Sleep

Sleep is absolutely vital for the body and brain to function properly, but sleep disruption is almost universal in the perinatal period. This can have a huge impact on parenting and on mental health. 

In this episode we talk to Dr Chiara Petrosellini about the complicated relationship between sleep and perinatal mental health. Tune in to hear about the science of sleep, the specific challenges in the perinatal period, and evidence-based strategies for improving sleep during this crucial time. 

Recommended resources:

• The Sleep Foundation
• BMJ visual summary on optimising sleep for night shifts
• Maternal sleeping problems before and after childbirth: a systematic review (open access paper)

If you or someone you know is struggling with mental health difficulties, there is lots of help available. You can contact your primary care provider in the first instance, or if you are based in the UK the NHS perinatal mental health website will help you to find support in your local area.

Transcript

[00:00:11] Chrissy: Welcome everyone to the Beyond Baby Blues podcast. My name is Dr. Chrissy Jayarajah and I'm a consultant perinatal psychiatrist working in London.

[00:00:22] Lynsey: And I'm Dr. Lynsey McAlpine. I'm a trainee psychiatrist also based in London. And today we're joined by my friend and colleague, Dr. Chiara Petrosellini. Chiara is an obstetrics traineewho has joined us for this episode about sleep in the perinatal period. Chiara welcome to the podcast.

[00:00:38] Chiara: Thank you. Thanks for having me.

[00:00:40] Lynsey: So Chiara, tell us a little bit about yourself. 

[00:00:42] Chiara: So I, did a genetics degree before I did medicine and in that time I did a little bit of research in psychiatric genetics and I kind of fell in love with your specialty. So I went into medicine just to do psychiatry and then I accidentally fell in love with obstetrics along the way and had a bit of a life crisis so I decided to do obstetrics with a view to kind of making perinatal mental health my area of expertise. So I'm currently out of the training program, um, doing a PhD looking at the role of sleep in the development of postpartum psychosis. 

[00:01:12] Lynsey: Amazing. I mean, I know I'm slightly biased here, but I think it's really cool that you've taken on such an important topic for your PhD. I mean, there's hardly any research in this area and it's just so incredibly relevant to clinical practice. 

[00:01:24] Chrissy: Well, yeah, I think it's a huge issue, isn't it, around sleep. I know personally, I really struggled with sleep after I had my two daughters 

[00:01:34] Lynsey: and sleep disruption is such a widespread experience for new parents. Isn't it. Um, Chiara, I know that you have a lot of thoughts about the cultural norms and narratives that exist around sleep and parenthood. 

[00:01:44] Chiara: Yeah, so I mean We all know that sleep changes drastically once you have a baby, but the social narrative is that that is a normal part of motherhood and that compromising sleep for a prolonged period of time is absolutely fine and just part of motherhood. Um, and then Because it's so ingrained in the cultural norm that sleep disruption is normal, so it's not really something for us to address, it's something to just get on with. 

But there's an increasing recognition that although this is very common, it shouldn't be seen as normal. And actually There can be serious implications to prolonged sleep disruption and sleep deprivation. And there's increasing recognition of how sleep is linked to mental health problems. Which I'm sure we'll go on to talk about a bit more. 

[00:02:26] Lynsey: Yeah, absolutely. So I think most people will agree that sleep is super important. But sleep science is really complicated and I'm always struck by how little we actually understand about sleep. Given how much time we spend doing it. Because it's not just a matter of, you know, you go to bed and your brain switches off. It's a very active process with loads of essential things going on a biological level. So I thought that we could start by getting you to explain some of the basics of sleep physiology to us. And then from there we can go on and think a bit more about how it relates to perinatal mental health.

[00:02:59] Chiara: Yeah, so I think the first thing to do is to really take a step back and realise that although it's something that we all take for granted, that we hopefully all do at least a little bit every day, and most of us will spend about a third of our lives asleep um, it's not a passive process.

It's a very active metabolically regulated process and it's got an enormous impact on every physiological function and psychological function, in your body. 

