with Dr. Nicole Leistikow, Reproductive Psychiatrist and Psychotherapist
WHAT YOU’LL LEARN
- How Sleep Deprivation and Postpartum Depression Are Linked
- Changing the Message Around Postpartum Sleep
- How to Protect Chunks of Sleep (and Why It Matters)
- Creative Workarounds for Sleep Obstacles
- Why Sharing Nighttime Responsibilities Benefits Partners Too
- How to Protect Sleep Even While Breastfeeding
- Why Maternal Sleep Matters When It Comes to Postpartum Depression
Moms often feel like sacrificing sleep is just a part of motherhood. But there is a relationship between sleep deprivation and postpartum depression, postpartum anxiety, and other mental health concerns. If we want to support moms, protecting maternal sleep is important.
Today, I’m joined by reproductive psychiatrist and psychotherapist Dr. Nicole Leistikow to discuss the role of protected sleep in maternal mental health and how families can work together to support moms.
Sleep Deprivation Woes
When I had my first son, I was so fortunate to have support. I live in a country with maternity leave. I have a partner who wanted to do his part. And I have a supportive mother-in-law who came to stay with us and help however she could.
But when it came to sleep, I faced so many challenges. I believed that I should be the one to handle the night feeds. I kept my babies right by the bed and woke up at every coo and grunt. And my babies struggled to take bottles, making it difficult to share night feeds.
Like so many moms, I ended up sleep deprived and struggling. On my third maternity leave, I was diagnosed with postpartum depression. Looking back, I believe I might have experienced it with each of my postpartum periods, and I am sure that sleep deprivation was a contributor.
Eventually, we figured out ways to protect my sleep. When my sons were little, my husband would bring them to me for feeds and handle the diapering, rocking, and resettling. He did night feeds when he could. And I was able to come out of my sleep-deprived stupor and start to recover.
But it took a lot of planning, evaluating our own beliefs, and letting go of the perfect mother ideology that I had been holding onto.
Maternal sleep is complicated. But it’s extremely important. In fact, Dr. Nicole believes that protecting sleep for moms is one of the best things we can do—to support not only moms, but the entire family.
How Sleep Deprivation and Postpartum Depression Are Linked
Dr. Nicole has long believed that sleep is a crucial part of the puzzle that is missing when we treat postpartum depression. Through the course of her research, she came across a recent study centered around a new medication specifically to treat PPD—Brexanalone.
In the study, moms in their first six months of postpartum with severe depression were given an IV infusion of either the medication or a placebo. They had to stop breastfeeding for a period of seven days and be in the hospital for three.
The results showed strong levels of improvement in symptoms in the group that received the medication. Within 60 hours, the symptoms had greatly improved.
But interestingly, the moms who received the placebo also had a strong, fast, and lasting improvement in symptoms.
Dr. Nicole believes that the reason why is because those moms were able to sleep undisturbed in the hospital. She also suspects that the lasting effect in part happened because families had to offer nighttime support for the infants. They likely learned skills and methods that they continued, protecting maternal sleep even when moms returned home.
Taking moms out of the pressure cooker of infant care, juggling nighttime feeds and breastfeeding pressure and sleep deprivation, and allowing them to receive true, restorative rest, seemed to move the needle for PPD.
While Dr. Nicole says that more studies need to be done, this reinforces what she advocates for—maternal sleep matters.
We know that sleep has a strong impact on the brain. When moms are sleep deprived, they are more likely to experience severe PPD and PPA symptoms. Sleep deprivation for even just one night can impact our brain function.
So, if we know that sleep is necessary for brain health, why do we as a society devalue maternal sleep? Why do we believe that moms are just supposed to sacrifice their sleep and somehow continue to function?
Dr. Nicole says that message needs to change.
Changing the Message Around Postpartum Sleep
Through her experience counseling moms, Dr. Nicole came to realize that the conversation around postpartum sleep is important. It has to be more than just “sleep when the baby sleeps” or “you just need some rest.”
We need to explore sleep comprehensively—looking at the way we structure sleep for moms and how families can offer more support.
Dr. Nicole says that we need to focus the conversation on self-care, not self-sacrifice. Being a “good mom” doesn’t mean sacrificing yourself until there’s nothing left for the sake of your child or your family. Instead, you need to conserve yourself as a resource. Your family and your baby need you—and they need you well and healthy.
