Help me figure out why, post partum, I have suddenly become an insomniac
August 8, 2016 1:34 AM Subscribe
Four weeks after giving birth I suddenly became unable to sleep and the problem persists. Heavy medication keeps it in check but makes my life dull and keeps me from enjoying my baby girl to the fullest. What could cause my insomnia? YANMD, of course. Snowflakes inside.
I gave birth to a baby girl 3 months ago. She's perfectly healthy but had a bit of a rough start: I was induced at 37+4 due to high bp and had a long, arduous labor. In the last few minutes before she was born she was not recovering well in between contractions, so when she was born she was immediately whisked away to NICU where she was given oxygen and stayed for 2 nights. We were then sent home but returned to the hospital 2 days later when she became dangerously jaundiced and we had to spend 3 more days in the hospital while she recoved under blue lights. Since then she's been nothing but healthy and happy.
I spent the first 10 days of her life pumping 8 times a day to try and get my milk to come in but it never did. This may be because of a breast reduction I had 15 years ago or it may be because she could not stay close to me right after she was born, or perhaps a combination. Either way, she is unfortunately exclusively bottle-fed. I am quite sad about this but have been trying to accept it for what it is.
About 4 weeks after she was born I began to experience insomnia. I lay awake listening for little sounds to indicate that she might want a bottle soon and every little sqeak would send my heart racing (she sleeps in her own room for this reason, but I can still hear most of her sounds). In addition, I was very hot at night. Around 12 to 1 pm I would begin to feel almost feverishly hot, but it wasn't night sweats because I wasn't sweating at all. The insomnia got so bad that I did not sleep at all for a few nights and finally sat in my GPs office crying and begging for something that would help. He put me on temazepam first, but that only helped to put me asleep but not stay asleep. Then he put me on quetiapine 25mg and that has helped me get enough sleep to generally be somewhat functional. I've been on this for 2 months now. I've tried to play with the dosage (with my GPs approval) and most nights I can get some sleep on 12.5 mg. But it is fragmented at best and the overheating problem is still there.
Quetiapine is serious shit and I don't like the groggy feeling I wake up to that lasts until the early afternoon on most days. It's not safe for me to drive and I can't enjoy my life or my daughter much when I'm so tired and woozy. I've tried to go off the quetiapine a few times just to see if the problem had maybe gone away on its own but then I lie awake again all night. I do feel tired but it's like my brain can't take that last "hurdle" from wakefulness to sleep. It just stays on. And I continue to burn up in the middle of the night. The feeling of being hot is so bad that I will sometimes go stand in front of an open window mostly naked and let the outside air roll over me. Inside it's about 72 degrees F now. Outside, at night, it's about 55. Nothing cools me down and the feeling lasts until well into the morning.
Here's my question: what is causing this insomnia and what might help? Is it a hormonal problem? Is it a psychological problem? I have never had problems sleeping before and in fact I used to love sleeping and often took naps. Even in my last trimester I never had any problems.
Things that might be relevant:
- My daughter now sleeps through the night from about 9 or 10 pm to 8 am, so she is not the problem
- I have PDD-NOS
- I am seeing a therapist who specializes in PDD-NOS but they have no idea what is causing the insomnia
- My GP has no idea either
- I have been referred to a sleep lab but the waiting list is 10 weeks
- PPD has been ruled out by a specialist
- I take magnesium supplements but they don't seem to help
- I'm in the Netherlands
Thank you all in advance for any and all ideas you may have!
I gave birth to a baby girl 3 months ago. She's perfectly healthy but had a bit of a rough start: I was induced at 37+4 due to high bp and had a long, arduous labor. In the last few minutes before she was born she was not recovering well in between contractions, so when she was born she was immediately whisked away to NICU where she was given oxygen and stayed for 2 nights. We were then sent home but returned to the hospital 2 days later when she became dangerously jaundiced and we had to spend 3 more days in the hospital while she recoved under blue lights. Since then she's been nothing but healthy and happy.
