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.

hi there, thank you for your reply - honestly, talking to you has done so much more good than the myriad professionals i have been referred to!

Ive ordered the book and will also try a 5HTP supplement. I’ve now upped my dose to 15mg and, while it hasnt stopped the hourly wakes, i do feel a little calmer and have stopped dreading the nights quite so much. Did you also experience the frequent night wakes? (i fall asleep fine at 10pm now, but after 2am i’m in and out of very light sleep until morning). I wonder if this just needs time?

Its also reassuring you mention bringing variety back to your day - im going back to work in a couple of months after what I now realise was a much-too-long maternity leave - the monotony isnt really helping my situation! Imm hoping going back into the world will somehow shift my brain back into a better, deeper sleep.

Youre so right about the pressure for us to ‘do it all’ - the only thing ive done this year is survive , and even that was worryingly tough at times. Im quite a hardy person usually so naively didn't expect motherhood to hit me quite so hard, but I now realise i have been stuck in fight or flight the entire time. its so hard to process such a huge life change, and the support out there just isnt adequate.

I’m just so happy youve come out the other side - im sure youre giving so many others hope too.

Hi rsx2025,

Yes, for the first time in my life, from when my son was 3 months old, I had incredibly interrupted sleep, if any sleep at all. When I did get to sleep, I would often wake up half an hour later, as if a lightening bolt had gone through my body. And the sleep I did get often felt like incredibly light sleep, the likes of which I had never experienced before. Sometimes I had sort of waking dreams where I thought I was awake. The sleep I did get wasn't restful at all, and it was so hard when people tried to dismiss what I was experiencing, or suggested that because I had had a total of 4 hours sleep over a 24 hour period (which could be very broken up as you say) that that was okay/survivable.

The good news is that I am living proof that your sleep can improve with time. I now sleep like I remember sleeping before I had a baby, albeit with the help of a small amount of mirtazapine, 5htp and magnesium!

When I was struggling postnatally, I was originally prescribed Olanzapine (an antipsychotic), it got me sleeping again but like mirtazapine, it is not a knock out medication. I felt the high doses I was put on were not helpful for me, and I felt very depressed, but a dose of 2.5mg was tolerable for me and did get me sleeping better from the first dose. I just mention this in case it is something you want to explore, but also, it sounds as if the mirtazapine should do just as good a job and is quite similar I think.

Even on mirtazapine, I used to fall asleep from 10-12pm and just sleep through til 5 or 6 if baby would allow and sometimes there were night wakes too. It certainly didn't provide a real knock out, but it took the edge off. Then when other areas of my life began to stabilise, I noticed further improvements in my circadian rhythm and sleep/wake cycle.

This winter for example is the first winter since having my son (who is now 3.5) where I feel that deep, sleepy feeling setting in at about 10pm. That is what I used to feel! My body providing a strong signal that sleep time is near. Whereas when I was postnatal, it was as if my brain was no longer firing those helpful, sleepy signals. It is as if the brain is temporarily re-wired to provide for being awake for 24 hours of the day. It's awful! And it can feel very unfair if you're motherhood brain update includes insomnia for sure. I now sleep continually again without the lightening bolt wake ups. But it's honestly not because you've done anything wrong or cope with stress less well. It probably just means that your brain got more affected on the motherhood brain spectrum, this time round. I also wonder if c-sections or traumatic births can affect some more or make them more prone to postnatal insomnia.

I'm glad to hear you'll be starting work soon. I honestly think the diversity piece is so important I really think it's so important for mental health and the brain to have variety in life. So I do think this could help with your sleep, along with time and things all settling again.

I would also say that another thing that has improved and encouraged my sleep (although I admit I have the luxury of time out to be able to do this), but once my energy started returning, I joined a gym and learnt how to lift weights. There is something about it, that really tired me out in a way that cardio didn't in the same way. I also feel like my brain health has benefitted from the intensity and improved circulation of blood around the body etc. I'm not suggesting that you have the time of energy to do this right now, but maybe keep it in the back pocket as an idea for when things get just a bit more manageable, because it could be, that like me, this gives you the next leap in terms of getting your sleep back in synch.

It's a long old process but it can get better. But I'm sorry, it is utterly brutal when you are battling through each day with a small baby. You are right, there should be so much more support.

Please take care X