Sleep & Perinatal Mood and Anxiety Disorders

Apr 7

It is probably an understatement to say that LOTS of different emotions are felt while you are preparing to bring a baby into the world and during those postpartum months. The joys and excitement of a new baby can also be met with stress, anxiety, sadness, and other mental health concerns. Parental well-being is such an important factor in babies’ well-being, and sleep can certainly play a role!

What are PMADs?

Perinatal Mood and Anxiety Disorders, also known as PMADs, refer to a spectrum of mental health concerns around the time of having a baby. Perinatal includes during pregnancy and the 1st year after childbirth. PMADs includes:

Depression: feeling of sadness, lonely, disconnected, loss of interest and energy, suicidal, possible somatic symptoms (e.g., headaches), etc.
Anxiety: excessive worry, persistent thoughts, irritable, restless, poor concentration, sleep disturbances, somatic symptoms, etc.
Obsessive compulsive disorder (OCD): repetitive and intrusive thoughts, behaviors to reduce obsessive thoughts, fears, etc.
Post-traumatic stress disorder (PTSD): fears, flashbacks, anxieties, may be caused by traumatic childbirth or past trauma, etc.
Bipolar: mood changes that fluctuate between depressive and manic episodes
Psychosis: delusions, disoriented thoughts, homicidal or suicidal, etc.

This site has more information on PMADs as well as information on services and resources: https://www.postpartum.net/learn-more/

Here is a chapter in a book that discusses PMADs in detail: https://books.google.com/books?hl=en&lr=&id=RCQlDwAAQBAJ&oi=fnd&pg=PA14&dq=pmads+sleep&ots=h_zccaLQ39&sig=eGZp1oFIwDNAZ9szb_P9EVCSbBI#v=onepage&q&f=false

Mothers and fathers can suffer from PMADs.

It is important to seek help if you or a loved one is showing signs and symptoms of PMADs!

PMADs vs Baby Blues

It may (or may not) be surprising that up to 80% of mothers will feel the “baby blues” during the first few weeks of having a baby. Contributions to baby blues can include hormonal fluctuations, acute sleep deprivation, and just overall responsibilities and lifestyle changes that come with having a baby. It’s important to note that the baby blues are different from PMADs. Baby blues may include some similar symptoms to PMADs, but are short term, typically between 2 days to 2 weeks, and occur during the first 2-3 weeks postpartum. If symptoms continue beyond that, it is advised to seek out additional support since this may fall outside the realm of baby blues and within the spectrum of PMADs.

Risk of PMADs

There are risk factors for PMADs which include: history of mood and anxiety disorders, abuse (domestic, substance, etc.), previous trauma and trauma during childbirth, domestic abuse, lack of support and resources (income/job, insurance, child care, breastfeeding issues), unplanned pregnancy, physical pain, etc.

Sleep Influences

Unfortunately, there is a very common misconception that parents should be sleep deprived when they have a baby. It’s an accepted “norm” that can have detrimental effects on parents.

Fragmented sleep and sleep deprivation have been shown to increase the risks of depression and anxiety in the general population. Consider that pregnant mothers and postpartum parents are dealing with limited sleep plus all other responsibilities and influences as a new parent - this is almost the perfect storm for risks of mental health concerns. Sleep deprivation can also lead to impaired cognitive functioning, which is not ideal ever let alone when caring for a baby.

Here’s an article that looks into fragmented sleep for postpartum mothers and depressive symptoms: https://link.springer.com/article/10.1007/s00737-009-0070-9

These research studies look into the relationship between mother’s already dealing with depression and increased depressive symptoms postpartum when sleep deprivation is a factor. This shows the importance of addressing quality of sleep for postpartum parents which is likely directly related to their baby’s sleep. https://journals.lww.com/co-psychiatry/Abstract/2015/11000/Sleep_and_postpartum_depression.17.aspx

https://www.sciencedirect.com/science/article/abs/pii/S0884217515301453

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322694/

Not only are parents likely dealing with fragmented sleep and sleep deprivation with a new baby, but a baby’s sleep can also be a large cause of stress and anxiety. As a parent or caregiver, you may be feeling pressured to get your baby to sleep at certain times, sleeping independently versus with assistance, staying asleep after transferring into bassinet or crib, avoiding an overtired baby, managing skipped naps, dealing with early wakings, etc. These concerns about baby sleep can contribute to parent mental health struggles (and the struggle with sleep perfectionism).

PMADs and Influence on Infants

Postpartum mental health can have effects on infant development. Parent attachment to their infant can be affected, as well as the infant-caregiver relationship. There may be an influence on a baby’s developmental milestones, regulatory development, future likelihood of difficulties in areas of cognitive and emotional development and behavior challenges. The research does suggest that more research is needed in this area to fully understand the influences

More on the influence parent mental health can play short-term during infancy and long-term into childhood:

https://link.springer.com/article/10.1007/s11920-017-0857-8

https://www.sciencedirect.com/science/article/abs/pii/S0883941798800046

https://www.tandfonline.com/doi/abs/10.3109/09540269609037817

Getting Help for PMADs

Unfortunately, there are improvements to be made in the areas of screening for PMADs during pregnancy and postpartum. Some people don’t realize they are even dealing with these mental health concerns. They may brush off the thoughts and feelings as normal or maybe they feel there is a stigma to saying anything. BUT - Help is available! If symptoms and signs are lasting longer than two weeks, interfering with daily functioning, or you simply want some additional support, there is nothing wrong with seeking out help!

Although there are not always preventative measures that can be taken to avoid PMADs, it’s incredibly helpful to have the education on PMADs so that any signs can be recognized and responded to early on. Parents will be in a better place if they have coping skills and a safe space to address their concerns. This also goes for having the knowledge, understanding, and support to handle the newborn/infant stage.

Let’s Revisit Sleep and PMADs

Quality sleep can make a huge difference – as shown in the research -- for parental well-being, which in turn has positive effects on infant well-being – also in the research! Solving sleep concerns (for baby and parents) is not the sole focus for addressing PMADs (please seek out treatment to specifically address PMADs - here’s a starting point: postpartum.net). However, looking into potential sleep solutions can be a helpful step in addressing one piece of the puzzle.

If you are in a place where you feel ready to address your little one’s sleep so you too can focus on your own sleep and overall well-being, schedule a consult call with me so we can discuss your sleep goals!

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