Night time breastfeeding and maternal mental health

From Science & Sensibility

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Nighttime Breastfeeding and Maternal Mental Health
August 1st, 2010 by Kathleen Kendall-Tackett
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Leave a comment [Editor's Note: This is the first post from our new regular contributor, Kathleen Kendall-Tackett, Ph.D., IBCLC. Kathleen writes about breastfeeding, perinatal/postpartum mental health, and psychoneuroimmunology (PNI). She writes on her site, Uppity Science Chick, "Few fields of study are more exciting (than PNI), and they touch a wide range of seemingly unrelated topics: trauma and health; breastfeeding; postpartum depression. PNI studies help us understand risk factors for chronic disease and can teach us all how to live healthier lives." I'm very excited to welcome her here so we can all take part in these breath-taking discoveries. - AMR]

There is a movement afoot in childbirth education and perinatal health urging mothers to avoid nighttime breastfeeding to decrease their risk for postpartum depression. We know that if mothers follow this advice, it will have a negative impact on breastfeeding. But let’s put that issue aside for the moment and consider whether avoiding nighttime breastfeeding will preserve women’s mental health by allowing them to get more sleep. In short, is this good advice?

At first glance, it may seem to be. Since breast milk is lower in fat and protein than formula, we might assume that breastfeeding mothers sleep less than their formula-feeding counterparts. And when a mother’s mental health is at stake, avoiding nighttime breastfeeding might be worth the risk. However, recent research has revealed the opposite: that breastfeeding mothers actually get more sleep—particularly when the baby was in proximity to the mother. And that has major implications for their mental health. So if you want one more good reason for mothers to exclusively breastfeed their babies, here it is.

Breastfeeding Mothers Get More Sleep

In a study of 33 mothers at 4 weeks postpartum, Quillin and Glenn (2004) found that mothers who were breastfeeding slept more than mothers who were bottle-feeding. Data were collected via questionnaire that recorded 5 days of mother and newborn sleep. When comparing whether bedsharing made a difference in total sleep, they found that bedsharing, breastfeeding mothers got the most sleep and breastfeeding mothers who were not bedsharing got the least amount of sleep. Mothers who were bottle-feeding got the same amount of sleep whether their babies were with them or in another room.

Sleep patterns of 72 couples were compared from pregnancy to the first month postpartum via sleep diaries and wrist actigraphy (Gay et al., 2004). Most of the mothers were at least partially breastfeeding (94%) and 80% were exclusively breastfeeding. Most of the babies slept in their parents’ room and 51% regularly slept in their parents’ beds. Sleep and fatigue outcomes were not associated with type of birth, parent-infant bedsharing, or baby’s age. Mothers who were exclusively breastfeeding had a greater number of nighttime wakings (30 vs. 24) compared with mothers who are not breastfeeding exclusively. The exclusively breastfeeding mothers slept approximately 20 minutes longer than mothers not exclusively breastfeeding.

In a study of mothers and fathers at three months postpartum, data were collected via wrist actigraphy and using sleep diaries (Doan et al., 2007). The study compared sleep of exclusively breastfed infants vs. those supplemented with formula. In this sample, 67% were fed exclusively with breast milk, 23% were fed a combination of breast milk and formula, and 10% were exclusively formula fed. Mothers who exclusively breastfed slept an average of 40 minutes longer than mothers who supplemented. Parents of infants who were breastfed during the night slept an average of 40 to 45 minutes more than parents of infants given formula. Parents of formula-fed infants had more sleep disturbances. They concluded that parents who are supplementing with formula under the assumption that they are going to get more sleep should be encouraged to breastfeed so they will get an extra 30-45 minutes of sleep per night.

Not only do breastfeeding mothers get more sleep, but the sleep they get is of better quality. This study compared 12 exclusively breastfeeding women, 12 age-matched control women, and 7 women who were exclusively bottlefeeding (Blyton et al., 2002). They found that total sleep time and REM sleep time were similar in the three groups of women. The marked difference between the groups was in the amount of slow-wave sleep (SWS). The breastfeeding mothers got an average of 182 minutes of SWS. Women in the control group had an average of 86 minutes. And the exclusively bottle-feeding women had an average of 63 minutes. Among the breastfeeding women, there was a compensatory reduction in light, non-REM sleep. Slow-wave sleep is an important marker of sleep quality, and those with a lower percentage of slow-wave sleep report more daytime fatigue.

