Some Implications of the Sleep Patterns of Pregnancy for Postpartum Emotional Disturbances

Karacan, Ismet; Williams, Robert L.; Hursch, Carolyn J.; McCaulley, Mary H.; Heine, M. Wayne

doi:10.1192/bjp.115.525.929

Cited by 97 publications

(34 citation statements)

References 18 publications

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“…Results are similar to findings in the general population where more depressed patients (90%) experienced poor sleep quality compared to non-depressed patients, and over the long term, poor sleep quality increased risk for recurrence and relapse of depression, and risk of suicide (Holsboer-Trachsler & Seifritz, 2000). In an early classic study using polysomnography, Karacan et al (1969) found nondepressed postpartum women experienced increased stage 4 sleep (deep restorative stage) with a concomitant decrease in total sleep time, indicating that these postpartum women were sleeping more efficiently despite nighttime sleep disturbance related to infant care. The study also suggested that women who experienced poor sleep efficiency would be more likely to develop postpartum depression.…”

Section: Discussionsupporting

confidence: 79%

Sleep Quality in Women With and Without Postpartum Depression

Posmontier

2008

Journal of Obstetric, Gynecologic & Neonatal Nursing

119

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Objective-To compare and measure the effects of sleep quality on women with and without postpartum depression (PPD).Design-A case-control repeated measures matched pairs design. Setting-Home and obstetric office.Participants-Forty-six women who were 6 to 26 weeks postpartum. Two participants were dropped from the final analysis because they were outliers.Methods-Participants underwent wrist actigraphy at home for 7 consecutive days to measure sleep quality (sleep latency, wake after sleep onset, sleep efficiency, wake episodes). The Postpartum Depression Screening Scale measured depression severity. Psychosocial variables were collected during a screening interview. A structured clinical interview was used to diagnose PPD. Correlations, t-tests, and hierarchical multiple regressions were run to analyze data.Results-With the exception of wake episodes, sleep latency (B = 1.80, S.E. = 0.73, P<0.05), wake after sleep onset (B = 6.85, S.E. = 2.85, P<0.05), and thus sleep efficiency (B = −6.31, S.E. = 3.13, P<0.05) predicted PPD symptom severity.Conclusions-Women with PPD experienced poorer sleep quality than women without PPD, and sleep quality worsened with increasing PPD symptom severity. Clinicians need to address measures to improve sleep quality in depressed mothers to decrease symptom severity, and researchers need to develop interventions to facilitate better sleep quality in women with PPD. KeywordsSleep quality; postpartum depression; wrist actigraphy Callouts:1. In women with postpartum depression, nighttime breastfeeding demands, high-needs infants, and little nighttime support may negatively impact on sleep quality and further exacerbate depressive symptoms. 2.Women with PPD experienced poorer sleep quality than women without PPD, and sleep quality worsened with increasing PPD symptom severity. 3.Because poor sleep quality may negatively impact on PPD symptom severity, clinicians need to address measures to improve sleep quality and minimize nighttime sleep interruptions.Women are vulnerable to poor sleep quality in part because of dramatic hormonal fluctuations occurring during the reproductive cycle (Soares & Murray, 2006 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript especially estrogen and progesterone mediate neurotransmitter levels in the brain responsible for maintaining the quality of sleep. Immediately after childbirth, precipitous decreases in estrogen and progesterone precipitate sleep disturbances in most women including difficulty initiating and maintaining sleep even in the absence of infant care (Lee, McEnany, & Zaffke, 2000). Postpartum women experience less total sleep time, less sleep efficiency (time asleep vs. time in bed), and decreased time to rapid eye movement (REM) compared to nonpostpartum women. In spite of being biologically programmed to be awake during the day and sleepy at night, new mothers normally experience less sleep and a 20% increase in wake time during the first 6 weeks postpartum (Goyal, Gay, & Lee, 2007). Because the same neurot...

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Section: Discussionsupporting

confidence: 79%

Sleep Quality in Women With and Without Postpartum Depression

Posmontier

2008

Journal of Obstetric, Gynecologic & Neonatal Nursing

119

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“…Evidence that sleep deprivation plays a role in postpartum depression dates at least as far back as Karacan et al [1968], and no claim is made that the above hypothesis is novel. More recently, Ross et al [2005] did a critical review that implicates disturbance in the quality and quantity of sleep as a causal factor in depression.…”

Section: Discussionmentioning

confidence: 99%

Symptom features of postpartum depression: are they distinct?

et al. 2008

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The clinical features of postpartum depression and depression occurring outside of the postpartum period have rarely been compared. The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR 16 ) provides a means to assess core depressive symptoms. Item response theory and classical test theory analyses were conducted to examine differences between postpartum (n 5 95) and nonpostpartum (n 5 50) women using the QIDS-SR 16 . The two groups of females were matched on the basis of age. All met DSM-IV criteria for nonpsychotic major depressive disorder. Low energy level and restlessness/ agitation were major characteristics of depression in both groups. The nonpostpartum group reported more sad mood, more suicidal ideation, and more reduced interest. In contrast, for postpartum depression sad mood was less prominent, while psychomotor symptoms (restlessness/agitation) and impaired concentration/decision-making were most prominent. These symptomatic differences between postpartum and other depressives suggest the need to include agitation/restlessness and impaired concentration/decision-making among screening questions for postpartum depression. Depression and Anxiety

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“…Other studies in our lab on depressed patients [9], post-partum women [15], angina pectoris patients [16], and patients with kidney failure [13] have indicated that psychiatric and physical problems are accompanied by changes from the normal sleep pattern. However, Feinberg [7] suggests that changes in sleep characteristics produced by aging "far exceed in magnitude those produced by any pathological condition compatible with life.…”

Section: Introductionmentioning

confidence: 99%

Sleep Patterns of Pubertal Males

et al. 1972

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ExtractComparisons of three groups of normal subjects between the ages of 8 and 31 years, all of whom were studied under similar conditions, revealed certain common sleep characteristics. During the second and third decades of life, normal sleep is characterized by a concentration of stage 4 during the first third of the night and of stage 1-REM during the last third; and, during the first part of the night, by a progression from wakefulness down through stage 4. Percentages of stages 0, 1, 1-REM, and 3 do not differ significantly among age groups. There are, however, a significant increase in stage 2 and a significant decrease in stage 4 between the ages of 15 and 20 years.

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Some Implications of the Sleep Patterns of Pregnancy for Postpartum Emotional Disturbances

Cited by 97 publications

References 18 publications

Sleep Quality in Women With and Without Postpartum Depression

Sleep Quality in Women With and Without Postpartum Depression

Symptom features of postpartum depression: are they distinct?

Sleep Patterns of Pubertal Males

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