Changes in sleep patterns and depressive symptoms in first-time mothers: last trimester to 1-year postpartum
Abstract
Thirty-eight 1st-time mothers were recruited from childbirth classes and were assessed at 4 different time periods: the last trimester of pregnancy, 2-4 weeks postpartum, 12-16 weeks postpartum, and 12-15 months postpartum. Measures included a daily sleep-wake diary and a depression scale (Center for Epidemiological Studies Depression Scale, CES-D). Results reveal significant differences in week-day night sleep schedules (rise time, time awake due to disruptions, and nap time) at 2-4 weeks postpartum in comparison to other times of measurement. Total sleep time and bedtime was not significantly different between times of measurement. More depressive symptoms were reported at 2-4 weeks postpartum than at later postpartum measurements. Mothers who developed clinically elevated depressive symptoms (CES-D > or = 16) at 2-4 weeks postpartum reported more total sleep time, later rise times, and more time napping at the end of pregnancy in comparison to those mothers that reported fewer depressive symptoms (CES-D < 16) at 2-4 weeks postpartum.
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Several prospective studies document the relationship between sleep disturbance during pregnancy and subsequent reports of depressive symptoms at a later time among perinatal women.
“Several prospective studies document the relationship between sleep disturbance during pregnancy and subsequent reports of depressive symptoms at a later time among perinatal women (later in pregnancy [81] or in the early postpartum period [79,82,83]).”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [79]
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“Previous studies have shown that sleep problems during pregnancy are associated with an increased risk of depression both during pregnancy and postpartum [65,66].”
LeCheminant, J. D., Hinman, T. K., Pratt, K. B., Earl, N. R., Bailey, B. W., Thackeray, R., & Tucker, L. A. (2012) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/j.1600-0838.2012.01490.x · Cited by 48 · see citing works
“Furthermore, the sensitivity and specificity of the CES-D is 60% and 92%, respectively (Campbell & Cohn, 1991), and has been previously used in a postpartum population (Wolfson et al., 2003; Surkan et al., 2012; Tandon et al., 2012).”
MethodAre effects from a brief multiple behavior intervention for college students sustained over time?
Werch, C. E., Moore, M., Bian, H., DiClemente, C. C., Huang, I., Ames, S. C., Thombs, D. L., Weiler, R. M., & Pokorny, S. B. (2009) · Preventive Medicine · doi:10.1016/j.ypmed.2009.12.010 · Cited by 46 · see citing works
“Sleep was measured by assessing the number of hours usually slept each night during the past 30 days, and ranged from: 1=5 or fewer hours, 2=6 h, to 5=9 or more hours (Groeger et al., 2004; Wolfson et al., 2003).”
MethodXie, M., Wang, X., Zhang, J., & Wang, Y. (2021) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13575 · Cited by 44 · see citing works
Factors Associated with Clinically Significant Insomnia Among Pregnant Low-Income Latinas
Manber, R., Steidtmann, D. K., Chambers, A. S., Ganger, W. C., Horwitz, S. M., & Connelly, C. D. (2013) · Journal of Women s Health · doi:10.1089/jwh.2012.4039 · Cited by 43 · see citing works
Allison, K. C., Wrotniak, B. H., Paré, E., & Sarwer, D. B. (2012) · Obstetrics and Gynecology International · doi:10.1155/2012/878607 · Cited by 42 · see citing works
Disturbed dreaming during the third trimester of pregnancy
Lara-Carrasco, J., Simard, V., Saint‐Onge, K., Lamoureux-Tremblay, V., & Nielsen, T. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.01.026 · Cited by 38 · see citing works
“Whereas DD constitute a substantial sleep disturbance in frequent nightmare sufferers [19–21], sleep disturbances in turn predict adverse maternal and fetal outcomes, such as postnatal depression, preterm birth, lower birth weight, and longer labour durations [22–28].”
BackgroundRosenberg, J. M., Kapp-Simon, K., Starr, J., Cradock, M., & Speltz, M. L. (2010) · The Cleft Palate-Craniofacial Journal · doi:10.1597/09-210 · Cited by 39 · see citing works
“It is possible that, in particular, the Depression and Health subscale differences between mothers and fathers in this study are related to the depressive symptomatology, sleep disturbance, and other psychological and emotional difficulties experienced by many new mothers in the first few weeks or months of the postpa…”
Ladyman, C., & Signal, T. L. (2018) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2018.04.004 · Cited by 38 · see citing works
Sleep Disturbances and Symptoms of Depression and Daytime Sleepiness in Pregnant Women
Tsai, S., Lin, J., Wu, W., Lee, C., & Lee, P. (2016) · Birth · doi:10.1111/birt.12215 · Cited by 38 · see citing works
“These results were in line with those found in prior studies of pregnant women examining sleep and depression (2,6,28).”