The most recent study was published in the journal Sleep, a major sleep-medicine journal not necessarily known for their support of breastfeeding. This was a study of 2,830 women at 7 weeks postpartum (Dorheim et al., 2009). They found that disrupted sleep was a major risk factor for postpartum depression. But here is where it really gets interesting. When considering what disrupted sleep, they found that the following factors were related to disturbed sleep: depression, previous sleep problems, being a first-time mother, a younger or male infant, and not exclusively breastfeeding. In other words, mothers who were not exclusively breastfeeding had more disrupted sleep and a higher risk of depression.

Conclusions

The results of these previous studies are remarkably consistent. Breastfeeding mothers are less tired and get more sleep than their formula- or mixed-feeding counterparts. And this lowers their risk for depression. Doan and colleagues noted the following.

Using supplementation as a coping strategy for minimizing sleep loss can actually be detrimental because of its impact on prolactin hormone production and secretion. Maintenance of breastfeeding as well as deep restorative sleep stages may be greatly compromised for new mothers who cope with infant feedings by supplementing in an effort to get more sleep time. (p. 201)

In sum, advising women to avoid nighttime breastfeeding to lessen their risk of depression is not medically sound. In fact, if women follow this advice, it may actually increase their risk of depression.

References:

Blyton, D. M., Sullivan, C. E., & Edwards, N. (2002). Lactation is associated with an increase in slow-wave sleep in women. Journal of Sleep Research, 11(4), 297-303.

Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breastfeeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing, 21(3), 200-206.

Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847-855.

Gay, C. L., Lee, K. A., & Lee, S.-Y. (2004). Sleep patterns and fatigue in new mothers and fathers. Biological Nursing Research, 5(4), 311-318.

Quillin, S. I. M., & Glenn, L. L. (2004). Interaction between feeding method and co-sleeping on maternal-newborn sleep. Journal of Obstetric, Gynecologic and Neonatal Nursing, 33(5), 580-588.

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I found this interesting, given that there is common advice that bottle feeding will reduce the number of night time feeds.

REALLY??????????? I find this hard to believe. I mean.. FF babies generally sleep longer.. so doesn't that counteract all this evidence?? Or is that BF mums fall asleep easier instead of lying awake waiting for bub to wake again? And isn't part of the benefits of FF that Daddy can do a night waking once in a while?

The FF = more sleep is a bit of a myth turtleschell. Yes, it is some mother's experience, but not all by any means and there are plenty of breastfed babies that sleep through the night from very young ages also.
Breastfeeding does release hormones that promote sleep, so that could be one reason why exclusive breastfeeders get more sleep even with more wakups on average. I would guess that stuffing around with bottles would tend to wake you up more than just popping a boob out.

I think some mums find getting dad to do feeds during the night helps, but a lot just end up doing all the work anyway :dunno: Everyone's experience is different of course.

I think a lot of is from the sleepy hormones putting you straight back to sleep afterwards. Also, breastfeeding mums who are sleeping close to their babies will sync their sleep cycles so you will mostly only wake from a light sleep each time which is less tiring and easier to go back to sleep after. And of course co-sleeping mums can often feed without really waking up at all. And also that not all ff babies sleep longer I guess. Interesting, isn't it!

It's all about horses for courses. I find it easy to sleep even though DS2 wakes for a feed at least 4 hourly (sometimes more). I just fall back asleep and so does he and it's pretty relaxed. That's what suits me (and DS and DH too!) DS2 is still in with me, so no one really wakes up fully. I do get less sleep than I'd like - but for me, bf is one of the things helping me with post-partum hormones as it truely does make me feel good.
I do know that lack of sleep really does alter your mood and we do need to be careful. For some mums bottle feeding might be the answer - the other parent can do a night feed to ensure more sleep for the mum. But it's incorrect to assume that supplementary feeding and 8 hours sleep will always mean a happier mum or parents.

I get drowsy during the night feeds from BF hormones, but once I get out of bed to put DD back into her cot I get wide awake and alert and stay awake for about 30mins. Mann I wish we could cosleep. I think it's the cold air on my legs that wakes me up!

Wow, I'm going to show that to my mum (who is convinced that co-sleeping is the worst thing in the world second to breastfeeding).
I exclusively breastfeed and we co-sleep and I am getting more sleep than a lot of my friends who are both breastfeeding and formula feeding yet don't co-sleep.
I couldn't tell you how many times my little one wakes of a night as half the time I am half asleep, as is she!! It's awesome! We tried her in the cot for a few nights but we both found it too disruptive compared with what we were used to. She starts the night off in her cot and then after she wakes for her first feed, she is in with us!

I have my moments but overall, I'd say my mental health is pretty good!!


