My experience of postnatal insomnia - reassurance

[22Robin]

I wanted to share my story here to hopefully provide some reassurance with anyone battling with postnatal insomnia.

I will start by saying that if you are stuggling with insomnia postnatally, it really deserves the attention of a postnatal psychiatrist. You can hopefully access this help through the perinatal mental health team in your area (I am based in the UK).

When my son was 3 months old, I stopped sleeping. At first I went a few nights with about 2-3 hours sleep and it snowballed from there into 3 months of night after night of no sleep at all to just a few hours here and there. I have never suffered from previous mental health issues or poor sleep so this problem really seemed to appear from nowhere for me. I had had a traumatic birth experience, ending in C-section and a very high (hypomanic) experience after delivery and had been understandably stressed with adapting to life with a newborn but I had been feeling well in myself and was enjoying life. That's why the insomnia came as a bit of a mystery and as a shock. My heart goes out to you if you are experiencing this because it is really scary and takes away so much joy. It was awful to not have slept for 2 days and pick my baby up out of the crib knowing that I hadn't slept for that long and had another full day of care in front of me.

The longer the insomina went on, the worse my mental health became. I really think the insomnia was a result of a chemical imbalance in my brain because my body was entirely without its normal circadian rhythm and I was doing everything I could; excercise, supplements, early morning light walks, no caffeine etc to help my body get back into balance. All on top of looking after baby.

Help eventually arrived with the input of the perinatal mental health team in my area. With a lengthy period of experimentation they helped me with medication that got me sleeping again. I won't bore you with details of the period of experimentation but eventually a low dose of Olanzapine (2.5mg) and Mirtazapine (15mg) helped to restore my sleep cycle. These medications were both used off label to help with sleep due to their sedative side effects. To start with I believe I was put on far too high a dose of these meds and they made me feel very depressed and lacking in motivation - but at the lower doses they have helped me no end. Having my sleep return has given me confidence again and much needed rest. I hate having to rely on medication for sleep but I really felt I got to the point where I needed psychiatric intervention. Something had gone very wrong with my nervous system to be that sleepless. Whether it was hormonal, mental health related (depression, anxiety or mood disorder) or trauma related I will never know but it could have been a mixture of all of the above.

The few people I have come into contact with who have experienced postnatal insomnia have all been helped by a form of mental health medication. One woman was helped by Sertraline (this happened to make my symptoms worse), or another by Lexapro (which I never tried). I share this because there may be a combination for you out there that can really help with your insomnia.

My son is now 16 months old and the combination of Olanzapine and Mirtazapine has been working well for me for 6 months. I'm still upset to be having to take these medications and I do fear that they will wear off in their effectiveness but I have also been reassured by my GP that this is unlikely to happen. It is also hard to ween off these medications and I fear that my insomnia will lie beneath these meds. Still, in the absence of thorough research and understanding out there of postnatal insomnia, I needed to try something for my son's sake. People need to take meds for all sorts of health conditions and if I need to stay on these meds for life, then I will.

I hope if you are going through this awful condition, you may find this story of help. I would say that the orgiginal help I was offered through my GP was not helpful. They advised I read 'The Effortless Sleep Method' - which is not tailored to the experience of postnatal insomnia.

This has been a really interesting post. I also stopped sleeping when my first child was born but I did have terrible anxiety and depression. I was given zopiclone on a very short term basis and it helped me get back in to a normal sleep rhythm. This was prescribed by a psychiatrist working at the mother and baby unit I was referred to.
Im glad you were able to sleep again, please don’t feel bad about taking medication, you need it to function and take care of your child.
I would say to anyone experiencing post natal insomnia to seek help as soon as possible, please don’t suffer in silence.

Thank you for this post.

Mine also started at 3 months post partum (I wonder if something happens to your hormones then?!). Sertraline helped for a few months. The insomnia has come back at 14 months when I wasn’t feeling anxious at all. Seemed to have coincided with stopping breast feeding at night.
I have been taking a relatives zopiclone with the assistance of a sleep specialist just for a few weeks but the next step will be Mirtazapine.
Did your Psychiatrist know what triggered it for you? I’m just desperate to know what’s causing it as I slept brilliantly for months and have nothing to stress about!

Hi Nicola,

Thank you for your reply. I'm so sorry you've had a similar experience, it's so difficult. My psychiatrist really wasn't sure what had triggered the insomnia. She certainly didn't know whether it could have been caused by a hormonal shift/change/imbalance - but similar to you, I have very much suspected/wondered if this is what's been going on. It's so hard that this is such an under researched area. Similar to you, I really don't think my insomnia was caused by a mental health issue (even though having a baby does increase anxiety etc and even though the birth of my son was a tough one).