I spent the first 10 days of her life pumping 8 times a day to try and get my milk to come in but it never did. This may be because of a breast reduction I had 15 years ago or it may be because she could not stay close to me right after she was born, or perhaps a combination. Either way, she is unfortunately exclusively bottle-fed. I am quite sad about this but have been trying to accept it for what it is.
About 4 weeks after she was born I began to experience insomnia. I lay awake listening for little sounds to indicate that she might want a bottle soon and every little sqeak would send my heart racing (she sleeps in her own room for this reason, but I can still hear most of her sounds). In addition, I was very hot at night. Around 12 to 1 pm I would begin to feel almost feverishly hot, but it wasn't night sweats because I wasn't sweating at all. The insomnia got so bad that I did not sleep at all for a few nights and finally sat in my GPs office crying and begging for something that would help. He put me on temazepam first, but that only helped to put me asleep but not stay asleep. Then he put me on quetiapine 25mg and that has helped me get enough sleep to generally be somewhat functional. I've been on this for 2 months now. I've tried to play with the dosage (with my GPs approval) and most nights I can get some sleep on 12.5 mg. But it is fragmented at best and the overheating problem is still there.
Quetiapine is serious shit and I don't like the groggy feeling I wake up to that lasts until the early afternoon on most days. It's not safe for me to drive and I can't enjoy my life or my daughter much when I'm so tired and woozy. I've tried to go off the quetiapine a few times just to see if the problem had maybe gone away on its own but then I lie awake again all night. I do feel tired but it's like my brain can't take that last "hurdle" from wakefulness to sleep. It just stays on. And I continue to burn up in the middle of the night. The feeling of being hot is so bad that I will sometimes go stand in front of an open window mostly naked and let the outside air roll over me. Inside it's about 72 degrees F now. Outside, at night, it's about 55. Nothing cools me down and the feeling lasts until well into the morning.
Here's my question: what is causing this insomnia and what might help? Is it a hormonal problem? Is it a psychological problem? I have never had problems sleeping before and in fact I used to love sleeping and often took naps. Even in my last trimester I never had any problems.
Things that might be relevant:
- My daughter now sleeps through the night from about 9 or 10 pm to 8 am, so she is not the problem
- I have PDD-NOS
- I am seeing a therapist who specializes in PDD-NOS but they have no idea what is causing the insomnia
- My GP has no idea either
- I have been referred to a sleep lab but the waiting list is 10 weeks
- PPD has been ruled out by a specialist
- I take magnesium supplements but they don't seem to help
- I'm in the Netherlands
Thank you all in advance for any and all ideas you may have!
You're not breastfeeding, so your periods will probably return fairly soon. This could be your period returning. Keep in mind your hormones are all over the place and you've had a roller coaster ride so I would get them checked out to at least explain the burning up. It might also explain the insomnia, although that could just be that you've now gotten into a really bad sleep pattern and you're still on edge listening for the baby. Are you sleeping during the day?
posted by Jubey at 2:55 AM on August 8, 2016 [1 favorite]
posted by Jubey at 2:55 AM on August 8, 2016 [1 favorite]
Response by poster: Thank you! I am leaning towards hormonal myself. However, not to thread-sit, but a few more datapoints that I forgot:
- I had my first pp period about 3 weeks ago
- My thyroid and hemoglobin levels have been tested and turned up normal
- I do not sleep during the day (I have tried, but I really need the meds to fall asleep at all)
posted by piranna at 3:01 AM on August 8, 2016
- I had my first pp period about 3 weeks ago
- My thyroid and hemoglobin levels have been tested and turned up normal
- I do not sleep during the day (I have tried, but I really need the meds to fall asleep at all)
posted by piranna at 3:01 AM on August 8, 2016
I just googled 'insomnia after weaning baby' and apparently it is A Known Thing. Now, I've never experienced this myself (it sounds like you went cold turkey with the weaning whereas mine was more gradual) but I bet a La Leche group would have some answers.
posted by Jubey at 3:42 AM on August 8, 2016
posted by Jubey at 3:42 AM on August 8, 2016
Oh, and congratulations on the baby! And coming from someone who was up every 45 minutes through the night, for seven months straight with a baby, I hope you get some sleep soon. There is no hell like it. MeMail me if you need to.
