A New Year and Returning to Blogging

“Tomorrow, is the first blank page of a 365 page book. Write a good one.”
– Brad Paisley

I’ve seen this quote many new years past, but for some reason, it’s sticking with me more so now than ever before.  I haven’t blogged for over 4 months….the longest break since I started blogging in February 2009.  If you’ve been following my blog for some time, you may have noticed it’s been quiet over here and may have wondered if I’ve decided to call it quits.   Well, I’ve previously vowed I would never completely stop.  Blogging about maternal mental health will always be a passion of mine, as my experience 14 years ago has shaped me into the person I am now.  Blogging has also been a huge outlet for my thoughts and anger when I hear about our society’s shortcomings when it comes to maternal mental health.  As I’ve mentioned before, the anger that has fueled my passion has fizzled, and my anger has been directed toward the state of our government instead.  With my district’s Democratic nominee winning on November 6th and now with the House flipping blue (wooooot!!!!) this past Thursday,  I can breathe a sigh of relief and let go of some of my anger.

I’ve also been so busy at work that each day merges into the next and into the next with 10-hour days with no stops and often no lunch breaks……to the point that I’m feeling like my life is flashing before my eyes….and my daughter’s growing up so fast, she’s heading to HIGH SCHOOL this fall!  Plus, my parents and their health and other issues have been weighing heavily on my mind.

And so it comes to my latest philosophies, which are spin-offs of my long-time philosophy of “Just do it” and “Work hard, play hard.”

“Love, laugh and live life with no regrets”

and

“Life is too short for BS”

I don’t really take crap from anyone anymore.  I speak my mind.  I try to maintain work/life balance.  I’ve been trying to achieve more down time on weekends and each evening, trying to to sleep earlier and even squeezing in before bedtime a chapter or two of the bestseller “A Discovery of Witches” by my fellow Mt. Holyoke classmate, Deborah Harkness.   What more motivation do I have than the fact that the show is premiering in two weeks on Sundance Now?!  I’ve tried to see my parents more often.  I’m trying to do more with my daughter before she goes off to college and I <gulp> become an empty-nester. I’m trying to clean out loads of stuff I’ve been holding onto and just try to keep it simpler and less cluttered.  Cuz what am I going to do with stuff I’ve been hanging onto for years and don’t really need anymore?

Finally, as the new year begins, I would like to start up my blogging once more.  After all, I’m not used to not having my blog be one of the first blog resources that comes up when you search the terms “postpartum insomnia,” “can’t sleep when the baby sleeps,” etc.  Time to get to work and get to blogging again!

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How Hospitals/Docs and Magazines/Books on Pregnancy/Motherhood Can (and Should) Increase Public Awareness on a New Mom’s Need for Sleep

Let me start with how I believe OB/GYNs and hospitals–not to mention books and magazines on motherhood and pregnancy– can and should most definitely do more in terms of increasing public awareness of postpartum depression (PPD), which should start with this….the importance of sleep and getting adequate support to help reduce the risk of PPD rearing its ugly head.   OB/GYNs and/or hospitals should put right up at the top of the childbirth education curriculum–short though it usually is (a couple of hours…what a shame!)–the importance for new mothers to get at least 5 hours of uninterrupted sleep as much as possible during the first 6-8 weeks postpartum

What should be included in the education: 

1) the fundamentals of adult sleep, including what is considered “normal” sleep

2) sleep cycles

3) what to expect during late pregnancy and postpartum in terms of their impact on sleep

4) strategies for sleep management during late pregnancy and postpartum

5) effects of sleep deprivation

6) facts about newborn/infant sleep

Granted, for the greater majority of mothers out there a) the husband has to work full-time during the week and it is highly unlikely he could work the same hours and do the late-night feedings all week, and b) they lack the financial ability to hire a baby nurse, postpartum doula or nanny to help with late-night feedings.  What that means is, for most mothers out there, it is highly unlikely the mom can get the 5 hour block of sleep at night that she needs.  That shouldn’t, however, deter the OB/GYN from providing the simple fact that a minimum of 5 hours of uninterrupted sleep is imperative to the healthy functioning of an adult (more so for a woman who has just given birth), and depression is one possible consequence for the brand-new mother–hormones all outta whack and all–who fails to obtain that over the course of weeks following childbirth, a time in which she is at her most vulnerable. 

