle back to sleep. IF not he hands the baby to mom for a feed and then returns the baby back to the co-sleeper with little disruption to mom. But for many moms (especially with anxiety) bringing the baby into bed can be the easiest solution. Therefore the only consideration is how to make this safe and having a plan for how long this will last. The family bed is a beautiful place – as long as everyone wants everyone else there and everyone is getting the sleep they need. And it is one of these conditions that generally send the baby bird out of the nest.

Mood instability can be highly motivating in reaching what I call “the holy grail of sleeping through the night”. My programs all address the child’s developmental readiness and capabilities in autonomous sleep while stressing the vital importance and primary need of healthy relationship in a strong and loving bond. In general what benefits families where one or both parents suffer from a mood disorder are dependable, predictable sleep. And for typical babies this can happen, with our help, between 5-7 months of age.

What do you feel women and families can do to prevent symptoms of PPD and other emotional challenges?
Awareness is the fist step and is a key to the door of success. If the awareness of this issue is in place before you become pregnant or have a child then the next step is acceptance. This can be difficult to accept the unknown of how a child might affect your symptoms. But if you at least accept that it might, you can then take the next step of action. Have a plan. Make a plan with your spouse or partner of how you are going to handle these first few months of your infant’s needs.

But what if you wake up one day, at say 3:00 p.m., and you feel like you are in a fog?
You are still in your jammies (the same pair for the third day now), your precious infant is crying and you couldn’t care less. Your family and friends have expressed their concern and you feel numb and confused. In other words you don’t have the awareness until you “come to” in a state of overwhelm with a baby in your arms. This can feel like the worst day of your life. Because it was supposed to be the happiest moment and all you want to do is cry. From here the challenge will be, once again, acceptance. But there is hope out there. You are not alone and you don’t have to do it alone. The action is to educate yourself and get the help you need. There are solutions and you can find the one that feels right to you and get into action.

Can you discuss a success story? Have you worked with anyone who has been struggling with PPD or other adjustment challenges and has recovered?
Yes. Most mothers put it off and continue to suffer longer than they need to. One client came to me through a recommendation by her therapist. Her child was 10 months old and she was still waking every hour in the night to nurse. The mother had put off night weaning out of fear…fear of her own anxiety over the crying.

How bad would it be? How long would it last?
The first night her child struggled with falling asleep but the crying wasn’t half as bad as mom had projected. During the night the child woke every hour but within 5 minutes returned to sleep on her own. And so it goes. The story we make up about the cry is most often far worse than the actual experience of the cry.

Is there anything else you would like to share about your work with moms or prenatal and postpartum health?
A mother with depression or mood instability can not sustain sleep interruptions in the night for too long. The well being of the family will, sooner than later, depend on HER getting quality sleep. In most cases the thought of the process is much worse than the reality of it. And when they get to the other side, and the quality and quantity of sleep has improved so dramatically, they all say the same thing…”Why did I wait so long?”