I have recently had a few nights of insomnia and it does unsettle me because I worry I'll go backwards. But when it happens now, it seems to be around my period (so again there could be a hormonal link). But in general my sleep has been stable with the medications I mentioned previously. I stopped breastfeeding when my son was 6 months old because I wanted to see if my menstrual cycle returning would stabilize things. In the end, I'm not sure if this helped with my sleep or not because I was simultaneously experimenting with different meds. If you've stopped breastfeeding, it could be that your hormones changing are affecting your sleep pattern - perhaps once your cycle returns you will see more stability?

I really hope your sleep begins to stabilise with the help of mirtazapine. Let me know how it goes.

Wishing you all the best navigating it all - it's extremely tough xx

Thank you for your reply and I'm sorry to hear of your experience but very pleased to hear you found a solution for the sleep. I did try zopiclone prescribed by the GP initially but the insomnia rebounded when I stopped taking it.

Yes, so important not to beat ourselves up (like I have) about taking medication. I've definitely needed help in that form to function and look after my son : )

Dear robin

I could have written your story word for word. In three months partum and I can not sleep!
ive been prescribed Xanax and zopiclone but I’m so afraid that these medications are not a long term solution. My doctor said Mirtazapine is the next option but I’m so scared of the side effects and weight gain.

I went from being completely healthy and happy to now a shadow of my former self with three kids under 3 to care for.

really need help and reassurance

thanks in advance

Hi Som3,

I'm really sorry to hear you're struggling with this postnatal insomnia. It sounds like something can happen to women at the 3 month postpartum mark. As this has been the case for yourself, Nicola (above) and myself.

I completely understand the concerns you have about the different medications. Similar to you, I used zopiclone for a while. The only issue was that my sleep problems came back when I stopped taking it. The Olanzapine and mirtazapine have seemed to work well for me and the sleep feels a lot more natural than that whilst taking the sleeping pills. I get occasional nights of insomnia around my period. I have put on about a stone in weight, which is very frustrating but beats not sleeping. My experience seems to be that the medications slow the metabolism and so I can no longer get away with eating what I used to. Other than that I have very few side effects from the meds. I feel a little bit 'flat' but also less anxious.

It's all a bit of a difficult trade off. For me, the sleep got so bad that I just couldn't afford not to try the medications. I really feel it's such a difficult experience because very few people really understand the sheer inability to sleep. I think people think it's because we're too anxious/worried to sleep - but for me there was genuinely nothing on my mind, it just felt like my body had lost the ability to sleep. Like my internal clock was completely off whack.

I do want to ween off the meds eventually and I'm trying to hold the hope that this is possible. I'm going to make very slow and incremental changes whilst tapering off them but I fully expect this to take years. But I have the security that I can go back on them if needed.

I don't know if it's of help to hear my story but I do believe there is hope and that you can find a way through this. When I was not sleeping I honestly thought nothing would/could never help me. Things are still not perfect for me and I'm still on a journey with this but things are so much better than they were. I feel 90% back to myself which is a damn site better than where I was. I can enjoy my little boy again.

Take care and let me know how it goes x

Did you experience this with any of your other children? I feel the same as 22robin, even the nights where I wasn’t anxious it would happen. Like my body just didn’t have an ‘off’ button. My insomnia has come back again now I’ve fully stopped breast feeding two weeks ago but It was better for a while.
Because it’s now the third proper episode I’ve had and I recovered twice before , I’ve reassured myself it’s transient and will pass. Just frustrating how poorly understood this all is.
I was advised to wean off zopiclone by halving and quartering the tablets over two weeks rather than abruptly stop taking them. Which worked for me before. The meds really do help.
I’m so sorry you’re going through this

@22Robin thank you so much for your reply.

I started Cbt today which was helpful but honestly my anxiety is so out of control I feel like it’s pointless at this stage- maybe it will be more helpful once my anxiety is under control.

Im speaking with my psychiatrist later in the week and the next step will be mirtazapine or olanzapine + sertraline …. I’m just so Afraid I’ll be out of it on the meds … even though I’m out of it with the lack of sleep as it is!

how do you find the olanzapine ?

I just want my life back - simple as! I’ll never take my health for granted again

thanks so much for your help x x

@Som3 I'm really pleased to hear you'll be seeing a psychiatrist this week.

