Prenatal Sleep Expectations Predict Postpartum Sleep Quality, Study Finds

Pregnant women's expectations about postpartum sleep may predict their actual sleep quality after delivery, outweighing the influence of parity, prior sleep disorder history, and psychiatric history, according to research presented at SLEEP 2026 in Baltimore, Maryland.¹

Sleep disturbance affects an estimated 60% to 80% of postpartum women and is independently associated with increased risk for postpartum depression and anxiety. Despite this, it is widely normalized as an inevitable part of new parenthood, which may contribute to missed opportunities for early intervention. The present findings suggest that the window for intervening may begin well before delivery: maladaptive beliefs about sleep, assessed during pregnancy, independently predicted how poorly women actually slept in the weeks and months after giving birth.

“Postpartum sleep disruption is often treated only after problems develop, but our findings suggest there may be an opportunity to intervene earlier during pregnancy,” lead author Sammy Dhaliwal, a clinical health psychologist who is a research fellow with the Department of Obstetrics & Gynecology in the Perelman School of Medicine at the University of Pennsylvania, said in a statement. “Addressing sleep-related beliefs and postpartum anxiety during prenatal and postpartum care may help improve sleep and emotional well-being in new mothers.”

Study Design: Sleep Cognitions in Pregnancy as Predictors of Postpartum Sleep Outcomes

The prospective study enrolled 432 pregnant women at approximately 24 weeks of gestation.² Participants completed measures of their attitudes and beliefs about postpartum sleep, current sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and mood using validated scales for depression (Edinburgh Postnatal Depression Scale) and anxiety (Generalized Anxiety Disorder-7). Assessments were repeated at postpartum weeks 6, 12, and 24. A subset of 49 women also wore wrist actigraphy at 6 to 8 weeks postpartum, providing an objective measure of sleep independent of self-report.²

Sleep Predictions, First-Time Mothers, and the Role of Postpartum Anxiety

Results showed 70% of pregnant women (n = 301 of 432) expected poor sleep in the postpartum period, defined as anything above "sometimes" on a 5-point Likert scale.² The degree of predicted sleep disruption during pregnancy significantly predicted postpartum sleep concerns above and beyond parity, prior sleep disorder history, and prior psychiatric history.

Among healthy, first-time pregnant women specifically, those who predicted greater sleep disturbance had significantly more disrupted sleep postpartum on both actigraphy and self-report measures (β = 0.42; P <.01; R²=0.14).²

Among women who predicted the worst sleep quality, postpartum anxiety significantly moderated the relationship between prenatal sleep predictions and postpartum sleep outcomes. The greater a woman's postpartum anxiety, the worse her objective and subjective sleep quality, an effect that was independent of her anxiety levels during pregnancy, suggesting that postpartum anxiety exerts its own influence on sleep beyond what antenatal mood alone would predict.²

The mechanisms underlying these findings align with well-established cognitive models of insomnia. Maladaptive sleep-related cognitions, including dysfunctional beliefs, catastrophizing, and sleep effort, are recognized perpetuating factors in chronic insomnia in general populations. When overnight infant care decreases, parents may continue to experience sleep difficulties due to unhelpful sleep-related thoughts and behaviors, contributing to chronic insomnia; unhelpful sleep-related cognitions and behaviors are identified as modifiable perpetuating factors and potential therapeutic targets for preventing and reducing insomnia in perinatal populations.

“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,” Dhaliwal said. “This suggests that attitudes and beliefs about sleep during pregnancy may represent a modifiable target for early intervention before postpartum sleep problems emerge.”

References

1. Associated Professional Sleep Societies. Expecting poor sleep is associated with worse postpartum sleep quality. Published June 10, 2026. Accessed June 15, 2026. https://www.sleepmeeting.org/expecting-poor-sleep-is-associated-with-worse-postpartum-sleep-quality/

2. Dhaliwal S, Gehrman P, Le H, Keller J. Know thyself: how much does what we think about sleep matter? Interventional targets for treating perinatal sleep concerns [abstract 1093]. Sleep. 2026;49(Suppl 1). https://doi.org/10.1093/sleep/zsag091.1092

3. Quin N, et al. Preventing postpartum insomnia: findings from a three-arm randomized-controlled trial of cognitive behavioral therapy for insomnia, a responsive bassinet, and sleep hygiene. Sleep. 2024;47(8):zsae106. https://doi.org/10.1093/sleep/zsae106