Pregnancy is an exciting time full of joy, anticipation, and utter bliss. But this happy time can be rocked by serious sleep disturbances that make it anything but joyful. It is normal for women to be tired and feel a little fatigued from carrying around a new life inside them. So it’s not unusual that 78% of women report sleep disorders during pregnancy even if they have never had problems sleeping before.
Sleep disturbances affect pregnant women more often than not due to several reasons. Changing hormone levels during pregnancy can cause them to feel more tired than normal. The numerous trips to the bathroom during the night can contribute to this as well. Excessive daytime sleepiness in the first trimester usually happens due to rising progesterone levels. Snoring may occur due to hormonal changes that have inhibitory effect on muscles. Pregnant women who are obese may be at risk of developing sleep apnea and should see their doctor if this becomes an issue. Such complications as low birth weight, preeclampsia and gestational hypertension may be associated with sleep apnea.
Pregnancy can cause or worsen existing sleep disorders. A study of over 600 pregnant women with sleep disorders revealed that 26% of them reported symptoms of restless leg syndrome (RLS). Another issue is GERD or gastroesophageal reflux disease; a study found that 30 - 50% of pregnant women experience problems with acid reflux.
Poor sleep can also affect the labor and delivery times. Researchers from the University of California discovered that pregnant women who slept less than 6 hours per night had longer labors and were 4.5 times more likely to have their babies by cesarean. This has become such an issue that doctors now regularly discuss sleep habits with patients as a part of their basic prenatal care. Pregnant women should make sleep a priority during their pregnancy as early as possible.
First-time mothers have a hard time sleeping because of anxiety about labor and delivery or balancing work and motherhood. Getting enough sleep is even harder once the baby is born. Sleep loss caused by frequent bathroom trips, nausea, and occasional insomnia can take a toll on your health if it persists.
It is not uncommon to have sleep issues during your pregnancy. Here are some symptoms that may keep you awake at night:
Frequent urination – You may wake up frequently during the night to use the bathroom due to increasing pressure on the abdomen. This leads to poor sleep quality if it occurs several times per night.
Nocturnal gastroesophageal reflux – GERD is a common problem in pregnancy. The stomach acid rises up into the esophagus and throat at night when you lay down. The symptoms are lessened by sitting up or raising the head of the bed to a 45 degree angle. GERD can damage the tissue in the esophagus if not treated.
Sleep apnea – Sleep apnea is a sleep disorder in which you may experience repeated pauses between breaths and gasping for air upon waking. A common symptom of sleep apnea is heavy snoring and choking sounds on waking from sleep.
Restless legs syndrome (RLS) - If you have that urge to stretch, rub, or move your legs during the night you might have a disorder known as RLS or Restless legs syndrome. Symptoms of RLS is a tingly, achy, itchy, or otherwise unpleasant sensation in the legs that makes you want to move them.
Insomnia – Symptoms of insomnia include trouble falling asleep, staying asleep, or waking up too early. Episodes of insomnia are often stress or anxiety-related and center around labor, delivery or life changes that motherhood will bring about. Fetal movements, back pain, and nausea can frequently disturb sleep during pregnancy as the pressure on the body increases.
The Effects of Pregnancy on Sleep
Changes in sleep patterns happen frequently during pregnancy. Things like frequent nighttime awakenings, trouble going back to sleep, fatigue or excessive daytime sleepiness affect the quantity and quality of sleep.
Some sleep issues that emerge in the early stages of pregnancy may disappear as pregnancy progresses, or worsen in intensity. A large number of women experience increased nighttime awakenings especially during the third trimester. Hormone changes, psychological adjustments, physical discomfort impact sleep and result in a sleep deficit.
Hormones and Sleep
Pregnancy is dominated by hormones. Changes in the growing body put pressure on vital organs resulting in physical discomfort while standing, sitting, and lying down. Dramatic hormonal changes during pregnancy affect mood, metabolism, and pattern of sleep. With so much going on in the body, it is easy to see why women tend to be cranky in the latter stages of pregnancy:
Oxytocin - can bring on strong contractions that disrupt sleep. The increase in oxytocin level may also lead to a higher incidence of labor and delivery during the night.
