Colic, Sleep Deprivation, Inadequate Support as Risk Factors for PPD

Just a quick post about colic, sleep deprivation, and inadequate support for the new mom as key risk factors for postpartum depression (PPD). There are many topics I want to blog about, but it’s another case of too many ideas, not enough time.  Since these risk factors make up some of the crucial pieces of the puzzle of my PPD experience, and since the Babble post titled “DR. HARVEY KARP ON WHY HE BELIEVES PPD IS MORE COMMON THAN EVER BEFORE” by Wendy Wisner showed up on my Facebook feed today, I decided to do a quick blog post about it. This blog post joins my previous post about Dr. Karp and his 5S technique “Baby Fussy or Colicky? Try the Amazing 5 S’s!“, a technique that helps babies sleep and parents cope with colic.  Colic causes sleep deprivation and feelings of incompetence from not being able to calm your crying baby (due to lack of prior baby care experience and lack of adequate support/guidance provided by someone with experience).  I basically said the same things in my book.

Dr. Karp also believes the following, which are also points that I mention throughout my book:

  1. Sleep deprivation can change brain physiology in the amygdala by causing it to become more hypervigilant and a triggering of the body’s fight or flight mechanism.  This state can cause a new mother to feel anxious and remain in a constant state of alertness, fearful that something bad may happen to her baby.
  2. Self care is as important as caring for the baby…it takes a village….a health mom means a healthy baby
  3. A mother’s getting enough sleep and support = key to reducing the occurrence of postpartum mood disorders

The bottom line is new mothers MUST get adequate support.  But with many parents struggling financially and not being able to afford help (via resources like doulas) and family members experienced with baby care not living close by and/or are too busy to help, it’s no wonder there are so many cases of PPD.  Please see my past posts about the critical role social support plays in minimizing the occurrence of PPD here and here.

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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.