Evaluating Sleep Deprivation as a Risk Factor for Postpartum Depression

Announcer:
You’re listening to Advances in Women’s Health on ReachMD. On this episode, we’ll hear from Dr. Nicole Leistikow, who’s an Assistant Professor in the Department of Psychiatry at the University of Maryland School of Medicine and on the Education Committee for the National Curriculum in Reproductive Psychiatry. She’ll be discussing sleep as a risk factor for postpartum depression. Let’s hear from Dr. Leistikow now.

Dr. Leistikow:
When we’re thinking about how sleep deprivation affects the mental health of new mothers, it is important to say that we don’t really understand the pathophysiology of mental illnesses to the point that we understand, for example, the pathophysiology of high blood pressure or heart disease. However, we do know a lot about the contributing factors to mental illnesses, including postpartum depression, and we have a lot of information on the effects of sleep deprivation outside of the postpartum period. And I summarized some of these findings in a piece that I wrote in 2022 called Prescribing Sleep, an Overlooked Treatment for Postpartum Depression.

So when we think about sleep, we know, for example, that keeping someone awake just for 19 hours—so just letting them wake up in the morning and then not letting them go to sleep that night—actually impairs their hand-eye coordination to the point that it’s similar to being drunk and having a blood alcohol concentration that could get you a DUI in most states. We also know that sleep deprivation lowers mental resilience and can affect decision-making capacity and even memory.

So what are the effects of sleep in postpartum? In the first six months of life, infants need to wake every 1 ½ to 2 ½ hours to feed, and parents experience both acute and chronic sleep deprivation night after night. So purely in terms of sleep, taking care of multiple infant night feedings is a significant destabilizing provocation for the brain. And this would be true for anyone, but now we take the additional provocations caused by delivering a baby and being postpartum. So there’s an acute crash in both estrogen and progesterone levels that have been built up gradually over nine months and then precipitously fall over the course of two days, and this is what likely causes what we call the postpartum baby blues. This is something experienced by up to 80 percent of mothers, which encompasses notable emotionality and crying, and this happens within the first two weeks of delivery and then typically self-resolves. That’s called the baby blues, and that’s likely caused by this hormonal crash. However, for women who are more sensitive to hormonal shifts and certainly for women with a history of prior mental illness, such as a history of depression or a history of anxiety or OCD, this abrupt shift in hormones is a risk factor for them to go on to develop more than just the baby blues.

So postpartum depression has many contributing risk factors: a history of sensitivity to hormonal shifts, a history of vulnerability to depression, and stressors brought on by a new baby, including infant feeding. But out of all of these, I would say that vulnerability to hormonal shifts and sleep disruption are the two largest factors. And sleep is one of the factors that we can actually do something about. And so when severely disruptive sleep is remedied, the benefits can be felt almost immediately.

So it’s a crucial factor in triggering and sustaining postpartum depression, but sleep is also an amazing opportunity to treat postpartum depression. Sometimes I tell my patients that if they can get a sufficient dose of sleep, which I describe as a four- to five-hour chunk of sleep plus some additional sleep, they may start to feel the benefits within two to three days and sometimes even after one night. 

Announcer:
That was Dr. Nicole Leistikow talking about sleep as a risk factor for postpartum depression. To access this and other episodes in our series, visit Advances in Women’s Health on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!