We Know Sleep Is Vital to New Moms’ Mental Health, So Why Don’t We Do More About It?

The first thing my dad told me after my daughter’s birth was, "Watch, you'll get used to the shorter sleep—four hours is all you need."

He was right.

Before pregnancy, I was an eight-hour-or-nothing person, but as a new mom, I quickly learned to survive on a couple of hours at a time and about six hours per day.

During the first few months, my fiancé and I woke every two hours to decode the cry of our baby. Soon, there were other interruptions: My daughter began teething which seemed to wake her up at night, or would scream whenever I left her sight. I was also getting the hang of pumping—all of which translated to less and less rest. I'm now thirteen months into parenthood, and I find myself counting a six-hour snooze with one or two interruptions a major win.

What has struck me most, is how normalized sleep deprivation is. Everyone accepts this as a new parenthood rite of passage—a badge of honor to survive on a mere four or five hours of sleep. After all, you can’t do much about it. Especially not in a country without universal paid parental leave, where over half of American mothers return to work within three months of giving birth. And while individual companies may make time for the birthing parent, there’s typically even less time—or none at all—given to the non-birthing parent.

That’s a problem not just because getting adequate sleep is vital for just about every other aspect of life—from cognitive function, immune health, metabolism, and memory. Sleep is also critical to a new mother’s mental health.

For almost two decades—if not longer—researchers have been documenting the strong relationship between postpartum mood and anxiety disorders (PMADs), and poor sleep quality.

"We know that first-time postpartum depression affects about 10-15 percent of new moms," Michele Okun, PhD, who is the director of the Sleep and Biobehavioral Research Lab at University of Colorado at Colorado Springs, tells Well+Good. "Recurrence rates are anywhere from 25-40 percent, so this is a major public health concern."

So why aren’t we doing anything to help protect new moms’ sleep? The onus shouldn’t be on new moms to figure out a solution, but while we wait for broader change, there are some steps you can take.

The link between sleep deprivation and PMADs

Sleep deprivation can be dangerous at any point in life. According to Okun, chronic sleep disruption can drastically impact your mood, energy levels, put you at higher risk for chronic disease, and even compromise your immune system. 

"This can also cause higher levels of inflammation in the body," Okun says. "When you have chronic sleep disruption over time, it can lead to low-grade levels of inflammation, which is associated with cardiovascular disease, hypertension, obesity, depression—you name it."

In a 2022 study, researchers surveyed mothers between the ages of 18 and 45-years-old all in the postpartum period (ranging from two weeks to one year postpartum). An overwhelming 97 percent of mothers surveyed reported they experienced some sort of sleep quality issue and 26 percent reported depressive symptoms in addition to high fatigue levels.

In another similar study, researchers focused on people who did not have a previously diagnosed history of depression or current symptoms and found that those with poor sleep quality had more symptoms of anxiety or depression in the first year postpartum, further demonstrating the link between sleep and mental health concerns.

Last year, the FDA took a step in the right direction with the approval Zurzuvae, the first oral drug to treat postpartum depression (PPD) in adults. Although Zurzuvae is still only available by prescription, meaning there are barriers to attaining the drug, the phase 3 clinical trial showed improvement within just three days, and with continuous symptom improvement through 45 days. While it's important to not understate how vital this drug is; it also shouldn't be presented as a solution for a wider systemic issue: New mothers still require support, childcare help, and sleep.

"We already know that inflammation increases in chronic sleep-deprived people, but this can be exaggerated during pregnancy, putting people at a higher risk of preeclampsia or depression," Okun says. 

Immediately after giving birth, hormones, like estrogen and progesterone, drop dramatically. Okun says that both hormones are heavily involved in mood regulation and sleep, making a newly postpartum person more vulnerable to disruptions once their baby is born. 