My experience of the Olanzapine is that at a dosage of 2.5mg it got me sleeping again from the first dose. I didn't have any bad side affects at that dosage, in fact I felt immediately much calmer. Obviously I can't say that this will happen for you as everyone's bodies are so different but that's what happened for me. When I say I slept again, I was getting 5-6 hours a night and it felt like light sleep but that was a huge step in the right direction.

Then sadly, for a number of reasons, my dosage got increased up to 10mg. I now believe that the 10mg dose was for too much for me and it made me feel very low in mood. That's actually why I started then taking mirtazapine as well, because I was so low in mood even though I was sleeping again! However mirtazapine is also good for sleep and my sleep improved further whilst taking this also. When I realized that the Olanzapine was affecting my mood negatively at a high dose I immediately started to reduce it back down and found that my mood was much improved and I no longer felt depressed. I wish I had just stuck to the 2.5mg dose of Olanzapine, as that works for me now. At 2.5mg dosage I don't think I notice any side effects at all. But I am taking the mirtazapine too - just to muddy the waters a bit.

I would just say to always try and take the lowest dose of these medications to get the maximum affect.

Like you I was so reluctant to take medication but I was also extremely on the edge and the lack of sleep was making me so anxious and not myself that I literally felt I had no other option than to go down that path.

I know it's so hard. You're doing everything you can. Well done for trying the CBT.

Let me know how it goes. I know how utterly soul destroying it all can be. Please take good care. I honestly feel you will find a way out/through this like I have. X

Hi - sorry I know this is an old post but can I ask if you were able to feed baby at night whilst on mirtazapine? My GP mentioned it as the next option for PPA (sertraline made my insomnia much worse) but I'm worried I'll be too groggy to get up in the night.

Hi ThatCoralLion,

I'm sorry you're experiencing PPA and insomnia. As an update, I now just take mirtazapine (7.5mg per night), and I've entirely come off the olanzapine (which was a really slow and steady process). And I'm sleeping well. I still have interrupted nights sleep as my 2.5 year old will often wake in the night etc. Sometimes my husband has to wake me up but I'm absolutely fine to wake up and attend to my son's needs and eventually get back to sleep. For me, it doesn't turn me into a zombie at all. I do hope to get off the mirtazapine eventually but I imagine it will take time. I would recommend taking the medication several hours before bed. I should also mention that I did stop breast feeding when I was taking the mirtazapine and olanzapine but that was probably because I was taking two lots of medication and was on very high dosages to start with. I guess your doctor will be able to advise on the low dose of mirtazapine and breastfeeding. Good luck with it all and I hope the mirtazapine can help you.

Thanks! I've got my prescription sorted so hopefully will be on the mend soon. I'm desperate to feel like myself again.

@22Robin just wondering how you are now? Are you still on the mirtazapine?

Hi, yes I'm still taking mirtazapine but have halved the dose again, so I just take 3.5mg pee night, about 30 mins to 1 hour before bed. My sleep is still stable thankfully. I also take 5htp and magnesium supplements. I have had periods of less great sleep (4-5) hours a night but that is bliss compared to true insomnia where you might not get any at all. I am so grateful for sleep these days and since recovering. But currently I get 6-7 hours a night and again, that feels like a real blessing.

Hope you are coping okay if you are experiencing postnatal insomnia.

Thanks for your reply. I'm glad you are doing better. My situation is a bit different in that I had a what I think was an ovarian cyst rupture (huge pelvic pain) around the time I was dropping breastfeeds. I suddenly experienced panic attacks, anxiety and insomnia and then stopped breastfeeding completely. I went on mirtazapine and then came off 2 months later but the anxiety and insomnia came back so I'm back on the mirtazapine. Really hope I'm not stuck on it forever. I think my symptoms are hormonal.

It sounds like you've been through so much and it all sounds really traumatic on your body. It's horrible going through something that makes you feel so out of control.

Looking back, I think I had been more shocked by my son's birth than I appreciated and afterwards I was very 'high' with some hallucinations, to a low with sleeplessness, so I now wonder if my insomnia was actually a symptom of kind of a kind of mood instability like bipolar. Anyway, I will never fully know. But I still maintain that I think a large part was hormonal.

If the mirtazapine helps with sleep for now then great, and I'm sure you won't be on it forever (I appreciate I still am on a low dose and my son is 3.5) but I think it can take that long to really start to feel like yourself again. I also think it's worth experimenting with the lower doses when the time is right.

Wishing you all the best whilst you navigate forward and re-stabilise.

Thank you so much.

