On Postpartum Depression and Insomnia

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sleep deprivationI have a lot of symptoms when I’m depressed: mood swings, fatigue, memory problems, unreasonable anger, sensitivity to criticism, guilt, self-doubt, hopelessness, apathy — none of it’s particularly good, but some are worse than others. One of my worst symptoms has always been insomnia. It’s kind of a funny thing, because I’m exhausted all the time, but when I finally make it to bed after a long day of cleaning, caring for my family, and checking as many items as possible off my to-do list, more often than not I end up staring at the wall for hours wondering if my life will ever be normal again.

After months of four or five hours of sleep every night (this was during my second pregnancy), I went to the doctor and begged for help. I couldn’t take it anymore — I was forgetting everything, losing mental acuity, and was nearly incapable of interaction with my nearly two year-old son. She told me to take a mild painkiller/sedative (non-narcotic), which would be safe for both me and my baby, and would help me sleep. It was like manna from the gods, and I slept like a log every night for the rest of my pregnancy.

Then my son was born, and I stopped taking the sleep aid. I figured my sleeping schedule would be unpredictable for a while, so I should just try to get back into the habit of falling asleep on my own. Unfortunately, the insomnia came back quickly and vengefully, as if it had been waiting until I was unguarded to steal back the sleep I’d been enjoying over the past few months.

I’ve been dealing with the insomnia for almost 18 months now. On a good night, I am able to fall asleep around midnight. On a bad night, I’m up till 3 or 4 am. Neither of these situations is actually all that great — my day starts around 7:30, when my older son wakes up; sometimes earlier.

According to the National Sleep Foundation, short sleep duration (less nightly sleep than the recommended 7-9 hours for healthy adults) comes with many risks, including but not limited to:

  • Increased risk of motor vehicle accidents
  • Increase in body mass index — a greater likelihood of obesity due to an increased appetite caused by sleep deprivation
  • Increased risk of diabetes and heart problems
  • Increased risk for psychiatric conditions including depression and substance abuse
  • Decreased ability to pay attention, react to signals or remember new information

In addition, chronic insomnia is linked to increased risk of illness and morbidity. Sleep and depression have a complicated relationship, as it’s not definitively known whether sleeplessness causes depression or depression causes sleeplessness. Either way, insomnia is a very common symptom in people with depression. And for a person with postpartum depression, the extra hours of lonely introspection that often accompany wakefulness in the wee hours are the last thing she needs.

This post isn’t necessarily a guide to how to get more sleep — there are specialists, such as those who work with the National Sleep Foundation, who are far more qualified than I to deliver that information. Instead, I wanted to give you the one piece of wisdom I’ve learned over the past year-and-a-half. Granted, it’s kind of a no-brainer, but I think it warrants repetition, since you might have heard it already.

Don’t give in.

Insomnia can be a dangerous symptom of postpartum depression, perhaps one of the most dangerous, but I made the mistake of viewing it as a sort of blessing in disguise when my PPD was at its worst. Let me explain: during the day, I am Mom. I’m Wife. I’m Maid. I’m Friend. I’m All of the Above. I have hardly a second to just be Me, and I’d often end the day thinking to myself, “What a waste of time.” This was the postpartum depression talking, of course, but it got to me. I started to think that the hours of the day weren’t nearly enough time to accomplish what I wanted to do with my life, apart from my obligations to others.

I started to relish those wakeful hours of the late night and early morning, began to see them as “me time,” when I could work on my novel, fold laundry while watching back episodes of TV shows my husband doesn’t care to watch, blog, do my toenails. But then morning would come, and I would be miserable. Not necessarily extremely tired, because more often than not I would be wired to the point of discomfort, but cranky. Irritable. Just plain mean. Insomnia is not a color I wear well.

I’m trying desperately to change my mindset about sleeping. It’s not a checkmark on my to-do list; it needs to be a priority in my life. All the not sleeping I’m doing is seriously compromising my health and is most likely interfering with my recovery from postpartum depression, not to mention probably preventing me from losing all the baby weight I’ve not been able to shed.