Um, essentially, when you are asleep, there is a shift in your whole body from the sympathetic nervous system to the parasympathetic nervous system.

[00:03:35] Lynsey: And can you explain what you mean when you say sympathetic or parasympathetic nervous system? 

[00:03:40] Chiara: So, the sympathetic and parasympathetic nervous systems are two components of what we call the autonomic nervous system. So,, they are bodily functions which are, let's say, automatic, that you're not consciously thinking of, and together these two systems regulate. involuntary and reflexive functions of the body. 

So typically the sympathetic nervous system is what we refer to as the fight or flight system. 

[00:04:06] Lynsey: So that's, um, that's the body system that gets activated when there's some sort of threat, right. It's the system that prepares the body to take action. So for example, it makes the heartbeat faster and stronger, and it diverts blood to the organs and muscles that the body needs for intense physical activity. And then in contrast, the parasympathetic system has sort of the opposite effect. 

So how does that work?

[00:04:29] Chiara: Um, so, it's often referred to as the rest and digest function of the body. So it maintains that body's normal environment, drops your heart rate, drops your blood pressure it kind of resets things, um, and it's more active once you're in a state of calm and you're wanting to sleep. So we think about things like cortisol levels, we think about things like insulin resistance, um, all of that gets reset.

Um, the other thing to bear in mind, is that there's a whole system in the brain that clears waste, called the glymphatic system, and it only works when you're asleep. So if you stay awake the whole time, there is quite literally no time for that rubbish to be cleared. 

[00:05:08] Lynsey: Yeah. So there's this substance called adenosine triphosphate or ATP for short. And it's the basic unit of energy for the body. And as you can imagine, the brain uses up a huge amount of ATP over the course of an average day. And then when we sleep our brains replenish that supply of ATP ready for the next day.

[00:05:27] Chiara: Yeah, absolutely, and that process of Consumption of ATP generates a molecule called adenosine, and that is almost like your sleep debt. So adenosine builds and builds and builds and builds, and until you sleep that won't be cleared. 

,and guess what, , inhibits adenosine? 

Coffee. So caffeine will block your receptors and fool your body into thinking that there's no adenosine around, temporarily, but once Your receptors are free again, your body will be hit with the extra adenosine that's all built up in that time. , so you're kind of fooling your body into thinking that you're not sleepy when you are. 

[00:06:00] Lynsey: I should probably mention a conflict of interest here, which is that this podcast is entirely fueled by coffee. 

[00:06:04] Chrissy: was just about to say I feel attacked because I'm sipping my coffee with extra shot here 

I ask a question, Chiara, in terms of the long term issues around sleep deprivation. So, obviously, we think about it in motherhood and, parents with young babies but I'm also thinking about those who are working shift patterns, Any sort of thoughts around that Change in the sleep wake cycle for years on end

[00:06:29] Chiara: I suppose that introduces the concept of a circadian system, so our sleep wake cycle is governed by two processes. So there's process S, which drives your desire to be asleep, and that's the adenosine that we were just talking about. And then there's process C, which drives your desire to be awake, and that's your circadian system.

And essentially there will be a cyclical nature to pretty much every biological function in your body. It's a 24 hour ish cycle of peaks and troughs in wakefulness, and it is influenced by lots of things, but the primary influencing factor in this is light.

[00:07:04] Lynsey: That's right. And I know that this is a bit of an oversimplification, but basically there's a hormone called melatonin that mediates this circadian sleep wake cycle. So during the daytime, when you're exposed to natural light, that light suppresses the production of melatonin in the pineal gland in your brain. But then as the light starts to fade in the evening, your brain will produce more melatonin. 

And that hormone signals to your brain and the rest of your body. That it's time to start preparing for sleep, which is part of what makes us feel drowsy towards the end of the day. So there's a few important points to make around that. 

So firstly, um, this might not surprise you, but newborn babies don't have that cycle of melatonin production in response to light levels. 

 And secondly, since light is the main trigger that controls these circadian systems. We know the artificial sources of light can disrupt that normal sleep, wake pattern. And that's especially true of blue lights and screens, which is why we recommend that people avoid screens and phones before bedtime.