Awareness + Preparation = Keys to a better postpartum experience and reducing the risk of PPD (Note:  You may not be able to prevent PPD if you are at risk, but it certainly doesn’t hurt to be prepared to have a better postpartum experience):

  • While you are still pregnant, reach out to friends and family members to provide practical support (like help watching the baby, cooking, laundry, housework, errands) and emotional support (someone who can listen to you, provide advice and be empathetic and nonjudgmental) after the baby arrives.  Believe me, after the baby arrives, you will have neither the time nor the energy to search and coordinate.  If family and friends are not options, consider hiring a baby nurse and/or a doula to help during the first couple of months, if you can afford it.    Having a baby nurse to help with nighttime feedings will enable you to get the sleep you need to take care of the baby the whole rest of the day while your husband is at work, and your husband to get the sleep he needs to go to work each day.  
  • Resist temptation to use your baby’s nap time to try to catch up on housework, do laundry, address birth announcements, write thank-you notes, or handle other projects.  I know it’s so much easier said than done. I would suggest you scope out the wording and pick out the birth announcement you want to order (and thank-you cards) before having the baby.  That way, you won’t be stressed out finding the perfect one to send after the baby has already arrived, worry about not getting them out within a month after the baby’s born and hustling to get thank-you cards out within 30 days of receiving a gift.  

What happened to me I wouldn’t want to see happen to you…..

I thought I could handle taking care of the baby, cleaning up, finding announcements, addressing them and mailing them out, etc. since I typically thrive on multi-tasking and I never thought it would be any different after having a baby.  And believe me, the word thrive doesn’t come close to describing how much I try to squeeze in in a day’s time.  Silly me had failed to realize that I had just had a baby, which is a very big deal physically.  And that’s on top of the 7 days of hell I spent at the hospital, not to mention the multiple surgeries, daily blood work, MRIs, loss of 4 units of blood, and constant hunger (see previous post for details of my hellish hospital stay). 

I returned home from the hospital fully expecting to resume my old routine in addition to taking care of the baby.  Every time my mother or mother-in-law suggested I lie down or sit down, put my feet up and relax, I waved them off, saying that I was A-OK and didn’t need to nap.  Now that I’ve actually experienced insomnia and PPD, I know that my mother’s and mother-in-law’s advice was excellent advice.  Relaxing/resting is beneficial, even if you can’t fall asleep.  Problem is, I’m neither a napper nor a rester.  I’ve always considered napping a waste of valuable time that could be spent doing something productive.  For as long as I can remember, at least from the time I was 13 years old, napping was never my thing.  I wasn’t about to nap now. 

Don’t feel guilty for napping instead of doing something productive.  Now is not the time to feel compelled to try to impress others or try to fit the mold of what in your mind is how a perfect mother should be like.  After all, no one is going to expect that your house be spotless with a new baby to take care of.   Don’t worry if your house isn’t spotless and neat for visitors.  I know that’s easier said than done.  My house is messy on a normal day sans baby in the picture, let alone with baby (and exhaustion) in the picture.  It didn’t help that I resisted the idea of hiring a cleaning lady because I was brought up to clean my parents’–and now my own–house, so why pay someone else for the work I can do myself, even if it is for the sake of convenience?   I have issues with privacy and trust in hiring a stranger to come into the house (same reason I couldn’t hire a nanny).   

Don’t be like me, letting yourself get caught up in one hell of a vicious cycle:  If you don’t clean, you are less willing to have visitors, so you will feel more lonely and isolated than ever, which makes your PPD worse….

Insomnia versus Sleep Deprivation in new moms (yes, there is a difference between the two)

Here, finally, is my post on sleep (as a follow-up to my post “Some Postpartum Advice for New Moms-Part I”) ….or actually, insomnia.  Just what is insomnia?  Equally frustrating as explaining the difference between the baby blues and postpartum depression (PPD) is explaining the difference between having insomnia and not having the ability (or lack of opportunity/time) to sleep.  Insomnia is when you can’t sleep at night and can’t nap during the day no matter now exhausted you are.  I’m not talking about sleep deprivation, which is what ALL new parents experience in the first 3 months postpartum.  I’m not talking the lack of opportunity or time, either.  To be perfectly clear, a person with insomnia has difficulty falling asleep and/or difficulty staying asleep, even when the baby sleepsInsomnia is one of the most common symptoms of PPD. In fact, it has been shown that early severe fatigue predicts depressive symptoms at 1 month postpartum.  For me, insomnia was my very first symptom of PPD and I wholeheartedly believe that the constant sleep interruptions that started during my week-long stay in the hospital charted a course that was headed for PPD.