There’s no easy fix for insomnia, I know this, and like I said, I’m not suggesting I have any answers about that. But I do want to encourage all of you who may be dealing with insomnia, as I am now, to make sleep a more important part of your daily routine. Don’t allow it to become an afterthought, as I have. Do whatever it takes to make it to bed at a reasonable hour, and try to be tired when you get there. You’re probably rolling your eyes and thinking, Easier said than done, but I know it’s possible. It’s worth a try, at least.

Alexis Lesa

So what do you think? Have you had problems with postpartum depression and insomnia, how have they affected you, and what, if anything, worked?

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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  1. My lack of sleep has resulted in my boss, who is taking off from work for the next five work days, telling me, "Maybe you should take some time off too!" And I am. Friday and Monday. Oh glorious time off!

  2. Yes, I had insomnia and was on Ambien for awhile and my psychiatrist recommended that I go get my hormones checked.. Turns out, I had low progesterone levels.. Ever since then, I take natural progesterone pills and I sleep like a baby. I also have hypothyroidism and take Armour Thyroid which has been a major boost in my life….I agree with you Alexa… great article

    • Janna more women need to check their hormone levels! It plays an important role especially in insomnia after pregnancy.

  3. Lauren Wichterman says:

    Two months after my son was born, and after I had begun to feel really anxious and obsessive, I had a week when I stopped being able to sleep. One night I couldn't sleep at all. The next night I got 6 hours of sleep, the next two nights — about 4 hours, and the next night about a half an hour. I was beside myself: I was trying to breastfeed my son, and I had already begun to take Zoloft for my anxiety. But I could NOT sleep. My milk production went down and my family, in a couple of days, used up all my frozen milk in the freezer! One more thing to be stressed about, right? I sat around in a daze all day, on auto-pilot, wishing I could be a different mom to my son versus the brooding, distracted zombie I had become.
    The therapist that I began to see for my PPD/PPOCD called my ob/gyn and talked to him about the fact that sleep deprivation was a huge contributor to PPD, and that he should really prescribe me something for sleep. He had wanted to wait and see how the Zoloft worked, although I had asked him to give me something for sleep. Thankfully, he gave me Ativan to use PRN for sleep.
    For about a month, I took 1 mg of Ativan/night, sometimes less. I slept in another room and tried to prioritize sleep as much as possible, per my therapist's instructions. MY husband did baby duty overnight. I stuck with the breastfeeding, which despite my hard times, was the one thing that made me feel like I was holding it together — by a thread, mind you.
    Slowly but surely, my sleep got better. After a month, I would take the Ativan only when I needed to — usually if I was feeling really anxious or obsessive. I returned to our family bed, and relished cuddling with my husband and baby, which in turn allowed me to sleep better.
    My story is proof that you can get through this! Healing takes time… luckily, we have a lifetime to bond with our child, and get this whole motherhood thing down.

  4. insomnia was my number one struggle through ppd/a. The only thing was with me, it gave me incredible anxiety. I would think about sleep nonstop, and I would obsess about it. It got so bad that i went several nights on only 2 hours of sleep at the most. I went to urgent care to get a benzodiazepine I was so desperate. Lack of sleep really messes with you! This is my number one fear with TTC and having another child. I don't know how I'll ever get past it fully.

  5. A couple of long bouts of insomnia (one during PPD) had me thinking about sleep all wrong. I was looking at it like a quest or something almost unattainable. Once I could say to myself, "if I sleep, fine…if I don't, fine" and believe it, I did much better. Also, I never look at the clock when I can't fall asleep. It doesn't matter what time it is -it won't change anything as far as my sleep goes – except maybe to make me more anxious.

  6. I hear you sister! Sleep deprivation is a form of torture for a reason! The insomnia nearly killed me and coupled with severe anxiety and ocd resulted in hospitalization for 6 weeks in a mother and baby unit following the birth of my first daughter 5 and a half years ago. I tried everything – hot baths/showers before bed, camomile tea, deep breathing, meditation tapes, cognitive behavioural therapy, exercise, relaxation tapes, medication – you name it, I tried it. What helped? Medication, medication, medication – zyprexa, ambien and eventually a change in antidepressant. Also the passage of time…I was obsessed with sleep for almost 3 years. 8 months ago we had another baby and this time I stayed on medication, went straight to the mother and baby unit after my daughter was born so that they could feed her a bottle overnight (I decided to breastfeed during the day and bottle feed at night)and monitor my depression and my doctor organised for an inhome carer (free of charge!!!) to come to my house every night from 9 pm to 7 am so that I can sleep while she looks after the baby – it has been an absolute godsend and made for a much easier transition second time around.

