For most women, pregnancy is a time of great joy, excitement and anticipation. Unfortunately, for many it can also be a time of serious sleep disturbance, even for women who have never had problems sleeping. In fact, according to the National Sleep Foundation’s 1998 Women and Sleep poll, 78% of women report more disturbed sleep during pregnancy than at other times. Many women also report feeling extremely fatigued during pregnancy, especially during the first and third trimesters. Considering the physical and emotional demands of pregnancy and the prevalence of sleep disorders among pregnant women, it’s no wonder that expectant mothers become so tired.
One of the reasons for fatigue and sleep problems during pregnancy are changing hormone levels. For example, rising progesterone levels may partly explain excessive daytime sleepiness, especially in the first trimester. Hormonal changes may also have an inhibitory effect on muscles, which may result in snoring and in obese women increase the risk of developing sleep apnea and may be partly responsible for the frequent trips to the bathroom during the night. These interruptions as well as those caused by nausea and other pregnancy-related discomforts can result in significant loss of sleep. Many women experience insomnia due to emotions and anxiety about labor and delivery, balancing motherhood and work, or their changing relationship with their partner. This is especially true of first time mothers. For most women, getting a full night’s sleep becomes even harder once the baby is born. It is very important for pregnant women to prioritize sleep and to find effective strategies for managing their sleep problems as early as possible in their pregnancy.
Expecting mothers seem to be among some of the most afflicted when it comes to sleep loss. In fact, according to a poll by the National Sleep Foundation, 78% of women reported more disturbed sleep while pregnant than at any other time.
Pregnancy and Sleep Disorders
Insomnia is one of the most common sleep disorders. Insomnia’s primary symptoms include difficulty going to sleep, difficulty maintaining sleep, and waking up too early without being able to go back to sleep.
Pregnant women often report symptoms of insomnia due to stress and anxiety about labor, delivery, motherhood, and balancing parenting with work or school. Other pregnancy related problems such as discomfort, back pain, and fetal movements also contribute to sleep loss.
Restless Leg Syndrome
Restless leg syndrome (RLS) is a condition characterized by sensations in the legs such as cramping, itching, aching, burning, creeping, or pulling that occur when the legs are at rest, most notably while in bed.
The symptoms are relieved only by moving the legs temporarily. Shortly after movement, the legs begin to develop the sensations again. These uncomfortable feelings can make sleep difficult, as the need to constantly be moving the legs to reduce symptoms keeps sufferers awake.
Nearly 26% of women report symptoms or RLS during pregnancy, with symptoms at peak during the 7th and 8th month of pregnancy. Most RLS symptoms disappear within one month of delivery.
Obstructive sleep apnea (OSA) is a sleep disorder characterized by interrupted breathing during sleep as a result of an obstruction of the upper airways. Fatty tissues of the throat relax and collapse back into the airways during sleep. The results are loud snoring followed by pauses ain breathing, and then gasping or choking sounds as the brain partially wakes from sleep to force the body to increase breathing effort. These partial awakenings from sleep reduce the overall quality of sleep making suffers experience excessive daytime sleepiness during the daytime. Morning headaches are also associated with lower oxygen levels in the blood.
Women who are already overweight are more likely to develop sleep apnea as a result of an excess build up of fatty tissues in the throat due to the added weight gain experienced during pregnancy.
Nocturnal gastroesophageal reflux disease (GERD)
GERD, or heartburn, is a frequent complaint among pregnant women. Heartburn in pregnant women can be attributed to a few occurrences during pregnancy most notably are hormonal changes that cause the digestive system to slow down including muscles in the esophagus that push food down. Another contributing factor to GERD is the growing uterus putting pressure on the stomach and sometimes pushing stomach acids up into the esophagus.
Symptoms of GERD can worsen during sleep as the sufferer lays down, allowing the acids to move up into the esophagus more easily.
Treatment for sleep problems during pregnancy is complicated by the fact that drug therapy can harm a developing fetus. For example, most drugs that are used to treat insomnia carry some risk and are typically not recommended for women who are pregnant or nursing. However, by practicing good sleep hygiene, most women are able to manage pregnancy-related insomnia.
Most medications for RLS also pose risks to a developing fetus. Women most at risk for developing RLS during pregnancy are those with low levels of dietary folate and/or iron. This should be considered even before getting pregnant. Prenatal vitamins that include folate and iron supplements will help reduce RLS symptoms during pregnancy, but folate is better absorbed in foods (whole grains, cereals, and breads than it is in pill supplements; coffee decreases absorption and vitamin C increases absorption of folate from foods.
Overweight or obese women who become pregnant, women who gain excessive weight and women who report snoring should be evaluated for sleep apnea. Continuous positive airway pressure (CPAP) is a safe and effective treatment for sleep apnea during pregnancy.