BackgroundResultBrief integrative multiple behavior intervention effects and mediators for adolescents
Werch, C. E., Bian, H., Carlson, J. M., Moore, M., DiClemente, C. C., Huang, I., Ames, S. C., Thombs, D. L., Weiler, R. M., & Pokorny, S. B. (2010) · Journal of Behavioral Medicine · doi:10.1007/s10865-010-9281-9 · Cited by 37 · see citing works
“These items were adopted from previous research on sleep patterns (Groeger et al. 2004; Wolfson et al. 2003 ).”
Cognitive Behavioral Therapy for Insomnia and Women's Health
Nowakowski, S., & Meers, J. M. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.01.002 · Cited by 37 · see citing works
Stremler, R., McMurray, J., & Brennenstuhl, S. (2019) · Behavioral Sleep Medicine · doi:10.1080/15402002.2019.1601629 · Cited by 35 · see citing works
Sarberg, M., Bladh, M. K., Svanborg, E., & Josefsson, A. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-0917-9 · Cited by 36 · see citing works
“A few studies have also explored the relationship between PPD and sleep during pregnancy, but they report diverging results and use different methods for measuring sleep associated factors [21–25].”
ResultBipolar affective disorder in the postnatal period: investigating the role of sleep
Bilszta, J. L. C., Meyer, D., & Buist, A. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00845.x · Cited by 34 · see citing works
Connolly, C. P., Feltz, D. L., & Pivarnik, J. M. (2014) · Kinesiology Review · doi:10.1123/kr.2013-0009 · Cited by 34 · see citing works
Habitual snoring and depressive symptoms during pregnancy
O'Brien, L. M., Owusu, J. T., & Swanson, L. M. (2013) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-13-113 · Cited by 32 · see citing works
“In recent years several studies have shown a relationship between poor sleep and depressive symptoms in pregnant and postpartum women [9-11,14,30-32].”
BackgroundMaternal subjective sleep quality and nighttime infant care
Gress‐Smith, J. L., Chambers, A. S., Ong, J. C., Tikotzky, L., Okada, R. L., & Manber, R. (2010) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646831003727918 · Cited by 29 · see citing works
“For example, studies that used sleep diaries, as the present study did, did not find an association between infant care-taking or maternal sleep, and maternal depression during the first postpartum year (Dorheim et al., 2009; Goyal et al. 2007; Wolfson et al., 2003).”
ResultTaveras, E. M., Rifas‐Shiman, S. L., Rich-Edwards, J. W., & Mantzoros, C. S. (2010) · Metabolism · doi:10.1016/j.metabol.2010.09.008 · Cited by 28 · see citing works
Pregnancy and the Postpartum Period
Wolfson, A. R., & Lee, K. A. (2005) · Elsevier eBooks · doi:10.1016/b0-72-160797-7/50116-6 · Cited by 29 · see citing works
Postpartum Period and Early Motherhood
Stremler, R., Sharkey, K. M., & Wolfson, A. R. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00158-6 · Cited by 26 · see citing works
Sleep, daily activity rhythms and postpartum mood: A longitudinal study across the perinatal period
Krawczak, E. M., Minuzzi, L., Simpson, W. S., Hidalgo, M. P. L., & Frey, B. N. (2016) · Chronobiology International · doi:10.3109/07420528.2016.1167077 · Cited by 26 · see citing works
“For instance, studies comparing depressed and nondepressed women in the postpartum period have shown those with depression have worse self-reported sleep (Huang et al., 2004; Wolfson et al., 2003).”
Shaun, M. M. A., Nizum, M. W. R., Shuvo, M. A., Fayeza, F., Faruk, M. O., Alam, M. F., Ahmed, M. S., Zaman, S., Mali, S. K., & Hawlader, M. D. H. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03839-w · Cited by 24 · see citing works
Restless legs syndrome and pregnancy in Kayseri, Turkey: A hospital based survey
İsmailoğulları, S., Öztürk, A., Mazıcıoğlu, M. M., Serin, S., Gültekin, M., & Aksu, M. (2010) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2010.00437.x · Cited by 23 · see citing works
Kempler, L., Sharpe, L., Marshall, N. S., & Bartlett, D. J. (2020) · SLEEP · doi:10.1093/sleep/zsaa101 · Cited by 21 · see citing works
Timing and variability of postpartum sleep in relation to daytime performance
McBean, A. L., & Montgomery‐Downs, H. E. (2013) · Physiology & Behavior · doi:10.1016/j.physbeh.2013.09.003 · Cited by 23 · see citing works
“Postpartum women report later rise times compared to pregnancy (Swain et al., 1997; Wolfson et al., 2003), indicating a tendency towards delayed sleep timing during the postpartum period.”