"Hormones play a big role in those first few weeks, and changes in sleep and mood can definitely be hormonally driven," she says. "However, once those hormones balance out, if sleep is still poor, it can contribute to mood changes in the first month or two. Once those symptoms are there, they tend to stick around if unaddressed."

A study published by the Journal of Developmental and Behavioral Pediatrics found that, on average, new mothers studied had a sleep duration of 6.39 hours at their baby's three-month mark. That duration only tipped to 6.84 between their child's 12-24 month mark. In other words, even after children likely started sleeping through the night, moms still aren't getting the recommended seven to nine hours.

A lack of support for new mothers

Despite the demonstrated link between PMADs and sleep deprivation, there often isn't much oversight on an individual level. Most new moms are screened for postpartum anxiety and depression at their six-week follow-up exam via a mood-related questionnaire called the Edinburgh Postnatal Depression Scale. Although potentially helpful, with as many as 40 percent of new moms skipping their postpartum visit, it's easy to see how quickly a new mom can fall through the cracks.

"That one-month or six-week evaluation period is really insufficient," Okun says. "At any time in that first year, a new parent could develop postpartum mood and anxiety disorder."

It’s a sentiment other doctors agree with as well.

"Sometimes moms can feel like candy wrappers that are then cast aside once babies arrive," Catherine Monk, PhD, director of Women’s Mental Health and ob/gyn at NewYork-Presbyterian, tells Well+Good. "There's a huge drop-off in terms of contact with the new mother once baby arrives.”

Monk says the fourth trimester—that 12-week time period after the birth of the baby—is critical for ongoing care.

Okun agrees, noting that the Diagnostic and Statistical Manual of Mental Disorders—the go-to manual for identifying mental health conditions—only defines postpartum depression as occurring within the first month after delivery, a narrow scope that has been widely contested.

In a 2021 study, researchers found that underlying depression was one of the leading factors that caused suicidal ideation during pregnancy and postpartum. In that same study, researchers also found that suicides may have accounted for up to 20 percent of postpartum deaths.

"When we look at these numbers, it's so clear that people are underserved in the postpartum period," Lindsey Bliss, a doula, birthworker, and founder of The Carriage House Birth, tells Well+Good. "It's part of why reproductive justice work has been gaining momentum. It's truly a crisis."

How experts are pushing for change

The lack of support for new parents has encouraged them to look beyond traditional medical practices and emphasized the importance of community resources and holistic models, like doula care and midwifery. It’s also why birth workers, like Bliss, says that planning is essential and yet so often overlooked. 

"We plan for weddings down to flowers and invites, but we don't do that type of planning for the postpartum experience," Bliss says. "However, this indicates a larger systemic issue for which people blame themselves. You are not the problem. Ultimately, society has failed families and birthing parents."

While not new, doula care has become more popular in recent years, and there’s a lot more education around the benefits of birth worker care at all stages available to expectant parents. Some health insurance companies and legislation finally recognize doula care as an eligible expense for expecting parents. 

For example, New York State recently expanded Medicaid services to cover reimbursement for doula services via the New York State Medicaid Doula Services Benefit. The New York City Department of Health and Mental Hygiene released a report last year, showing that 4.76 percent of city residents who gave birth in 2022 had the support of a doula during pregnancy and  4.19 percent had doula support during childbirth.

Financial challenges are a real barrier to postpartum care (like doulas). Thankfully, many groups are also working on various initiatives to help make postpartum life more equitable for new parents.

• There are larger nationwide organizations, like Paid Leave For All, a non-profit campaign supporting leaders and legislators to make paid family leave more accessible nationwide.
  
• Bliss points to The Motherhood Center of New York, an organization that provides virtual and in-person resources for birthing people experiencing PMADs, PPD, PTSD, postpartum psychosis, and more.
• They also shout out the ARIAH Foundation, a non-profit organization that provides resources for BIPOC people impacted by systemic oppression in the reproductive health system.
• Former Teen Vogue editor-in-chief Elaine Welteroth recently leveraged her star-studded network to launch The Birth Fund. This organization provides grants for holistic pregnancy and midwifery care to mothers and families.
• Bliss's organization, Carriage House Birth, also provides families with accessible and affordable resources.

