Postpartum Depression vs. Sleep Deprivation
October 6, 2014 6:11 AM Subscribe
I've struggled on and off with postpartum depression since Toddler Maarika was born, but things seem a bit more dire now that I'm on month 21 of sleep deprivation. Last week I had two blissful nights of 7 straight hours of sleep and felt amazing, but now we're back to the standard multiple wake ups per night. Is it worth trying medication for depression when the root cause is likely chronic sleep deprivation?
Additional info: I took Zoloft for a couple months about 4 years ago and didn't like the side effects. As opposed to that bout of depression, right now I'd say I'm way too tired/numb/resigned to cry about anything. I saw a therapist last year, who helped me work through a lot of the initial postpartum depression and adjustment to being a mom of a kid with unique medical issues. I'm still nursing (and will be as long as possible, due to medical issues) and said kid is just a horrible sleeper, so that lack of a light at the end of that tunnel is also depressing. My husband has taken over most night wakings as best as he can, but our kiddo usually loses his mind around 4:30am if my boobs don't appear, and he's often up for the day before 6:00am.
Additional info: I took Zoloft for a couple months about 4 years ago and didn't like the side effects. As opposed to that bout of depression, right now I'd say I'm way too tired/numb/resigned to cry about anything. I saw a therapist last year, who helped me work through a lot of the initial postpartum depression and adjustment to being a mom of a kid with unique medical issues. I'm still nursing (and will be as long as possible, due to medical issues) and said kid is just a horrible sleeper, so that lack of a light at the end of that tunnel is also depressing. My husband has taken over most night wakings as best as he can, but our kiddo usually loses his mind around 4:30am if my boobs don't appear, and he's often up for the day before 6:00am.
In order to be the most effective parent you can be, it is time for you to stop being so sleep deprived, by any means necessary. This situation is not sustainable for you (or anyone -- I would be horribly depressed and losing my mind also).
I understand that continuing to nurse is important, but it doesn't sound like you strictly need to nurse at night. Can your husband just let your son lose his mind at 4:30 am? So they'll be up for that hour and a half. Maybe you guys can trade off nights, as I assume your husband will also be a ball of miserable depression if he never gets a whole night's sleep. It won't kill your kid to have a screaming fit, and it's time for him to learn that a) mama is a human being with her own needs, sleep included, and b) losing his mind doesn't get him what he wants.
I'd be willing to bet that eventually -- after an extinction burst -- your son will give up and go back to sleep once he realizes that the mind-losing isn't going to make boobs appear. Good luck. I've been you and it's not easy. Just think about how much happier you and your son will both be when you're not miserable and depressed anymore!
posted by woodvine at 6:33 AM on October 6, 2014 [11 favorites]
I understand that continuing to nurse is important, but it doesn't sound like you strictly need to nurse at night. Can your husband just let your son lose his mind at 4:30 am? So they'll be up for that hour and a half. Maybe you guys can trade off nights, as I assume your husband will also be a ball of miserable depression if he never gets a whole night's sleep. It won't kill your kid to have a screaming fit, and it's time for him to learn that a) mama is a human being with her own needs, sleep included, and b) losing his mind doesn't get him what he wants.
I'd be willing to bet that eventually -- after an extinction burst -- your son will give up and go back to sleep once he realizes that the mind-losing isn't going to make boobs appear. Good luck. I've been you and it's not easy. Just think about how much happier you and your son will both be when you're not miserable and depressed anymore!
posted by woodvine at 6:33 AM on October 6, 2014 [11 favorites]
"Is it worth trying medication for depression when the root cause is likely chronic sleep deprivation?" I would say no, partly because sleep problems are a common side-effect of antidepressant drugs. You say that you didn't like the side-effects of Zoloft. Well, other antidepressant drugs also have side-effects, and Zoloft is actually known as a drug with better-than-average tolerability. I would explore alternative approaches (especially ways that you can improve your sleep, since you're already established that better sleep makes you feel better).
Also, and more importantly, if you're going to nurse, you really don't want your baby to absorb the antidepressant from your milk. Antidepressants are known to have harmful effects on brain function.
posted by akk2014 at 6:36 AM on October 6, 2014
Also, and more importantly, if you're going to nurse, you really don't want your baby to absorb the antidepressant from your milk. Antidepressants are known to have harmful effects on brain function.
posted by akk2014 at 6:36 AM on October 6, 2014
I agree with cocoagirl. If you can pump, PUMP. Otherwise, use formula, even if you're resistant, just as a supplement for night feedings. As someone who had to do that (I never produced enough milk), I can anecdotally report that my daughter is just fine.
It sounds like it will make a huge difference for you to be able to sleep without disturbance (perhaps in a separate room, away from the child/monitor), and still help your child as best you can with pumping/formula/a combination thereof.
posted by miss tea at 6:38 AM on October 6, 2014
It sounds like it will make a huge difference for you to be able to sleep without disturbance (perhaps in a separate room, away from the child/monitor), and still help your child as best you can with pumping/formula/a combination thereof.
posted by miss tea at 6:38 AM on October 6, 2014
Best answer: Yes, it is worth seeking treatment for your depression.
No, getting enough sleep isn't going to magically make everything better.
My 24 month old still nursing frequent night waker is sleeping a little better these days. After the first two weeks of getting almost six straight hours of sleep per night the euphoria wore off, it became the new normal, and the depression was back. Right now I'm treating it with liquid vitamin supplementation and amino acids and it takes the edge off, enough that I've tabled the question of asking for meds for the time being, but only because I'm still nursing and would prefer to wait (also, I have good reason to believe my depression is situational).
If you can't get more sleep but can improve your physical condition in other ways (vitamins, exercise) it may help in the short term but honestly, give yourself a break and seek treatment as soon as possible.
posted by annathea at 6:46 AM on October 6, 2014 [1 favorite]
No, getting enough sleep isn't going to magically make everything better.
My 24 month old still nursing frequent night waker is sleeping a little better these days. After the first two weeks of getting almost six straight hours of sleep per night the euphoria wore off, it became the new normal, and the depression was back. Right now I'm treating it with liquid vitamin supplementation and amino acids and it takes the edge off, enough that I've tabled the question of asking for meds for the time being, but only because I'm still nursing and would prefer to wait (also, I have good reason to believe my depression is situational).
