All women are at risk for postpartum depression (PPD), and there is growing evidence to suggest that poor sleep during pregnancy and the postpartum period may be a risk factor for the development of depression. A recent longitudinal study supports the hypothesis that disrupted sleep may contribute to the emergence and extent of postpartum depression symptoms.

This was a small study, including 25 healthy primiparous women were recruited from their outpatient obstetricians’ offices. Subjects wore wrist actigraphs for 1 week during the third trimester of pregnancy and again during the 2nd, 6th, 10th, and 14th weeks postpartum and also completed sleep logs and sleep surveys.

Subjective sleep assessments were strongly predictive of depression severity scores, as measured by the Edinburgh Postnatal Depression Scale (EPDS) as measured at all time points (p?<?0.001). Actigraphic measures of sleep maintenance, such as sleep fragmentation, sleep efficiency, and wake time after sleep onset, were also significantly correlated with EPDS scores postpartum. There was no relationship between nocturnal sleep duration and EPDS scores.

This study provides additional evidence that poor sleep maintenance (as measured by wrist actigraphy), rather than fewer hours of sleep, is associated with EPDS scores during the postpartum period and that subjective assessments of sleep may be more accurate predictors of postpartum depression than wrist actigraphy.

Undoubtedly the interplay between sleep and depressive symptoms is quite complex. Does sleep disruption cause depression? Or is sleep disturbance merely an early symptom of a depressive illness? We might not fully understand this interplay, but we do know that certain techniques may be used to improve sleep quality, and there is evidence to suggest that certain interventions – using medication or non-pharmacologic strategies – can also reduce the risk and/or severity of postpartum depression.

Ruta Nonacs, MD PhD

Park EM, Meltzer-Brody S, Stickgold R. Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity. Arch Womens Ment Health. 2013 Dec;16(6):539-47.