posted by Jubey at 3:46 AM on August 8, 2016
posted by Jubey at 3:46 AM on August 8, 2016
Best answer: Sorry for the constant updates but apparently overheating is also a common side effect of seroquel (the drug you're taking.) Now, I'm absolutely not a doctor, just someone with Dr Google, but did yours say anything about it when you about it up to them? It might be worth considering switching medication or tapering off.
posted by Jubey at 4:04 AM on August 8, 2016
posted by Jubey at 4:04 AM on August 8, 2016
Best answer: What's in your magnesium supplement? My experience in Germany was that there were many different mag supplements on the shelves promising all kinds of things, but they were nearly all made exclusively with magnesium hydroxide or magnesium oxide which are very non-bioavailable. You only absorb about 4% of the magnesium in there, total waste of time. Instead you need magnesium citrate which is more like 90% bioavailable. I found literally one supplement containing this form in all the many I looked at in Germany, so I'm wondering if The Netherlands are the same.
The reason I mention this is your description of being very hot and also not being able to shut your brain off to get over the edge to sleep matches my experience with a magnesium deficiency and getting the correct supplements fixed it in literally one day. I also had occasional muscle cramps and racing heart at the same time, but I also had a very severe deficiency at that point.
In your case something hormonal is probably a lot more likely. Your doctor should be doing some blood tests and trying to get to the bottom of it rather than just treating the symptoms with the heavy drugs (although doing that at the same time also makes sense, you do need to sleep regardless). But in the meantime, maybe switching to a different magnesium supplement is also worth trying -assuming yours isn't already the right kind- since it's a relatively quick easy thing to try out.
posted by shelleycat at 4:08 AM on August 8, 2016 [3 favorites]
The reason I mention this is your description of being very hot and also not being able to shut your brain off to get over the edge to sleep matches my experience with a magnesium deficiency and getting the correct supplements fixed it in literally one day. I also had occasional muscle cramps and racing heart at the same time, but I also had a very severe deficiency at that point.
In your case something hormonal is probably a lot more likely. Your doctor should be doing some blood tests and trying to get to the bottom of it rather than just treating the symptoms with the heavy drugs (although doing that at the same time also makes sense, you do need to sleep regardless). But in the meantime, maybe switching to a different magnesium supplement is also worth trying -assuming yours isn't already the right kind- since it's a relatively quick easy thing to try out.
posted by shelleycat at 4:08 AM on August 8, 2016 [3 favorites]
Best answer: I'm not remotely surprised by this. I mean:
...she was immediately whisked away to NICU where she was given oxygen and stayed for 2 nights.... we returned to the hospital 2 days later when she became dangerously jaundiced and we had to spend 3 more days in the hospital...
You are now 100% responsible for keeping a very small and helpless human alive and given that her life was actually threatened + the normal anxiety of new parenthood + PPD, it seems pretty logical to me that you're hyper-vigilant and that is making it hard to sleep. Does your PPD+NOS treatment include an anti-depressant and/or anti-anxiety drug?
I am curious if you are able to sleep solidly during the daytime at all.
posted by DarlingBri at 4:11 AM on August 8, 2016 [4 favorites]
...she was immediately whisked away to NICU where she was given oxygen and stayed for 2 nights.... we returned to the hospital 2 days later when she became dangerously jaundiced and we had to spend 3 more days in the hospital...
You are now 100% responsible for keeping a very small and helpless human alive and given that her life was actually threatened + the normal anxiety of new parenthood + PPD, it seems pretty logical to me that you're hyper-vigilant and that is making it hard to sleep. Does your PPD+NOS treatment include an anti-depressant and/or anti-anxiety drug?
I am curious if you are able to sleep solidly during the daytime at all.
posted by DarlingBri at 4:11 AM on August 8, 2016 [4 favorites]
Being tired but unable to sleep and feeling hot are two classic symptoms of thyroiditis. Moreover, postpartum thyroiditis is fairly common.
