HMN 2026: How Expecting poor sleep is associated with worse postpartum sleep quality

A new study to be presented at the SLEEP 2026 annual meeting found that pregnant women’s expectations about postpartum sleep predicted their actual sleep quality after delivery, outweighing prior sleep and psychiatric history.

Results show that 70% of pregnant women (301 of 432) expected poor sleep in the postpartum period. The level of predicted sleep disruption during pregnancy was a significant predictor of postpartum sleep concerns. Among first-time pregnant women without prior health concerns, those who predicted greater sleep disturbance had significantly more disrupted sleep postpartum, as measured by both actigraphy and self-report. Additionally, among women who predicted the worst sleep quality, higher postpartum anxiety significantly worsened objective and subjective sleep quality, independent of anxiety levels during pregnancy.

“Most pregnant women in our sample anticipated poor postpartum sleep before it occurred, and it was striking that those expectations predicted worse sleep outcomes even after accounting for factors such as prior sleep disorders, psychiatric history and number of previous births,” said lead author Sammy Dhaliwal, a clinical health psychologist and research fellow with the Department of Obstetrics & Gynecology in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “This suggests that attitudes and beliefs about sleep during pregnancy may represent a modifiable target for early intervention before postpartum sleep problems emerge.”

According to the American Academy of Sleep Medicine, sleep is essential to health, and it requires adequate duration, good quality, appropriate timing and regularity, and the absence of sleep disturbances or disorders. Sleep disturbance affects an estimated 60%–80% of postpartum women and is associated with an increased risk of depression and anxiety. However, it is often regarded as an expected part of the postpartum experience.

The study enrolled 432 pregnant women at approximately 24 weeks of gestation. Participants completed measures of their attitudes and beliefs about postpartum sleep, current sleep quality using the Pittsburgh Sleep Quality Index, and mood using validated depression and anxiety scales. Assessments were repeated at 6, 12 and 24 weeks postpartum. A subset of 49 women also wore wrist actigraphy at 6–8 weeks postpartum to provide an objective measure of sleep.

Dhaliwal said the findings point to two potential intervention targets: addressing sleep-related beliefs during pregnancy and treating postpartum anxiety.

“Postpartum sleep disruption is often treated only after problems develop, but our findings suggest there may be an opportunity to intervene earlier during pregnancy,” Dhaliwal said. “Addressing sleep-related beliefs and postpartum anxiety during prenatal and postpartum care may help improve sleep and emotional well-being in new mothers.”

The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 15 during SLEEP 2026 in Baltimore.

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