If you can't get more sleep but can improve your physical condition in other ways (vitamins, exercise) it may help in the short term but honestly, give yourself a break and seek treatment as soon as possible.
posted by annathea at 6:46 AM on October 6, 2014 [1 favorite]
Try addressing the sleep issue first. You have to resolve it for everyone's health, including your son's. If you do that and still feel horrible, then it's time to think about medication, therapy, etc. If he's 21 months, I strongly urge you to consider total night weaning. There's no physical reason for him to need milk or formula or anything at night. He's used to it, so not getting it will make him awfully mad, but after a week, his tummy will be used to waiting until a more reasonable hour. Try a strict no nursing until Mr. Sun comes up policy, with your husband handling all night wakings. (or you know, reassuring him, then letting him cry. the world will not end.) It'll make everything harder for a week or two, but the chances are very good that things will then get better.
(Yours, the hypocrite who didn't night wean until 24 months when I lost my darn mind, Chocotaco)
posted by chocotaco at 6:49 AM on October 6, 2014 [4 favorites]
(Yours, the hypocrite who didn't night wean until 24 months when I lost my darn mind, Chocotaco)
posted by chocotaco at 6:49 AM on October 6, 2014 [4 favorites]
Nursing and sleep training are not mutually exclusive. I don't know the details of your child's unique medical issues, so please excuse me if I am wrong here, but it is highly unlikely that a 21 month old *needs* to eat at night.
I recently ran across the Troublesome Tots website, which has a lot of helpful discussions about what sleep training is and isn't. This page discusses dropping night feedings. (Do read parts 1 and 2 as well, though).
To riff off chocotaco's comment, depending on where your child is developmentally, you could try giving him one of those child alarm clocks that tell the kid when it's ok to get up. Tell him he can nurse when the bunny wakes up. (That one's just an example; there are others.)
Having had periods of sanity and extreme insanity, which were directly linked to sleep issues in our house, you will be a better parent when you are sleeping. You may have other issues that need to be resolved as well, but you will be a better parent when you are sleeping.
posted by telepanda at 6:58 AM on October 6, 2014 [8 favorites]
I recently ran across the Troublesome Tots website, which has a lot of helpful discussions about what sleep training is and isn't. This page discusses dropping night feedings. (Do read parts 1 and 2 as well, though).
To riff off chocotaco's comment, depending on where your child is developmentally, you could try giving him one of those child alarm clocks that tell the kid when it's ok to get up. Tell him he can nurse when the bunny wakes up. (That one's just an example; there are others.)
Having had periods of sanity and extreme insanity, which were directly linked to sleep issues in our house, you will be a better parent when you are sleeping. You may have other issues that need to be resolved as well, but you will be a better parent when you are sleeping.
posted by telepanda at 6:58 AM on October 6, 2014 [8 favorites]
Best answer: I also had to nurse longer than we might have and more frequently through the night than he'd otherwise have needed for his age. At some point I went back to his doctor and said "this isn't sustainable - what are our other options?" and she helped me figure out a new plan. Sleep deprivation and depression both can give you some tunnel vision where you can't realistically evaluate alternatives - get some help with that to find ways to get yourself some more sleep.
posted by judith at 7:18 AM on October 6, 2014 [3 favorites]
posted by judith at 7:18 AM on October 6, 2014 [3 favorites]
Best answer: It sounds like the therapist helped. Can you see her again? Treatment for depression doesn't have to just be medication; therapy can be (and should be) an important part of it. Your therapist would also be a much more qualified person to help you decide whether you do want to go back on medication, and which medication.
As for irresponsible scaremongering about antidepressants in breastmilk, studies have also found that mothers dealing with untreated depression often cause neurological changes in their babies, too. You need to do what's appropriate for you to stay healthy, psychologically and physically, because a child demands so much of you.
posted by jaguar at 7:20 AM on October 6, 2014 [4 favorites]
As for irresponsible scaremongering about antidepressants in breastmilk, studies have also found that mothers dealing with untreated depression often cause neurological changes in their babies, too. You need to do what's appropriate for you to stay healthy, psychologically and physically, because a child demands so much of you.
posted by jaguar at 7:20 AM on October 6, 2014 [4 favorites]
Can you co-sleep so that you don't really have to wake up? I had a lot of success with sleeping with my little ones right beside me in the bed so that when they fussed I only had to wake up enough to get them to latch and then I would go back to sleep again instantly while they nursed. You don't have to be awake or sitting up for you boobs to be out, and with a thick layer of petroleum jelly, delaying the diaper change until six A.M. won't cause diaper rash.
Are you getting time to get some light exercise outside? If you can both go for a walk every day it might be very helpful both to your mood but also to helping Child Maarika sleep better. Kids that get some breeze and sunlight and rain seem to sleep better than ones who are never outside unless they are being carried out to the car or back inside to a building. If walking is not practical, consider putting Toddler Maarika out in the yard or a park on a blanket so he at least can get the fresh air even if you can't get the exercise.
If Child Maarika has special needs it maybe that depression is a natural reaction to your situation. It immobilizes you and keeps you closer to home and keeps the little one away from dangerous animals and people. Sometimes it makes a depression easier to weather if you think of it as being a necessary and yet transitive thing like the pain of childbirth and the post-partum soreness.
But again, like birth pain and post-partum pain, getting pain relief is sensible and good for you. Why not seek help for your depression, and see what anti-depressant the doctor recommends. You can then research the effect on nursing mothers and their babies. It's also possible that the doctor will recommend a non-medicinal treatment for your depression. There are also many therapies such as keeping a gratitude journal that some people have found very helpful.
posted by Jane the Brown at 8:09 AM on October 6, 2014 [2 favorites]
Are you getting time to get some light exercise outside? If you can both go for a walk every day it might be very helpful both to your mood but also to helping Child Maarika sleep better. Kids that get some breeze and sunlight and rain seem to sleep better than ones who are never outside unless they are being carried out to the car or back inside to a building. If walking is not practical, consider putting Toddler Maarika out in the yard or a park on a blanket so he at least can get the fresh air even if you can't get the exercise.
If Child Maarika has special needs it maybe that depression is a natural reaction to your situation. It immobilizes you and keeps you closer to home and keeps the little one away from dangerous animals and people. Sometimes it makes a depression easier to weather if you think of it as being a necessary and yet transitive thing like the pain of childbirth and the post-partum soreness.