And then thirdly, like you mentioned Chrissy, when people do shift work, this completely disrupts their normal circadian systems. 

[00:08:09] Chiara: And if you do shift pattern, um, you are basically telling your body to do the opposite of what your biological function wants you to do. And the result of that is, once again, this chronic sympathetic overdrive where your heart rate goes up, your blood pressure goes up. And if you do that over a prolonged period of time, we know that that contributes to cardiovascular disease. 

[00:08:30] Lynsey: Yeah, that reminds me about a paper that I saw a few years back in the British medical journal about how to optimize your sleep for night shifts. It was aimed at junior doctors, but I imagine that a lot of the advice in there is useful for anyone who has to switch up their sleep patterns. So, if I can find the paper, I will share it in the show notes for anyone who's interested.

So the other thing I wanted to ask you about Chiara is about what actually happens when we go to sleep. So I know that the phrase sleep architecture often comes up when I'm reading about the different stages of sleep. Could you talk us through what that actually means?

[00:09:03] Chiara: Sure, so sleep architecture is just the term that's used to describe four different stages of sleep that we go through. So adults, have 90 minute cycles of sleep. And within those 90 minutes, you flow through four different stages.

Three of those are non rapid eye movement, NREM sleep. And then one of those is REM rapid eye movement sleep. , and it's really important to bear in mind that each of those. Stages of sleep have very different biological functions. All of them are important for health, but you kind of need to go through one to proceed to the next.

It's a flow of states, one after the other. And as you progress through those 90 minute cycles, the REM component becomes longer and longer. , so if sleep is persistently, broken up or if you're chronically sleep deprived you won't quite get to that part of sleep where you have prolonged parts of REM sleep.

[00:09:56] Chrissy: So Chiara, can I ask the question, if you are woken up during the night, so for example, if you've got a little baby who wakes up every couple of hours or so, does the cycle start over again, or how does that work?

[00:10:08] Chiara: Yeah, the cycle starts over again

[00:10:10] Lynsey: So, I guess what that means is that if your sleep is getting disrupted frequently through the night, you wouldn't be getting as much REM sleep since that's the last stage of the cycle. And then there's lots of other different things that can affect the, um, the flow through these different phases of sleep. 

So, I know for example, the lots of psychiatric medication can affect your sleep architecture. Are there any other things that can change it?

[00:10:32] Chiara: Yeah, so I mean the predominant one is obviously sleep duration. So, If you don't sleep for very long, that will completely change your body's decision as to which part of the sleep cycle to stay in. Uh, but in addition to that, lots of environmental factors like, consumption of alcohol, caffeine, um, hormones have a very Potent effect on sleep architecture. So estrogen and progesterone we know can change it.

That's probably why some women find their sleep changes over the course of their menstrual cycle and similarly sleep architecture changes significantly in pregnancy, not just postpartum. 

[00:11:06] Lynsey: And that brings us very nicely to my next question, which is about what happens to sleep in the perinatal period. 

[00:11:11] Chiara: So, I suppose you don't need to be a doctor or an obstetrician to know that once a baby comes, your sleep will be disturbed. But what often goes unnoticed is that sleep changes drastically even during pregnancy for a variety of reasons. So you have, um. physical changes of pregnancy that means that it is trickier to breathe, to get comfortable.

You'll be waking up to go to the toilet all the time. , so as pregnancy progresses, sleep is increasingly disrupted. We know that oestrogen and progesterone can interfere with your ability to maintain both that non REM and the REM sleep. Um, so very often women already feel sleep deprived or they already feel dissatisfied with their sleep before the baby's even come. 

[00:11:54] Lynsey: Yeah. And as you said, something that tends to get progressively more pronounced over the course of the pregnancy. I saw some fairly recent research about how, probably about three quarters of women will have some level of sleep disturbance in the third trimester. Which means that in many cases before the baby has even arrived, a woman will have accrued a substantial amount of sleep debt. And then it's time for the delivery. So what happens there?