Intensive mothering ideology tells us we should mother at an absolute cost of ourselves. But when we sacrifice our sleep, we’re sacrificing our brain function and mental health.
Moms often end up so desperate for sleep that they feel pressured to sleep train or try to control their baby’s sleep—but they are never told that they can, and should, create a plan for their own sleep separate from the baby’s.
Instead of just sleeping when the baby sleeps or dealing with sleep deprivation, Dr. Nicole says we need to view the family as an ecosystem. Your ecosystem might include a partner, family members, or even night doulas—and all of those support people can be involved in the plan for night sleep.
Dr. Nicole pointed out that it doesn’t make sense to put all of the night load on the shoulders of one person—especially when that person is the one who needs to function most during the day, carrying the bulk of the emotional and mental load, care work, and decision making. We need our brains functioning in order to carry out that work efficiently.
How to Protect Chunks of Sleep (and Why It Matters)
One of the mistakes we make when it comes to maternal sleep is believing that little naps or broken-up sleep are enough. Sometimes we think that as long as our sleep adds up to a reasonable number overall, we should be able to function.
But even if someone “sleeps” for eight hours, being woken up every hour, they are not going to feel rested or get the deep sleep their brain needs. We need restorative sleep—and that comes in longer chunks of sleep.
Dr. Nicole pointed out that just because moms might not be able to carve out a full night’s sleep when their babies are little doesn’t mean they can’t achieve a restorative chunk. With the right planning, we can structure the night in a way where moms get at least one 4-5 hour stretch of sleep.
For example, if a mom is able to go to sleep at 8:00 p.m., and the baby wakes up at 12:00 for the first feed, perhaps a partner can handle that night feed while the mom sleeps in a separate room. Then, the partner can put the baby monitor next to mom, who can wake at the next feed, while the partner goes and gets their chunk of restorative sleep.
Sometimes, families need to get creative, play “musical beds,” and take shifts in order to protect sleep for everyone involved.
Consolidating sleep makes a big difference for the brain. If every caregiver can get one 4-5 hour stretch, it makes the fragmented sleep for the rest of the night easier to handle. Dr. Nicole said this can have a big impact on postpartum depression suffering, keeping our symptoms less severe and making management easier.
It can feel uncomfortable or foreign to start thinking about sleep like this. As moms, it’s hard to break away from the idea that it’s our responsibility to feed or care for the baby.
But Dr. Nicole pointed out that it’s a marathon—not a sprint. We don’t want mothers to push themselves beyond their limits and experience burnout.
We can only keep up the intensity of motherhood for so long before our bodies and brains try to shut off. Infant sleep is likely to be fragmented for at least six months—and moms deserve to have a good postpartum experience during that time.
Dr. Nicole encourages her clients to think beyond just giving themselves permission to prioritize their sleep. She wants us all to view it as part of being a good mother—protecting our brains so we can function allows us to enjoy motherhood more, function at a higher level, and give the best of ourselves to our baby and our family.
Instead of just trying to survive the first six months at best (or struggling with severe PPD and PPA symptoms), we can allow ourselves to sleep, so we can be healthier and happier and enjoy experiencing our introduction into motherhood.
Creative Workarounds for Sleep Obstacles
Dr. Nicole said that it’s common for her clients to have objections when she starts talking to them about how to prioritize their sleep. She pointed out that the most common is our inner belief that we should be the one to wake up at night with the baby—and that’s why she believes that’s the first place to start.
Moms often believe that they should protect their partners’ sleep, especially if they stay home or take maternity leave and the partner is working outside of the home. However, Dr. Nicole adamantly believes that care work is often harder than having to work a job. You have to be “on” constantly, make decisions, solve problems, think critically, and function at a high level, often without breaks.
We need to reframe the thinking that our partner’s sleep matters more. Moms work—whether they stay at home or not—and they need quality sleep.
That internal belief isn’t the only barrier that comes up, however. Another common objection that comes up is that some couples don’t want to sleep in separate rooms. Dr. Nicole pointed out that postpartum sleep difficulties don’t last forever. Eventually, things will resettle.
Many moms point out that their babies have difficulty taking bottles, like my own did. If you are in this situation, first try to have a caregiver give the baby a bottle when you are not present, and keep persisting. It can take some time but many babies will eventually take a bottle.