You need sleep to stay healthy and to be able to take care of your baby day in and day out.  I had it bad.  You’d think that sleep deprivation would cause exhaustion which would cause me to fall asleep readily and at first opportunity.  That couldn’t be further from the truth in my case.  I couldn’t fall asleep, even when the baby was sleeping.  I couldn’t nap during the day, even with someone taking care of the baby for a few hours.  When I told my doctor I couldn’t sleep at night, he instructed me not to take naps, to which I said “That’s not an issue because I can’t nap either…I can’t sleep at all.”

I encourage you to try one or more of the following to try to switch gears and condition your body out of this situation.  The key is to have the patience to stick it out for at least a couple of weeks.  I know with PPD it can be really hard to do, but please try your best.  Things don’t happen overnight.

  1. If you can’t fall asleep within 30 minutes, stop trying to sleep.  The more I couldn’t fall asleep, the more I was unable to fall asleep.  This effect is referred to as conditioned insomnia where your mind doesn’t expect you to fall asleep, which in turn, keeps you from falling asleep. Lying there waiting to fall asleep but not succeeding will only eat at you and make you more and more frustrated.  It will do you no good.  The harder you try to sleep, the more anxiety you will experience, and that anxiety will keep you from falling sleep—a vicious cycle.  The key in those situations, it seems, is not to expect to fall asleep.  If you fall asleep, great.  Just relax and try to blank out your mind from any thoughts.  Sounds so easy, but is so hard to do.   So many people warned me that the last thing I should do is toss and turn in bed for more than half an hour at a time.  Instead, I should get out of bed and go into another room to watch TV or listen to some quiet music before trying to fall asleep again (this is to interrupt the conditioned insomnia).  Of course I didn’t heed their advice because I was stubborn.  In my mind, sleeping was the only thing I should be doing in the middle of the night.  Plus, I should be exhausted and able to fall asleep instantly.  But after 2 hours of tossing and turning, I was in a state of anguish beyond words.  Had I known at the time that PPD was behind this all, it never would’ve gotten this bad.
  2. Avoid looking at the time.  Move your clock(s) out of the room, if necessary, as watching time go by will only serve to make you feel even more anxious about not being able to fall asleep.
  3. Get a headphone noise canceller or white noise generator to use while getting your 5 hours of uninterrupted sleep.  This is, by the way, just if you have someone like your husband or relative staying with you and helping to care for the baby at night.  My husband had suggested getting me a headphone noise canceller or white noise generator in terms of helping me not to overreact to my daughter’s noises and his snoring (which I could hear even when he was in the den or living room downstairs).  I swear back then I could hear a pin drop, I was so attentive to every little sound that was made in the house!
  4. Have your husband or whoever might be staying with you to give you a back/shoulder massage right before bed.  Ordinarily, a back/shoulder massage right before bed feels so good and is so relaxing, I would fall asleep immediately.  Needless to say, my husband’s massages when I was already sick with PPD didn’t help me one smidgeon.
  5. Establish a bedtime ritual:  Much like trying to condition your baby to associate a bath, reading a book and/or humming a lullaby with going to bed, you should try to recondition your mind to associate drinking warm milk (if you’re not lactose intolerant) and eating something high in complex carbs that can promote drowsiness like bread, taking a hot soothing bubble bath or listening to relaxation music (the kind that would be played during a massage) with going to bed.  I never realized that the reason why so many people suggest warm milk to help you sleep is because it contains tryptophan, which increases serotonin, promoting sleep.
  6. Avoid exercising within 2 hours of going to bed.  My doctor suggested exercise anytime during the day except for within 2 hours of your bedtime may burn off excess energy/reduce jitteriness and promote sleep.  I tried but couldn’t keep this up.
  7. Avoid napping during the day.  My doctor suggested that I avoid napping during the day, as it may charge me up to the point and increase the likelihood that my body will feel less tired at the end of the day.
  8. Do a wind-down routine.  My mother suggested I do a wind-down routine, similar as I would do for my daughter, every night before going to bed.  I should avoid exerting myself or watching stimulating television shows or read books that require too much thinking.  She gave me some information about Chinese relaxation techniques that have been used for centuries.  I tried that, but that night, I ended up having my first anxiety attack from failing to fall asleep after 3 hours of doing that relaxation exercise.  She also suggested I try breathing exercises and visualize positive things when I’m in bed, so as to facilitate sleep.  But try as I might, it was to no avail.  The harder I tried, the more I expected to be able to sleep, and the more agitated/panicked I felt that I would never fall asleep without medication for the rest of my life.  A friend told me that counting backwards in three’s helps her sleep.  I tried that too, but with no success.  It actually drove me crazier.
  9. Reserve your bedroom for sleeping only.  There’s a reason behind the saying “Mothers know best.”  But nearly half the time, I dismiss my mother’s advice as “old wives’ tales.”  Well, when my mother advised me to reserve the bedroom for sleeping only and not do anything like read, watch TV or write in bed, I waved off her advice saying “Uh huh whatever you say, mom.”  Then, I read in “Postpartum Depression Demystified“ by Joyce Venis, RNC and Suzanne McCloskey (pg 41) that you should “Make your room your sleep sanctuary.  In other words, don’t watch TV, read, or play with your baby there.  Your bedroom should be only for sleep.” So, mom really does know best, after all.
  10. Stay away from caffeine.  For me, caffeine wasn’t a factor, since I was totally caffeine free all of my pregnancy and continued to be caffeine free postpartum.
  11. If within a week all the above suggestions fail–provided you don’t experience tremendous anxiety from not being able to fall asleep–then it’s time to see your doctor.  Don’t wait or you could you find yourself going down the same road I traveled—in other words, experiencing high anxiety and panic attacks from not being able to fall asleep.  Don’t wait.  You could go from bad to worse very quickly, and I wouldn’t want you to experience what I experienced (or worse).  Do see a doctor for an evaluation to help determine what is causing your insomnia.  Be honest about all your symptoms when talking to your doctor.  No question is a stupid question when you are a patient.  Doctors are paid to provide medical care, which includes consultation about your diagnosis and treatment.  Leaving out key details will only impede your recovery.  Also, do not let your doctor try to convince you that this is temporary and is experienced by all new mothers.  If you find that your doctor doesn’t know the difference between the blues and PPD, it’s time to find another doctor.  If you don’t know where to find a doctor that can help, reach out to your state PSI coordinator.