  7. I loved this post so much! I had one pretty bad bout of insomnia, and it lasted quite a while. It was within the past year or so, and I've struggled with anxiety/depression ever since my nearly 2 1/2 year old daughter was born. I know sleep deprivation played a huge role in my PPD/anxiety, so losing out on that sleep when I was having insomnia this past year just created anxiety on top of anxiety and brought back memories of what the sleep-deprived me was like (not pretty). I found that I fell asleep just fine, but I'd wake up after a couple hours and not be able to get back to sleep. It had a very negative effect on my ability to function and I was very irritable and just exhausted all the time.
    After talking to a friend (who is also a licensed counselor), I realized there were some pretty big issues I needed to deal with and I was just letting them stew beneath the surface. I went to therapy to deal with them, and also to process the PPD/anxiety I experienced and never got therapy for.
    So, therapy was one thing that worked for me. I really think that the junk I hadn't dealt with was wreaking havoc in my subconscious and was playing a role in the middle of the night waking. Once I talked things through and had some closure and resolution, I was sleeping fine again.
    Another thing that has worked for me in trying to fall asleep easily is reading. I read until I start nodding off and my eyelids are super heavy, and when I do that, I have no issues falling asleep quickly. I find that on nights when I do not read at all, I struggle to fall asleep.
    One thing I worry about with my current pregnancy/postpartum experience is how to manage the sleep effectively once the baby is born. I know the lack of sleep can cause such a downward spiral, but I just can't wrap my mind around a way to get that managed and under control at the beginning.
    Thanks again for your honest and thought-provoking posts. I'm glad Katherine has you guest posting here – you are a great asset to her blog!

  8. I didn't read this before leaving my comment, but I'm so glad I came back to read it! Breastfeeding was a huge issue with my daughter and because she wouldn't latch, I was up pumping every 3 hours as I was instructed to do. I never really got more than a 2 1/2 hours stretch of sleep at a time. I'm expecting #2 in April, and although I'm not as concerned about PPD/anxiety this time as I feel we have a good plan in place if needed, one thing that really, really worries me is the issue of sleep. I want to try breastfeeding this new baby, but I have to admit part of me wants to just use formula so that I can get some somewhat decent sleep and at least split night time duties with my husband. I really feel like decent sleep could be a huge protective factor in trying to combat the depression/anxiety/coping issues. Would you mind sharing at all how it worked with the night time bottle feeding and daytime breastfeeding? Were you pumping prior to bedtime for the night feedings? Did it effect your milk supply at all? I've had 3 different lactation consultants say that at the beginning it is crucial to feed every 2 to 3 hours to establish a good supply (and hearing that makes me want to cry knowing what it will do to my sleep…). I know it's different for every woman, but since it worked well for you, I'm just really interested in learning more so I can consider it as an option for us. Thank you!

  9. Wow. I have not suffered from PPD, but I have suffered from insomnia for over 20 years. Now I have Restless Leg Syndrome, and as a result, have been taking meds with have at the added bonus of being a sedative. I sleep well now. The funny thing is, until I started taking the sedative and sleeping for many consecutive hours, I had no idea this was even possible. I do understand how difficult it is to function with no sleep. I do advise sleep meds. I really do. Good luck to you.

  10. Hi Sera!
    Although I had concerns about supply and the risk of mastitis and was more willing to move to formula if necessary (with my first I wanted to breastfeed at all costs ), I really wanted to breastfeed as it was the one thing I did well with my first and I felt it helped with bonding when in the throes of depression. My doctor wrote a letter to the hospital where I gave birth saying that the midwives were to encourage comp feeding so that I could sleep. I therefore started the middle of the night bottle feeding immediately after birth. I did the last breast feed around 10/11 and the first feed around 5/6. My daughter slept in the nursery away from me for the first 4 weeks. The morning start gradually stretched out with time and I did have to express some mornings (electric breast pump)as I was full from going so long without feeding. I was warned that I may have to choose between breastfeeding and sleep as my supply may drop but I haven't had to. My baby fed every 2 or so hours during the day for the first 5 months and my body adjusted to the overnight gap. I think my breasts adjusted better the second time around. It all clicked much sooner and I didn't have the engorgement I had with my first. Of course everyone is different. My baby is now 8 months old and I have started expressing more as she takes the bottle (having had it since day one) and I am starting to give her some formula during the day as I am moving towards weaning her.