Estrogen - enlarges blood vessels which can lead to swelling or edema in the legs and feet. It may also cause congestion which interferes with breathing during the night. Furthermore, it can reduce the amount of dreaming phase of sleep - the REM sleep.
Progesterone - contributes to frequent urination, nasal congestion, heartburn. In addition, it reduces the amount of rapid eye movement (REM) sleep (a stage of sleep responsible for lucid dreaming).
Melatonin levels tend to increase during pregnancy and increased levels of prolactin in the body may lead to more slow-wave sleep.
Sleep Cycles During Pregnancy
Studies have shown a dramatic change in sleep patterns during pregnancy. Sleep efficiency or the amount of time spent asleep while in bed decreases due to frequent nighttime awakenings.
Here is a look at how sleep changes over all three cycles of pregnancy:
- First Trimester (12 weeks): During this phase the quantity of sleep as well as the amount of slow-wave (deep) sleep may decrease due to frequent nighttime awakenings. On the other hand, total sleep time may increase as napping is frequently needed during the daytime.
- Second Trimester (Weeks 13 to 28): Sleep tends to improve as the number of nighttime awakenings decrease. However, sleep quality will decrease again towards the end of the 28th week.
- Third Trimester (Weeks 29 to term): Women entering the third trimester experience more physical discomfort and frequent nighttime awakenings which contribute to poor sleep quality. Sleep is lighter with an increase in stage 1 and 2 sleep. As a result, napping increases during daytime hours.
Sleep Problems During Pregnancy
Sleeping can be difficult when pregnant. When you have other issues going on at the same time it can compound the problem even more. More often, symptoms of sleep disorders appear during pregnancy due to the physical changes in the body.
For some women, pregnancy is the only time they ever suffer from a sleep disorder. Their quality of sleep prior to becoming pregnant was normal. Existing sleep disorder such as restless legs syndrome and sleep apnea may worsen in pregnancy as well. We will look at each trimester and see the effects of changes on the body at each stage until labor and delivery:
During the first trimester, women may experience excessive daytime sleepiness and fatigue more often. Daytime napping is common for pregnant women and may increase as the time progresses. As more progesterone is produced in the body, sleep is often fragmented and disturbed. In the first 7 weeks, up to 37,5% of women report an increase in daytime sleepiness.
Morning sickness (nausea and vomiting), breast tenderness, increased appetite, back pain, increased urination, and anxiety are some of the chief complaints of this phase of development. These physical and psychological issues can interfere with healthy sleep. Anxiety can become problematic if the pregnancy was unplanned and contribute to episodes of insomnia.
During the second trimester sleep typically improves. Nausea and vomiting experienced in the first few weeks usually disappears. Frequent urination slows down a bit as well.
Towards the end of second trimester, sleep might be disrupted by stomach pain or irregular contractions known as Braxton - Hicks contractions. Due to an increase in weight sleep may be disrupted by the movements of the baby during the night, increased heartburn, and possible snoring from nasal congestion.
In the final trimester, sleep may become even more disturbed. Sleep issues and nighttime awakenings happen more often due to the increased pressure on the woman’s bladder. Issues affecting sleep during this phase of pregnancy include:
- Nightmares or vivid dreams
- Breast tenderness
- Joint and back pain
- Shortness of breath
- Leg cramps
- Frequent urination
At this time, the most physical demands are put on the woman’s body and sleep deficits become apparent. Episodes of sleep apnea and RLS or other sleep disorders may appear due to increased weight gain. It is harder at this stage to get comfortable for sleeping and many women report an increase of joint and back pain due to the larger size of the baby. Pillows and lumbar supports can provide some relief.
Due to the increased size of the fetus and the pressure put on the vital organs, more women may experience heartburn or gastro-esophageal reflux disease (GERD). A wedge pillow can reduce discomfort and provide some relief of symptoms. This is an important time to watch for increased swelling of the ankles, hands, or face. During this phase of pregnancy preeclampsia (high blood pressure only occurring during pregnancy) may occur, which has an impact on sleep and circadian rhythms.
Treatments for Sleep Issues
Treating sleep issues is difficult when a woman is pregnant. Many of the medications used to treat insomnia can harm a developing baby and are not recommended for pregnant women or nursing mothers. However, it is possible to manage sleep issues related to pregnancy without the use of pharmaceuticals by practicing good sleep hygiene.
