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Desperately Seeking Sleep

The first night home after my twins were born was utterly exhilarating. The quiet intimacy of nursing my children made that first round of night feedings more magical than taxing. When morning rolled around, I realized I hadn't slept for more than a half hour at a time, but with my husband's help I managed to squeeze in a nap the next day, and I told myself that I was ready for another nonstop night.

Needless to say, the second night was harder than the first. By the fourth night it was hard to get up when I heard the cries, and after two weeks I was in tears every night myself. The well-wishers had gone home, the presents had stopped coming, my husband had gone back to work, and I was completely alone. It was the most exciting time in my life  -- and I had never felt worse.

The list of things no one tells you before you become a mother is fairly exhaustive  -- in part because nature arranges for us to forget the hardest parts so that we'll remain open to the prospect of doing it all again; in part because experienced mothers know that if they told the whole, unadulterated truth, it might well mean the end of the species. But for me, no part of new motherhood was as shocking, as overwhelming, as the cumulative impact of sleep loss.

Some days I was so wiped out that I feared I would be unable to meet my babies' needs  -- much less do anything besides that. Many more days, I mourned the fact that I was simply too tired to enjoy a time I had so looked forward to.

The lowest point came when I nearly stepped in front of a bus; because I was so disoriented, I looked in the wrong direction crossing the street. My husband marks it differently: For him, the darkest moment came around four one morning, when he watched me pound the bed with my fists and scream "no, no, no" as my son refused to go back to sleep after nearly an hour of nursing and rocking.

My babies didn't start sleeping through the night until they were almost 7 months old. By then, my exhaustion had come to feel like a chronic illness  -- something that would always be with me, that might be dealt with, managed, but never cured. But complaining or asking for help seemed pointless. After all, didn't everyone go through this?

Nell Bernstein is a freelance writer and mother of two in Berkeley, CA, who frequently covers children's issues.

A Wake-Up Call

Yes, just about everyone goes through this  -- but that doesn't mean it should be ignored or dismissed. "One of the biggest challenges and surprises to new parents is the impact of sleep deprivation," confirms Jodi Mindell, Ph.D., associate director of the Sleep Disorders Center at Children's Hospital of Philadelphia and author of Sleeping Through the Night. "Whenever I talk to groups of physicians or medical students who aren't parents, they say 'What's the problem?' They find it difficult to understand why a newborn who sleeps 16 to 20 hours a day would be so disruptive to a family. But as adults, what we need is uninterrupted, prolonged sleep. Even if you're lucky enough to get your eight hours, if it's interrupted frequently throughout the night, then it's not high quality rest."

What makes the sleep loss that comes with new parenthood particularly challenging is that, unlike an all-nighter for work or a bout of insomnia, it often stretches on for months. "Adults can typically tolerate one or two nights of sleep loss," Mindell says, "but when you get chronic sleep debt, it gets more and more difficult. Your memory, reaction time, decision-making, and creativity are all impacted." The most powerful effect may be on what researchers call "emotional regulation." In layperson's terms, Mindell explains, this means that it's a lot harder for a person to keep it together. For a new mother, this feeling is compounded by the fact that her hormones are fluctuating. "No wonder new parents are more likely to be tearful or to fight with their partner," says Mindell. She adds that she sees many couples who argue bitterly over how to handle their infant's sleep issues, disputes that are often triggered by the parents' frustration over their own sleep loss. "I jokingly tell parents, 'Don't consider divorce yet. Wait until you're getting more sleep yourselves.'"

Sleep deprivation may be connected to health conditions such as postpartum depression as well. The symptoms of both, Mindell notes, are nearly identical: irritability, moodiness, and not feeling like yourself. This correlation may start even before the baby is born. Amy R. Wolfson, Ph.D., associate professor of psychology at the College of Holy Cross in Worcester, MA, and author of The Woman's Book of Sleep, recently tracked a group of women from their third trimester through 13 months postpartum. The women who had the most difficulty with sleep late in their pregnancies, she found, reported higher levels of depressed moods throughout their baby's first year. That shouldn't be surprising, she says. "If you're chronically sleep-deprived going into the postpartum months, and then your sleep is further disrupted, there's more risk of mood disorders striking."