  11. Katherine Stone/Post says:

    Good for you!

  12. Katherine Stone/Post says:

    I do the same thing! I refuse to look at the clock when I wake up in the middle of the night. It helps prevent me from obsessing over how much time I have left to get some rest.

  13. Katherine Stone/Post says:

    Isn't she? Thanks for saying that Sera. I'm really glad to have Alexis as part of Postpartum Progress.
    Also … congrats on your pregnancy!

  14. I can totally relate when it comes to this issue. I had insomnia and PPD with both of my girls. I honestly think that not sleeping enough before my first daughter was born spiraled me out of control. I had PUPPS syndrome with my first daughter, PUPPS syndrome is an itchy rash that you get usually on your torso but mine was severe it was all over my body come my 9 month and it was VERY uncomfortable. I had this rash all over my body, everywhere except my face. There was no comfort and I could not sleep….so 3 weeks without sleep before they induced me and then an emergency c-section after 2 days of induction. I was completely exhausted. Once I get home with my new baby girl I did not sleep, it ruled my thoughts and all I thought about was sleep but was unable to do so. It became an obsession in my mind, it ruled all my thoughts, when could I sleep and how much sleep could I get and what if I did not hear my daughter cry….it was awful!
    I did seek help and once I started to take an antidepressant, I also used a sleep med in the beginning. I then was able to relax enough and my thoughts started to become my own again I was able to sleep.
    Sleep is still an issue for me today and my daughters are now 2 and 7. What I do today is use a white noise machine and my room at night is dark…there are no lights from anything. I need it this way to relax and be able to sleep soundly.
    It is so difficult and I know it may seem impossible right now if this is an issue for you but it will get better and you just need to try and see what works for you….little steps but eventually you will get to the top of those steps and you can look back and see how far you have come. Good Luck and sleep well.

  15. Before PPD/A, I was able to put my head on a pillow and I was out for the night…an easy 7-8 hours of sleep at the least…then "IT" happened…Insomnia was the worst symptom during my bout with PPD/A. I was sleeping 2/3 hours a night, and the other 21 hours..I was pacing around my house like a mad woman. It was not until my doctor prescribed me a sleep med, and my mom took over night duties for a few weeks, I found myself sleeping again…and it felt as though slowly but surely, I was getting back to normal… I was able to cope with what was going on with me, and take all the necessary steps to get myself treatment. I still continue battling insomnia, but it doesn't lead me into crazy panic attacks anymore…I've learned how to read a book, count my breaths, and wait for my sleep aid to kick in!!! SLEEP IS ESSENTIAL!…

  16. Katherine Stone/Post says:

    I had horrible problems with sleep when I had postpartum OCD. I could go to sleep at night, but when I had to get up in the middle of the night to feed my son I could not go back to sleep to save my life. It was nightmarish to be that exhausted and lay there feeling desperate. Eventually, a sleep management plan in combination with medication was what worked for me.

  17. That is awesome! Sounds like you have a pretty great boss.

  18. Wow, that is so amazing…it must have been such a wonderful thing to have help when you were at your most vulnerable. It's a good thing your doctor understood how invaluable sleep is to recovery from delivery and prevention of PPD. That warms my heart like you have no idea, just his/her awareness of the dangers of sleep deprivation, especially to a mother with a history of PPMDs.
    Just awesome.

  19. Thank you, Sera! I have loved being a part of Katherine's mission and I only can feel grateful that I am helping anyone as much as I have been helped in the past by Katherine.
    I hadn't even considered the fact that underlying emotional issues might be a part of my inability to sleep, so thanks for mentioning that. It's definitely something to look in to.

  20. Christina says:

    Amino acids (specifically 5-HTP) helps my sleep tremendously. The Mood Cure by Julia Ross talks about different types of amino acids. I also work with my naturopath, my counselor, and my zoloft! But the 5-HTP really makes a difference for me.

