Behavioral sleep medicine psychologist, Dr. Shelby Harris, maps out goals (and realities!) of optimal postpartum sleep.

Newborns need 24/7 care. And yet parents of newborns need to squeeze in a meaningful amount of shut-eye to properly care for them (and themselves). Getting adequate postpartum sleep is a universal parenting challenge, and yet it is different—and temporary—for each parent. 

"Don't expect sleep to be perfect,” advises Dr. Shelby Harris, a behavioral sleep medicine psychologist. “Even if you have all the help you can get, your body is going through a firestorm." 

We spoke with Dr. Harris to demystify what it means to be sleep-deprived with a newborn—and how to cope.

Q: How does pregnancy impact sleep?

A: In the first trimester, there are hormonal changes, but the second trimester gets a little better. The third trimester is when you really have disrupted sleep. You are bigger, uncomfortable, and wake up to pee every few hours. Your body is preparing for the baby. I’ve had patients who have stress dreams about leaving the car seat on top of the car.

Q: How does this compare with the postpartum period, with all its sleep interruptions and hormonal changes? 

A: Right after the baby comes, sharp drops of progesterone and estrogen disrupt our sleep. Then oxytocin and prolactin come in, and those are hormonal changes too. The shifts often lead to mood changes, depression, and anxiety, as with perinatal mood and anxiety disorders.

Once you add stressors such as breastfeeding and night wakings, it’s a lot. And of course, you just delivered a baby. It’s a total firestorm. 

Q: What’s a good sleep goal to support postpartum mental health?

A: Getting at least four consecutive hours of sleep is a protective factor against postpartum anxiety and depression, and for baseline emotional regulation. If you have a history of depression or anxiety, your risk is very much heightened for a perinatal mood or anxiety disorder (PMAD), if you aren’t getting enough sleep.

If you can get more than four consecutive hours of sleep, great! But remember that with sleep, quality trumps quantity. Getting four or five hours of uninterrupted sleep is more refreshing than getting six hours of interrupted sleep. 

Q: What if you have good sleep hygiene but still can’t get that four-hour block of sleep?

A: If you’re having issues, spend less time in bed. Do your last feed of the day around 11 p.m., just before your bedtime, and then get a solid four to six hours of sleep, if you can.

It’s very effective for many people, but very hard to do, because moms of infants are often exhausted. They get into bed tired but not necessarily sleepy: tired but wired. Doing this is a sleep restriction. Save the time you spend in bed for sleeping; don’t get in bed until you’re ready to fall asleep.

Q: What are your tips for getting back to sleep after a night waking?

A: If you wake up anxious and alert, get out of bed, rather than stay there and worry. Stay off  screens, and go do something else, like read a physical book or magazine. Once you start to feel tired, you can go back to bed.

Q: What about meditation?

A: Meditate during the day, which is more approachable than at night, because there’s no anxiety about trying to fall asleep. Turn your feeding time into a meditation time. Start with 2 minutes. You could put some music on and just listen to the bass line, or listen to every little noise your baby makes.

It’s OK, if your mind wanders; it will do that. You are just practicing meditation, strengthening your ability to focus and refocus every day.

Q: Do you recommend cognitive behavioral therapy (CBT) to address sleep issues?

A: We work on the cognitive part. I see a lot of moms who think, “If I don’t sleep, I won’t be good at my job or be a good mom.” But when you put pressure on yourself to sleep, that is the kiss of death for sleep. 

The behavioral part is sleep hygiene—it’s basic, and has to be there. But sleep hygiene alone won’t solve sleep problems, if insomnia has become a more entrenched issue. 

Q: What are your thoughts on sleep supplements? 

A: Sometimes I recommend melatonin for jet lag, or for people who sleep eight hours but on weird schedules, but melatonin is not really a sleep aid. Magnesium can be helpful, and so can iron. If you feel like you can’t sit still, you may be suffering not from insomnia but rather from restless leg syndrome (RLS), and an iron deficiency can cause that. Sometimes it gets misdiagnosed as anxiety.

Q: How do you suggest people take melatonin? 

A: When we use melatonin in the sleep field, it’s usually half to one milligram. But I repeatedly see people who are taking 10 or 20 milligrams. In many other countries you need a prescription for it. But not in the United States. When I advise people to stop taking it, a month later, they usually are sleeping better. It is most commonly associated with vivid dreams and nightmares. Always consult with your OB-GYN before taking it, if you are nursing.

Q: What’s the most surprising factor regarding moms and sleep?

A: Women usually accept that they’re going to experience a firestorm in the beginning of parenthood. Usually by six months, hormones and baby sleep have settled. If you still have insomnia, you might accept it and continue suffering, chalking it up to motherhood.

At this six-month point, however, you might have conditioned behavioral insomnia, not hormonal insomnia; you wake up because you think you hear your baby cry. And I have many patients whose sleep issues have been brushed off by doctors. But if your child is sleeping better, and you are not, it’s time to get some help.

Q: How else do you know when to call for help?

A: If you feel like your sleep issues are impacting your ability to take care of yourself and your baby, and you experience this feeling at least three times a week, for several weeks, talk to your doctor. There are always little things we can modify along the way. 

The Society for Behavioral Sleep Medicine lists people who practice sleep therapy. Seek out someone who specializes in perinatal sleep. You can also check PsyPact (The Psychology Interjurisdictional Compact), which lists the states in which psychologists can practice across state lines, such as through telehealth.

Have more questions about navigating sleep postpartum?

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