Additional Suggestions

Here are some of the things we did to help my daughter sleep through the night, which may be helpful to you:

  1. If you are breastfeeding without any difficulties, you may want to consider having the baby sleep in your room in a co-sleeper so you can pull the baby into bed with you for nighttime feedings without ever having to get up.
  2. If you aren’t breastfeeding, it would help to prepare bottles of pumped milk or formula in advance and have your husband take turns with you in terms of nighttime feedings.
  3. By 3 months if you haven’t done so already, have the baby sleep in her crib in her own room so you will not constantly be disrupted, especially if the baby tends to make a lot of noise while sleeping.  My daughter started sleeping in her own room at 6 weeks because her noises kept us from sleeping during the night, which I know contributed toward my insomnia and PPD.  I had every intention of keeping her in our room through the 2nd month.  Avoid setting this expectation, as it will only let you down harder if you are unable to follow through.  The fewer expectations you have and the more open-minded/flexible you are, the better off you will be.
  4. Keep a clear distinction between night and day as bed time and awake time, respectively.  Keep the room completely dark and quiet at night and bright during the day, with constant noise and hustle and bustle of activity (even when the baby naps during the day).  Doing this consistently can contribute toward your baby’s sleeping through the night earlier.  Every baby is different, I realize.  Fortunately, our daughter was sleeping through the night within 2 months.
  5. Establish a bedtime ritual for your baby, like reading a book or humming a lullaby so she associates bedtime with them.  My daughter used to hum and then drift off to sleep.  So she clearly associated humming with sleeping.  In fact, at four years old, I can still tell when she’s tired because she would all of a sudden start humming/singing to herself.
  6. At 3 months, you may want to start trying to avoid immediately going to your baby when she cries during the night or as you put them to bed.  It’s tough to not immediately go to your baby when they cry.  A minute can feel like an eternity when you hear your baby crying.  At first, you may want to give it 5 minutes before going to her.  If you can’t last 5 minutes, try 3 minutes at first and work your way to 5 minutes.  And then over time, stretch the interval to 10-15 minutes before going into her room, calming her down and letting her cry another 10-15 minutes.  To calm her, you can try humming a lullaby or talking to her, avoiding picking her up, and then walking out of the room.  Repeat this until she falls asleep on her own.  Pick her up and comfort her (or feed her if necessary) only when all else fails.  Keep this up…it will work.