BackgroundInfluentialSlyepchenko, A., Minuzzi, L., Reilly, J. P., & Frey, B. N. (2022) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.21m13991 · Cited by 21 · see citing works
Baiardi, S., Cirignotta, F., Cicolin, A., Garbazza, C., D’Agostino, A., Gambini, O., Giordano, A., Canevini, M., Zambrelli, E., Marconi, A. M., et al. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1086-0 · Cited by 22 · see citing works
“Of special importance for the present project is the consistent finding that specific sleep abnormalities are already observed in never-depressed high-risk probands and predict the subsequent onset of depression [15, 16].”
BackgroundStress, sleep quality and unplanned C aesarean section in pregnant women
Ko, Y., Lin, P., & Chen, S. (2014) · International Journal of Nursing Practice · doi:10.1111/ijn.12267 · Cited by 20 · see citing works
Sleep Disturbances and Sleep-Related Disorders in Pregnancy
Izci‐Balserak, B., & Lee, K. A. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4160-6645-3.00138-9 · Cited by 20 · see citing works
Sasaki, N., Yasuma, N., Obikane, E., Narita, Z. C., Sekiya, J., Inagawa, T., Nakajima, A., Yamada, Y., Yamazaki, R., Matsunaga, A., et al. (2020) · Neuropsychopharmacology Reports · doi:10.1002/npr2.12155 · Cited by 19 · see citing works
“, to prevent sudden unexpected death in infancy); and medical causes of crying and parent self-care [32, 46, 47].”
BackgroundPreventing recurrence of postpartum depression by regulating sleep
Sharma, V., Sharkey, K. M., Palagini, L., Mazmanian, D. S., & Thomson, M. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2237194 · Cited by 17 · see citing works
Davies, S. M., Todd-Leonida, B. F., Fallon, V., & Silverio, S. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19084494 · Cited by 16 · see citing works
“For instance, mothers with high levels of anxiety may be vulnerable to misinterpreting their infants’ behaviours [32], and therefore perceive typical infant waking as atypical [33,34].”
BackgroundVerma, S., Pinnington, D. M., Manber, R., & Bei, B. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14021 · Cited by 15 · see citing works
“The pattern of change in sleep – wake timing observed in this study are generally consistent with a previous observation of progressively earlier rise-times from pregnancy to 12 – 15 months postpartum (Wolfson et al., 2003).”
BackgroundResultSharkey, K. M., Boni, G. M., Quattrucci, J. A., Blatch, S., & Carr, S. N. (2016) · Sleep Health · doi:10.1016/j.sleh.2016.05.002 · Cited by 15 · see citing works
Evaluating Insomnia During Pregnancy and Postpartum
Lee, K. A., & Caughey, A. B. (2007) · Humana Press eBooks · doi:10.1007/978-1-59745-115-4_15 · Cited by 13 · see citing works
Shim, S. H., Lee, S. Y., Jung, I., Heo, S., Han, Y. J., Kwak, D. W., Kim, M. H., Park, H. J., Chung, J. H., Lim, J. H., et al. (2024) · Journal of Korean Medical Science · doi:10.3346/jkms.2024.39.e31 · Cited by 12 · see citing works
“33 Based on the results of these studies, collecting information of sleep duration and quality is important to identify women with high risk of PPD.”
BackgroundThe effect of postpartum sleep quality on mothers’ breastfeeding self-efficacy level
Bay, H., Ekşioğlu, A., Soğukpınar, N., & Turfan, E. Ç. (2022) · Early Child Development and Care · doi:10.1080/03004430.2022.2078319 · Cited by 12 · see citing works
GAYLOR, E. E., & Manber, R. (2004) · CRC Press eBooks · doi:10.3109/9780203998007-9 · Cited by 12 · see citing works
Chiara, L. D., Mazza, C., Ricci, E., Koukopoulos, A. E., Kotzalidis, G. D., Bonito, M., Callovini, T., Roma, P., & Angeletti, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312507 · Cited by 11 · see citing works
Reduced Verbal Memory Retention is Unrelated to Sleep Disturbance During Pregnancy
Wilson, D. L., Barnes, M., Ellett, L., Permezel, M., Jackson, M., & Crowe, S. F. (2012) · Australian Psychologist · doi:10.1111/j.1742-9544.2012.00076.x · Cited by 11 · see citing works
Subjective Sleep Quality in Depressed and Non-Depressed Mothers During the Late Postpartum Period
Cho, E. (2009) · Korean journal of women health nursing/Yeoseong geon'gang ganho hag'hoeji/Yeoseong geon-gang ganho hakoeji · doi:10.4069/kjwhn.2009.15.2.108 · Cited by 11 · see citing works
“이에 본 연구에서는 산욕부 주관적 수면의 질과 산후우울 과의 상관성에 관한 선행연구(Huang, Carter, & Guo, 2004; Wolfson et al., 2003)에 기초하여, 산후우울증의 조기발견과 조기치료에 목적을 둔 경증 산후우울 선별 기준(EPDS 총점 10점)에 따라 대상자를 산후우울군과 비우울군으로 분류한 다 음, 각 군의 수면의 질 특성과 관련요인간의 상관성을 비교분 석하였다.”
