Feeling exhausted is a part of pregnancy that often starts before you even take a test. That heavy-in-your-bones, eyes-half-mast feeling persists through the first trimester, usually takes a break during the second, and then comes back full force during the final weeks. But by that point, exhaustion can be eclipsed by insomnia—usually because of a growing belly, shrinking bladder and full-body discomfort.

So by the time you give birth, one of the greatest physical and emotional feats of endurance, you would think sleep might be easier to achieve.

And then comes postpartum insomnia.

What is postpartum insomnia?

Postpartum insomnia is the consistent inability to fall or stay asleep after having a baby.

Why am I unable to sleep postpartum?

A few things can cause postpartum insomnia—including the third trimester of pregnancy! During those final weeks of pregnancy, it’s common to get up multiple times throughout the night, whether to use the bathroom, to find a comfortable sleeping position or to manage frustrating discomforts like heartburn. Worrying about upcoming parenthood is also a common cause of restlessness.

These behavioral changes disrupt our sleep architecture, leading to more shallow sleep because we pop in and out of it. And because our minds love routine, our circadian rhythm gets messed up, too, causing long-term sleep struggles that persist into the postpartum period.

Once baby is born, postpartum hormones can lead to insomnia. Progesterone—a hormone that facilitates relaxation—drops after giving birth. Estrogen—a hormone that helps reduce the amount of time it takes to fall asleep—also drops postpartum. These adaptive bodily changes create a super awake state to help parents leap into responsiveness when the baby cries. So, they’re great for staying vigilant, but not so much for sleep.

When does postpartum insomnia go away?

Hopefully, postpartum insomnia fades away when the baby develops a sleep structure. When you’re able, try going to bed at the same time every night and waking up at the same time every morning. This predictability allows our bodies to adjust and form a new routine alongside the baby’s.

If your baby is sleeping great and you still experience severe sleep issues, know that untreated clinical insomnia may require intervention. Otherwise, insomnia can last for years—the last thing any parent needs!

How many hours of sleep should a postpartum mom get?

Here’s the thing. In an ideal world, moms and other postpartum birthing parents would get at least seven consecutive hours of sleep per night. But anyone who’s had a baby, or recently had one, knows this is an impossible goal since newborns need to eat every two to four hours.

A better hope for any newly postpartum parent is a four-hour consecutive stretch in 24 hours, but this greatly depends on the individual baby, your pediatrician’s recommendations and whether or not you have a support person. Ideally, you achieve nine cumulative hours of sleep within 24 hours.

It’s understandable then that many new parents wonder how long sleepless nights last with a newborn. While this is also very much dependent on the baby, infants typically sleep longer stretches by about three months of age, and around four to six months old are developmentally able to sleep through the night. Whether they do is a whole other thing!

Can breastfeeding cause insomnia?

There is a correlation between breastfeeding/chestfeeding and postpartum insomnia for a few different reasons.

  • Feeding schedule – Regardless of how you feed your baby, they will need to eat every two to four hours, and many parents struggle with falling back asleep after a feeding.
  • Hunger – Not the baby’s, but yours! Breastfeeding/chestfeeding is hard work. According to the CDC, breastfeeding/chestfeeding can burn about 500–700 calories per day, and those who do it need extra calories to keep up energy and milk production. Which means hunger pains may keep you awake.
  • Breast engorgement, discomfort and leakage – The longer the stretch between feedings, the more uncomfortable breasts become as they fill with milk. When they get too full, it can feel like sleeping on an actual rock, and the pain may even wake you up.

Here are some tips for how to fall back asleep after breastfeeding/chestfeeding.

  • Dim the lights – Use as minimal light as possible when feeding the baby throughout the night so neither of you is fully wakened. Try clipping a booklight to your nightstand.
  • Stay off screens – It’s tempting to scroll or watch a show. But just as your phone helps keep you awake by stimulating your brain, it can make you stay awake by delaying the release of melatonin. If you use apps to track baby’s feedings, use a pen and paper in the middle of the night and update the app in the morning.
  • Follow your hunger cues – Eating before bed can affect your sleep quality as your body works through digestion. But breastfeeding/chestfeeding can also make eating a necessity and keep you awake with hunger. Here we say, do what works best for you.
  • Listen to white noise – Not only can white noise help baby sleep, but it can also help you by covering up sound inconsistencies and disturbances and giving you a steady place to focus attention.

