Sleep Quality and Quantity in Low-Income Postpartum Women

Abstract

Purpose To describe and explore patterns of postpartum sleep, fatigue, and depressive symptoms in low income urban women. Study Design and Methods In this descriptive, exploratory, non-experimental study, participants were recruited from an inpatient postpartum unit. Subjective measures were completed by 132 participants across five time points. Objective sleep/wake patterns were measured by 72 hour wrist actigraphy at 4 and 8 weeks. Mean sample age was 25 years, high school educated with 3.1 children. Over half the sample reported an annual income less than 50% of the federal poverty level. Results Objectively, total nighttime sleep was 5.5 hours (week 4) and 5.4 hours (week 8). Subjectively, 85% met criteria for “poor sleep quality” at week 4, and nearly half were persistently and severely fatigued through 8 weeks postpartum. Clinical Implications The majority (65%) of women in this study met the definition of “short sleep duration,” defined as sleeping ≤ 6 hours per night. Adverse effects of this short sleep on physical and mental health as well as safety and functioning, especially within the context of poverty, may be profound. There is an urgent need for further research on sleep in low-income underrepresented women to identify interventions to that can improve sleep and fatigue as well as discern the implications of sleep deprivation on the safety and physical and mental health of this population.

Link between insomnia and perinatal depressive symptoms: A meta‐analysis

“…For Tikotzky and colleagues (Tikotzky, 2016), we used the correlation coefficient between the Insomnia Severity Index (ISI) and EPDS. For Doering and colleagues (Doering, Szabo, Goyal, & Babler, 2017), data were retrieved at 4 weeks postpartum, given full data availability. For Dorheim and colleagues (Dorheim, Bondevik, Eberhard-Gran, & Bjorvatn, 2009), the odds ratio value was obtained at 7 weeks postpartum.…”

Socio-Ecological Context of Sleep: Gender Differences and Couples’ Relationships as Exemplars

“…In particular, it is important for future research to address disparities in insomnia diagnoses among sexual and gender minority populations, considering the finding that they are twice as likely to be diagnosed with insomnia as their cisgender counterparts [ 79 ]. Similarly, socio-demographic and racial disparities increase the risk for poor sleep health, particularly in rural communities [ 105 – 107 ], but socio-economic status and ethno-racial diversity are rarely accounted for in sleep research [ 107 ]. Furthermore, large-scale studies could provide a more nuanced understanding of sleep across the lifespan by including parity (number of children) in analyses of young and middle adulthood, which may impact sleep and related health outcomes differently across gender and culture [ 73 , 108 – 112 ].…”

Social-ecological considerations for the sleep health of rural mothers

“…One important aspect of policy change that could enhance sleep health in mothers who reside in non-Medicaid expansion states is guaranteeing paid maternity leave. Postpartum sleep is associated with highly fragmented sleep in the first 12 weeks postpartum (Montgomery-Downs et al 2010 ), short sleep duration (Doering et al 2017 ), and excessive daytime sleepiness (Filtness et al 2014 ) yet mothers often report returning to work within 8 weeks of giving birth. Recently, paid postpartum leave demonstrated positive effects on mental and physical health in Australia, particularly for those who had insecure work situations (Hewitt et al 2017 ).…”

“…In particular, poor health outcomes during the postpartum period are likely compounded in rural women due to the prevalence of financial strain in rural areas, lack of coordinated postnatal care, geographic isolation from medical services and mental health stigma (Hung et al 2017 ; Kozhimannil et al 2017 ; Levin and Hanson 2020 ; Mollard et al 2016 ; Nidey et al 2020 ). Moreover, within rural populations, socio-demographic differences and disparities contribute to elevated risk for poor sleep health and other related health outcomes (Doering et al 2017 ; Mersky et al, 2020 ). Individuals located at the margins of mainstream rural communities (e.g., migrant farm workers), with intersectional identities composed of multiple social positions embedded within systems of inequality (López and Gadsden 2016 ), may experience even more barriers to accessing healthcare (Ceballos et al 2013 ; Schminkey et al 2019 ), are currently underrepresented in research efforts (Hargraves 2002 ; Jackson et al 2020 ; Schminkey et al 2019 ), and are underserved in their communities (Henning-Smith et al 2017 ; Tangel et al 2019 ).…”