Accidents also increase as sleep loss accumulates. The sleep-deprived, says Mindell, are likely to cut themselves or trip and fall. The greatest risk may come from driving while sleepy  -- especially when it's compounded by the distraction of a crying baby in the backseat. "Driving drowsy is like driving drunk," says Stephanie Faul of the AAA Foundation for Traffic Safety. In 1997, researchers at the Centre for Sleep Research at the University of South Australia released the results of a study that proved exactly that. Forty subjects performed a test designed to measure psychomotor performance  -- once after they had been given a potent mixture of alcohol and orange juice, and once after they had been kept awake for a sustained period. After 18 hours awake, their performance was the same as when their blood alcohol level was .05 percent, the same as after a woman has about two stiff drinks. After 24 hours, impairment almost doubled, to the equivalent of being legally drunk in most states.

"You cannot control your sleep," cautions Faul. Military studies of soldiers who suffered extreme sleep deprivation found that they literally fell asleep between steps. "Sleep is like food and water," explains Faul. "If your body needs it, it will try to get it somehow."

The Night Shift

First-time mothers, who have less experience in managing both their infants' sleep and their own, may be hardest hit. Kathryn Lee, R.N., Ph.D., a professor of nursing at the University of California at San Francisco, studied the sleep patterns of new and experienced mothers. First-time mothers, she found, experienced significantly more disturbed sleep and were more fatigued at one month postpartum. The reason for this, says Lee, is that the experienced mothers fed, diapered, and got their babies back to sleep faster, so they got more sleep themselves. While first-time moms spent an average of 28 percent of the night awake, veteran moms whittled it down to 15 percent.

Experienced mothers also appeared to get proportionally more deep sleep (the restorative state) in the early postpartum months than first-time moms did. When Lee compared rates of deep sleep in both groups to their rates before they got pregnant, she found that experienced mothers spent more time in this restorative sleep phase than rookie moms, for reasons that aren't clear. Rates of deep sleep between the groups evened out when the babies were 3 months old.

Thankfully, both groups appear to get a boost from breastfeeding, adds Lee. Research indicates that prolactin, which is present in high levels in breastfeeding mothers, may foster deep sleep, helping them squeeze out more benefits from their time in bed.

Dreaming Of Sleep

While most babies start sleeping through the night by 6 months of age, it doesn't always follow that parents do the same. Parents usually settle into a more regular sleep pattern a few weeks later, says Mindell, but that doesn't mean a return to the blissful slumber they remember from their pre-child days.When the National Sleep Foundation questioned 1,004 adults about their sleep habits for its 2001 Sleep in America poll, those with children reported that they slept less during the week, had more daytime sleepiness, and more frequent insomnia than those without. In fact, 76 percent of adults with children under 18 reported frequent sleep problems.

For most parents, time eases the pain of sleepless nights. Babies  -- and the tiny bellies that make night feedings necessary  -- grow faster than you can imagine, and early months soon become a bleary-eyed memory. "Would we be better parents, spouses, workers if we were getting more sleep?" asks Mindell. "Absolutely. But we get through it. We're quite resilient and we function." In the meantime, taking your own sleep needs as seriously as you take your baby's will help make everyone happier.

Smart Sleep Solutions

As a new mother you'll go to any extreme to protect your infant's sleep  --banishing the dog, hushing your husband, pacing the floor for hours with your baby in your arms. But are you taking your own sleep seriously? Before exhaustion overwhelms you, fight for your own right to rest. Here, solutions to help save your sanity.

[BOLD {Pump it up}]
If you're nursing exclusively, you'll likely find yourself bearing the brunt of night duty. In this situation, a breast pump (which you can rent or buy) can be invaluable, allowing you to work out a nighttime shift system with your partner to maximize sleep for both of you.

[BOLD {Work out a shift system}]
Even if your husband has gone back to work, talk with him about doing his share at night  --after all, taking care of a baby is hard work too. For example, a nursing mother could pump a bottle of milk and then go to bed at 9:00 p.m. Dad gives the baby the bottle the first time he wakes, and Mom is on duty the second half of the night. That way each parent gets a solid five- or six-hour stretch of sleep each night, plus a few interrupted hours.

[BOLD {Ask for night help}]
When people ask you how they can lend a hand, take them at their word. While spending a night with your baby may seem a lot to ask, most people can weather a single night of sleep deprivation without too much trouble. And they'll take pleasure in knowing they've given you something a lot more valuable than another casserole or pair of footed pajamas.

