with Clinical Psychologist Dr. Shelby Harris
WHAT YOU’LL LEARN
- What Qualifies as a “Sleep Problem”
- Sleepiness vs Fatigue
- Why Women Are At Higher Risk for Sleep Issues
- The Sleep Issues Moms Face
- What Causes Insomnia
- Tips for New Moms to Get Sleep
Maternal sleep deprivation is very common. Even if baby sleeps, moms often find themselves battling insomnia–struggling to fall asleep, stay asleep, or get good quality sleep. When you’re a new mom, it’s easy to become obsessed with sleep. Watching the clock, obsessing over wake windows, and worrying about when your baby will sleep through the night seem to be common mom pastimes.
But the baby isn’t the only one who needs to sleep—moms do too. And we often have an uphill battle to face when it comes to sleep issues. Dr. Shelby Harris, clinical psychologist and author of The Women’s Guide to Overcoming Insomnia, joins me to discuss sleep difficulties for moms.
(For the second part of our conversation, on tips to manage maternal sleep deprivation, catch our blog post for part two!)
Your Sleep Matters
Before my first son was born, I spent a lot of time preparing for his sleep. Picking out a bedside co-sleeper for when he was little, choosing a crib for later, shopping for sleep sacks and pacifiers and sheets.
What I didn’t spend any time doing was forming a plan for my own sleep. I imagined that I would sleep when the baby slept and that even though I would be tired, it would be manageable.
Of course, it was harder than I had ever imagined. I stirred at every movement, every noise my son made. I intervened to nurse probably more often than I needed to. And I tried to take on every nighttime responsibility—not because my husband wasn’t willing to support, but because I felt like I had to be the one to do everything.
If I could do it all over again, I would do things differently. I would probably move the co-sleeper a little farther away. I would try to worry less. But most importantly, I would make a plan from the beginning to protect my own sleep.
Sleep is something that we think we must sacrifice as moms—and, to a degree, we do. But there’s a difference between waking up to feed the baby and letting go of sleep as a priority. All too often, I hear from clients who absolutely can’t sleep—beyond frequent night wakes for the baby.
In Dr. Shelby’s book, she dives into the sleep issues moms face—from insomnia to fatigue to sleep apnea. I was excited to chat about sleep from a different perspective.
What Qualifies as a “Sleep Problem”
There are many different sleep struggles that people face, all with various factors and outcomes. Some people struggle to fall asleep, while others have trouble staying asleep. Some wake early, or wake up feeling groggy even if they had a full night’s rest. Sleep struggles can be medical, psychological, or even social.
Insomnia is one of the most common sleep issues Dr. Shelby sees. Up to 30% of the population struggles with it—and 50% have trouble sleeping from time to time. Insomnia is defined as having trouble falling asleep, staying asleep, or waking earlier than you want at least three times a week.
With short term insomnia, this occurs for 1-3 months. If it persists beyond three months, it’s considered chronic.
Another common sleep problem is sleep apnea—a disorder affecting breathing during sleep. Dr. Shelby pointed out that, although we think of sleep apnea occurring in older, overweight men who are heavy snorers, that’s not always the case.
Plenty of young, healthy women suffer from sleep apnea as well, and the snoring might be lighter than we think. It arises often during pregnancy, particularly in the third trimester. Sleep apnea can cause sleepiness and fatigue, leaving people feeling like the sleep they get is not of good quality.
Restless leg syndrome is another common sleep issue. It is very common during pregnancy and the postpartum period, and can make it difficult to fall asleep or sleep well.
As Dr. Shelby said, it’s normal to have nights of poor sleep here and there—we all do. But when it’s affecting you on a regular basis or persisting, it’s time to take a closer look at your sleep issues.
Sleepiness vs Fatigue
Sleepiness and fatigue can both be signs of underlying sleep issues, but they are distinctly different. With sleepiness, you might find yourself drifting off during the day, unable to keep your eyes open.
But with fatigue, you might feel tired, but wired and unable to fall asleep. Dr. Shelby describes fatigue as feeling like you are dragging bricks along with you. People with fatigue often don’t feel as if they have the energy to carry on through the day.
I experienced extreme fatigue during my third postpartum period—a symptom of postpartum depression in my case. When I finally sought treatment, I told my husband that it felt like shackles had been taken off my feet and I could finally move forward.
As moms, we sometimes wear fatigue as a badge of honour, treating it like something that should be normal once you have a baby.
But Dr. Shelby says that shouldn’t be the case. Sleep disturbances are part of being a parent. But if you carve out protected sleep periods and you still have trouble falling asleep, or you find yourself waking up in the middle of the night on your own, she encourages you to see a doctor about appropriate treatment.
Why Women Are At Higher Risk for Sleep Issues
According to Dr. Shelby, before adolescence, the rates of sleep struggles are fairly even for everyone. After adolescence, however, women are more likely to face sleep issues. They face shifts in their hormones that impact their sleep.
It’s common to suffer from insomnia before a period, due to spikes and drops in estrogen and progesterone. (In fact, Dr. Shelby often recommends that women who suffer from anxiety check to see if it aligns with their menstrual cycle. Knowing the pattern helps arm you with knowledge when you seek help from a doctor.)
