Postpartum Mothers Of Twins Have Significant Sleep Restriction, Depressive Symptoms

The study, authored by Elizabeth Damato, PhD, of Case Western Reserve University in Cleveland, Ohio, focused on 14 mothers of twins that were, on average, delivered three-and-a-half weeks early. Measures included actigraphy, sleep diaries, and standardized instruments for fatigue, sleep quality, and depression.

According to the results, by the time the twins reached full-term, mothers were sleeping an average of 5.4 hours in a 24-hour period, with over 70 percent reporting less than six hours of sleep. Furthermore, the sleep was very fragmented, with an average of 15.1 sleep episodes daily, each lasting an average of 22.4 minutes. Almost half of mothers reported mild to severe depressive symptoms. By the time the twins had been home for eight weeks, average sleep duration had only improved marginally to 5.6 hours daily, although this was achieved in fewer sleep episodes lasting an average of 31.8 minutes each. The percentage of women with depressive symptoms decreased to less than 25 percent. Mothers reported improved sleep quality and decreased fatigue levels over time.

"As primary caregivers for families, mothers caring for twins experience enormous workload, extreme exhaustion, and limited time to meet their own needs," said Dr. Damato. "Additionally, mothers of twins are likely to be caring for babies that are premature. Premature infants are more fragile, require more vigilant care, and are more difficult to feed than full term infants. Meeting the increased demands of two premature infants places mothers at risk for sleep deprivation. Recent evidence suggests that sleep deprivation and the resultant fatigue are related to the development of postpartum depression. Postpartum depression is known to have negative effects on the quality of mother-child interactions and on the child's biological and behavioral development."

Although the effectiveness of sleep strategies has not been formally evaluated for mothers of twins, the following tips are offered for new mothers on how to get a good night's sleep:

• Resist the urge to clean house or catch up on chores when the baby sleeps. Instead, use that time to rest or sleep.
• Accept offers of help from family and friends and use that time to rest or sleep. Limit visitors during the first few weeks who require you to entertain them.
• Recognize that a newborn's biological clock is immature and babies don't begin sleeping for 6-8 hour blocks during the night until they are around 3 months old.
• Get in the habit of a regular routine that can assist in sleep training your baby and keeping both of your circadian rhythms on schedule.
• Follow a consistent bedtime and morning routine for you and your baby.
• Establish a relaxing setting at bedtime.
• Dim bedroom lights in the evening and let light into the room in the mornings.
• Maintain a regular feeding and activity schedule for you and your baby (meals, bathing, walks, etc).
• If nursing your baby, learn to do this lying on your side so you can rest while your baby feeds. If formula-feeding your baby, keep room temperature water and powdered formula by your bedside to avoid nighttime trips to the kitchen to conserve your energy.
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
• Consider a bassinet in your bedroom to avoid nighttime trips to the nursery.
• Take shifts with your partner to allow each of you to get a larger block of uninterrupted rest and sleep.
• When returning to work, take cat naps during work breaks or at lunch time.

Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.