Written by Allyson Malecha, Master of Science in Biology
Expert Review by Christine Stevens, Sleep Coach and Owner of Sleep Solutions by Christine

Between midnight diaper changes, late-night feedings, and the overall stress of being a new parent—getting a good night’s sleep is notoriously difficult with a newborn at home. For some new mothers, though, this restlessness can turn into a serious sleep disorder.

While a newborn baby at home can certainly prevent you from sleeping through the night, postpartum insomnia is its own unique medical condition, unrelated to the baby’s behavior. There are many possible causes of postpartum insomnia, but fortunately, it can be treated with medication and/or therapy so better sleep is possible.

My Baby Is Sleeping, So Why Can’t I?

After hours of caring for your baby, they’re finally sleeping peacefully in the crib next to you. You’ve settled into bed and closed your eyes. Given how exhausted you are, you should have nodded off half an hour ago, but you just can’t fall asleep.

Why does this happen? 

Insomnia is a sleep disorder that impacts the ability to fall asleep or stay asleep. Struggling to fall back asleep after waking up early is another sign of insomnia.

While a lack of sleep due to interruptions from a newborn is to be expected, postpartum insomnia is not the result of the baby’s sleep schedule. In fact, those living with postpartum insomnia often report that the inability to sleep still impacts them while their baby is sound asleep.

In new mothers, postpartum insomnia is common, with nearly all new mothers reporting at least some symptoms of insomnia. More serious insomnia is often associated with other postpartum health concerns like depression and pain.

What Is Postpartum Insomnia?

Postpartum insomnia impacts nearly 60 percent of women immediately after childbirth. While the prevalence of insomnia decreases as the baby grows up, more than 40 percent of women still fulfill the diagnostic criteria for insomnia when their child is a toddler.

Common symptoms of postpartum insomnia include:

  • daytime fatigue or sleepiness
  • irritability
  • anxiety or depression
  • low energy
  • inability to focus
  • chronic pain
  • memory lapses

As a broad disorder generally describing sleeplessness, postpartum insomnia varies from person to person. During the pregnancy and postpartum period, both the body and mind undergo tremendous changes, causing a disruption to normal sleep patterns. 

Hormonal Changes

To maintain a healthy pregnancy, the body naturally adjusts hormone production to adapt to the new life growing inside it. While these hormonal changes are vital to producing a healthy fetus, research shows that they also cause sleep fragmentation as well as nausea, heartburn, and back pain.

The cruel irony is that although sleep is linked to better pregnancy outcomes, the hormonal changes that go along with pregnancy make it hard to get a good night’s rest.

Bodily Pain

Another possible factor in postpartum insomnia is increased bodily pain. While it has not been determined whether postpartum insomnia causes bodily pain or vice versa, there is a relationship between the two. Those who report more postpartum fatigue and pain are also those who report the most frequent sleep disruption.

Psychological Changes

It’s not just the body that changes after childbirth. Psychological changes—including depression, anxiety, lack of concentration, and irritability—are common as well. These psychological changes can be caused by the hormones mentioned earlier or by external pressures. After all, there’s no denying that being a new parent is stressful.

Disruptions to the sleep schedule caused by laying awake at night feeling anxious can ultimately lead to chronic insomnia.

Disruption in Circadian Rhythms

Another factor in postpartum insomnia is the alteration of circadian rhythms. Waking up at odd hours and an inconsistent sleep schedule can alter the body’s internal clock and cause further disruptions. Difficulty falling back to sleep after waking up early can be the result of altered circadian rhythms.

The circadian rhythm is controlled primarily by cortisol and melatonin. Cortisol controls alertness and stress responses, and is highest in the early morning. Melatonin production begins before bed to prepare the body for sleep. For new mothers, consistent disruptions and stressors can alter the production of these hormones.

While many people try to “catch up” on sleep during the day, this generally results in lower quality sleep than they would get at night, and only furthers their internal clock’s confusion.

How Long Does Postpartum Insomnia Last?

In general, insomnia falls into one of two categories depending on how long the symptoms persist:

  1. Short-Term (or Acute) Insomnia: Sleeplessness that lasts only a few days or weeks and is usually caused by a traumatic event
  2. Chronic Insomnia: Long-term sleeplessness that occurs for three or more nights per week and lasts for 3 months or more

There is no set timeline for overcoming insomnia. Depending on the root cause, it may last only a few weeks or may persist for months—in which case, it’s best to consult a medical professional.

Combating Insomnia with Better Sleep Habits: Tips for New Moms

If you’re having trouble falling asleep after giving birth, developing better sleep habits can help. Good sleep hygiene is important for everyone, but it’s especially important for new mothers as their body recovers and they take on new responsibilities of caring for their baby.

Just remember that, when trying out new strategies to fall asleep, first ensure that your baby is in the care of a trusted adult or safely asleep on their back, without any soft objects or beddings in the crib like pillows, blankets, or stuffed animals.

