Perinatal and Postpartum Insomnia

Women are disproportionately affected by insomnia (12.8% of women vs 9.7% of men)

 

15% to 80% of women in the first trimester and 66% to 97% of women in the third trimester experience sleep problems

Perinatal insomnia is a very common occurrence, with many factors like waking up constantly to go to the bathroom or pregnancy discomfort. If you are able to fall back asleep quickly, this may not be a problem. However, when you find yourself spending long periods of time laying awake in bed unable to fall back asleep, fatigued during the daytime, and anxious about your sleep, you may be experiencing perinatal insomnia. When significant and prolonged, perinatal insomnia has been associated with preterm birth, gestational diabetes, and perinatal mood and anxiety disorders (PMADs).

There are 3 components in the development of insomnia- predisposing, precipitating, and perpetuating. You might have already experienced insomnia in other parts of your life, and may identify with a few "predisposing factors". One of these predisposing factors is the female sex, others being a background of anxiety or depression, tendency to be hyper-aroused, or hormonal changes (pregnancy or may insomnia around your period). When insomnia starts becoming a problem, there is often a "precipitating factor". In pregnancy that might be physical discomfort or needing to use the restroom, in postpartum part that might be having to wake to care for your baby or feeling hyper-aroused or worried about your baby's safety in the middle of the night. The 3rd component is "perpetuating factors". These are the components that help you feel a little better in the moment, but lead to maladaptive behaviors and beliefs around sleep and contribute to chronic insomnia. This might look like staying in bed for many hours waiting for sleep to come, napping during the daytime because you're fatigued, and extreme increases in anxiety around sunset or bedtime with catastrophic thinking about "never being able to sleep again".

 

Treatment of insomnia is focused on prevention and treatment of the perpetuating factors. This means the work can start whether you are in the precipitating phase to avoid the insomnia getting worse or at the perpetuating phase to undo the maladaptive behaviors. CBT-i has an average treatment response rate of 70-80% and can be paired with sleep medications if needed. CBT-i may included techniques like sleep restriction and stimulus control. Sleep medications may help jumpstart your sleep, reset your circadian clock, and give you temporary relief of your fatigue as we work through the behaviors around sleep using CBT-i. 

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Resources: "The Women's Guide to Overcoming Insomnia" by Shelby Harris: link here.

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