It's so awful there isn't more research in this area. We are left trying to figure out what the hell has happened to us.

I'm only on day 11 back on the mirtazapine so still feeling depressed and anxious. I'm hoping it lifts soon.

I know, it's so awful going through this hormonally triggered/mental health related experience that is postnatal and therefore very different to other experiences of mental health disruption and to often find very little support. I suffered for 3-4 months without adequate care from GP /health visitor teams etc & until the postnatal mental health team in the area came online - with psychiatrists etc. and even then, the support offered was quite heavy handed. I think I would have suffered less had I not been prescribed such high doses of medications offered. Anyway, we get there in the end by experimenting and finding the things that work for us.

I'm sorry you're still feeling very depressed/anxious. If you're on quite a high doses of mirtazapine it could be that taking less could help lift your mood (I found this) but also don't want to advise things as I'm certainly not a doctor.

It could also quite rightly be that you are still reeling from all of the experiences that you've had. All I can say is take one day at a time and in my experience things get so much better. Even though I'm still taking 3.5mg of the stuff a night, I feel really great these days and I think so much shifts when you start to feel freedom come back online, variety of activity in the day to day and start having so much fun with your kid etc. I know that probably feels light years away and it's okay to grieve what should perhaps have been a lovely first year with one's baby. Sending love

(I will always reply to posts here because it helps me feel like I can turn my experience just slightly into some kind of less lonely one for others)

Thanks again for your reply. I'm glad you are feeling so good! It gives me hope!

My LO is now 23 months old. I actually had a really great first year of his life, I was I think the happiest I've ever been..this is in contrast to my first born's first year as I had PPA and PPD (not diagnosed) and he was born shortly before lockdown. I didn't breastfeed my first. I never went on meds and my mental health slowly got better naturally over the year or so (the PPA went first, around 6/7 weeks).

I didn't have any mental health issues after my 23 month old was born. I'm now pretty sure the breastfeeding hormones kept me mentally well and now they are gone I'm have the PPA and PPD. But now the perinatal MH Team won't help as they only work up to 12 months. This all started when I reduced feeds/stopped feeding around 17/18 months old.

I'm on 15mg of the mirtazapine. I know it worked for me last time so hoping it will now.

I'm mostly feeling low and generally fed up now. But I'm trying to remember that it would be quite normal to feel like this. My children are such hard work at the moment and everyday is just groundhog day. I have very little support. I'm exhausted from everything that's happened over the last few months. Life is hard.

I want to start exercising to help, I used to run. But last time I took the mirtazapine I had a painful knee and I don't know if the mirtazapine caused it (arthralgia is a listed side effect). So I'm worried about injuring myself and then attributing it to the mirtazapine, rightly it wrongly, and then wanting/needing to stop it, as I don't know what I would then do.

What is your plan now? Are you going to reduce or stop the 3.75mg or are you happy to continue it?

I'm so sorry you've been through such a rough time and I think it's so poor that postnatal support is often only given during the first year after birth, as of course it really can come on later in the journey, especially when there are these big hormonal shifts that occur when breastfeeding stops etc! I think it's possible that some of the feel good hormones that breast feeding gives can actually help push mothers through an awful lot, and when you stop, you can realise how hard you've been pushing and working - like a total slump after all the labour. I didn't have this experience exactly but I know friends that report this. And obviously having more than one child is a huge slog. I'm sorry things feel such a grind at the moment and that you're not feeling yourself. All I can say is that with my experience I reached total rock bottom and didn't think I'd ever feel like myself again, and now I do... But I possibly have less stress with just one child, none the less, most of my friends with 2 report things getting ever more manageable etc. but it's a long old road this parenting game. I really think you will come through this and I really hope the mirtazapine at least helps to stabilize sleep a bit. Are you starting to sleep a bit better with it? They say it's more sedating at lower doses than 15mg but probs not as ideal if you need it for anxiety/depression too. Just know that this is absolutely nothing to do with you or your capacity - you are doing amazing looking after your kids and going through this. In cases like this, good enough is blimmin outstanding, it really is. This has most likely happened due to the hormonal changes you've experienced and the understandable demands of mothering, particularly if you don't have much support. I really feel for you. Please do let me know how things go X

You are so kind... Thank you so much... It means a lot.

Yes my sleep is already miles better (though this morning I woke in the early hours trembling I did go back to sleep).

I am 90% less anxious too. Just feeling very low but hoping it will lift soon.