  1. Establish a Consistent Sleep Schedule

While it can be difficult to establish a consistent sleep schedule with a new baby at home, it is important to make your sleep schedule as consistent as possible to keep your circadian rhythm in sync.

Carve out a consistent bedtime routine, and try to schedule at 7-8 hours for uninterrupted sleep while you work to restore your circadian rhythm. If that sounds easier said than done, consider enlisting the help of a partner or friend to respond to your baby’s needs at night until you’re able to start falling asleep easier.

  1. Avoid Electronics Before Bed

Other potential disruptors of circadian rhythms are screens that emit blue light, like cellphones and computers. Blue light exposure can suppress melatonin production, and delay the circadian rhythm. While melatonin production can recover within 15 minutes, blue light exposure too close to bed can mean your melatonin production will be delayed.

While it may be tempting to tuck the baby in and binge a few shows on Netflix to unwind at the end of the day, it’s best to avoid screens at least 30 minutes before bed. Some experts even recommend avoiding screens for up to three hours before hitting the hay.

  1. Practice Meditative Breathing Exercises

Relaxation techniques can be used during the day and at bedtime. Breathing exercises like the 4-7-8 technique can reduce anxiety and help you to relax in the hours before bed. This technique involves emptying the lungs, taking a deep breath in for 4 seconds, holding your breath for 7 seconds, and breathing out forcefully through pursed lips for 8 seconds.

In addition to promoting relaxation, the technique is also designed to help you take your mind off whatever may be stressing you out.

  1. Establish a Daytime Routine That Promotes Restfulness

How you spend your day has an effect on how well you sleep at night. That’s why it’s important to build your day around practices that promote restfulness. This includes exercising regularly, limiting caffeine and alcohol intake, avoiding large amounts of liquids or food right before bed, and following a calming nighttime routine.

Make room in your daily schedule for the activities that will help you get a better night’s rest, and establish strict cut-off times for caffeine, electronics, and large meals.

  1. Don’t Force It

Sometimes, the pressure to fall asleep becomes its own source of stress. When you’re worrying that you aren’t falling asleep “fast enough,” the best thing to do is get out of bed and perform a relaxing activity, like reading, in low light.

Know When to Seek Professional Help

If you have tried many different strategies to improve your sleep but still find yourself waking up in the middle of the night, struggling to fall asleep, or feeling sleep deprived, it is best to seek medical intervention. There is no shame in seeking help for postpartum depression and insomnia, and you are not alone.

Your medical professional might advise that you take medications or undergo cognitive behavioral therapy to aid in restoring your sleep.

Do not take any medications or supplements without the input of a medical professional, especially if you are breastfeeding. Almost any medication you take has the potential to transfer to the baby during breastfeeding. A trained medical professional can help you weigh the risks and benefits of any potential medication.

Over-the-Counter Sleep Aids for Nursing Mothers

Some over-the-counter (OTC) sleep aids that your doctor may recommend include antihistamine medication and melatonin supplements.

Keep in mind that while there are other OTC options for promoting sleep, it is not advised to use aspirin or naproxen-containing products while breastfeeding, as they can cause rashes or bleeding abnormalities in babies.

Antihistamines

Antihistamines, like diphenhydramine (Benadryl), are allergy medications that have the side effect of inducing drowsiness. Antihistamines reduce allergic reactions through suppressing histamines, part of the immune system that are also responsible for alertness.

If breastfeeding while using antihistamines, the newborn should be monitored to ensure that they are not being made drowsy as a result of the medication.

Melatonin

Melatonin is another option to aid in sleep. As a supplement, melatonin can help to regulate the circadian rhythm and is generally considered safe and effective. It is best to take melatonin about two hours before you plan on falling asleep, as it can take some time to kick in.

Treating Insomnia with Cognitive Behavioral Therapy

While supplements and medication can help, the most effective treatment for insomnia is cognitive behavioral therapy (CBT). This form of therapy is focused on changing your behaviors throughout the day and before bedtime to combat problematic habits that contribute to poor sleep.

CBT works by teaching you how to recognize beliefs and behaviors that impact the ability to sleep. There are multiple techniques that can be used by a CBT-trained therapist. Some of these include relaxation techniques and biofeedback. Through these techniques, you can observe signs in your body like heart rate or muscle tension and adjust them through breathing and physical relaxation.

The main goal of CBT is to ensure that your environment and mental state are conducive to sleeping. A CBT-trained therapist will likely work with you in multiple ways to help you identify and resolve the problems that are hindering your ability to sleep.

When Poor Sleep Becomes Insomnia

While a loss of sleep is to be expected with a new baby, if you believe that you are living with postpartum insomnia, seek help from a medical professional. Postpartum insomnia and postpartum depression are common and can be treated.

Seeking help for these conditions and getting treatment as soon as possible is important for your health as well as your baby’s well-being.