If you’re wondering what you can take for insomnia while breastfeeding/chestfeeding, there is a range of medications, from over-the-counter to prescription, that are relatively safe. Speak with your provider about your options.

Tips to help with postpartum insomnia

When exhaustion begins to feel like an emergency, there are a few things you can do to help with postpartum insomnia, understanding that the newborn stage is a difficult, sleep-deprived time for every parent.

  • Split shifts – If you have a partner or other support person, care for the baby in shifts while the other sleeps so you can have an uninterrupted stretch. This may even look like sleeping in a separate room.
  • Avoid caffeine four to six hours before bedtime – Caffeine may feel necessary during the newborn days, but limit intake close to bedtime. Remember caffeine is not just in coffee, but also in tea, sodas, chocolate and some medications.
  • Nap strategically – Don’t nap after 3 p.m. and keep naps (when/if you can find time for one) under one hour.
  • Don’t lie in bed awake – If you’re still awake after more than 15-20 minutes, get up and try a relaxing activity (reading, stretching, breathing) and return to bed when you’re sleepy.

A note on newborn sleep noise. Many parents have difficulty sleeping through the noises their babies make, which can lead to insomnia. The American Academy of Pediatrics (AAP) recently updated its safe sleep recommendations, suggesting babies sleep in their parents’ room until they are at least six months old (reduced from 12). Consult your pediatrician if you have any questions about safe sleep for your baby.

When anxiety sets in as the sun sets

An often experienced but not always talked about aspect of the postpartum period is the “sundown scaries.”

This night anxiety can start in late pregnancy when we begin to associate an anxious mental state with nighttime sleep (Will I sleep tonight? How uncomfortable will I be?). Once the baby is born, those anxious thoughts are amplified (How many times will baby wake up? Will I hear them? Will feeding go ok? Will I get any sleep at all? How hard will tomorrow be?). These types of worries can make nighttime feel like the loneliest, most stressful time of the day.

While it sounds simple, this is when it becomes critical to ritualize relaxation. The goal? To communicate to your body that you’re safe. It’s a skill—that takes lots of practice—to help relax your physical body and turn off your fight or flight response. The more we do it, the easier our bodies can click into relaxed mode. Try:

  • Diaphragmatic breathing – Take slow, deep breaths from your belly
  • Guided visualization – Think of a scene that brings you peace, picturing its every detail
  • Mindfulness meditation – Scan your body from your toes up to your head, focusing on how each body part feels

If persistent worry keeps you from sleeping, speak with your provider or a mental health professional as soon as possible.

Is postpartum depression (PPD) just sleep deprivation?

It’s understandable to relate the symptoms of postpartum depression—depressed mood, severe irritability, feelings of inadequacy, difficulty bonding with the baby, lack of interest in activities that brought you joy, loss of energy, feeling numb and other symptoms—to severe lack of sleep. However, a lack of sleep does not cause postpartum depression.

Postpartum depression is a mood disorder caused by several factors and should be taken seriously. If you have any postpartum depression symptoms or are concerned about how you feel in any way, make an appointment to speak with your provider who can get you the help you need.

Remember, rest counts

Even if you’re not sleeping, allow your body to rest and take comfort in knowing rest does count. Rest puts your body into recovery mode and restores it, even if you’re awake while it’s happening.

The postpartum period is rife with difficulties, and a lack of sleep on top of the profound changes you’re experiencing makes everything feel harder. Thankfully, we’re incredibly adaptable as humans. And as impossible as it seems now, I can promise you will sleep again.

Resources:
  • CBT-i Coach is the gold standard for insomnia treatment.
  • MotherToBaby.org is a reputable website that documents medication use during pregnancy and while breastfeeding/chestfeeding.