But again, like birth pain and post-partum pain, getting pain relief is sensible and good for you. Why not seek help for your depression, and see what anti-depressant the doctor recommends. You can then research the effect on nursing mothers and their babies. It's also possible that the doctor will recommend a non-medicinal treatment for your depression. There are also many therapies such as keeping a gratitude journal that some people have found very helpful.
posted by Jane the Brown at 8:09 AM on October 6, 2014 [2 favorites]
Big hugs to you. I don't know about your situation, but I just recently came out of a ~8 month period of extreme sleep deprivation because my son was a horrible sleeper. I had many symptoms of depression during that time (frequent crying, numbness, unbelievable fatigue of course, feeling hopeless), and I was assessed as such, and after about a week of sleeping better, I feel 100% happier, stronger, more able to cope, you name it. Total reversal.
In case you want to peruse any sleep advice, here's my AskMe from a few months ago. Note that while my son used to nurse all night long (every ~1 hour or less), he now nurses at bedtime, once just before dawn, and then when he wakes up around 6:00 or so. I had anticipated that "night weaning" would be terribly traumatic and difficult - so I wasn't even THINKING of trying - and I was really just hoping to get 3-hour chunks of sleep between feedings. But it turned out he spontaneously stopped waking up to nurse as soon as he figured out how to go to sleep on his own. He loves nursing even more now, nurses much better during the day and the nursing relationship is going strong.
posted by Cygnet at 8:10 AM on October 6, 2014 [1 favorite]
In case you want to peruse any sleep advice, here's my AskMe from a few months ago. Note that while my son used to nurse all night long (every ~1 hour or less), he now nurses at bedtime, once just before dawn, and then when he wakes up around 6:00 or so. I had anticipated that "night weaning" would be terribly traumatic and difficult - so I wasn't even THINKING of trying - and I was really just hoping to get 3-hour chunks of sleep between feedings. But it turned out he spontaneously stopped waking up to nurse as soon as he figured out how to go to sleep on his own. He loves nursing even more now, nurses much better during the day and the nursing relationship is going strong.
posted by Cygnet at 8:10 AM on October 6, 2014 [1 favorite]
I'll second telepanda's recommendation of that Troublesome Tot link--it's really helpful. I also agree that night weaning doesn't have to mean the end of nursing. I have found that nights when baby iminurmefi is up frequently and getting nursed a lot, he's a pretty terrible nurser during the next day--hard to keep on the boob, very distractible, and doesn't take much in. When he does sleep through the night (or only wakes up once for a feed), he's much more efficient and focused during the day with nursing. I think he's taking in the same amount of milk, just during the day which is so much more humane for me.
Personally I would focus on trying to find ways to get you more sleep, versus taking antidepressants, if you didn't tolerate the side effects well before. Sleep may be tougher to achieve but will come with no side effects. However, if uninterrupted sleep is impossible--and I'd shoot for at least 3 nights a week of at least 6 hours uninterrupted--then I'd probably try antidepressants rather than do nothing.
posted by iminurmefi at 8:56 AM on October 6, 2014
Personally I would focus on trying to find ways to get you more sleep, versus taking antidepressants, if you didn't tolerate the side effects well before. Sleep may be tougher to achieve but will come with no side effects. However, if uninterrupted sleep is impossible--and I'd shoot for at least 3 nights a week of at least 6 hours uninterrupted--then I'd probably try antidepressants rather than do nothing.
posted by iminurmefi at 8:56 AM on October 6, 2014
I agree with the others who suggested night weaning. Kudos to you for making it to toddlerhood feeding on demand!
Also, if you do decide to use medication, please make an informed decision based on research and discussions with your doctor. The article posted above is ill-informed scaremongering, and is about pregnancy rather than nursing anyhow. There are some meds that are safer to use while breastfeeding. LactMed and Kellymom are both good resources for more info.
posted by sanitycheck at 8:56 AM on October 6, 2014 [2 favorites]
Also, if you do decide to use medication, please make an informed decision based on research and discussions with your doctor. The article posted above is ill-informed scaremongering, and is about pregnancy rather than nursing anyhow. There are some meds that are safer to use while breastfeeding. LactMed and Kellymom are both good resources for more info.
posted by sanitycheck at 8:56 AM on October 6, 2014 [2 favorites]
Oh man, I really feel for you because my wife and I were in the same place. Our daughter was born "high needs" and was extremely colicky for a long time. There were points in her first year where she was waking up screaming every 45 minutes all night long (and my wife was co-sleeping and nursing on demand the entire time). Were we depressed? Um, that doesn't even begin to describe it. We both felt like we had PTSD by the time she started sleeping just a little bit better.
I hate hate hate that I'm going to mention this, because I know that your choices about breastfeeding are yours and yours alone, so feel free to ignore. What changed was that finally, at (coincidentally) 21 months, my wife decided to wean completely, after unsuccessfully trying to night wean for several months before that. We were desperate for sleep. I was actually against the idea of weaning completely (and now I wonder why I was so resistant). It was rough for a couple of nights and she actually had her mom help with the process, but then it was not a big deal and our daughter adapted surprisingly quickly, and she immediately started sleeping for longer stretches. She of course continued to be a highly sensitive kid who woke up at night, but those wake-ups gradually decreased over time. She just turned three and still wakes up maybe once a night and needs help settling down again, but oh god we are rested! As soon as were were able to get good chunks of sleep we both immediately started feeling so much happier and more resilient.
posted by bennett being thrown at 8:57 AM on October 6, 2014
I hate hate hate that I'm going to mention this, because I know that your choices about breastfeeding are yours and yours alone, so feel free to ignore. What changed was that finally, at (coincidentally) 21 months, my wife decided to wean completely, after unsuccessfully trying to night wean for several months before that. We were desperate for sleep. I was actually against the idea of weaning completely (and now I wonder why I was so resistant). It was rough for a couple of nights and she actually had her mom help with the process, but then it was not a big deal and our daughter adapted surprisingly quickly, and she immediately started sleeping for longer stretches. She of course continued to be a highly sensitive kid who woke up at night, but those wake-ups gradually decreased over time. She just turned three and still wakes up maybe once a night and needs help settling down again, but oh god we are rested! As soon as were were able to get good chunks of sleep we both immediately started feeling so much happier and more resilient.
posted by bennett being thrown at 8:57 AM on October 6, 2014
Response by poster: Thanks, everyone, for your baby sleep ideas. Please trust me when I say that we've tried them all over the course of the past 21 months. My two nights of good sleep last week were due to Toddler Maarika miraculously not losing his mind at 4:30am - I thought we had turned a corner, but alas, it was not long-lasting. Formula/cow's milk is not an option due to dietary restrictions, and in any case the kiddo will offendedly throw a sippy cup of water across the room if you offer it at night. Additionally, we've gone through the night weaning process twice now - even when he went the entire night without nursing (which he managed for a couple months), it did not stop the multiple wake ups per night. The 18 month sleep regression hit us particularly hard, so caving to the 4:30am nursing session was like a snooze button that bought us an extra couple hours of sleep. Lately we've tried letting him scream it out at 4:30, but that literally results in him being up for the day at 4:30. He throws himself at the bedroom door because he wants to get up and play.