InfluentialEpidemiology of sleep disorders in pregnant subjects: A questionnaire based survey
Adhikari, T., Sen, M. K., Suri, J., & Vaidya, S. (2009) · Indian Journal of Sleep Medicine · doi:10.5005/ijsm-4-3-106 · Cited by 11 · see citing works
“The overall prevalence of sleep disorders are outlined in Table 9 maintenance of sleep (DIMS) in the later part of the pregnancy (12,13,14,15) and higher incidence of post partum blues (12,16).”
BackgroundKadam, K., Anvekar, A. R., & Unnithan, V. B. (2023) · Journal of Yeungnam Medical Science · doi:10.12701/jyms.2023.00087 · Cited by 12 · see citing works
“Previous studies have noted that alterations in sleep quality may not only lead to depressive symptoms during pregnancy [38] but may also be responsible for postpartum depression in the few weeks following delivery [39].”
Backgroundde Mola, C. L., Carpena, M. X., Dias, I. M., Meucci, R. D., Romero, P., & César, J. A. (2023) · Sleep Health · doi:10.1016/j.sleh.2023.05.003 · Cited by 10 · see citing works
Yun, B. S., Shim, S. H., Cho, H. Y., Heo, S., Jung, I., Jeon, H. J., Han, Y. J., Kwak, D. W., Kim, M. H., Park, H., et al. (2021) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13602 · Cited by 10 · see citing works
Ladyman, C., Gander, P. H., Huthwaite, M., Sweeney, B., & Signal, T. L. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2020.1772265 · Cited by 8 · see citing works
“…poor sleep in early pregnancy predicts worsening depressive symptoms in later pregnancy (Eichler et al., 2019; H. Skouteris, Wertheim, Germano, et al., 2009) and poor sleep in late pregnancy presents an increased risk of postpartum depression (Tomfohr et al., 2015;Wolfson et al., 2003).”
BackgroundRonzio, C. R., Huntley, E. D., & Monaghan, M. C. (2012) · Behavioral Sleep Medicine · doi:10.1080/15402002.2011.642487 · Cited by 7 · see citing works
“In our sample, the mean WASO of 49 minutes is similar to actigraphy-derived WASOs in other studies of postpartum mothers ( Shinkoda, Matsumoto, & Park, 1999 ; Wolfson, Crowley, Anwer, & Bassett, 2003 ) and further supports the persistence of disturbed sleep beyond the initial months of the postpartum period.”
ResultDepression and sleep in the postnatal period. A study in Nepal and Norway.
Dørheim, S. K. (2009) · NORA - Norwegian Open Research Archives · Cited by 8 · see citing works
Ward, B. A. (2007) · Humana Press eBooks · doi:10.1007/978-1-60327-042-7_8 · Cited by 6 · see citing works
“Poor sleep at the end of pregnancy may also increase the risk of postpartum blues [26, 70], although further research needs to be done to verify the role that sleep disruption plays in the subsequent development of postpartum depression.”
BackgroundInfluentialPregnancy-Related Sleep Disturbances and Sleep Disorders
Ward, B. A. (2016) · Springer eBooks · doi:10.1007/978-3-319-41400-3_9 · Cited by 6 · see citing works
Parimi, M., Marshall, C., & Prata, N. (2026) · Women's Health Issues · doi:10.1016/j.whi.2025.10.009 · Cited by 4 · see citing works
Cox, R. C., Aylward, B. S., Macarelli, I., & Okun, M. L. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119523 · Cited by 4 · see citing works
Mao, F., Marroun, H. E., Kocevska, D., & Luik, A. I. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106791 · Cited by 4 · see citing works
- Authors
- Wolfson, A. R., Crowley, S. J., Anwer, U., & Bassett, J. L.
- Affiliations
- College of the Holy Cross (US)
- Venue
- Behavioral Sleep Medicine
- Publisher
- Informa UK Limited
- Published
- 2003-02
- Volume
- 1
- Issue
- 1
- Pages
- 54-67
- ISSN
- 1540-2002 (ISSN-L)
- 1540-2010
- OpenAlex
- W2032765500
- Cited by
- 134
- References
- 41
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 9 · 2015: 9 · 2014: 8 · 2013: 14 · 2012: 8
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioral Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Keywords
- postpartum depression, sleep patterns, primiparous women, napping, bedtime, rise time, total sleep time, pregnancy, postpartum period
- MeSH terms
- Adult, Depression, Female, Humans, Mothers, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Third, Sleep Wake Disorders, Depression, Postpartum, Sleep Disorders, Circadian Rhythm
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