  21. Marianne Bastiani says:

    Hi Sera!
    I should just clarify that the middle of the night bottle feed has, from day one, been a bottle of formula.
    Marianne

  22. I wanted to say that I was one of the lucky ones in this department. But it's not lucky. I can not sleep enough. Even after we switched to formula and my husband took over the nights and the early wake ups with my toddler I can't sleep enough. I can (and sometimes do) go to bed after i put the kids down. That's before 8pm I could be snoozing away. I could sleep straight through to 8 or 9 and then need a nap by noon. Nap while the kids are napping 12-2 and then nap on the couch while cartoons entertain the kids 4-5, then in bed by 8 or 9 that night.
    I feel like I have to stay up some nights just for that 'me' time but run out of toothpicks to prop my eyelids open. It's not like I'm doing exhausting work during the day. I'm not working in the Nevada dessert. I'm just existing. And it's exhausting.

  23. I also suffered severe insomnia when this illness began for me in my third trimester with my first (and only) child. I was a champ at sleeping prior to this and never in a million years thought that I would have insomnia. Never. I'm convinced that the insomnia is what sent me on a terrifying downward spiral into a very dark and lonely place. I was just having anxiety before the insomnia hit, and it literally happened over night. Within a week of not sleeping, I was a complete mess. I was in a state of panic 24/7, was having intrusive thoughts, not eating, crying continuously, etc. I couldn't make a decision to save my life. I was missing work left and right. I couldn't be alone. I couldn't think. I ended up practically moving in with my mom and dad at 34 yrs. old because my husband had no idea how to help me and I was falling apart at the seams. I was able to get a few hours of sleep there for some reason, but that was it. This went on for the remainder of my pregnancy. 12 weeks of pure hell! I don't know how I made it. I am quite sure looking back that I was near psychosis. I'll spare the ghory details about the dark thoughts that consumed my mind from that time. I went from a cute pregnant lady to a complete and total mess in a very short period of time. Not sleeping wreaks total havoc on anyone's mental state. My mom still says she does not understand how I made it and delivered a perfectly healthy daughter. I was losing 4 lbs. a week towards the end. Nonstop prayer and the support from my family and friends is what carried me. The OB/GYN was no help. They wanted to hospitalize me in the mental ward and offered no explanation as to what was happening. When I thought I was being wheeled to the labor and delivery ward (after an ER visit ordered by the OB/Gyn) to be monitored, I was actually taken to the mental ward. I was completely traumatized and couldn't talk about it for a long time. One of the doctors prescribed zoloft at a super high starting dose of 100mg, which sent me into a 2 day panic attack. Another doctor from the practice prescribed ativan, while another in the practice told me what terrible things could happen to my baby because of it. And she was not nice about it. Zero compassion. The whole thing still makes me angry beyond words. I still need to write some letters to some folks.
    At any rate, I'll jump ahead to now (18 months postpartum) and say that I finally got the proper help (because of my own research)after my daughter was born, got on medication, fired a bully of a psychiatrist, saw a therapist, and am now sleeping 7-9 hrs. a night. And life is a whole lot better because of it! I am still on a lower dose of my antidepressant. Mostly because I am so traumatized by the insomnia and what it did to me, and this medicine is what got me sleeping again. I still struggle some nights (mostly around my cycle), but I am not thrown into a complete panic because of it. That took a long time. I too was obsessed with sleep, counting hours, etc. I'll second not looking at the clock. It does help. I still don't understand why insomnia is such a huge component with PPD. But I sure found out how very common it is since my own struggle began. It's so cruel!

  24. That could be a sign of something going on with your thyroid or other hormone imbalances. Have you talked to a doctor and had extensive blood work done? If you have and they're still telling you everything's checking out normally, you might want to consider seeing a specialist such as an endocrinologist. Your situation sounds like it could use some attention. I really hope things get better very soon!

  25. Yikes. That is truly awful, Kristin. I can't even begin to express my level of disgust for doctors who don't understand how to properly treat women with PPMDs–even on just a human-to-human basis, no medicine involved. It's not rocket science; just be nice to the suffering pregnant woman. Sheesh.
    I'm so glad you made it through that terrible time and that you seem like you're adjusting well. I can understand how such an experience would leave you traumatized, there is definitely a lot of residual emotion that comes with that type of situation.
    Thank you for sharing.