Those hormonal triggers for sleep issues persist throughout women’s lives—in perimenopause and menopause. The hormone shifts can cause short term or chronic insomnia.
The Sleep Issues Moms Face
Moms face many factors that contribute to sleep struggles. Sleep disturbances often begin during pregnancy, due to increased urination, heartburn, or physical discomfort.
Once the baby comes, moms are often taking on more night wakes and feeds, and dealing with stress, or even anxiety and depression, all of which come with higher risk for insomnia.
Even after a baby starts sleeping better, many moms find that their bodies become accustomed to waking up. Unfortunately, this often leads to more sleep disturbances—moms find themselves waking often and anxiously awaiting baby’s wakeups.
Moms also carry extra pressures and stress in the home, often taking on the primary responsibility for the care work. That stress is a recipe for sleep struggle.
Sometimes moms have trouble getting diagnosed with sleep issues. The symptoms are often misdiagnosed as anxiety or depression. Other times, they are dismissed completely because of the baby.
But Dr. Shelby said that the perinatal period is a high-risk time for sleep issues. It’s important to be on high alert to notice if you need help.
What Causes Insomnia
Medical professionals used to believe that insomnia was always caused by another condition—often depression or mental health struggles. But we now know that there are countless reasons people suffer from sleep. Sometimes, they are obvious (like a newborn who wakes up every hour all night long!) Other times, they are harder to determine.
Dr. Shelby says that sleep psychologists focus on the Three P’s when trying to get to the root of sleep issues.
Predisposing Factors: There are some factors that make people more likely to develop insomnia, including working night shifts, having a new baby, or a history of sleep issues in the family. Those factors might set the stage for sleep struggles, but they don’t always cause insomnia.
Precipitating Factors: Other factors arise that might trigger insomnia. Pregnancy, stress, concerns about the world, or even excitement can throw off your sleep. Sometimes these lead to chronic insomnia.
Perpetuation: When we start to experience insomnia, we all too often develop habits to help us in the short-term that actually perpetuate the condition. We nap or change our sleep routine by going to bed early or waking up early. Sometimes we worry about sleep, which makes it harder to fall asleep. Other times we turn to sleep aids or alcohol to help us get through the day.
It’s hard to recognize that these perpetuation factors make the problem worse because they feel like common sense solutions at the time. But sleep treatment often requires changing these behaviours.
Tips for New Moms to Get Sleep
New moms have their own ways to perpetuate insomnia and sleep struggles. It is tempting to scroll your phone or turn on the light when doing a night feed. Dr. Shelby said we need to think about what will help calm our brains.
Another way we perpetuate sleep struggles is by worrying about our sleep and the baby’s sleep to an extreme degree. It’s important to have a realistic understanding of what infant sleep should look like and set reasonable expectations to ease some of that worry.
Sometimes, it can feel impossible to get enough sleep as a new mom. But it’s important to prioritize sleep where you can. Dr. Shelby says that if you can protect a period of at least four (but ideally six) hours of sleep, it can help restore your body and brain.
If that’s unrealistic for you, consider bringing in a partner or family member to provide naps during the day. Ordinarily, it’s best to avoid napping. But in the postpartum period, you often have to get creative to get sleep.
We can also get creative about how we divide night feeds. If you bottle feed, trade off with a partner if possible. If you are nursing and can’t share night feeds, try to offload other responsibilities, like diaper changes or resettling.
Most importantly, remember that your sleep and the baby’s sleep are two different things. If you cling to the idea that the baby must sleep in order for you to sleep, you might stress yourself out trying to control sleep—causing more sleep difficulty in the long run.
Make a plan for your own sleep, separate from the baby’s sleep plan. If you can, make a mom sleep plan in advance, before the baby comes and you’re in the thick of a sleep crisis.
Sleep is an important part of your mental health—If you are someone who has had anxiety or depression before having a baby, sleep deprivation increases your risk of developing postpartum depression or anxiety. (If you’re struggling, visit our Wellness Center to book a free consultation with a mom therapist).
To hear more from Dr. Shelby about sleep, be sure to read the second part of the blog post on mom-centered sleep, where we’ll dive into sleep hygiene and how to get more sleep!
Ready to make your mom sleep plan? Download our FREE Sleep Plan for Moms to learn about sleep myths, make a plan for support, and protect your sleep!
Shelby Harris, PsyD, DBSM is a clinical psychologist and sleep specialist in private practice in NY. She is board certified in Behavioral Sleep Medicine and treats a wide variety of sleep, anxiety and depression issues using evidence-based, non-medication treatments. Her self-help book, The Women’s Guide to Overcoming Insomnia: Get a Good Night’s Sleep Without Relying on Medication was published in 2019. Before going into private practice, she was the longstanding director of the Behavioral Sleep Medicine Program at the Sleep-Wake Disorders Center at Montefiore Medical Center. Dr. Harris has been an invited columnist for the New York Times “Consults Blog,” and is frequently quoted in the media. Dr. Harris can also be found on Instagram at @SleepDocShelby where she provides evidence-based information about sleep wellness and sleep disorders.
- Shelby’s Book: The Women’s Guide to Overcoming Insomnia
- Happy as a Mother Wellness Center
- A Sleep Plan For Mom