What to do if you're sleep-deprived right now

Here are some things new parents can do to ensure a safer, happier environment for themselves and, therefore, their children and family. 

Nap

We know that sleeping when the baby sleeps isn't great universal advice. However, that doesn't write off the power of a good nap. "Naps are a great way to offset sleep loss or sleep deprivation and sleepiness," Okun says. "You'd be surprised at how much you can refresh cognitively, mentally, emotionally, and physically with just a 30-minute nap." If you can squeeze in a snooze when your baby is resting—great. 

Set up help ahead of time with friends or family

If you can't squeeze in naps, that's okay. Having your support people take other things off your plate can also contribute to rest. "Talk to your friends and family before you give birth and discuss having a meal dropped off to ensure you're nourishing your body," Bliss says. "I often point people to Meal Train, a service that helps arrange meals for people during major life events, such as new babies or surgeries."  

When friends and family came over to visit, use the time to ask for a hand to fold laundry or wash dishes. Take a moment to identify areas where you may need help, and have your support people take things off your plate so you can spend time resting, recovering, or bonding with your baby.

Pump and trade off with your partner on the overnight shifts

If you pump or breastfeed your baby, create a shift schedule with your partner or support person. Cheyenne Varner, a mom of two, doula, and the founder of The Educated Birth (an online platform that provides digital resources for pregnancy, birth, and postpartum health), says that having honest discussions with your support people about who prefers to wake up at night versus the morning can help alleviate some of the stress birthing parents feel about always being on.

"I always say in my childbirth education classes 'Don't DIY'," Varner says. "Delegate tasks like bottle feedings overnight or in the early morning so you can get some rest to better flow through your day."

Find small pockets of self-care

When you're sleep-deprived and recovering from childbirth, self-care can feel like the most frivolous thing ever, but experts say to think about self-care beyond fancy treatments or even things that take you out of your home. "I know there are some days that are tough, but a walk and getting some sunlight really helped me feel better mentally in my postpartum period," Bliss says. "Having someone even hold baby so you can have a hot cup of tea can make all the difference in your mood and regulate your nervous system." Finding time in your day to do something intentional for yourself, even if it's just eating lunch alone for 10 minutes, can be a good mindfulness practice that can help you feel more centered mentally. 

Again, these moments can't wholly replace an eight-hour snooze, but when you're already so exhausted, they can help you feel less anxious and more clear headed, all of which help if you're experiencing exhaustion, stress or early symptoms of PMADs.

Go to a fancy sleep hotel—if it's in your budget

In recent years, there has been an increase in postpartum hotels and retreats, where new parents can check in immediately after birth or in the first 12 weeks, with some offering round-the-clock infant care and night care so parents can sleep, have access to prepared meals, breastfeeding support, and more.

Julia Kim, the founder of Sanu Postpartum Retreat and a mom of two, says that the rise in postpartum retreat options speaks directly to the need for better postpartum care. Kim got the idea to launch a postpartum retreat from her own experience with postpartum care (or lack thereof) after having her first child.

"A lot of the preparation for babies happens in the prenatal period. We see doctors regularly, and you know exactly what vitamins to take and what habits to adopt," Kim says. "Then boom, you enter the postpartum period, and there's so much to learn—how to feed, how to change, how to handle a new baby, and there's very little hands-on support for new parents in that phase." 

Inspired by postpartum care in countries like South Korea, where a considerable emphasis is placed on a birthing parent's recovery, Kim wanted to create a space where new moms and dads could receive customized care for their babies and themselves during their stay. "Everyone's stay looks different because we create a personalized plan for each parenting team that comes through to ensure you feel equipped with tools for success when you go home," Kim says.