[BOLD {Turn visitors into nap nannies}]
If an overnight stay seems too much to ask, consider asking visitors to watch the baby for a couple of hours so you can take a nap. Even if the baby is napping too, you'll sleep better knowing someone else is on call. Another option: Have a babysitter come early in the morning before Dad leaves for work. For example, if Dad takes the 6:00 a.m. feeding, and the sitter arrives at 8:00 a.m., you get to sleep from 5:00 a.m. until noon.

[BOLD {Let Momcome to visit}]
If your parents or in-laws offer to come stay for an extended visit, say yes. Have Mom do one of the late-night or early-morning feedings to ensure your rest. This may be the one time in your life when you're nothing but glad to have your mother-in-law come visit!

[BOLD {Hire a night nurse}]
A night nurse will come to your house and take full responsibility for after-hours care  --feeding, changing, and soothing your baby while you get some much-needed sleep. Even if you are breastfeeding exclusively, a night nurse can greatly reduce your time awake by bringing the baby to you and putting her back down once she's finished her midnight meal or by feeding the baby bottles of pumped breast milk. Night nurses are expensive (sometimes running upwards of $20 an hour), but even if you can't afford one on a regular basis, bringing someone in for a few nights when you are at the end of your rope may make all the difference. To find a night nurse in your area, contact the National Association of Child Care and Referral Agencies at 800/424-2246, or visit its website at www.childcareaware.org

[BOLD {Consider night care}]
Some childcare centers are open around the clock. While most cater to shift workers who work nights on a regular basis, they may have openings for the occasional emergency  --like a mother who is about to collapse from sleep deprivation. To find childcare in your area, try the National Association of Child Care and Referral Agencies.

[BOLD {Take a sleep vacation}]
New parents are often advised to make time for romantic getaways to keep the flame alive during the transition to parenthood. That's great, but if you're lucky enough to have friends or relatives who can take your baby for a night or a weekend, you may want to hold off on that tryst with your husband and try a "sleep-in" instead. Consider treating yourself to a hotel room and putting up the "Do Not Disturb" sign.

[BOLD {Turn off the monitor}]
If your baby really needs you, he'll let you know. In the meantime, lying awake listening to every flutter and murmur on the intercom can be counterproductive.

[BOLD {Start sleep training}]
While it's unrealistic to expect your baby to sleep through the night before 3 to 6 months, it's never too early to start good sleep habits. Learn about the different methods of sleep training to find one that's right for your family. Two helpful books: [ITALIC {Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby,}] by Tracy Hogg, and [ITALIC {Sleeping Through the Night: How Infants, Toddlers and Their Parents Can Get a Good Night's Sleep,}] by Jodi Mindell, Ph.D.

[BOLD {Practice good sleep hygiene}]
Even the most exhausted mother may have a hard time dropping off to sleep when her mind is racing from a nonstop day of childcare. Practicing basic "sleep hygiene" techniques can help ward off frustrating postpartum insomnia. Keep your bedroom dark and quiet; don't use your bed for working or watching television; schedule exercise, like a brisk walk with your baby, for the late afternoon; and try taking a warm bath a couple of hours before bedtime.

[BOLD {Talk to your doctor}]
Even after a baby is sleeping through the night, it takes most parents two to four weeks to break their own night-waking habit and start sleeping well themselves. If you're still having trouble sleeping after a month or so, a thorough checkup can rule out a medical cause such as thyroid problems, which are common in the postpartum months. Your doctor can also refer you to a therapist who can help determine whether your sleep loss is due to hormonally driven postpartum depression, sleep deprivation, or both.

[BOLD {See a sleep specialist}]
If you just can't bounce back from the disruptions a baby has made to your schedule and your biorhythms, consider seeing a sleep specialist to help you get back on track. The American Academy of Sleep Medicine can help you find an accredited sleep center in your area (507/287-6006; www.aasmnet.org

[BOLD {Avoid driving drowsy}]
If you absolutely must drive after a rough night, take a nap before you get behind the wheel (even 20 minutes can make a significant difference). According to the AAA Foundation for Traffic Safety, many sleep-related crashes occur during the afternoon hours, when most people experience a natural drop in alertness, so schedule errands that call for the car in the morning hours. To learn more about sleep contact the National Sleep Foundation at 202/347-3471, or visit www.sleepfoundation.org

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