The Link Between Sleep and Perinatal Mood and Anxiety Disorders

It goes without saying that new parents can expect to experience some level of sleep deprivation. That coupled with a sudden shift in hormones can lead to the "baby blues," which typically occur two to three days postpartum and resolve within a couple of weeks. But if overwhelming feelings of sadness, anxiety, and exhaustion don't dissipate in two weeks, it could be a perinatal mood and anxiety disorder (PMAD)—something researchers say can be heavily affected by lack of sleep.

An estimated 15 to 21 percent of pregnant and postpartum women develop a PMAD, the most common complication of pregnancy and childbirth. PMADs include anxiety, depression, obsessive-compulsive disorder (OCD), panic disorder, postpartum post-traumatic stress disorder (PTSD), bipolar disorder, and postpartum psychosis.

While postpartum depression (PPD) is most often discussed, recent studies have found that anxiety is more common. And because these disorders can occur during or after pregnancy, "perinatal" is a more accurate term. "We were finding that people didn't recognize themselves if we just said, 'postpartum depression,' because it implies you have to be postpartum and many issues begin during pregnancy," says Catherine Birndorf, M.D., CEO and medical director of The Motherhood Center of New York.

When Meghan Markle spoke in March about having suicidal thoughts while pregnant with her first child, she shined a light on perinatal depression. According to a 2020 study in JAMA Psychiatry, researchers found that thoughts of suicide and intentional self-harm in the year before and after giving birth had nearly tripled between 2006 and 2017. Women who were Black, low-income, or dealing with a mental health condition were at the highest risk.

Some of the disorders may overlap, but one thing researchers are finding they all have in common is sleep deprivation. "Sleep deprivation can lead to, be a symptom of, and intensify anxiety disorders (like OCD, PTSD, and panic attacks)," says Christina Hibbert, Psy.D., clinical psychologist and author of This Is How We Grow. "And insomnia is a primary symptom of both depression and bipolar disorders. Extreme sleep deprivation is also known to trigger depressive and manic episodes and can often set off a psychotic episode as well."

How New Parents Can Sleep Better

A 2018 study found that poor sleep quality during and after pregnancy was associated with greater symptoms of postpartum anxiety and depression, also confirming the importance of good sleep hygiene. So how can new parents, especially those without partners or paid leave, improve the quality of their sleep?

A great first step is enlisting a trusted family member, friend, or postpartum doula to watch the baby so that you can get at least five hours of sleep. "Suggest having a 'sleepover' with another friend who has a baby, then split the night into shifts," says Adrienne Griffen, executive director of Maternal Mental Health Leadership Alliance (MMHLA). "One mom takes the early shift (8 p.m. to 1 a.m.) while the other sleeps. Then they can swap."

Experts say it's also a good idea to incorporate useful strategies and tools in your bedtime regime to facilitate sleep. Winding down with deep breaths before sleeping in a dark room with red or amber nightlights can be helpful, says certified sleep coach Jen Varela. While blue light from electronic devices and overhead lights can keep you awake by blocking the sleep hormone melatonin, red and amber-colored lights may increase melatonin production. Varela also recommends sleeping on your side to help the brain clear waste more efficiently.

Another useful tool? Using a sound machine to block out noise. "It's the sudden change in noise that causes sleep disturbances. So brown noise, which lowers the higher frequencies, works better than white noise," says Varela, founder of Sugar Night Night, a platform helping families achieve better sleep through workshops, phone or online consultations, and group coaching. "A low sound like a box fan is known to trigger relaxation and improve sleep."

Another affordable, safe option for sleep issues is 30 minutes of bright light therapy upon awakening, which has been shown to decrease symptoms of depression during and after pregnancy. These come in the form of light boxes or wearable devices like visors, although the latter aren't as effective.

Can Light Therapy Really Help?

In the meantime, new research is being conducted to find ways to help PMADs through sleep and light therapy. The National Institutes of Health (NIH) and Rhode Island Hospital recently funded a multi-site, randomized clinical trial to examine personalized integrated chronotherapy (PIC) as a treatment for depression and anxiety during pregnancy versus traditional treatment.

"The purpose of the study is to test whether adding a prescribed sleep schedule and morning bright light to usual care for anxiety and depression during pregnancy can improve sleep and mood, and prevent postpartum depression," says principal investigator Katherine Sharkey, M.D., Ph.D., lead researcher at Rhode Island Hospital/Brown University.

Along with using light boxes for 30 minutes each morning from the third trimester to six weeks postpartum, "each woman receives a personalized sleep prescription based on her individual sleep rhythm, which is measured by an actigraphy watch they wear throughout the study," says Kristina M. Deligiannidis, M.D., lead researcher at the Feinstein Institutes for Medical Research.

A previous pilot study showed that adding PIC did improve mood more than typical depression treatment alone. "And, based on what we know about circadian rhythms, the recommendation to 'sleep when the baby sleeps' might not be the best advice, because many women find it hard to sleep during the day when their biological clock is programmed to be awake," says Dr. Sharkey.

When to Ask for Professional Help

Getting more sleep can be helpful, but of course, it's not always enough. Support groups, talk therapy, and/or medication may be necessary. There is still a stigma around asking for help, but new parents shouldn't feel guilty or selfish about reaching out.

Expectant and new parents can start by asking their obstetrician, OB-GYN, or pediatrician to give them a questionnaire called the Edinburgh Postnatal Depression Scale (EPDS), which helps determine whether they have a PMAD and need to see a professional.

A bridge between moms and trained professionals, Postpartum Support International (PSI), is a trusted resource to find local (or virtual) help for PMADs. And targeted online support group meetings can connect parents with other parents and provide additional resources to their families.

"The most important thing is simply to reach out," says Dr. Hibbert. "Say the words, 'I need help,' and then let help in. As a mom of six who's struggled with sleep and PMADs myself, let me say, 'You are not alone, and with help, you will be well.'"

The Bottom Line

Sleep deprivation during and after pregnancy can lead to PMADs. Swapping night shifts with a partner or friend, practicing good sleep hygiene, using a brown noise machine, and trying bright light therapy are some ways to help prioritize sleep. But never hesitate to reach out for help. Postpartum Support International has a helpline (800-944-4773).

If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 800-273-8255. For those struggling with other mental health issues, the National Alliance on Mental Illness offers mental health education, resources, and a helpline (800-950-6264).