Of course, round-the-clock help doesn't come cheap. Sanu Postpartum Retreat starts at $835 per night with a three-night minimum. Boram, another postpartum wellness retreat located in New York City, offers stays starting at $950 per night for a seven-night stay. 

Hire a postpartum doula, night nurse, or additional help

Postpartum doulas can be a great option, however, like sleep retreats, there are barriers to getting in-home help.

Varner acknowledges that postpartum doula care may be expensive for most people. Still, she says, changing perspectives to look at doula care as a critical investment (like you would medical or midwifery care) can help with recovery.

"A postpartum doula should understand your goals and help set you up for success during that period," Varner says. "For some people, that can look like coming in for a few hours to set up meals to help save you time; others might fold your clothes and put them away so everything is easy to find after a sleepless night; some may help you with latching, some may even step in overnight so you can focus on pumping and rest."

However, not to be confused with a housekeeper or cleaner (while those are also valuable roles), Varner says it's important to recognize doulas as specialists trained in working with new and expecting families. "Our work is all centered around people going through that specific time," Varner says. "[If] you want someone who's going to be able to address things in your home with the mindset of: There's a baby here, and there's someone who just gave birth here, then you're going to need someone with that specialty, and that's a postpartum doula." 

Most postpartum doulas are also trained to spot signs of exhaustion, early signs of anxiety and depression, or even physical symptoms. "I can't tell you how many near misses that I've encountered where I'm like, okay, we should pack our bags and go to the hospital because you are showing signs of preeclampsia," Bliss says of catching the potentially deadly condition early in her clients. In other words, although you might write off a particular feeling due to sleep-deprivation, a doula might be able to spot a more significant medical concern.

The cost of doula care will vary based on your location, but according to Bliss, postpartum doulas can vary from $35 to over $100 per hour. "A lot of times, doulas will offer a sliding scale or payment plan option," they say. "There are some doulas who are learning and would love to support a family in need. You can also even reach out to a doula to discuss help in exchange for a review or testimony." In states like New York, you may be eligible for doula care to be covered if you receive Medicaid, and some insurance companies may also offer reimbursement for some doula services through an HSA or FSA account.

"I also encourage people to think creatively if you're having a baby shower or have a registry, maybe consider people chipping in towards doula or night nurse support instead or purchasing other items you may find less useful," Bliss says.

Know when to speak up

Dealing with sleep deprivation can be mentally and physically exhausting, and there are times when a nap or visit from a friend can help offset those feelings. Other times, you may want to seek medical intervention if signs of anxiety or depression don't subside or worsen.

Varner says to look out for red flags like isolation or a new parent not wanting to bond with their baby or engage with other people. "As a support person, it's really important that you're providing a safe, judgment-free environment because some things, like intrusive thoughts or ideas, we can't physically see," she says. "We should also pay attention to intense levels of anger, which can also be a sign of postpartum rage." 

If you are experiencing these signs or notice them in a loved one, you should encourage them to seek help ASAP. You also want to pay attention to physical symptoms in the fourth trimester. "If there's exhaustion to the point where healing is disturbed, you should also seek medical help," Varner says. "Think bleeding at abnormal levels, aches and pains that don't improve, pelvic floor issues that worsen." Bliss also points to a free guide to PMADs by The Motherhood Center of New York, which she shares with her clients and network.

Ultimately, Bliss says, information is power, and supporting families boils down to conversations, open communication, and knowing how to look out for one another. Bliss says. Empowering new moms and dads with the proper tools, even just a quick snooze, a grocery store run, or a hot cup of tea may seem insignificant to some, but can truly save a life.

If you or someone you know is struggling with mental health, call SAMHSA’s National Helpline at 1-800-662-HELP (4357) or go to FindTreatment.gov for resources and treatment options. If you’re having thoughts of harming yourself or others, call or text 988 for the Suicide & Crisis Lifeline.