If your doctor hasn't already checked your thyroid levels, I would ask them to do that immediately.
posted by pie ninja at 4:26 AM on August 8, 2016
If your doctor hasn't already checked your thyroid levels, I would ask them to do that immediately.
posted by pie ninja at 4:26 AM on August 8, 2016
Best answer: (Ah, sorry, just saw that your levels have been tested for thyroid. Did they run TSH or just T4? It's possible for some people to get thyroiditis symptoms at T4 levels that are at the high end of normal -- if that's you, your TSH should still be wacky.)
posted by pie ninja at 4:27 AM on August 8, 2016
posted by pie ninja at 4:27 AM on August 8, 2016
Response by poster: I've gotten more useful suggestions from you lovely internet strangers in a few hours than I did from my healthcare professionals in two months.
Jubey: I'm going to contact my local La Leche to see if they know anything about this and my GP to see if there are any other medications he can put me on. Thank you!!
pie ninja: I called the blood lab to see what they tested but it was TSH and the value was 1.7, which is supposed to be well within the normal range. But it's nice to have ruled this out, thank you!
shelleycat: I checked my magnesium supplement and it is only magnesium oxide so I am buying a citrate version today. Hopefully this helps!!
Also DarlingBri thank you for pointing out that it makes sense that my girl's rough start messed me up a bit. I kind of knew that, but felt like a big baby about it because she is healthy now after all. I don't know if it is the root cause of my insomnia because it doesn't explain the weird overheating, but I am going to bring it up with my therapist to see if I have stuff I need to work through anyway.
posted by piranna at 5:10 AM on August 8, 2016 [2 favorites]
Jubey: I'm going to contact my local La Leche to see if they know anything about this and my GP to see if there are any other medications he can put me on. Thank you!!
pie ninja: I called the blood lab to see what they tested but it was TSH and the value was 1.7, which is supposed to be well within the normal range. But it's nice to have ruled this out, thank you!
shelleycat: I checked my magnesium supplement and it is only magnesium oxide so I am buying a citrate version today. Hopefully this helps!!
Also DarlingBri thank you for pointing out that it makes sense that my girl's rough start messed me up a bit. I kind of knew that, but felt like a big baby about it because she is healthy now after all. I don't know if it is the root cause of my insomnia because it doesn't explain the weird overheating, but I am going to bring it up with my therapist to see if I have stuff I need to work through anyway.
posted by piranna at 5:10 AM on August 8, 2016 [2 favorites]
Maybe it's not prescribed in Europe much? But I have had great success with trazodone for insomnia, especially for staying asleep, and I don't wake up feeling like I was hit by a truck.
posted by listen, lady at 5:22 AM on August 8, 2016 [1 favorite]
posted by listen, lady at 5:22 AM on August 8, 2016 [1 favorite]
I want to add that low iron can mess with your sleep.
posted by catspajammies at 5:26 AM on August 8, 2016
posted by catspajammies at 5:26 AM on August 8, 2016
The hot flashes indicate to me it's probably hormonal. I take a medication which blocks estrogen and hot flashes are a well known side effect, especially at night.
posted by something something at 6:31 AM on August 8, 2016
posted by something something at 6:31 AM on August 8, 2016
I spent the first 10 days of her life pumping 8 times a day to try and get my milk to come in but it never did. This may be because of a breast reduction I had 15 years ago or it may be because she could not stay close to me right after she was born, or perhaps a combination. Either way, she is unfortunately exclusively bottle-fed. I am quite sad about this but have been trying to accept it for what it is.
Wanted to address this, because I strongly believe that social pressures and misinformation around breastfeeding contribute to PPD/postpartum PTSD. And PPD definitely led to insomnia for me - and I combo-fed, so the breastfeeding I did do (70% of my baby's diet), did nothing to stop the insomnia
1) You and your daughter went through a life-threatening experience, and you immediately started pumping nonstop, before you had a chance to recover. You did it with the best intentions, but this is HARD on someone who just went through what you went through. It's another layer of stress and performance and "good mom" anxiety on top of everything else. You displayed some heroic effort there - you can congratulate yourself for how hard you tried.