We sort of co-sleep - my husband will go in and sleep on the mattress with him during his first wake up, but the shit hits the fan at 4:30 until I go in. We have a small two-bedroom house, so if he's pounding down the bedroom door with my husband in the room, I hear everything.
We've talked to our son's medical team about this, and at this point they just look at us with horrified expressions (all of his doctors have multiple young kids themselves), say we should talk about this with the pediatric neuropsychologist at our next scheduled appointment, and will help us come up with a nutrition plan if I need to stop nursing altogether.
The one exception to my own too tired to cry state is hearing about how other people struggled for what seemed to them like forever but ultimately managed to get their kids to sleep YEARS before we will. Instant waterworks. God, I feel like such a complete failure as a parent. And that's where the cycle of self-loathing starts yet again.
posted by Maarika at 9:55 AM on October 6, 2014
We sort of co-sleep - my husband will go in and sleep on the mattress with him during his first wake up, but the shit hits the fan at 4:30 until I go in. We have a small two-bedroom house, so if he's pounding down the bedroom door with my husband in the room, I hear everything.
We've talked to our son's medical team about this, and at this point they just look at us with horrified expressions (all of his doctors have multiple young kids themselves), say we should talk about this with the pediatric neuropsychologist at our next scheduled appointment, and will help us come up with a nutrition plan if I need to stop nursing altogether.
The one exception to my own too tired to cry state is hearing about how other people struggled for what seemed to them like forever but ultimately managed to get their kids to sleep YEARS before we will. Instant waterworks. God, I feel like such a complete failure as a parent. And that's where the cycle of self-loathing starts yet again.
posted by Maarika at 9:55 AM on October 6, 2014
It sounds like you've tried a lot of stuff, and this all sounds really hard. My impulse is to suggest that you co-sleep with the baby for the next few nights from bedtime on down to see if it helps anything for you that you don't need to get up out of bed and go to your baby. If it doesn't help--if you sleep too lightly, if toddler kicks you, if you still feel sleep deprived--then you haven't really lost anything, if you're already sleeping really poorly.
Because you've tried so many things, you've probably seen it, but the big resource I've seen thrown around for night weaning is Jay Gordon's method.
Because it needs to be said: you are not a failure. There are huge variations in sleep of all people, not just babies. He might just be a crappy sleeper. Many adults don't sleep through the night, either.
posted by PhoBWanKenobi at 10:08 AM on October 6, 2014
Because you've tried so many things, you've probably seen it, but the big resource I've seen thrown around for night weaning is Jay Gordon's method.
Because it needs to be said: you are not a failure. There are huge variations in sleep of all people, not just babies. He might just be a crappy sleeper. Many adults don't sleep through the night, either.
posted by PhoBWanKenobi at 10:08 AM on October 6, 2014
You are not a failure. You are doing the best you can with a very difficult situation. Please seek help as soon as possible, not just from the pediatric neuropsychologist but from your own doctor. Please get every possible support you can - a psychiatrist, a therapist.
If you have an appointment with your child's main physician overseeing his care to come up with a dietary plan, but it isn't, like IMMINENT - please call them to get the appointment moved up and tell them you have an urgent issue to discuss and it cannot wait not even 1 more week. Prioritize your health, because your child needs you to be healthy. If you work, consider FMLA leave. If you can get help from family or babysitters so you can take a nap during the day or go to bed earlier at night, get help for that and do it. Do whatever you need to do! Take care of yourself. With hugs.
This, too, shall pass. SOON.
t+b
posted by treehorn+bunny at 10:09 AM on October 6, 2014 [9 favorites]
If you have an appointment with your child's main physician overseeing his care to come up with a dietary plan, but it isn't, like IMMINENT - please call them to get the appointment moved up and tell them you have an urgent issue to discuss and it cannot wait not even 1 more week. Prioritize your health, because your child needs you to be healthy. If you work, consider FMLA leave. If you can get help from family or babysitters so you can take a nap during the day or go to bed earlier at night, get help for that and do it. Do whatever you need to do! Take care of yourself. With hugs.
This, too, shall pass. SOON.
t+b
posted by treehorn+bunny at 10:09 AM on October 6, 2014 [9 favorites]
Also, this series on infant sleep might reassure you that this is NOT your fault: here. Without intervention (ie, sleep training), the sleep of many babies would look like yours. It's okay if you decide you need sleep training, too. But it's so important to know that you are not a failure. It sounds like you have done an amazing job nurturing and feeding a baby with unique issues while sleep deprived and/or depressed. You are terrific. Please know that.
posted by PhoBWanKenobi at 10:14 AM on October 6, 2014 [7 favorites]
posted by PhoBWanKenobi at 10:14 AM on October 6, 2014 [7 favorites]
Best answer: Co-sleeping for us (with mama and baby in the same bed) have made night-nursing and night-waking survivable. The trick for me is to go to bed earlier, though, too. 10pm is too late for me now if we get up at 7am. 8 or 9pm is when I have to go to bed in order to get enough sleep.
You are NOT a failure. Western society's expectations are the failure.
posted by jillithd at 11:41 AM on October 6, 2014 [3 favorites]
You are NOT a failure. Western society's expectations are the failure.
posted by jillithd at 11:41 AM on October 6, 2014 [3 favorites]
Breast milk doesn't really have much staying power overnight unless there are other foods in the diet. Would it be possible to feed him something else right before bed? Also, perhaps you could find a resource for extra breast milk that is not from you, and that could be a supplement at 4am?