 We found that for 1-2 weeks at a time while she was teething, and even after she learned how to go back to sleep, she would wake up every night at around 2:30 AM crying.  She needed our comfort during that time to fall back asleep.  So we’d pick her up, hold her while sitting in the rocking chair, and sometimes hum her back to sleep.  After about 5-10 minutes, we’d put her back in her crib whether she was asleep or not.  At first, we feared she had regressed.  But it was only temporary.  You may find this will happen to your baby while they are sick, teething or have an ear infection.  A baby who is teething and/or has a fever and/or is not feeling well should be comforted immediately.

 By 4 months, in order to teach her to fall asleep in her crib while she is still awake, begin putting your baby to bed at night while she is still awake.  If your baby will only fall asleep if you rock, nurse and/or hum a lullaby, she will come to depend on being rocked, nursed and hummed to in order to fall asleep, so that when she wakes up in the middle of the night, she won’t know how to fall back asleep without your intervention.

Stay tuned for my next post that continues on this topic, specifically in relation to awareness of the importance of sleep and setting up a support network before you have your baby as being the key to prevention of insomnia (and PPD).

Insomnia – My Very First PPD Symptom

The very first sign that I was about to begin my postpartum depression (PPD) journey was a sudden development of insomnia one day six weeks after I had my baby.   One day I was fine, the next I wasn’t sleeping.  It was like my mind decided to stay on, despite the fact that I was exhausted beyond words.  Especially since I never even really had a chance to “recharge my batteries”–if you will–from my 7-day stay in the hospital after suffering from complications during delivery.  Some people may think that I developed PPD as a consequence of the trauma of having a partial hysterectomy only 3 days after having my first child and realizing I would never be able to have any other children.   Well, sure, the fact that she was going to be our only child and we had gone through a difficult IVF process (more on that in a later post) certainly didn’t help matters.  It was not, however, the only factor that caused PPD to rear its ugly head.   While I was in the hospital, the hospital staff always had to come in during the middle of the night to take my temperature and sometimes blood.  I’d be sleeping and they’d come and wake me up.  Didn’t they understand how important sleep is to a new mother?  I was never able to get a block of 4-5 hours of sleep during that dreadful week in the hospital.

After the past four years of introspection and journaling my thoughts and feelings into a book, I wholeheartedly believe it was the constantly interrupted sleep and prolonged hypervigilance that kicked off my PPD journey.  The first 1-2 months postpartum is a period in which the new mother is particularly vulnerable to stressors particularly if she doesn’t get the rest she needs to recover from childbirth.  She needs at least 4-5 hours of uninterrupted sleep a day during this time to allow her body to reach the deep sleep it needs to help her body recover.  I’m not saying this to be funny, as I realize all new parents are sleep-challenged during the first 3 months.  It’s what the subject matter experts are recommending, which is why practical (and emotional) support is important for new mothers during that time (see previous post).

For the first month, my husband and I wanted the baby to sleep in our room.  She could only sleep in her car seat, which we kept in a pack n play next to our bed, which made sense because the car seat kept her in an “in-utero” like position.  She also had to be tightly– and I mean tightly– swaddled–also to simulate the in utero experience to which she was accustomed for much of her existence up to this point.   She couldn’t sleep lying flat.  Of course, we learned all this through trial and error.   She also kept making strange animal-like sounds all night long. It’s a shame we didn’t record any of those sounds, which were like little grunts and chirps and what-not.  Anyway, every little sound she made startled me awake, while my husband slept through it all out of sheer exhaustion. After all, we had gone through hell in the hospital and he was just about as sleep deprived as I was.   A natural concern for my baby’s health and fearing SIDS probably contributed to my hypervigilant state (though I understand this is a relatively common phenomenon among new mothers).  We eventually had no choice but to move her into her room so I could sleep better.

When the baby was 36 days old, she developed what seemed to be colic.  She’d cry non-stop for hours at a time, sometimes after 5:00PM, sometimes starting from 8:00PM.  One day that week she didn’t stop crying until 4:00AM.  It was the scariest experience, not knowing what was wrong with her…what was causing her to cry non-stop like that.  We wanted to comfort her, but nothing we did would stop the crying.  We had heard some horror stories of babies crying non-stop for 15 hours at a stretch for months.  We thought we were doomed to the same experience.

