by Dr Caroline Hendry (PhD Developmental Biology)
The arrival of a new baby is supposed to be one of the happiest and most joyful experiences of our lives. Yes, it is exhausting, yes, it is rollercoaster of emotion, but by and large we’re brought up to believe that despite the pain, the tears and the frustration, having a baby is supposed to make us feel good. But what if it doesn’t?
Postnatal depression is surprisingly common in Australia and indeed around the world. But despite the prevalence - one in seven Australian women are diagnosed with postnatal depression following the birth of a child1 - it is hardly discussed at all. During my own pregnancy and after the birth, I never had a conversation about it with any of the women close to me. Taboo topic? Maybe. Or maybe it’s just really hard to talk about because no one even really knows why or how it happens.
Postnatal depression risk factors
There are several risk factors associated with postnatal depression: a personal history of depression is an obvious one, along with stressful life events, trauma, or marital conflict2. Another factor that doctors and scientists are looking closely at is sleep. It’s a well-known fact that women in the later stages of pregnancy, as well as postnatally, experience disrupted sleep cycles, poor quality of sleep, and a general lack of sleep2. And it can happen night after night, week after week, month after month. So could chronic sleep deprivation also be associated with and possibly even contribute to postnatal depression? Some scientists think so.
The link with sleep deprivation
Strong support for the link between sleep disruption/deprivation and postnatal depression comes from a recent publication by Alison Lawson and colleagues in the Journal of Affective Disorders2. The researchers investigated many different, independent studies on sleep and depression in the postnatal period, and ranked each study for its research strength, that is, how good the study was. For instance, only one single study out of 31 was ranked “strong” in its research strength, whereas the others were all “moderate” or “weak”. By looking at many studies at once, the researchers hoped that they might be able to better see the big picture and figure out whether sleep disruption/deprivation during pregnancy and after birth has anything to do with postnatal depression.
The results are thus: of the 15 studies that looked at sleep during pregnancy and later development of postnatal depression, nine studies found a relationship, including the only “strong” study in the entire group. Of the 31 studies that looked at sleep during the postnatal period and development of postnatal depression, 24 studies found a relationship. So it seems that sleep during pregnancy, as well as sleep during the postnatal period, has some kind of relationship with postnatal depression.
Is this surprising? It is well established in regular (non-postnatal) people that poor sleep quality is associated with an increased risk of depression and anxiety3, 4. In fact, sleep disturbances are one of the hallmarks of depression and anxiety, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders5. So if it’s true for the general population, then it makes sense that the same would apply to postnatal women. But unlike the general population, most postnatal women are breastfeeding, and therefore unable or unwilling to take sleeping pills and other drugs in order to try to combat insomnia. So what options are there for upping our sleep and reducing the risk of postnatal depression?
So what can you do?
One of my favorite sayings for new mothers is “eat when baby eats; sleep when baby sleeps; fold laundry when baby folds laundry”. This little piece of advice has a two-prong message: one; not to get frazzled by the build up of chores around the house, and two; to sleep as much as possible. As hard as it is to put ourselves first sometimes, it’s absolutely fundamental to maximize sleep both immediately following childbirth as well as throughout baby’s early development years. If you don’t, as these studies clearly suggest, you inadvertently increase the risk of developing postnatal depression. A happy, healthy Mum makes for a happy, healthy bub, so you might need to put yourself first and do whatever it takes to ensure you get a good night’s sleep – tonight!
1. Post and Antenatal Depression Association Inc. (PANDA). www.panda.org.au Fact Sheet 14 “Women and Postnatal Depresison”.
2. Lawson A, Murphy KE, Sloan E, Uleryk E, Dalfen A, 2015. The relationship between sleep and postpartum mental disorders: A systematic review. J Affect Disord. 1;176:65-77. doi: 10.1016/j.jad.2015.01.017.
3. Alvaro, P.K., Roberts, R.M., Harris, J.K., 2013. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep 36, 1059–1068.
4. Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., Lombardo, C., Riemann, D., 2011. Insomnia as a predictor of depression: a meta- analytic evaluation of longitudinal epidemiological studies. J. Affect. Disord. 135, 10–19.
5. American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Washington, DC.
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