[00:12:16] Chiara: So depending on women's birth plans, you may have quite significant sleep disruption over the course of delivery. So as an example, if you have a prolonged, induction of labour process, you may have several nights that are disturbed, from pain, from just being in a hospital, and, you know, the adrenaline of everything that's going on around you.

And then even once the baby comes, even if everything has gone absolutely fine, you often have this adrenaline Dump, but at the same time rising oxytocin for the excitement of having a new baby, so you've got extreme exhaustion But you're often unable to sleep because you're so stimulated by everything that's going on around you And I'd say that's almost the norm irrespective of timing and mode of delivery

[00:12:59] Lynsey: And then after all that, there's a new baby in the picture. So what happens to seek postnatally?

[00:13:05] Chiara: So, sleep disruption, once there is this new baby, is basically Pretty much universal, um, and There will be disruption not just to how long you're able to sleep for But also to just how much your sleep is fragmented And so going back to what we were talking about your sympathetic nervous system and that Chronic kind of overdrive, um, it's like you're constantly trying to give your body the opportunity to rest, but you're constantly being Jolted up and prohibited from going into that more restful state.

[00:13:36] Chrissy: So yeah, I think, these are really important points. And, you know, we talked a little bit about how the physiological changes in pregnancy can affect sleep. But I also think, of course, there's the other aspect, the emotional changes of being pregnant It's not all kind of sunshine and rainbows. There are, concerns and worries about maybe the health of the baby or their own health, financial worries, practical considerations that can keep them up at night and can affect sleep just as much as those physical changes can. And then again, when the baby's born, there may be disturbed sleep, not just because of the baby waking up through the night. 

But it's the mother that finds herself awake in the early hours of the morning, unable to get back to sleep, there's so many things that come to mind that can affect the sleep. And I think we, as clinicians have to be really careful to not stereotype. Uh, mothers saying, oh, you've got a baby, of course your sleep is going to be disturbed 

 we've talked a bit, Chiara, about sleep deprivation and sleep restriction, but how would you define insomnia and when does sleep deprivation or bad sleep turn into a diagnosis of insomnia? 

[00:14:49] Chiara: hmm. So insomnia has been defined in different ways in the literature. The definition I prefer is the inability to sleep or to maintain sleep, so to stay asleep once you're asleep, despite adequate opportunity to sleep. So someone who is being woken up every two hours by their baby and is exhausted and because they're constantly busy. That's not someone who has insomnia. That is just someone who is sleep deprived because they have a constant stimulus that is preventing them from sleeping. Someone who has insomnia is someone who has adequate opportunity to sleep, uh, they have a window of opportunity in which they can sleep and they physically are unable to.

I think that kind of introduces quite nicely the concept of sleep efficiency, which is so important. It's probably more important from a mental health perspective than how long you sleep for. Essentially, sleep efficiency is the proportion of time you spend in bed where you're actually asleep. Um, so how able are you to use the time available to you to actually sleep?

And I find that that's often a more valuable question when talking to women. Um, so, you know, If you ask someone who's just had a baby, how's your sleep? The vast majority of them will say it's awful, and that'll be the end of the conversation. What's more valuable is asking someone when sleep is available to you so when the baby's asleep, when you have no disruptions, if I give you a five star hotel with a luxury bed, then what happens to your sleep? That is more important, and that will give you more information on what's actually going on for this woman 

[00:16:19] Lynsey: That's a really good way of framing the question Chiara. And that gives us the opportunity to start to unpick what our patients are actually experiencing. So along with trying to understand the sleep efficiency, I always want to know, you know, what's on their mind when they're trying to fall asleep at night

so for example, are they getting stuck in really ruminative anxious thought patterns that are stopping them from falling asleep? Um, I also want to know about whether they're experiencing nightmares, which might be a sign of a post-traumatic stress type illness. And I'd also want to know about early morning waking, which is where people wake up in the early hours of the morning, but then can't fall asleep again, which we often see in depressive illnesses.