Exactly one week later,  just as suddenly as her colic started, it stopped.  Of course, we weren’t sure when/if the colic would return.  So I guess you could say we were both quite wary from the time the sun went down and all through the night.  Just as with everything in life, there’s always a negative where there is a positive.  The colic stopped, so we both thought things could go back to normal.  I would get up for the late night feedings so that my husband could go to work.  Turns out, things wouldn’t work out the way we planned.

Two days later–or the 45th day (or about 6-1/2 weeks) postpartum– my insomnia started from out of the blue.  I couldn’t fall asleep until after 3:00 AM.  In fact, I wasn’t sure whether I slept at all.  It certainly didn’ feel like it.   I didn’t know why this was happening.  Perhaps I was waiting for the baby to cry.  I thought it was a matter of calming down, telling myself that the baby’s colic was gone and probably would not return.  I should relax.  Other mothers were telling me that they were always in a state of shallow sleep and jump at the slightest wimper from their babies.  I was like, great…..I’ve got a lot to look forward to.

I’ve never not been able to fall asleep before.   It’s painful for me to reflect back on those days of not being able to fall asleep all night, tossing and turning, knowing that everyone else is asleep, looking at the clock as the time to get up and feed the baby approached, and seeing the sun come up–all the while knowing that this all didn’t make any sense because, after all, I was exhausted beyond words.  At one point, I got less than 9 hours of sleep over 3 days.  My fear was I’d be physically and mentally impaired from not getting any sleep for so many days in a row that I wouldn’t be able to take care of the baby.  I just wanted to tear my hair out.  I wanted to go screaming into the night, running until I reached a point of exhaustion and just pass out.  I couldn’t endure all those hours of tossing and turning any longer.  The feeling of loneliness was so overwhelming and almost too much to bear.  I was desperate for company, for someone to comfort me and help me overcome this dreadful condition.  I couldn’t expect my husband to keep me company much because he had to go to work early in the AM and had a long day of work, so he needed his sleep.  I only woke him up when I felt I was at the end of my rope.

It didn’t help that every time a friend/relative asked me how I was doing, I’d tell them exactly what was going on….with the insomnia and all.  And each time, I would get this look and a wave of the hand and the comment:  “You’re a new mother….new mothers never get any sleep.  But you should definitely sleep whenever the baby sleeps.”  And I’d say the same thing over and over again…..I wish I could sleep when the baby sleeps, but I can’t.”  Then I’d get the same response:  “Just try harder…..put your feet up, lay back and you’ll fall asleep….all you need to do is relax.”  To which I’d say:  “You just don’t understand.  The baby’s been sleeping through the night since she was 2 months old, which is great.  But I will lie there all night, tossing and turning until the sun comes up, arms numb and cold, heart beating fast/palpitating – all of which is, needless to say, disconcerting.  How can I take care of the baby when I can’t get any sleep at all?”  Then infuriatingly, they’d say:  “Just take a nap during the afternoon, when the baby sleeps.”  Then I’d end the conversation (because I would’ve had enough at that point):  “You don’t get it….I can’t nap.  I can’t sleep, even if I wanted to and even if the baby sleeps.  She sleeps fine.  I have INSOMNIA.”  Telling them that was just about as easy as telling them that I had PPD.  You could see from the look on their face that they still didn’t get it, even though they’d nod to give the the appearance of understanding.

I didn’t know anyone who’s had insomnia, so I never had the support I needed to get me through those dark days.  All I needed was some understanding and reassurance that I wasn’t losing my mind.   My doctors were no help in that respect.  NO HELP AT ALL.  My husband tried to comfort me, but of course, he had no way of knowing what it was like and how scared I was.  I think this was the only time in my life in which I felt so scared and helpless.  All other times in my life, I had some amount of control whether it was a problem at school, problem at home, problem at work, nastier-than-hell fight with a boyfriend, or illness (there was always a cure, like medicine for my recurring bouts of bronchitis and colds throughout the year, or major surgery to remove my dermoid cyst).