Gastroesophageal reflux (GERD) can be treated with over-the-counter antacids.
There is no over-the-counter remedy for pregnant women who experience frequent nighttime urination but see “Coping” for what you can do to minimize the problem.
The good news about most of the sleep problems experienced by pregnant women is that they tend to go away once the baby is born, but women should still pay close attention to their sleep after they give birth as new sleep problems may arise.
Sleeping well throughout pregnancy can be challenging. Follow these coping tips throughout your pregnancy to minimize loss of sleep:
- Plan, schedule and prioritize sleep.
- Unless your health care provider has advised against it, try to exercise for at least 30 minutes per day.
- Sleep on your left side to improve the flow of blood and nutrients to your fetus and to your uterus and kidneys. Try to avoid lying on your back for extended periods of time.
- Drink lots of fluids during the day, especially water, but cut down on the amount you drink in the hours before bedtime.
- In order to avoid heartburn, do not eat large amounts of spicy, acidic or fried foods. Also, eat frequent small meals throughout the day.
- Snoring is very common during pregnancy, but if you have pauses in your breathing associated with your snoring, you should be screened for sleep apnea. Also, have your blood pressure and urine protein checked—especially if you have swollen ankles or headaches.
- If you develop RLS, you should be evaluated for iron or folate deficiency.
- If you can’t sleep, don’t lie in bed forcing yourself to sleep. Get up and read a book, knit or crochet something for your baby, write in a journal, or take a warm bath.
- When sleeping, lie on your left side with your knees and hips bent. Place pillows between your knees, under your abdomen and behind your back. This may take pressure off your lower back.
- Put a nightlight in the bathroom instead of turning on the light to use the bathroom — this will be less arousing and help you return to sleep more quickly.
- Add daytime naps as necessary, but reduce them or nap earlier in the day if you have difficulty falling asleep at night.
The need to use the bathroom frequently at night can disrupt sleep as expecting mothers often wake multiple times in the night for bathroom breaks. These frequent trips disrupt sleep patterns and can cause symptoms of daytime fatigue.
Pregnancy Sleep Tips
If you’re an expectant mother you shouldn’t let the potential for developing a sleep disorder scare you too much. For many pregnant women, sleep troubles can be fixed by following a few simple sleep hygiene practices to minimize the risk of sleep disorders and maximize the amount of nightly sleep. Furthermore, many of the tips for sleeping while pregnant are also very useful sleep tips for just about anybody suffering from sleep loss.
- Maintain a regular sleep/wake cycle. Prioritizing sleep is key in getting sleep. Making sure that you’re going to bed and waking up at the same time every day (including weekends) goes a long way in feeling more awake and alert during the day.
- Exercise regularly. Unless your doctor advises against it, regular exercise should be done at least 30 minutes a day. Getting out any pent up energy through exercise will increase circulation, improve mood, and help you fall asleep easier at night. However, no vigorous exercise should be done too close to bedtime. If you prefer to workout later in the day, some light exercises such as yoga are recommended.
- Cutback on fluids at night. It’s very important to stay hydrated during pregnancy, but to help reduce late night trips to the bathroom avoid drinking large amounts in the hours leading up to bedtime.
- Avoid Spicy Foods and heavy meals before bedtime. Eating spicy foods before bedtime can increase the chances and severity of heartburn at night. Eating heavy meals before bedtime makes the body work harder during sleep to digest your food, distracting it from working on the repairs your body needs for the next day’s activities. If you’re feeling hungry close to bedtime, try eating a light snack such as a banana, crackers and cheese, or a small bowl of cereal.
- Sleep on your left side. During the third trimester of sleep it is recommended that expecting mothers sleep on their left side. This increases the flow of blood and nutrients to the fetus, uterus, and kidneys. Also, try to avoid sleeping on your back for extended periods of time.
- Use pillows. Special pregnancy pillows can go a long way towards nighttime comfort. Another pillow tip to reduce back pain is to lay on your left side with hips and knees bent and place pillows between your knees, under your abdomen, and behind your back.
- When having trouble sleeping get out of bed. If sleep is alluding you, don’t lie in bed willing it to come. Get out of bed and do another relaxing activity such as reading, writing, take a warm bath, or any other relaxing activity before returning to bed.
- Take short naps during the day. For the most part, naps are usually advised against as they tend to disrupt regular sleep cycles making going to sleep at night more difficult. However, studies have shown that napping while pregnant can prove beneficial. A poll by the National Sleep Foundation found that 51% of women reported at least one midweek nap and 60% reported napping on the weekends. However, if you choose to nap make sure they’re no more than 20-30 minutes long, and don’t nap too close to bedtime.