[00:16:58] Chrissy: And also women may be waking up intermittently during the night quite frequently, but to the extent that they're setting an alarm to check on the baby every hour of the night, to check that the baby is breathing, to check that , the blanket hasn't gone over their head because they've got this fear, this overwhelming fear of the baby dying in their sleep or being suffocated. And the baby could be sleeping fine. And otherwise you would probably be sleeping fine, but you're actually forcing yourself to wake up or stay alert. With the purpose of checking to see if any accidental harm is coming to your child.

And that's one of the common scenarios in anxiety, but also in obsessive compulsive disorder, which I think it's really important to note can be a new condition that presents in the postnatal period for mothers. You don't have to have had it prior to pregnancy.

[00:17:52] Lynsey: So clearly sleep disturbance can be a symptom of a number of different mental disorders. Like we've mentioned here. But the relationship between sleep and mental illness can be quite complicated at times. Chiara. I know that it's something you described as a bi-directional relationship.

[00:18:06] Chiara: Yeah, so we previously used to think that changes in sleep were just an early symptom of a mental health problem.

But over time, we're recognizing that the relationship is a little bit more nuanced than that. And that in some cases, yes, sleep changes can represent part of a wider mental health problem. but in other circumstances it's the sleep problems themselves that contribute to your risk of developing a psychiatric illness.

And we know that sleep changes can predate mental health problems by quite a significant period of time. So for example, looking at perinatal depression, we know that if , someone has significant insomnia when in early pregnancy, they have three times the odds of then developing a depressive illness, much later in the pregnancy or postnatally.

Um, but also in older studies where they used to sleep deprive people, you can induce new onset mental illness in people who otherwise are well. So it is a complex relationship that goes two ways. 

[00:19:06] Lynsey: Yeah, absolutely. 

So there's increasing recognition that sleep problems in the perinatal period need to be taken seriously. And as you've both mentioned, it's important that we don't just dismiss these symptoms as part of the normal experience of parenthood. I wanted to highlight some of the findings from the UK confidential inquiry into maternal deaths. Um, so for the benefit of our international listeners, I should just explain that in the UK and Ireland, we have an annual detailed case review of all maternal deaths, which occurred during pregnancy and in the first postnatal year. With a view to identifying themes and recurring issues and priorities for service improvements. It looks at all causes of maternal death. Um, and there's always a chapter on death due to psychiatric illness as that's one of the leading causes of maternal deaths. And in the 2022 report, one of the key findings was that for women who had died by suicide, A substantial proportion of them had experienced a marked and enduring sleep disturbance prior to their death. So one of the recommendations that came from that report was that professionals should be alert to sleep disturbance, um, by which I mean severe sleep disturbance, that's not improving with treatment. As an indication that things might be seriously wrong. 

Okay, so Chiara, I know that you're particularly interested in the relationship between sleep and postpartum psychosis. And I should just mention the, if any of our listeners would like some background information about postpartum psychosis, you can check out our previous episode on the topic. Um, chiara. Could you tell us a bit about your research in this area?

[00:20:39] Chiara: Yeah, so outside of the perinatal period, it is well established that sleep loss can be a potent trigger of mania or psychosis for some people who are particularly vulnerable to sleep disruption. In studies of women with postpartum psychosis, by far one of the earliest and most common symptoms is either not needing to sleep or not being able to sleep, which can actually predate the psychotic symptoms or the manic symptoms that then develop. .

So there is a recognized relationship there, it's just not very well understood. In studies of women with bipolar disorder, for instance, they have seen that For women who describe sleep loss as a personal trigger of a manic episode, those women are twice as likely to develop postpartum psychosis than those who are not after having a baby.

So, it's clear that there are some people for whom sleep loss is a particular trigger and some people who for whatever reason might be a little bit less vulnerable to sleep disturbance. and in my research we're looking both at, the average pregnant population, and higher risk women to try and understand in what ways sleep contributes to the development of postpartum psychosis. 

[00:21:49] Chrissy: Such important and great work, Chiara, and I think it was one of our first podcasts we were saying we need more, clinicians getting involved in academic clinical work. And here we have someone who's doing it. So fantastic. 