2) Your kid will be indistinguishable from breastfed children. She'll be just fine. Nothing to worry about here. It's okay to be sad it didn't work out, of course. But she's going to be okay. Feel reassured that the best you can do, is quite good.
3) Your child's lack of immediately proximity to you did not cause you to "fail" to breastfeed. Women who give up babies for adoption or have stillbirths regularly have to inhibit the lactation that starts up anyway in absence of a baby. You do not need to feel bad about this. You did everything right, you made all the right decisions to save her life. You did great.
4) If you're secretly feeling like your breast reduction surgery was a mistake, because it may have contributed to this situation: NOPE. Your child benefits from your physical health and ability to care for her. If your breast size was making you so miserable you got a reduction, it would probably be making your life even worse right now. So. Another good decision on your part.
I had therapy with a psychologist who specialized in postpartum issues. Would highly recommended for these free-floating feelings of guilt. PPD related insomnia is a completely normal thing to expect in the face of what you went through. Three months is not a long time to feel better after something like this.
posted by Coatlicue at 7:34 AM on August 8, 2016 [15 favorites]
Wanted to address this, because I strongly believe that social pressures and misinformation around breastfeeding contribute to PPD/postpartum PTSD. And PPD definitely led to insomnia for me - and I combo-fed, so the breastfeeding I did do (70% of my baby's diet), did nothing to stop the insomnia
1) You and your daughter went through a life-threatening experience, and you immediately started pumping nonstop, before you had a chance to recover. You did it with the best intentions, but this is HARD on someone who just went through what you went through. It's another layer of stress and performance and "good mom" anxiety on top of everything else. You displayed some heroic effort there - you can congratulate yourself for how hard you tried.
2) Your kid will be indistinguishable from breastfed children. She'll be just fine. Nothing to worry about here. It's okay to be sad it didn't work out, of course. But she's going to be okay. Feel reassured that the best you can do, is quite good.
3) Your child's lack of immediately proximity to you did not cause you to "fail" to breastfeed. Women who give up babies for adoption or have stillbirths regularly have to inhibit the lactation that starts up anyway in absence of a baby. You do not need to feel bad about this. You did everything right, you made all the right decisions to save her life. You did great.
4) If you're secretly feeling like your breast reduction surgery was a mistake, because it may have contributed to this situation: NOPE. Your child benefits from your physical health and ability to care for her. If your breast size was making you so miserable you got a reduction, it would probably be making your life even worse right now. So. Another good decision on your part.
I had therapy with a psychologist who specialized in postpartum issues. Would highly recommended for these free-floating feelings of guilt. PPD related insomnia is a completely normal thing to expect in the face of what you went through. Three months is not a long time to feel better after something like this.
posted by Coatlicue at 7:34 AM on August 8, 2016 [15 favorites]
I feel like our stories are very similar. I was induced at 32 weeks due to severe pre-eclampsia (primarily my BP was 200/100). My daughter is now 8 and a giant 3rd grader, so everything turned out fine. Congratulations on your new baby, by the way :)
I have often remarked that having a baby made me turn from the deepest sleeper to the lightest sleeper. For me, having a baby, especially early, really made my anxiety come out. I was always Type A to begin with, but having such an unpredictable, dangerous turn of events happen surrounding the birth and my own health put me on edge. My baby was on a schedule of feedings from the NICU and stuck to it quite well, but I do remember laying in bed listening for her, neglecting my own needs. I also remember the old adage to "sleep when the baby sleeps"--yeah right, that's impossible when you have a household to maintain as well.
When I finally developed chest pains out of nowhere, I went to urgent care and found an extremely compassionate provider who recognized the mental health component of my situation, and I was placed on Ativan on an as-needed basis. That helped, but that type of medication is not really a long-term solution for me--I'm active, I'm a parent, I work full time, I have other interests. I have finally found relief with Zoloft, and not very much either--just 50 mg once per day keeps me able to focus and not worry about every little thing. \
Surprisingly to many people, I was not bummed out or sad about how things turned out--I was legitimately excited to finally be able to meet my little girl and relieve my painful and scary symptoms. So no PPD for me, either. But Zoloft has been amazing for me and controlling my anxiety.
