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Can Sleep-Breathing Problems Cause Postpartum Depression?

A recent study recommended that all new mothers be screened for postpartum depression. This is not a bad idea, since so many women are likely to undergo some form of depression in the postpartum period. Even my wife Kathy experienced it after our first son, Jonas, was born.

There are many good explanations for postpartum depression, but here’s a simple, but unexpected reason that has to do with progesterone.

As women progress through pregnancy, they all gain weight. Significant weight gain can push most people into developing obstructive sleep apnea. Progesterone has been shown to be protective in obstructive sleep apnea by acting as an upper airway muscle stimulant—it increases muscle tone in the genioglossus muscle (the tongue, the largest upper airway dilator). During pregnancy, progesterone elevates significantly, but just after delivery, it drops, but you still have all that weight.

Modern humans are susceptible to breathing problems at night due to the fact that we can talk. As a result, our upper airways are unprotected. Add to this the documented shrinking of our jaws and dental crowding from a radical change in our diets, you end up with a tongue that takes up relatively too much space. Bottle-feeding, which is another modern Western invention, is also thought to cause malocclusion and dental crowding.

Sleep-breathing problems can be a major cause of postpartum depression. Biochemical changes in the brain due to sleep-breathing problems can look identical to classic depression findings. This is also a reason why many women say that they never sleep the same again after the last pregnancy. The good news is that with a proper examination and appropriate treatment, many women can begin to sleep better after having a child. In addition to screening for depression, you should also screen for sleep-breathing problems.

For the women reading this, has your sleep quality never been the same since your last pregnancy?

Do All Pregnant Women Have Sleep Apnea?

We know that significant weight gain is a common aggravator of obstructive sleep apnea. If you already have narrowed jaws and gain some weight, then you'll move up the sleep-breathing continuum that I describe in my book, Sleep, Interrupted. But why is it that when women become pregnant, sleep apnea is the last thing that's considered whenever they develop depression, high blood pressure or extreme fatigue? 

Two recent published studies perpetuate this myth amongst doctors that sleep apnea can't happen in pregnant women. One study showed that about 2/3 of pregnant women responded to depression using acupuncture. Another study showed that antidepressant use during pregnancy led to small, but measurable developmental delays at 19 months. Depression (during pregnancy or post-partum) is a major problem with many women. But rather than saying that it's pregnancy-related depression, it should be looked at as a sleep-breathing problem, since one major reason for depession is lack of deep, quality sleep that's common with all pregnant women. Pharmaceutical companies promoting anti-depression medications to replace deficiencies in brain biochemistries doesn't help either.

One reason why not every woman that's pregnant goes into depression during or after pregnancy is due to the effects of progesterone, which has been called the "feel good" hormone. One of the interesting properties of progesterone is that it's an upper airway muscle stimulant. It increases tongue muscle tone and tension. During pregnancy, progesterone goes through the roof, since it's needed for maintaining the uterus and development of the baby. But if the weight gain is too much, or if your jaw is too narrow, then the effects of progesterone won't be as helpful. Once you deliver, progesterone drops, but you're still left with all that weight. This is one major revelation that I had when my wife experienced severe post-partum depression after the birth of our first son, Jonas.

We also know that many women who develop pre-eclampsia (dangerous high blood pressure) during pregnancy have various degrees of sleep-breathing problems, which can be treated effectively with standard sleep apnea treatment options.

For the women that's reading this blog, did you have any significant depression during or after pregnancy? How did you deal with it, and if your saw a doctor about it, what did they recommend? Please enter your answer in the comments section below.

Pregnant Women On CPAP For Pre-eclampsia

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