[00:21:59] Lynsey: So moving onto my next point, I wanted to talk about what we can actually do about sleep disturbance in the perinatal period. Now there is a lot of advice out there for new parents and much of it is completely contradictory and not necessarily based on any science. 

[00:22:14] Chiara: Yeah, so there's, there's several things to juggle here. There are choices around feeding method. And whether or not, say, you sleep train or you don't sleep train. And all of that is intrinsically linked with, you know, the mother's sleep.

So there's, there's lots of pieces of the puzzle here. What I would say in general is stay away from any advice that is extreme and that tells you that something is off. All good or all bad because that's almost always not going to be the case. These decisions are really nuanced and they need to be individualized.

My personal top tip is when trying to make any sort of choice in this realm is just remember that there's more than just one person in this equation. It's not just the baby, the mother. is a human being in her own right. Her well being has enormous impact on the child's well being. And there's often more people in the house as well.

So you need to consider all the different aspects, because all those pieces of the puzzle together will create well being. It's not just about deciding, as an example, I must breastfeed at all costs because that's the best for my baby. It might be, But does that come with costs for you? It may be protective for some people.

It may be harmful for some people. It's all about making , individualized assessments of the situation that consider everyone involved, including the mother. 

[00:23:29] Lynsey: Yeah. And I just add to that, but one of my colleagues. Dr. Alex Bartha has put together a really helpful list of evidence-based sleep tips for new parents, which is something that I've been referring to a lot and sharing with my patients in clinic. It's all really helpful, pragmatic advice that can help to improve or maintain sleep health. And I think what I really liked about it was that you can kind of take the bits that are useful and leave the bits that aren't necessarily useful in your own circumstances. Um, Alex has very kindly given me permission to share his sleep tips. So I'm going to add them to the show notes and onto our social media pages in case anyone wants to take a look.

But sometimes these practical measures aren't enough to improve someone's sleep. So what should we be doing when people still have insomnia, even after they've done everything that they can to improve their sleep routine. 

[00:24:16] Chrissy: Yeah. So one of the important things to think about is treating the underlying mental illness if there is one. Obviously common things are common. So postnatal depression or anxiety or OCD and psychosis may be associated with sleep disturbance.

 it's really worthwhile checking on the symptoms and signs of other things that may be going on and treating that during the perinatal period, um, there is a very good recovery rate in that women can get better quite quickly with adequate support and treatment. 

[00:24:45] Lynsey: Yeah, absolutely. And that makes me think about something that Chiara mentioned earlier before we started recording. Um, when we were talking about some of the challenges around stigma and mental illness . And how sometimes it's easier for people to talk about sleep. So when someone mentions that they're tired or that they're not sleeping well, That should really be sparking our professional curiosity. You know, we shouldn't just take it at face value, but instead we should be trying to explore what that actually means for that person. And whether there are any other symptoms happening alongside the sleep problems. 

[00:25:16] Chiara: No, absolutely, we were talking about how, um, there is so much weight into just one word, and sometimes people will say, I'm tired, but what does tired mean? What does that come with? Is it really just physical exhaustion? What are you trying to tell me? And there is definitely, some evidence that There is less stigma associated with talking about sleep than there is, mental health.

 You may well have women who are more able to talk to you about a sleep problem than a mental health problem. 

[00:25:45] Lynsey: Yeah. So that conversation about mental health is a really good starting point. And we can investigate and treat any mental illnesses that arise that might be having an impact on someone's sleep. We might also want to consider whether there's any physical health issues that are affecting their sleep patterns. For example, lots of women experience transient thyroid problems in the postnatal period, and that can have a substantial impact on sleep. 

But if all of these measures don't work, we might need to consider starting some treatment for insomnia. 

And there are a few different options here. So one option is a type of psychological therapy that we call cognitive behavioral therapy for insomnia or CBT-I for short. 