Anyway, I think you have two, maybe three things going on here. First, the hot flashes are completely normal and will go away in 3-6 months as your hormones normalize. If you get on oral birth control pills they will likely go away altogether. Second, if I were you, I'd get thee to the doctor and inquire about a low dose of an anti-depressant medication. Third, how is your blood pressure now? Are you having headaches, or seeing stars, or just feeling off? I'm kind of wondering why you were not put on a beta-blocker or calcium-channel blocker for good measure for 3-4 months postpartum.
You just went through a major event and things will never be the same. You can never plan 100% for childbirth and having a baby. It's just reality. You never know what you will get. I think my life has been much easier since I went on Zoloft. I wish you luck.
posted by FergieBelle at 7:40 AM on August 8, 2016 [2 favorites]
I have often remarked that having a baby made me turn from the deepest sleeper to the lightest sleeper. For me, having a baby, especially early, really made my anxiety come out. I was always Type A to begin with, but having such an unpredictable, dangerous turn of events happen surrounding the birth and my own health put me on edge. My baby was on a schedule of feedings from the NICU and stuck to it quite well, but I do remember laying in bed listening for her, neglecting my own needs. I also remember the old adage to "sleep when the baby sleeps"--yeah right, that's impossible when you have a household to maintain as well.
When I finally developed chest pains out of nowhere, I went to urgent care and found an extremely compassionate provider who recognized the mental health component of my situation, and I was placed on Ativan on an as-needed basis. That helped, but that type of medication is not really a long-term solution for me--I'm active, I'm a parent, I work full time, I have other interests. I have finally found relief with Zoloft, and not very much either--just 50 mg once per day keeps me able to focus and not worry about every little thing. \
Surprisingly to many people, I was not bummed out or sad about how things turned out--I was legitimately excited to finally be able to meet my little girl and relieve my painful and scary symptoms. So no PPD for me, either. But Zoloft has been amazing for me and controlling my anxiety.
Anyway, I think you have two, maybe three things going on here. First, the hot flashes are completely normal and will go away in 3-6 months as your hormones normalize. If you get on oral birth control pills they will likely go away altogether. Second, if I were you, I'd get thee to the doctor and inquire about a low dose of an anti-depressant medication. Third, how is your blood pressure now? Are you having headaches, or seeing stars, or just feeling off? I'm kind of wondering why you were not put on a beta-blocker or calcium-channel blocker for good measure for 3-4 months postpartum.
You just went through a major event and things will never be the same. You can never plan 100% for childbirth and having a baby. It's just reality. You never know what you will get. I think my life has been much easier since I went on Zoloft. I wish you luck.
posted by FergieBelle at 7:40 AM on August 8, 2016 [2 favorites]
I had miserable insomnia with my second child. I was nursing so all I could take was Ambien, which helped a bit. Ultimately, it went away by the time she was maybe 6 months old. I don't know for sure, but it sure felt like it was my hormones going haywire and my body felt I should always be awake to take care of that baby. It was my second baby and we were both healthy, but, ugh, hormones. Congrats on the baby and good luck! I hope the insomnia abates soon for you.
posted by rebeccabeagle at 10:59 AM on August 8, 2016
posted by rebeccabeagle at 10:59 AM on August 8, 2016
It sounds like what I went through for several months during menopause. So yeah, it sounds like your hormones might be out of whack. Have you tried taking benadryl or melatonin, both of which have few or no side effects? Trazodone is dangerous in my opinion; I took it once and was speeding all night instead of sleeping and it may affect other people that way too. Can you see a gynecologist or a midwife? Your GP may not be knowledgeable enough about such things...
I hope you get some answers and some sleep soon. Congratulations on the baby girl!
posted by mareli at 2:26 PM on August 9, 2016
I hope you get some answers and some sleep soon. Congratulations on the baby girl!
posted by mareli at 2:26 PM on August 9, 2016
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posted by fshgrl at 2:46 AM on August 8, 2016 [2 favorites]