Yeah, this situation is really not sustainable for you and your docs need to move heaven and earth to figure out a way to support you in finding a solution.
posted by St. Alia of the Bunnies at 11:45 AM on October 6, 2014
Yeah, this situation is really not sustainable for you and your docs need to move heaven and earth to figure out a way to support you in finding a solution.
posted by St. Alia of the Bunnies at 11:45 AM on October 6, 2014
Coming back in to say that one of the most eye-opening things I heard from a lactation consultant was, "Baby's not STILL hungry. Baby's hungry AGAIN. They're different things." I cried when I heard that. Why? Because it was suddenly clear to me that I hadn't failed at feeding baby the first time. I just had a baby who was hungry, again.
What does that have to do with sleeping? Well, as the single parent of a 9yo and a 5.5yo, I can now tell you that sleep training can work THE SAME WAY. It isn't always something you just do once and you either fail or succeed. You may succeed FOR NOW. And need to do it again. You may fail FOR NOW, and need to do it again. I just went through a year of my 5.5 yo waking me up between 2-5am every night. My doctor finally said, "This has to stop. Lock your door. It's ok if he bangs on it. It's ok if he cries for two hours. It's ok if he throws stuff. It's ok if he wakes his brother. You. Need. Sleep." Now, I prepared 5.5yo-Cocoa with a number of gentle but direct conversations, and together we had strategies lined up to help him, but the message was, "Everyone is healthier with sleep. Mommy needs better sleep. You need better sleep. I am not getting out of bed anymore and you are sleeping in your bed. We will all be ok even with a few rough nights because we are working on something bigger." I did this over a long weekend and it's worked. FOR NOW. I know things change and we may need to do it again, because things change.
YOU'RE NOT FAILING. You just haven't hit on the adaptation that currently meets the emergent needs of your family. My advice is work on sleep training. Sippy-cup-across-the-room is fine. Totally kid-proof his room and put a child lock on the inside door handle. Put his mattress on the floor if he climbs out of a crib. Tie up strings from any blinds or curtains. Tape up the outlets. He wants to play? Great, get him a SUPER SPECIAL night time friend for when he's awake. Earplugs for you. If he wakes at 4:30, kudos to him for rising to meet the day. You will see him at 7:00. 4:30am is not when Mommies and Daddies get up to play.
posted by cocoagirl at 11:45 AM on October 6, 2014 [3 favorites]
What does that have to do with sleeping? Well, as the single parent of a 9yo and a 5.5yo, I can now tell you that sleep training can work THE SAME WAY. It isn't always something you just do once and you either fail or succeed. You may succeed FOR NOW. And need to do it again. You may fail FOR NOW, and need to do it again. I just went through a year of my 5.5 yo waking me up between 2-5am every night. My doctor finally said, "This has to stop. Lock your door. It's ok if he bangs on it. It's ok if he cries for two hours. It's ok if he throws stuff. It's ok if he wakes his brother. You. Need. Sleep." Now, I prepared 5.5yo-Cocoa with a number of gentle but direct conversations, and together we had strategies lined up to help him, but the message was, "Everyone is healthier with sleep. Mommy needs better sleep. You need better sleep. I am not getting out of bed anymore and you are sleeping in your bed. We will all be ok even with a few rough nights because we are working on something bigger." I did this over a long weekend and it's worked. FOR NOW. I know things change and we may need to do it again, because things change.
YOU'RE NOT FAILING. You just haven't hit on the adaptation that currently meets the emergent needs of your family. My advice is work on sleep training. Sippy-cup-across-the-room is fine. Totally kid-proof his room and put a child lock on the inside door handle. Put his mattress on the floor if he climbs out of a crib. Tie up strings from any blinds or curtains. Tape up the outlets. He wants to play? Great, get him a SUPER SPECIAL night time friend for when he's awake. Earplugs for you. If he wakes at 4:30, kudos to him for rising to meet the day. You will see him at 7:00. 4:30am is not when Mommies and Daddies get up to play.
posted by cocoagirl at 11:45 AM on October 6, 2014 [3 favorites]
Breast milk doesn't really have much staying power overnight unless there are other foods in the diet is an old myth -- don't worry about that.
My daughter did not sleep through until around 2.5. I did nothing at all to encourage or discourage night nursing; it just happened. Waking frequency was all over the map until then. Your kid is normal, and you are doing a great job, full stop.
When she was young I was very annoyed with the amount of general blither and received wisdom about "postpartum depression" that never managed to connect it to sleep deprivation. I feel like @#$* on too little sleep. Most people on too little sleep do end up unhappy. It's a big issue and it makes me crazy that the answer is so often "Mom has a problem with PPD" rather than "Mom needs more sleep."
The 6am part sounds really rough.
What I did was take sleeping meds as needed (most are quite safe for nursing, especially with a toddler) so that I could manage to fall back asleep without hassle and maximize what I wrung out of each night, sleep-wise. I went to bed at un-grown-up-like hours like 8pm lots when my kid was little. It was just the two of us and if she wasn't tired that wasn't my problem; I went to bed with her next to me and that was it, it was bedtime, in a child-proofed room with white noise going. I also laid down during the day and napped with her. Cuddling with your kid releases oxytocin, if memory serves, and it has a soporific effect. Even if you don't actually sleep, the results of a pretend nap can be really refreshing.
I also gained a lot of weight because for a while eating a tonne of nice warm comfort food helped me sleep, and I didn't notice when the results of that snuck up on me. So, recommended only with caution, but, sometimes, pizza helps.
Best of luck. "This is scary but not dangerous" and "this will pass" are good mantras.
posted by kmennie at 12:00 PM on October 6, 2014 [1 favorite]
My daughter did not sleep through until around 2.5. I did nothing at all to encourage or discourage night nursing; it just happened. Waking frequency was all over the map until then. Your kid is normal, and you are doing a great job, full stop.
When she was young I was very annoyed with the amount of general blither and received wisdom about "postpartum depression" that never managed to connect it to sleep deprivation. I feel like @#$* on too little sleep. Most people on too little sleep do end up unhappy. It's a big issue and it makes me crazy that the answer is so often "Mom has a problem with PPD" rather than "Mom needs more sleep."
The 6am part sounds really rough.