Likewise, medications used to treat symptoms of RLS are also not recommended for pregnant women. However, prenatal vitamins containing iron and folate supplements can reduce the RLS symptoms. Breads, cereals, and whole grains are excellent sources of iron and folate as well. Women with low iron and/or dietary folate levels should consider taking vitamins before becoming pregnant.
Pregnant women who gain a lot of weight and have issues with snoring need to be evaluated by their doctors for sleep apnea. CPAP or continuous positive airway pressure is the recommended treatment for sleep apnea, and is safe for use during pregnancy.
While there is no treatment indicated for frequent nighttime urination, there are helpful suggestions in the “tips” section below which may help to minimize sleep disruption.
Over-the-counter antacids may be used for gastroesophageal reflux (GERD) as there is no danger in using them during pregnancy.
Once the baby is born, many sleep issues pregnant women are experiencing now will go away on their own. However, sleep deprivation after giving birth may still be an issue due to the demands of a newborn.
Finding a Good Sleeping Position
It is true that is difficult to find a comfortable sleeping position when you get to the last trimester. However, there are some things that can help you to get comfortable and encourage restful sleep. Here are a few suggestions:
The most comfortable position is lying on your side with your knees bent and with some pillows placed under your abdomen or between your legs for additional support. It improves circulation, supplies more oxygen for you and the baby and reduces excess pressure (baby’s weight) on the large vein carrying blood back to the heart from your feet and legs.
Shifting positions is something you really have no control over while you are sleeping. However, you probably won't be able to roll over onto your back because it will be too uncomfortable. If you do shift onto your back you’ll probably wake up from the discomfort after a few minutes.
Tips for Sleeping Success
You should not take any over-the-counter sleep aids (including herbal remedies) without your doctor's approval. While they are perfectly fine for non-pregnant women, they may contain ingredients that are not good for your developing baby. If you want to increase your chances of getting a good night's sleep, follow these tips instead:
- If you are worried about the delivery, taking a childbirth class should help relieve some of your anxiety. It is helpful to have a support system and knowledge to ease the fears that keep you awake at night.
- Doing yoga stretches before bed can be very relaxing and help you sleep better. It’s great for unwinding and de-stressing at the end of the day. Just avoid doing any rigorous exercise right before bed.
- Try to get in the habit of going to bed and waking up at the same time each day (even on weekends). This helps to reset your circadian rhythm and help you fall asleep easier.
- Avoid eating a full meal or drinking a lot of fluids for several hours before going to bed. Make sure to get your nutrition early in the day, just not in the evening. You may prefer to eat more at breakfast and lunch and have a small dinner to compensate.
- Nap earlier in the day if you have difficulty falling asleep at night.
- If you have pauses in you breathing associated with your snoring, you should be screened for sleep apnea.
- Restrict your consumption of coffee, tea, and soda as much as possible. Restrict caffeine intake to the morning or early afternoon.
- Make sleep a priority. Plan a time to go to bed each night.
- If you can’t fall asleep don’t just lay there staring at the ceiling. Get up and do something productive for 30 minutes and then try again.
- Sleep on your left side to improve blood flow and make breathing easier. Try to avoid laying on you back for extended periods of time.
- Exercise for at least 30 minutes per day as long as your doctor agrees.
- Eat small meals frequently throughout the day to avoid heartburn. Do not eat large amounts of fried, acidic or spicy foods.
- RLS can be treated with iron and folate supplements and through diet during pregnancy. Stretching may also help relieve the tension in your legs and prevent cramps or instances of restless leg syndrome.
- Install a nightlight in the bathroom and use it instead of turning on the light. It will be less arousing and may help you be able to go back to sleep once you return to bed.
- Have your blood pressure and urine protein checked regularly. Let your doctor know if you experience headaches or have swollen ankles.
- Sleep on your left side with a pillow placed between your knees, under your abdomen and behind your back to relieve pressure on the lower back and feel more comfortable.
Keep in mind that insomnia for any reason during pregnancy is short-lived and will usually disappear after the baby arrives. Work with your doctor to minimize sleep deprivation and maximize your nutritional intake for your best health.