Had I read all the books that I’ve been reading these past 4 years BEFORE my PPD journey began, I probably could have avoided the panic attacks that developed 1-2 weeks later (more on this in a later post).  The books all say that insomnia–the inability to fall asleep and/or stay asleep EVEN IF the baby is sleeping– is one of the first symptoms of PPD, especially if it occurs beyond the 3rd week postpartum.  Had I known what I know now, instead of simply taking the Ambien that was prescribed to me by my OB/GYN, I would’ve insisted that he screen me for PPD.  Ultimately, after the insomnia spiraled into panic attacks and the Ambien started to lose its effect, I had to find a GP (this is the one I referred to in an earlier post) who prescribed Paxil and Xanax (I was still on Ambien at the same time).    Thankfully, within a month I was sleeping without the Ambien.  Such a relief that I was not dependent on Ambien as I feared I’d be for the long haul!

There is a tremendous difference between sleep deprivation–which ALL parents experience in the first 3 months–and insomnia which is not being able to fall asleep and/or not being able to stay asleep, even when the baby sleeps. Insomnia can be caused by a fear of falling asleep because something bad will happen if you do, or a constant state of anxiety with busy thoughts and worries that keep you running on high energy like the Energizer ® rabbit that keeps going and going and going. I suppose after 4 weeks of constantly interrupted sleep and such a state of extended hypervigilance–both of which my body was unaccustomed to–were enough to turn on the insomnia switch.   I read that adrenaline, which is produced by the adrenal glands during stress, can increase the body’s fight or flight response, and persistent high levels of adrenaline can cause palpitations, insomnia and anxiety or panic attacks.     I also read that an extended period of sleep deprivation and/or constantly interrupted sleep is a form of torture used on POWs to extract information from them.  Not that I’m trying to draw an analogy here to my first motherhood experience as torture.  It wasn’t.  It was just that my body was not used to enduring sleep deprivation and high levels of  anxiety over an extended period of time, without fully allowing my body to relax and recover from childbirth and all the drastic hormonal changes that went along with it.

When I was well on my road to recovery, I asked my GP and OB/GYN (and staff) why they didn’t think I had PPD even though I had some of the symptoms (e.g., insomnia and extreme anxiety), they said I didn’t exhibit the typical signs of PPD and I didn’t communicate my problems sufficiently to them.  Well, hello….but why do I, the patient, need to tell the healthcare professional that insomnia lasting beyond the 4th postpartum week should act as a telltale indication for PPD?  Symptoms persisting beyond the 3rd-4th week is no longer the baby blues.  Crying, the trademark of baby blues, is not necessarily a primary symptom for those suffering PPD.  It certainly wasn’t for me.  If they had asked me to describe my symptoms and better yet, if they knew enough about PPD to put one and two together, they would have diagnosed me then instead of starting me on a painful voyage seeking answers, compassion and treatment.

Here’s my advice to you if you are experiencing insomnia and you are beyond 3 weeks pospartum:

  • Seek medical help before it has a chance to spiral into something worse.  Don’t just take Ambien or some other sleep aid, and leave it at that.  Ask your doctor if he/she has experience treating PPD.  If he/she doesn’t but you’d prefer to stick with this doctor, tell him/her he/she needs to screen you for PPD and reach out to Postpartum Support International for information/resources.   You always have the option to find a psychiatrist who can screen you for PPD, provide you with a listening ear and advice, and prescribe any medications as necessary.  If this is your first time experiencing a mood disorder, don’t be afraid to seek therapy.  What matters is you must do what it takes to get well.  Certain PPD patients do well with a combination of medication–especially if they are very symptomatic and need treatment for their symptoms before therapy can be beneficial–and therapy.
  • Be honest about all your symptoms when talking to your doctor. Leaving out key details will only impede your recovery.
  • Ask all the questions you feel you need to ask.  No question is a stupid question when you are a patient.  If your doctor doesn’t give you the opportunity to ask questions, rushing off before you’ve had a chance to ask any, that’s a sign you need to ditch that doctor.  Doctors are paid to provide you with the care that you need and deserve, which includes consultation about your diagnosis and treatment.

Remember this:  You need sleep to stay healthy and to be able to take care of your baby day in and day out. I had it bad and I wouldn’t want you to go through what I went through.  You’d think that sleep deprivation would cause exhaustion which would cause you to fall asleep readily and at first opportunity. That couldn’t be further from the truth for me.  With insomnia, I couldn’t fall asleep even when the baby was sleeping. I couldn’t nap during the day, even with someone taking care of the baby for a few hours.