What I did was take sleeping meds as needed (most are quite safe for nursing, especially with a toddler) so that I could manage to fall back asleep without hassle and maximize what I wrung out of each night, sleep-wise. I went to bed at un-grown-up-like hours like 8pm lots when my kid was little. It was just the two of us and if she wasn't tired that wasn't my problem; I went to bed with her next to me and that was it, it was bedtime, in a child-proofed room with white noise going. I also laid down during the day and napped with her. Cuddling with your kid releases oxytocin, if memory serves, and it has a soporific effect. Even if you don't actually sleep, the results of a pretend nap can be really refreshing.
I also gained a lot of weight because for a while eating a tonne of nice warm comfort food helped me sleep, and I didn't notice when the results of that snuck up on me. So, recommended only with caution, but, sometimes, pizza helps.
Best of luck. "This is scary but not dangerous" and "this will pass" are good mantras.
posted by kmennie at 12:00 PM on October 6, 2014 [1 favorite]
Best answer: Dear Ask metafilter, time to step up your game. Yes, Maarika's question is about postpartum depression and sleep deprivation. That doesn't mean it's ok to just lecture her about night weaning and sleep training without reading what she wrote to realize she's in an unusual situation. She has a toddler with a complex illness which requires not just a doctor but a medical team to manage. He can't drink formula or cow's milk. Before recommending sleep training, ask yourself if you would really be willing to let your child who has a serious illness cry it out. I sure as hell wouldn't.
Postpartum depression is strongly linked to sleep problems. My doctor told me of a study that found that getting at least 6 hours of sleep for 6 nights in a row can halt or reverse the progress of postpartum depression. Given that a couple nights of sleep really helped, prioritizing sleep is a great idea. Is going to sleep earlier possible for you? If you could go to bed at 8, then you'd have from 8-4:30 which is 8.5 hours. Your husband would take the kiddo if he's still awake then. You could use any means necessary to shift your bedtime to earlier - Benadryl and melatonin are the usual recommendations for nursing-safe sleep aids.
Is getting a night nanny an option?
What about moving your bed to the other side of the house so that when your toddler is upset at 4:30 you don't hear it?
akk2014, you're spreading incorrect and harmful information about antidepressant use that scares many women with postpartum depression into not getting treatment. The article you linked was to a news story, not a study, and describes a preliminary (not repeated) study showing a correlation (not causation) between antidepressant use during pregnancy and increased ADHD rates. Even if that article weren't bullshit, it's not relevant to Maarika because she is no longer pregnant. Postpartum depression has harmful effects on brain function. Postpartum depression is also one of the types of depression that responds best to SSRI treatment. The fact that you personally didn't respond well to SSRIs for (non postpartum) depression isn't relevant here.
Maarika, I don't know if you should use antidepressants but it is worth considering. It can help even when you are still sleep deprived. There are good data supporting use of Zoloft while nursing because very little of it gets into breast milk. Even if you didn't like the side effects 4 years ago, it might have a different effect on you now. Zoloft is usually the first SSRI suggested for nursing mothers, but there may be other options.
Is meditation appealing to you? My doctor told me that there are some studies showing that meditation can help treat postpartum depression symptoms. You could talk to a doctor or a therapist who specializes in postpartum mood disorders about that (or memail me). You can practice meditation even for just 5 minutes at a time, while your son is nursing.
Do you have time to exercise?
Please talk about this with your doctor and figure out a treatment plan that will work for you. treehorn+bunny is right, you need to prioritize this and get not let treatment for yourself be an afterthought in the complex maze of your son's care.
posted by medusa at 12:07 PM on October 6, 2014 [18 favorites]
Postpartum depression is strongly linked to sleep problems. My doctor told me of a study that found that getting at least 6 hours of sleep for 6 nights in a row can halt or reverse the progress of postpartum depression. Given that a couple nights of sleep really helped, prioritizing sleep is a great idea. Is going to sleep earlier possible for you? If you could go to bed at 8, then you'd have from 8-4:30 which is 8.5 hours. Your husband would take the kiddo if he's still awake then. You could use any means necessary to shift your bedtime to earlier - Benadryl and melatonin are the usual recommendations for nursing-safe sleep aids.
Is getting a night nanny an option?
What about moving your bed to the other side of the house so that when your toddler is upset at 4:30 you don't hear it?
akk2014, you're spreading incorrect and harmful information about antidepressant use that scares many women with postpartum depression into not getting treatment. The article you linked was to a news story, not a study, and describes a preliminary (not repeated) study showing a correlation (not causation) between antidepressant use during pregnancy and increased ADHD rates. Even if that article weren't bullshit, it's not relevant to Maarika because she is no longer pregnant. Postpartum depression has harmful effects on brain function. Postpartum depression is also one of the types of depression that responds best to SSRI treatment. The fact that you personally didn't respond well to SSRIs for (non postpartum) depression isn't relevant here.
Maarika, I don't know if you should use antidepressants but it is worth considering. It can help even when you are still sleep deprived. There are good data supporting use of Zoloft while nursing because very little of it gets into breast milk. Even if you didn't like the side effects 4 years ago, it might have a different effect on you now. Zoloft is usually the first SSRI suggested for nursing mothers, but there may be other options.
Is meditation appealing to you? My doctor told me that there are some studies showing that meditation can help treat postpartum depression symptoms. You could talk to a doctor or a therapist who specializes in postpartum mood disorders about that (or memail me). You can practice meditation even for just 5 minutes at a time, while your son is nursing.
Do you have time to exercise?
Please talk about this with your doctor and figure out a treatment plan that will work for you. treehorn+bunny is right, you need to prioritize this and get not let treatment for yourself be an afterthought in the complex maze of your son's care.
posted by medusa at 12:07 PM on October 6, 2014 [18 favorites]
To be fair, I think a lot of this depends on the details of Toddler M's health issues. If they are such that Toddler M needs to be checked on every time he awakes (unlike most children), then it is true, the sleep training advice does not apply. This is a question first for your doctors, and second for yourself. The goal of sleep training is not abandoning your child to cry for hours and hours, days on end. If that happens, it's not working and it's time to stop for a while. The goal of sleep training is getting to a place, within a reasonable amount of time, where everyone is sleeping better, including the child. Even if you decide it's not for you, and you've read other similar resources, Troublesome Tots is worth a look. It's at least a more nuanced discussion than you get in some other places. Sleep training is not a one-and-done thing. Sleep regressions are real, and kids who previously slept through the night do stop sleeping through the night at a moment's notice, and you have to start all over.