This is a really interesting article, thanks for sharing!!
Sue xx

I BFed and co-slept and was an over-tired mess!! I'm sure I would have been much better off sleep wise with my H getting up to do at least one feed in the night :lol:

I didn't find it easy to go back to sleep. It took a long time till I learnt how to go to sleep quickly. For ages I would feed for about an hour, then lie down awake for an hour then be up feeding again. I was shattered. My son and I never mastered feeding lying down- first we couldn't seem to get attachment to work then he just refused to even try so I would feed him him sitting up in bed, or sitting on a chair so my back didn't get as sore.

At the moment, we put the lump in his bed at about 10 or 11, he wakes up at about 3 or 4, I pop him in bed with me and promptly go back to sleep. Today I woke up at 7am with a boob out, a blissfully sleeping baby next to the boob (he seems to really like sleeping either on boobies or with a nipple practically up his nose) and reasonably refreshed.

A lot of it rides on falling back to sleep when you're feeding, I think. I was doing this with DD#1 as well. DD#2 was a non-sleeping screamer from hell so cosleeping would have only worked wearing armour and earmuffs.

I can readily believe it at 4 or 7 weeks postpartum, but I'd like to see what they'd find at 3-9 months postpartum. Especially as 3-4 months post partum is when most PND really gets going.

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The FF = more sleep is a bit of a myth turtleschell. Yes, it is some mother's experience, but not all by any means and there are plenty of breastfed babies that sleep through the night from very young ages also.
Breastfeeding does release hormones that promote sleep, so that could be one reason why exclusive breastfeeders get more sleep even with more wakups on average. I would guess that stuffing around with bottles would tend to wake you up more than just popping a boob out.

I think some mums find getting dad to do feeds during the night helps, but a lot just end up doing all the work anyway :dunno: Everyone's experience is different of course.

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My son was a FF bubba from week 2 and he woke every 3.5 hours around the clock for feeds until an older age.

My daughter is BF and she is the best sleeper - only waking once overnight for a feed (20 minutes both sides) and is gaining weight faster

So it isn't accurate that FF bubs sleep more in my experience

how interesting...
DS is fully BF, but sleeps in his own cot. DH is a heavy sleeper and if he were to roll on him, he wouldn't wake up I don't think. So for Jacksons own safety he's in his own cot!
I find that I'm able to doze in the recliner while I feed him and then once I get back to my own bed I'm out like a light ><;; DS used to sleep thru until he started teething, but we're slowly getting that under contol and he's only wake up once at night for a comfort feed, and we're both generally back to bed within 10 minutes *touch wood* - watch me jinx myself ladies!!
As for dads getting up to FF to give mum a break. Not a fan. However, my DH drives large machinery for work and I'd rather myself be sleep deprived than for him to kill himself or someone else because he is.

I was breastfed and slept through from 3.5 weeks, which is unusually (and perhaps worrisomely) early for any baby.

I now feel validated for co-sleeping and bfing - I'm the only one doing this in my Mum's Group and I felt a bit guilty about seemingly looking more rested than everyone else. I try very hard to show humility when someone asks how I'm sleeping ("yeah, really good" is my response) but it can't help but come across as smug. :redface:

Lying down when you're likely to fall asleep is IMHO much safer than sitting up. You can't drop a baby when you're both lying down.

I exclusively BF and we co-sleep, but I am not getting a lot of sleep. I suspect I would get a lot more sleep if DD wasn't breastfeeding and didn't use me to resettle. She wakes generally every hour at night and my mental health is suffering. It is not easy to get back to sleep after she has woken me up and I find myself lying awake until she wakes up next. I feel absent minded and stupid all the time, snap at the kids for minor things and to be completely honest I am finding it hard to form any sort of bond with DD - whenever I look at her all I see is a barrier to sleep - she is sucking the life out of me!

I felt the same Artechim. I really hope it improves for you soon, or you find some good solutions or support. I can't say I did really... "this too shall pass" was our answer.

Interesting thread!! Elf, we are similar to you - co-sleep from about 1am til about 6 or 7am... but I don't know that it is great sleep that I get when DS is lying there???

I was reading parts of this out to DH and he commented about me feeding at night in bed and how the article states that bf, co-sleeping mums get the most and best sleep, he said "So this is as good as its going to get for you??" LOL... I don't think I get a great deal of quality sleep.

Maybe I will adjust - we've only been doing this for 5wks after all. DD never really fed to sleep so it never really worked with her. I can't really be bothered trying to force DS to go back to sleep in his cradle after he feeds, he settles so much easier when he's next to me... funny that ;)

Ocean - yeah, when DS is in the bed I tend to stay in one position (sometimes a bad one and I wake up with a dead arm or leg) and sleep a lot lighter, I try and put him back in his bed as often as possible so I can spread out. But he's not even 6 weeks old and he's improving every day, so I'll regain the bed soon enough - he used to feed every 2 hours so waking up once at night is an infinite improvement!