If your baby is still resisting the bottle, you might have to think outside the box. A system like my husband and I created, which focused on the smallest amount of sleep disruption for me while still having me nurse, might help you extend your chunks of sleep.
Additionally, not everybody has the luxury of a support system they can call in. Solo or single parents often have difficulty calling in extra hands for help.
Dr. Nicole said the first step in that situation is to think if there are other people, even if it’s friends or extended family members. People are often willing to help if we are willing to ask.
Some single moms have even teamed up with other moms in similar situations and taken shifts together to prioritize each other’s sleep.
Even if you don’t have those options, there are adjustments you can make that might help, such as moving your baby farther away from the bed or into another room whenever you are able. For me, turning my baby monitor down low so that only real cries woke me up was a helpful tool.
These unique situations might take some thought and creativity to work through. You have to ultimately decide what works for you and your family.
Dr. Nicole said the bottom line is that we need to remember that getting quality, consolidated sleep is actually part of taking care of the baby—that it’s our job to protect ourselves so that we can be the best moms we can be.
Why Sharing Nighttime Responsibilities Benefits Partners Too
It’s also important to remember that it isn’t selfish to prioritize our sleep. When a mom is well, it benefits the baby. And, when we share nighttime and nurturing responsibilities with our partner, it helps them.
As our partners take more responsibility at night, they feel more capable and confident knowing that they have the ability to nurture, soothe, and care for the baby. This creates important bonding and empowers them in their role.
Dr. Nicole also pointed out that taking shifts at night shows our partners what we’re going through and creates an empathy that they might not have until they can physically experience it for themselves. This can help bring couples closer together.
The entire family benefits when a mom is able to consolidate and protect her sleep. Dr. Nicole said this is why moms also need to advocate for paternal leave. Even when dads are fortunate enough to be offered it, there is often societal pressure for dads to return to work quickly.
But when they do, they get shortchanged in their role as dads, missing out on bonding experiences and the chance to develop their abilities and confidence.
How to Protect Sleep Even While Breastfeeding
Another common obstacle to maternal sleep is breastfeeding. Moms are told that they need to feed often to encourage milk supply, and that they should pump if they miss a feed. This can lead moms to feel like they might as well take on the feedings themselves.
But Dr. Nicole said that starting at around 3-4 weeks postpartum, you can work slowly toward longer chunks of sleep even while pumping. She recommends extending the stretch slowly—pumping 20-30 minutes after your partner gives a bottle, then pushing it back until you are protecting an adequate chunk of sleep.
She also urges families to consider supplementing with formula if that opens up the door to a stretch of sleep. You can still get all the benefits of breastfeeding.
For many moms, this can feel like a failure. It’s driven into us that “good moms” breastfeed. But it doesn’t have to be that way. Flexibility around feeding can help us break out of sleep deprivation and protect our mental health.
Why Maternal Sleep Matters When It Comes to Postpartum Depression
Ultimately, Dr. Nicole wants us to change the way we think about maternal sleep, both as individuals living through it, and as a society thinking about the role of mothers.
We know that the postpartum period is a time of high risk for mental health struggles. For some moms, this risk is extra high. She says that it is not acceptable to sit back and say, “We know that there is a high likelihood you will develop PPD or PPA, but we don’t need to talk about how you can get adequate sleep.”
She pointed out that sleep is the most potent anti-depressant—and one that comes with no side effects.
We need to talk about maternal sleep, understand its importance, and support moms in prioritizing their sleep. It’s important to make a concrete plan in advance whenever we can, so we can avoid the devastating effects of sleep deprivation and keep moms healthy, happy, and well.
Don’t wait until a sleep crisis to set up your sleep plan. Download our FREE resource, A Sleep Plan for Mom, and learn how to overcome sleep obstacles before they arise.
Nicole Leistikow, MD is a reproductive psychiatrist and Clinical Assistant Professor in the Department of Psychiatry at the University of Maryland where she sees patients and trains residents and fellows in managing mental illness from premenstrual exacerbation, to pregnancy, postpartum and perimenopause. She completed both medical school and residency at Johns Hopkins. She is a former high school English teacher and freelance journalist and is on the Education Committee of the National Curriculum in Reproductive Psychiatry (NCRPtraining.org). She has written about women’s mental health for textbooks, scientific journals and on her private practice blog at www.womenspsychiatrybaltimore.com.