I think the sleep trainers have their hearts in the right place in that they are trying to encourage you to find a balance between your needs and your child's needs, because it's so easy to get sucked down the rabbit hole of putting your needs behind everyone else's even without the added complications you're facing.
But your best answer indicates you don't want to hear more about sleep training, so on to part 2:
Troublesome Tots actually recommends caving to the 4:30am feeding. I also recommend caving, and do it myself. For exactly the reasons you describe: A hungry kid is not going back to sleep at 4:30am, but a full one might. My suggestion for maximum sleep and calmness is as follows (go earlier if you need to!):
9PM: Get ready for bed
9:15PM: Put on an audio of a guided meditation for sleep
9:30PM:Hopefully you're asleep and will sleep 7 hours before Toddler M wakes up.
???PM: Your husband sleeps with Toddler M in his bed.
4:30AM: Toddler M stirs and whines. At the very first sign of 4:30am motion, your husband immediately trucks that *still sleepy* hungry baby into your room. You hear them coming, get a boob ready, latch him on, and doze back off. Husband goes back to sleep in Toddler M's bed and gets a few restful hours.
?6AM: You get up with Toddler M at a hopefully not too ungodly hour.
With any luck, you can convert a 4:30AM screaming wakeup into 4:30AM sleepy snuggle time.
Also, if bed-sharing with Toddler M is going to be an ongoing thing, consider investing in a double bed for Toddler M's room - having enough space will improve the quality of sleep for whoever's in bed with him.
posted by telepanda at 2:33 PM on October 6, 2014 [1 favorite]
I think the sleep trainers have their hearts in the right place in that they are trying to encourage you to find a balance between your needs and your child's needs, because it's so easy to get sucked down the rabbit hole of putting your needs behind everyone else's even without the added complications you're facing.
But your best answer indicates you don't want to hear more about sleep training, so on to part 2:
Troublesome Tots actually recommends caving to the 4:30am feeding. I also recommend caving, and do it myself. For exactly the reasons you describe: A hungry kid is not going back to sleep at 4:30am, but a full one might. My suggestion for maximum sleep and calmness is as follows (go earlier if you need to!):
9PM: Get ready for bed
9:15PM: Put on an audio of a guided meditation for sleep
9:30PM:Hopefully you're asleep and will sleep 7 hours before Toddler M wakes up.
???PM: Your husband sleeps with Toddler M in his bed.
4:30AM: Toddler M stirs and whines. At the very first sign of 4:30am motion, your husband immediately trucks that *still sleepy* hungry baby into your room. You hear them coming, get a boob ready, latch him on, and doze back off. Husband goes back to sleep in Toddler M's bed and gets a few restful hours.
?6AM: You get up with Toddler M at a hopefully not too ungodly hour.
With any luck, you can convert a 4:30AM screaming wakeup into 4:30AM sleepy snuggle time.
Also, if bed-sharing with Toddler M is going to be an ongoing thing, consider investing in a double bed for Toddler M's room - having enough space will improve the quality of sleep for whoever's in bed with him.
posted by telepanda at 2:33 PM on October 6, 2014 [1 favorite]
I like medusa's suggestion of your going to bed earlier. Could you push it even earlier, and trade off shifts with your husband? Maybe you sleep 6pm to midnight while he does any feedings; he sleeps midnight to 6am while you do any feedings? That way you each get at least six hours, hopefully more.
I still urge you to talk to your therapist again, but you and your husband really need to figure out how you can get more sleep right now and to make that a huge priority.
posted by jaguar at 2:54 PM on October 6, 2014
I still urge you to talk to your therapist again, but you and your husband really need to figure out how you can get more sleep right now and to make that a huge priority.
posted by jaguar at 2:54 PM on October 6, 2014
Best answer: I agree that getting to sleep earlier is a great thing to push for in the goal of you getting more sleep. (Especially if you could go to be at 8 or 9 and just get up for the day at 4:30am. It sounds horrible, but sometimes it's easier to just adjust to where your kid is right now.) It's hard to give advice, though, when I don't really know how difficult your days and nights are for your kid and you. I can't really assume that your kid's awful sleep is like my kid's awful sleep -- which is where your kid's medical team comes into play. It sounds like you have an appointment already and the pediatric neuropsychologist is the one who should help you. I'm guessing you already know, but make sure you go to that appointment with all the things you want to ask written down, so you can't forget them, and with space to write down answers, so you don't forget what they said. I know when I'm sleep deprived my memory goes out the window.
And do pursue an antidepressant solution as well -- if it could help brighten your moods even on low sleep days, it would be worth it.
We've talked to our son's medical team about this, and at this point they just look at us with horrified expressions
In case you are thinking this horror has something to do with your parenting, I have to say I seriously doubt it. I think this is their way of sympathizing because it is so hard to do anything when you haven't slept. This parent's solution to their child not sleeping is not because it will be directly applicable, and more because I think it's nice to see parents getting creative in difficult situations, and in parenting children with medical issues. That said, are there any groups of parents you could be part of who have kids with similar medical issues? It's really nice to be able to get advice and commiserate with people who have a better idea what you're going through. I think we learn to be the parents our kids need, even if it's incredibly hard. (And sometimes, when our kids are different, we seem a bit odd too. It's okay. My daughter had bad eczema as a baby, to the point where I had to keep her coated in vaseline. I was the only mom I knew whose entire wardrobe was covered in oil stains. It was nice when I met another mom with experience with eczema.) Until you get some parents who really understand, do you have a friend or relative you can call, one who will remind you that you're doing great? It's nice to have the reminders, when you forget sometimes that you're awesome and doing as good a job as is possible.
posted by Margalo Epps at 5:15 PM on October 6, 2014 [2 favorites]
And do pursue an antidepressant solution as well -- if it could help brighten your moods even on low sleep days, it would be worth it.
