Most women experience great joy, anticipation and excitement during pregnancy. However, pregnancy can also be a time of serious sleep problems, regardless of whether or not a woman has previously had disturbances at night. Nearly 80 percent of women reported more troubled sleep during pregnancy in the 1998 National Sleep Foundation’s Women and Sleep poll. It is particularly common for women to feel extremely fatigued during pregnancy during the first and third trimesters. The physical and emotional demands of pregnancy can make women very tired, especially considering the prevalence of sleep disorders among pregnant women.
Pregnancy, Hormones and Sleep Problems
During pregnancy, the natural fluctuation of hormones is one of the various reasons for fatigue and sleep problems. The higher levels of progesterone, which is a sleep-promoting hormone, may explain excessive daytime sleepiness, particularly during the first trimester. Hormonal changes may also cause snoring as the muscles relax, and obese women have an increased risk of developing sleep apnea.
Nausea associated with pregnancy, frequent nighttime bathroom trips and other pregnancy-related discomforts can result in a considerable sleep deficit. Insomnia is common in pregnant women, as well, especially for a first-time mother. This may be due to anxiety about their pregnancy, delivery, balancing motherhood and work, or their changing relationship with their partner. Insomnia may continue after the baby is born, as well, as it gets harder to get a full night’s sleep with a newborn. Pregnant women should prioritize sleep and find effective ways to manage sleep problems during the beginning of their pregnancy.
Pregnancy and Sleep Disorders
Some women are first diagnosed with a sleep disorder, among other health issues, during pregnancy. A study of more than 600 pregnant women found that more than one-quarter of them had symptoms of restless leg syndrome (RLS), a condition which is worst at night, as it characterized by unpleasant leg sensations which are relieved by movement. Heartburn, also known as gastroesophageal reflux disease (GERD) is also a common problem during pregnancy. Recent research found that between 30 and 50 percent of pregnant women experience almost continuous heartburn during pregnancy. Pregnant women, especially those who are overweight or obese, are at risk for developing sleep apnea, as well. Sleep apnea is a disorder characterized by repeated interruptions in breathing at night due to a blockage of the airway and frequent awakenings to resume breathing. Pregnant women with sleep apnea have further risks, as well, such as gestational hypertension, preeclampsia, or low birth weight. Women with sleep apnea may also be excessively sleepy during the daytime. For these reasons, it is very important for pregnant women experiencing symptoms of sleep apnea to seek treatment to avoid further complications.
Poor sleep also has consequences related to labor and delivery. Recent research from the University of California at San Francisco found that women who sleep fewer than six hours per night had longer labors and had nearly five times the likelihood of having a C-section delivery. Based on this research, experts recommend that doctors discuss sleep quality with pregnant women as a part of basic prenatal care. Some doctors call it “sleeping for two.”
Pregnancy and Sleep by the Trimester
Although you may have been used to jumping out of bed and grabbing a cup of coffee before heading to work for the daily grind, pregnancy changes every aspect of your life. With the usual complaints of nausea, vomiting, and exhaustion during the first trimester, you might be wishing it were acceptable to take naps during the workday. While the second trimester may offer some relief as you grow accustomed to your changing body, the third trimester may bring even more fatigue than the beginning of your pregnancy.
Symptoms of Sleep Disorders During Pregnancy
Some of the common sleep problems that may occur during pregnancy include:
- Insomnia - This includes difficulty falling asleep, staying asleep and waking up too early and feeling not feeling refreshed. Insomnia may be due to anxiety over labor and delivery or concerns about motherhood and balancing it with work. Nausea, back pain and fetal movements may also disrupt sleep for pregnant women.
- Restless Leg Syndrome (RLS) - Unpleasant feelings in the legs such as tingling or aching may keep a pregnant woman awake at night or the hours before bedtime. The symptoms are temporarily relieved by movement and stretching, which prevent restful sleep.
- Sleep Apnea - This sleep disorder interrupts breathing multiple times per night due to a blockage of the airway. Symptoms may include loud snoring, frequent pauses in breath and then gasping, snorting and choking to resume breathing.
- Nocturnal Gastroesophageal Reflux (GERD) - Also known as heartburn, this is a normal part of pregnancy. However, nighttime GERD can damage the esophagus and disrupt sleep.
- Frequent Nighttime Urination - This is another common feature of pregnancy, which can result in significant lack of sleep.
Treatment for Sleep Disorders During Pregnancy
Unfortunately, drug therapy may be out of the question for a pregnant woman due to the risk of harming the developing fetus. For instance, most of the drugs that are used to treat insomnia carry potential risks and are not usually recommended for pregnant or nursing women. However, many of the symptoms of pregnancy-related insomnia can be alleviated by practicing proper sleep hygiene.
The drug therapies for RLS also can pose risks for the development of the fetus. One way to alleviate the symptoms of RLS during pregnancy is to take a prenatal vitamin which contains iron and folate. However, folate is better absorbed in foods such as whole grains, cereals and breads than in supplements.
Overweight or obese pregnant women and women who gain excessive weight during pregnancy and snore frequently should be evaluated for sleep apnea. A continuous positive airway pressure (CPAP) mask is a safe and effective way to treat sleep apnea during pregnancy and does not harm the fetus.
GERD can be treated with over-the-counter antacid medications.
The good news is that many of the sleep disturbances experienced by pregnant women go away after giving birth.
How to Cope with Sleep Disturbances During Pregnancy
Getting adequate sleep while pregnant may be a challenge, but there are ways to minimize your sleep loss while pregnant:
- Prioritize your sleep by planning and scheduling a set wake/sleep time.
- Eliminate caffeine and alcohol during pregnancy, both which can cause sleep disturbances and harm the fetus.
- Watch your diet. Ask your health care provider for tips about what you should eat, specifically, during pregnancy.
- Try to get daily exercise for at least 30 minutes per day unless advised otherwise by a health care provider.
- Avoid lying on your back for extended periods of time, and try to sleep on your left side in order to improve blood flow and nutrients to the fetus, as well as to your uterus and kidneys.
- Make sure to get adequate fluids during the daytime, particularly water, but cut back on fluids in the hours before bedtime to limit nighttime urination needs.
- To avoid heartburn, eat frequent, small meals during the day and try to avoid large amounts of spicy, acidic or fried foods.
- Although snoring is common in pregnancy, if you stop breathing at night and wake up to resume breathing (which can be noticed by a bed partner before you’re aware of it), you should be screened for sleep apnea by a sleep specialist.
- Women who have RLS should be monitored for iron or folate deficiency.
- To take pressure off your lower back, lie on your left side with your knees and hips bent. A pillow between your legs, under your belly and behind your back can help facilitate this.
- For trips to the bathroom at night, use a nightlight in the bathroom rather than turning other lights on, as they are more likely to keep you awake upon returning to bed.
- Nap during the day when possible, but try to keep naps under an hour. Reduce napping during the late afternoon if you have difficulty falling asleep at night.
To learn more about how pregnancy may influence your sleep quality, please call The Los Angeles Sleep Study Institute at 1-855-690-0563.