I hope you continue to be well x

hi there, i can see this is quite an old post but im hoping you are still here as your voice is the kindest and most reassuring i’ve found in my many hours of doomscrolling about postpartum insomnia.

i’m 10 months PP now and the middle of the night wakes from those early days have broken something in me - while my little one sleeps all night, i’m pinging awake almost hourly until im so distraught i lie there crying until morning. Sleep has consumed my every thought - i worry about the night all day and have tried every single hack out there to no avail. Promethazine helped for 6 months but i am now totally tolerant and can feel the depression worsening with every bad night. I feel completely hopeless - even as i read your words of solidarity here, my brain is convinced ill never recover and i wont get to enjoy my child as she grows up.

After a particularly bad episode over xmas i am mow 10 days into a 7.5mg Mirtazepene prescription. It is helping me fall asleep quickly but not keeping me asleep past 2am - I wonder if you experienced this at all? Am considering upping to 15mg to hopefully quieten the storm in my head.

Do you think a lot of the root cause is that our nervous systems just need time to heal? i guess what im asking here is - could time be the real cure? (along with mirtazapene of course!)

I really want to thank you for writing this - im sure youve helped many more too! and of anyone else is still reading this, please share any positive stories!

Hi there rsx2025,

I'm so sorry to hear you are going through this. I completely feel your pain. I absolutely think something happens to our nervous systems and brain chemistry when we become Mum's and that some of us have a bigger 'brain event' than others. I recently read the book 'Matriecence' (2022) and it explained so beautifully the seismic brain changes that mothers undergo postnatally. And just as everything is a spectrum, some of us suffer worse, closer to the extremity. It is be you d 'baby brain'. The good news though is that I absolutely think your nervous system and your brain chemistry will settle and change over time and adjust back to a much more manageable state, and you will start to feel more like yourself again. Mine has! And, like you, I honestly thought nothing would work. If the mirtazapine is helping you get just 3-4 hours of consistent sleep a night then that consistency is worth clinging to. Obviously horrible to still be up from 2am though. No harm in experimenting with dosage and trying 15mg I say as that could work better for you.

I think something that could play a huge part in sleep regulation is serotonin. As we know, there is a link between this hormone and a healthy circadian rhythm. But guess what, I think a lot of stressed out and pressurized, sleep deprived mothers get depleted in serotonin. It could be that over time, the mirtazapine helps you to restore your serotonin levels a little, but just throwing it out there that I take 5htp too these days, along with a small dose of mirtazapine and I think this has helped. But I think the main thing that has helped my sleep since my son being born is actually feeling happier in myself these days, that has happened because I'm less stressed, can actually do more with my friends and sing and dance and do all the creative stuff I used to do before having a baby. I can exercise much more again etc. If course it's so hard to do anything for yourself before your kid turns 2/2.5 or even later for some and this is a real problem. I think my circadian rhythm is back because diversity in my day to day is back. And I believe this will happen for you too, but it does take time. And whilst diversity/self care in the day to day is not possible, then taking meds is absolutely okay in the short term and these can of course be reduced bit by bit in the long term. Of course it could be that you need to talk to a trained psychiatrist working in postnatal issues like I did to try other meds if mirtazapine does not suit you or work.

Of course, I am no doctor but I hope my perspective may be useful.

Motherhood is tough and we are the best mothers when we make tough decisions to survive it. More and more these days I am interested in how much pressure is out on mum's to 'do it all' and take on so much, when actually some of us are very vulnerable postnatally, not because we are 'weak' but because our nervous systems and brain chemistry has been shot to pieces and this is genetics, birth trauma, literal brain changes that happen to new mothers etc etc. we need support, understanding and of course all of this understanding is often lacking.

I hope I'll always respond here to mother's going through this because it is truly so horrible to feel like your circadian rhythm has vanished. I strongly believe that we can't just think our way out of this, we need help, support, meds, time and patience and kindness with ourselves and from those around us.

Please do let me know how it goes.

Xx

Sorry, that typo was supposed to say, it is beyond 'baby brain' (a useless term I think).

Sorry - I spelt the book title incorrectly - here it is

www.worldofbooks.com/en-gb/products/matrescence-book-lucy-jones-9781802061307?sku=NGR9781802061307&gad_source=1&gad_campaignid=22656538464&gbraid=0AAAAADZzAIBqySvMjhT7xyOqJ4qPOkHYX&gclid=Cj0KCQiA1JLLBhCDARIsAAVfy7io4JOFSv8bqg1Rv9PTkasMUnPLUkqH9p-Ab51TYIkeqqZjrLdR7n8aAjrxEALw_wcB