CBT-I is all about exploring the connection between the ways that we think the things that we do and how we sleep. So during treatment that might involve identifying the thoughts and feelings and behaviors that are all contributing to symptoms of insomnia. So the sessions might include a mixture of cognitive interventions, like a changing, inaccurate, or unhelpful thoughts about sleep. It might involve some behavioral interventions. 

So changing the stimuli before bed time, trying out things like sleep restriction and sleep compression. Um, and then things like developing relaxation techniques to try and establish healthy bedtime habits. And it might also include a component of what we call psycho-education. So providing information about the connections between thoughts and feelings and behaviors and sleep.

It's a really effective treatment. And in most cases, people will see results within sort of six to eight sessions, although that does vary depending on the individual person's needs.

And then I suppose the other treatment that we sometimes consider is medication for insomnia. So there are a few different medications that we can use in the perinatal period. And generally speaking, we prescribed these medications very much in the short term. So for a maximum of one to two weeks, and we use them as a way of resetting sleep patterns and getting someone into a more regular sleep pattern that they can then try and maintain without medication. 

[00:27:42] Chiara: Yeah, so I think As with anything in obstetrics and perinatal mental health, women need to be able to make individualized choices, and medication is not the right option for everybody. Uh, but it's important that people are aware that if they do want something pharmacological to help them sleep, there are safe options, it doesn't make you a bad mother, and it can be compatible with breastfeeding, and with the rest of your life.

[00:28:04] Chrissy: I think also I totally agree with that Chiara and I think one of the other aspects around medication both in pregnancy and in the postnatal period whether you're bottled or breastfeeding is that medicines for sleep generally the classes of medicines that we're thinking about work quite quickly. So for example, if you're going through a particularly bad period of sleep, you might take it for one or two nights.

And then you don't have to carry on taking it if you, if you recover in that sort of sleep deprivation. 

[00:28:34] Lynsey: Yeah. And there's an important caveat when we're prescribing these types of medication. Because obviously the nature of this kind of medication is that it's very sedating. And so it can be difficult for people who are taking it to get up to do baby care during the night. 

So I usually recommend that they have someone with them, whether that's a partner or a family member or friend, who's able to wake up and look after the baby, if it needs care overnight. Just in case it's impossible to get up because the medication is so sedating. And that's another very understandable reason why new mothers might be reluctant to take this medication for insomnia.

[00:29:08] Chiara: Yeah and I find that often there's almost this unspoken guilt where women feel that they can't because they're somehow wronging their baby if they allow themselves a bit too much sleep and You know, I think, again, this isn't for everyone, but it's, it's thinking about the bigger picture and thinking, actually, if I do get, not necessarily that much longer sleep, but better quality sleep, how much better able am I going to be in the daytime to care for my baby without resentment, without anger, without anxiety, without feeling absolutely shattered?

[00:29:39] Chrissy: Yeah, I guess I've been thinking about the last few years with my young children and the sleep deprivation experience on a personal level. And I think just, I know it sounds a bit trite, but things do get better and, um, it may not feel it at the time. 

They say the years go by fast, but the nights are really long. And it may feel like your child would never, ever sleep through the night ever. And this is your life for the rest of your life, but it does get better. And they do eventually get into a settled sleep routine and, um, there is sort of hope at the, end of the tunnel, but at the same time saying that, don't, you know, don't suffer in silence 

[00:30:19] Lynsey: some wise words from you there, Chrissy. And I think that's probably a good place to bring our episode to an end for today.

[00:30:25] Chrissy: So thank you everyone for listening to Beyond Baby Blues podcast. 

[00:30:29] Lynsey: Yeah. And a massive thank you to Chiara for joining us today and explaining it all so beautifully. And thanks also to the Royal college of psychiatrists, perinatal faculty, for all of their support with the podcast.

[00:30:40] Chrissy: You can now follow us on Instagram at Beyond Baby Blues. We also have a Twitter page at Beyond Baby Blues, and you're able to stream and download this podcast wherever you get your podcasts. 

[00:30:53] Lynsey: And if you're enjoying what we've done so far, you can help us get it out to a wider audience by subscribing sharing and putting ratings and reviews on your podcast platform. It all helps.