The Connection Between Sleep and Perinatal Mood and Anxiety Disorders

By Elizabeth Culnan, PhD, DBSM

Sleep is restorative – for our minds and our bodies. When we don’t get enough sleep, our ability to regulate our emotions can suffer. The postpartum period is a time when sleep deprivation and disruption are present. This lack of rest can exacerbate or even trigger a perinatal mood or anxiety disorder (PMAD), like postpartum depression or postpartum anxiety. In fact, 1 in 5 women experience a PMAD, making the postpartum period a critical time to not only “check in” on how you’re feeling emotionally, but also to monitor how well you’re sleeping. Let’s take a closer look at how sleep and PMADs are related.

Postpartum depression and difficulty sleeping

Women with postpartum depression have more difficulty sleeping than postpartum women without depression (Goyal, Gay, & Lee, 2009; Postmontier, 2008). More specifically, they have more trouble falling asleep and spend more time awake in the middle of the night than women without postpartum depression. Postpartum insomnia and poor sleep also predict postpartum depression (Okun & Lac, 2023). One takeaway from this research is that the relationship between postpartum depression and sleep is likely bidirectional. In other words, having postpartum depression may make it harder to sleep. Difficulty sleeping may also make it more likely that you’ll experience postpartum depression. This means tending to both your sleep and your mood is crucial.

Postpartum anxiety and difficulty sleeping

There is less research examining the relationship between sleep and postpartum anxiety; however, the results of those studies that have been done are similar to what we see when examining the relationship between sleep and postpartum depression. Women with postpartum insomnia and poor sleep are more likely to have postpartum anxiety (Okun & Lac, 2023). Similarly, sleeping poorly at six months postpartum is related to greater levels of postpartum anxiety (Okun et al., 2018).

Bipolar disorder

Sleep is critical when it comes to managing bipolar disorder. For many people, manic episodes can be triggered by sleep loss (Lewis et al., 2013). Since the postpartum period is a time when new parents are losing sleep and also having interrupted sleep, it’s a really important time to tune in to how you’re sleeping and what your mood is like. Women who rate sleep loss as a trigger for mania may have more than twice the odds of experiencing postpartum psychosis than women who do not rate sleep loss to be a trigger for mania (Lewis et al., 2013). The more you can protect your sleep, the better. What this looks like will be different for everyone, as we all have different resources at our disposal, but leaning on partners and family can often be quite helpful if they’re available.

What are the takeaways from this?

Trouble sleeping can be an indicator that you are currently experiencing a perinatal mood or anxiety disorder, that you’re at risk for experiencing one, or that you’re experiencing an exacerbation of the disorder. Similarly, having a perinatal mood and anxiety disorder may also place you at greater risk of having trouble sleeping.

What can I do?

While there is no way to completely get rid of sleep disruption during the postpartum period, coming up with a plan to try to protect your sleep can be helpful. Sometimes sleep advice for new parents reads as one-size-fits-all and unrealistic (e.g., “Just nap when the baby naps!”). What works best for each new parent is so personal, as we all have different supports available, different resources, and different preferences for when sleep feels most refreshing. The more you can reflect on what will work for you, the better. If you’re struggling to come up with ways to protect your sleep, getting connected with a therapist may help.

Additionally, if you’re getting treatment for postpartum depression, anxiety, or bipolar disorder and have started feeling better, but are noticing that your sleep still hasn’t improved, try seeking out a sleep psychologist or therapist. They can help you to come up with a plan to get more sleep or get rid of insomnia, which may also help prevent the postpartum depression or anxiety from worsening again.

Remember that you are not alone. So many women experience a postpartum mood and anxiety disorder, along with difficulty sleeping. Fortunately, both are treatable.

References

Goyal, D., Gay, C., & Lee, K. (2009). Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Archives of women’s mental health, 12(4), 229-237.

Lewis, K. J., Di Florio, A., Forty, L., Gordon-Smith, K., Perry, A., Craddock, N., … & Jones, I. (2018). Mania triggered by sleep loss and risk of postpartum psychosis in women with bipolar disorder. Journal of affective disorders, 225, 624-629.

Okun, M. L., & Lac, A. (2023). Postpartum insomnia and poor sleep quality are longitudinally predictive of postpartum mood symptoms. Biopsychosocial Science and Medicine, 85(8), 736-743.

Posmontier, B. (2008). Sleep quality in women with and without postpartum depression. Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(6), 722-737.

About the Author

Elizabeth “Liz” Culnan, PhD, DBSM

Elizabeth “Liz” Culnan, PhD, DBSM, is a Licensed Clinical Health Psychologist who is board-certified in Behavioral Sleep Medicine. She is also the founder of Mindful Health Psychology. She provides therapy for people living in Colorado, Illinois, and the 40+ states included in PSYPACT. Liz specializes in the treatment of sleep disorders and perinatal mental health concerns. She is passionate about combining these specializations to help people through the stressors, the difficulty sleeping, and major life transitions accompanying pregnancy, infertility, and the postpartum period. Her own experiences as a mom have cemented her commitment to and belief in this work.