  26. I have a lifelong struggle with insomnia (multiweek bouts a few times a year is my pattern) and when PPD hit, my insomnia became extreme (also impacted by trying to pump every 2 hours bc of difficutly breastfeeding and I was so determined that she would get breastmilk even at the expense of my own health and well-being). My daughter rarely slept longer than 45 minutes at a stretch until she was almost 4 months old and it would take me just about 45 minutes to fall asleep if I was lucky. Just like someone said above, I was falling apart at the seems. My mood was depressed and desperate. All that "nap when the baby naps" and "you'll sleep if you're tired enough" advice was even more crazy-making. I started to get frantic about sleep and very scared about my ability to function and care for my daughter. That fear was what finally got me to a doctor but I don't recall that we ever talked about insomnia and it is so intertwined with depression. The antidepressant helped a bit with sleep, as did doing some CBT and accupuncture helped (and is currently helping). One of my PPS relapse triggers is having more than 2 nights of insomnia in a row. I start to get anxious about going to bed and feel doomed and it is hard to put the brakes on it. I recently read Insomniac by Gayle Greene and it was the first time I felt like someone understood my insomnia experience. I can't recall if she has anything specific on PPD but she has some very interesting data about the huge lack of research into the relation of hormones and insomnia (or into any female-specific sleep issues).

  27. I didn't sleep at all for the first six days of my son's life. This was after 23 hours of hard labor, too. I was struck instantly with PPA. I recall feeling like there was a fire in my brain that wouldn't go out. Like a previous commenter, I was near delirious by the time I got help. I credit an amazing family support structure and fast medical help (yay, Ativan) with getting me some sleep at last. Because of that episode, I dealt with severe anxiety about sleep for a few weeks. I couldn't be with my son at night because I'd be panicking about when he would wake up to eat. My husband, the champ that he is, stayed with our little guy in his nursery until I slowly was able to bring him into our bedroom.
    I'm so glad you wrote this post and so many women have shared their experiences in the comments. I felt so alone during this time, convinced I was the only messed up mother in the world.

  28. I can totally relate to this story and all of the comments. I have suffered PPD twice and am about to give birth to my 4th (yes, I can't believe I am doing this again either). My BIGGEST symptom was sleep or lack thereof and constantly obsessing over it. Most sleep meds don't work for me with exception to benzos. However, I was so afraid of taking them for fear of addiction. The breaking point the last go round was when I realized it wasn't making sense to be so fearful of addiction when I just kept wanting to take my car off the road. So, broke down and took Klonopin (and a lot of it) for about 3 months. Then weaned off slowly. What a life saver! Without finally getting the sleep I needed, I probably would not be here today. I also went to a sleep specialist to confirm my psychiatrist's treatment. She said that for depressed patients, CBT methods for sleep are a no go. And she convinced me that the insomnia is often one of the first symptoms of depression and the last to go and it is SO important to get treatment for it. This time around, I will not hesitate to take the medication if that's what I need to get better!

  29. Insomnia is such a vicious cycle– both a trigger for postpartum mental illness and a symptom thereof. I bipolar disorder with "mixed episodes," meaning that when I am manic I have racing and agitated *negative* thoughts rather than the typical grandiosity and euphoria. Just a couple nights with little or no sleep will set this whole cart in motion. It happened very quickly with my first child; I was home with her for only one day before heading to the ER for psych hospitalization.
    The interesting thing for me is that with my second child, I am getting less sleep than I did with my first. My husband is working a lot of overtime, and my son is a fussier baby. I am on full "baby duty" five nights a week. I have been tired– exhausted sometimes– but still able to carry on and even be cheerful about it. I am able to go back to sleep after feeding my son, even if it's 4 times a night. I think the key this time around was a) four years of hard work in therapy since my daughter's birth and b) having a medication plan in place the minute I conceived. Being able to sleep when the baby sleeps seemed like a pipe dream the first time around, with all my horrific obsession and racing thoughts. This time around, I sometimes fall asleep with the bottle still in his mouth!