We've talked to our son's medical team about this, and at this point they just look at us with horrified expressions
In case you are thinking this horror has something to do with your parenting, I have to say I seriously doubt it. I think this is their way of sympathizing because it is so hard to do anything when you haven't slept. This parent's solution to their child not sleeping is not because it will be directly applicable, and more because I think it's nice to see parents getting creative in difficult situations, and in parenting children with medical issues. That said, are there any groups of parents you could be part of who have kids with similar medical issues? It's really nice to be able to get advice and commiserate with people who have a better idea what you're going through. I think we learn to be the parents our kids need, even if it's incredibly hard. (And sometimes, when our kids are different, we seem a bit odd too. It's okay. My daughter had bad eczema as a baby, to the point where I had to keep her coated in vaseline. I was the only mom I knew whose entire wardrobe was covered in oil stains. It was nice when I met another mom with experience with eczema.) Until you get some parents who really understand, do you have a friend or relative you can call, one who will remind you that you're doing great? It's nice to have the reminders, when you forget sometimes that you're awesome and doing as good a job as is possible.
posted by Margalo Epps at 5:15 PM on October 6, 2014 [2 favorites]
You don't even know how much I sympathise with you. For the first seven months of my now 14 month old daughter's life, she was up every 45 minutes through the night to breastfeed. For seven months! I was surviving on 2 hours of sleep a night, snatched in 10 minute bursts here and there and I couldn't sleep during the day when she slept because I had a toddler to look after too. I literally went crazy and was terrified of driving because I was afraid I'd have an accident falling sleep at the wheel, amongst many other things.
I'm convinced she wasn't doing this because she was hungry, she was using it to settle back to sleep. Eventually the only thing that helped was for my husband (who up until that point refused to help at all) to get up and settle her, often with formula. Once she realised she wasn't going to get Mummy's Magical Breasts, she started to sleep through. Now, apart from the occasional upset, she sleeps through every night and my sanity has come back. But boy, it was one of the hardest times of my whole life.
You've been given great advice here about nursing during the day and night weaning, as she should no longer need to feed at night. If she's using you to settle (quite likely) it may be time to get your husband involved or if that's not an option, hire a night nanny to help you do feeding and gradual sleep training and more importantly, allow you to sleep. It's almost impossible to function at all on the amount of sleep you're getting and as you're finding, something has to give. So I guess my advice given that you can't feed formula is to express during the day and have someone else give her this at night and slowly wean her off. (I'm no talking about cry it out here, there are other ways and hopefully a combination of things will work.) Good luck and PM me if you need to. Big hugs, and sleep well.
posted by Jubey at 6:00 PM on October 6, 2014
I'm convinced she wasn't doing this because she was hungry, she was using it to settle back to sleep. Eventually the only thing that helped was for my husband (who up until that point refused to help at all) to get up and settle her, often with formula. Once she realised she wasn't going to get Mummy's Magical Breasts, she started to sleep through. Now, apart from the occasional upset, she sleeps through every night and my sanity has come back. But boy, it was one of the hardest times of my whole life.
You've been given great advice here about nursing during the day and night weaning, as she should no longer need to feed at night. If she's using you to settle (quite likely) it may be time to get your husband involved or if that's not an option, hire a night nanny to help you do feeding and gradual sleep training and more importantly, allow you to sleep. It's almost impossible to function at all on the amount of sleep you're getting and as you're finding, something has to give. So I guess my advice given that you can't feed formula is to express during the day and have someone else give her this at night and slowly wean her off. (I'm no talking about cry it out here, there are other ways and hopefully a combination of things will work.) Good luck and PM me if you need to. Big hugs, and sleep well.
posted by Jubey at 6:00 PM on October 6, 2014
There's evidence that postpartum depression may be caused by an Omega 3 deficiency (fetus sucks you dry of your Omega 3 reserves to make its brain and Omega 3 deficiencies cause depression) so if you're hesitant to take antidepressants then you might want to try megadoses of Omega 3 supplements for a while. They're not only safe to take during breastfeeding but whatever extra Omega 3 your kid gets through your milk is good for him too. Omega Brite is a really good pharmaceutical quality supplement and the brand that has been used in a lot of the medical research on the benefits of Omega 3 supplements.
If you end up deciding to give antidepressants another try, Wellbutrin (bupropion) works much faster than most other types of antidepressants.
I've heard that one of the benefits of cosleeping is less sleep disruption to breastfeed -- you don't have to get out of bed to breastfeed and can actually semi-snooze after he latches.
posted by Jacqueline at 6:22 PM on October 6, 2014
If you end up deciding to give antidepressants another try, Wellbutrin (bupropion) works much faster than most other types of antidepressants.
I've heard that one of the benefits of cosleeping is less sleep disruption to breastfeed -- you don't have to get out of bed to breastfeed and can actually semi-snooze after he latches.
posted by Jacqueline at 6:22 PM on October 6, 2014
Best answer: I just want to encourage you to, yes, seek treatment in addition to seeing if you can rearrange your schedule a bit to go to bed earlier. Whether that's therapy or medical or both doesn't so much matter. It sounds like you're in a medical caregiver situation with your kid as well as the usual parental caregiver role, and that is SO much. While, yes, the well being of every parent can affect their relationship with their kids, you're doing more work than parents with healthy kids. You need more help. If it helps, you could think of your mental health practitioner as part of your son's medical team, because taking care of yourself will have a net positive effect on your family.
To answer your question more directly, both good sleep and antidepressants could help you get to a place where you can begin imagining other coping strategies. Why not try to get more sleep, and see what effect that has, since your body needs it anyway, before investigating other options?
posted by linettasky at 9:20 PM on October 6, 2014 [1 favorite]
To answer your question more directly, both good sleep and antidepressants could help you get to a place where you can begin imagining other coping strategies. Why not try to get more sleep, and see what effect that has, since your body needs it anyway, before investigating other options?
posted by linettasky at 9:20 PM on October 6, 2014 [1 favorite]
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I know it might be hard to hear and I understand the impulse to nurse baby no matter what (and have been around kids with medical issues where every little bit seems to count) but at a certain point it isn't good for baby if you're aggravating your depression by putting nursing needs ahead of your mental health. Can you talk with baby's ped to address issues with either formula or sleep training for one of the early morning feedings? And be explicit about your own emotional needs as you have that conversation? My kids' pediatrician was very attentive to both mom's and baby's needs; the mother-baby relationship is called a dyad for a reason.
Also, regarding the lack of light at the end of the tunnel, I know it seems that way now, but for 99% of kids, the sleeping really does get better. There may be hiccups and regressions, but things do get better. That said, if you're raising this cry now, then I think something's got to give: baby's sleep training, baby's need for breastmilk vs. pumped vs. formula, or your mental/emotional well-being. Best of luck.
posted by cocoagirl at 6:33 AM on October 6, 2014 [8 favorites]