Sleep and Pregnancy

By Madhavi Gupta, M.D.

Sleep and Pregnancy

Good sleep is important for a healthy pregnancy. Yet, pregnancy is a time of increased sleep disturbance making getting a good night’s sleep a challenge just when you need it most.

Epidemiologic studies suggest there is an increased need for sleep during pregnancy. The high levels of the hormones human chorionic gonadotropin and progesterone that are required to maintain pregnancy also promote daytime sleepiness and a desire for early bedtimes. At the same time there is growing evidence linking sleep disturbances with adverse outcomes and showing the positive role sleep can play in promoting better health for both mama and baby (1).

The American Academy of Sleep Medicine (AASM) says that one of the ways for expectant mothers to help give their baby a better chance of a healthy and full-term birth is to practice good sleep hygiene.

 

How pregnancy affects sleep

If you are having trouble sleeping, you aren’t alone. Experts say that most pregnant women struggle with sleep problems and problems start with the first trimester. At least 50% of pregnant women suffer from insomnia according to the Sleep Foundation

“During the first trimester, women experience frequent waking at night, often related to frequent trips to the bathroom during the night and nighttime nausea,” says Dr. Jodi A. Mindell, a professor of psychology at St. Joseph’s University in Philadelphia, and associate director of the Sleep Center at the Children’s Hospital of Philadelphia.

In the early days of pregnancy many women experience overwhelming daytime and evening fatigue and want to sleep longer at night. During the second and third trimester, it can be difficult to find a comfortable sleeping position. Heartburn, back pain, and leg cramps all contribute to sleep disruption.

 

Why sleep is so important

There are many benefits to sleep and some are specific to pregnancy. Sleep plays a major role in memory, learning, appetite, mood, and decision-making. Mom brain, also called momnesia, is actually a real thing (2) and one of the primary symptoms of mom brain is insomnia. Sleep contributes to your overall health and can have a positive influence on reducing stress. Sleep deprivation can have negative effects while good sleep increases the likelihood of a full-term pregnancy (3).

 

More successful breastfeeding

Improving sleep may improve maternal health and breastfeeding. Studies show that women with better sleep efficiency and more stable nightly sleep time are less likely to experience delayed onset of lactogenesis, the process of developing the ability to secrete milk (4). 

 

Sleep lowers the chance of depression

In a recent study, pregnant women sleeping less than 6 hours a night and reporting poor sleep quality in the third-trimester were at greater risk for clinical depression. The same study reported that improving sleep is associated with a reduction in depression symptom severity and prevalence in pregnant women (5). Another study showed a relationship between poorer sleep quality and postpartum depression indicating sleep affects depression both during and after pregnancy (6).

 

Better baby sleep habits and better temperment

Emerging evidence suggests that maternal sleep problems before and during pregnancy may predict sleep problems and crying in babies once they are born. Infants whose mothers had poor sleep quality and slept for less than 6 hours tended to cry more intensely and were associated with preterm birth and child sleep problems and temperament. On the plus side, since maternal sleep duration was positively associated with childhood sleep duration, focusing on better sleep can have a positive effect as well (7-8).

 

Sleep helps to regulate blood sugar

Sleep deprivation in the first trimester has been tied to gestational diabetes mellitus (9). Growing evidence indicates that sleep deficiency alters glucose metabolism and increases the risk of diabetes. Poor sleep may exacerbate the progressive increase in insulin resistance that normally occurs during pregnancy, thus contributing to the development of maternal hyperglycemia (10). 

 

Sleep and the immune system

Getting enough sleep is important to supporting a healthy immune system. Poor sleep quality and quantity during pregnancy can disrupt normal immune processes and lead to lower birth weights and other complications, according to a new study (11). 

This is even more important for women with depression. Women with depression are more likely than non-depressed women to suffer from disturbed sleep and to experience immune system disruption and adverse pregnancy outcomes (11). If you suffer from depression, it’s important to talk with your healthcare professional during your pregnancy.

 

Sleep and hypertension and preeclampsia

Multiple research studies show that poor quality sleep may contribute to hypertension and preeclampsia, a condition that can lead to preterm delivery and lasting complications for the mother’s heart, kidney, and other organs.  Pregnant women who get too much or not enough sleep in early pregnancy are prone to developing high blood pressure in the third trimester. Severe sleep deprivation in early pregnancy may also raise the risk of preeclampsia, (12).

 

Sleep and better labor

The amount of sleep you get in late pregnancy may predict the length of labor and likelihood of cesarean delivery. Research shows that women who experience sleep problems in late pregnancy have longer labors and are more likely to need a cesarean section (13). In one study, women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries. Women with severely disrupted sleep had longer labors and were 5.2 times more likely to have cesarean deliveries (14). 

 

Restless Leg Syndrome

Restless legs syndrome (RLS) is a neurosensory disorder that typically begins in the evening and often prevents a person from falling asleep. RLS is a common problem during pregnancy and thought to affect up to one-third of women in their third trimester. A recent study found that overall 36% of the pregnant women had RLS, and half had moderate to severe symptoms (15). 

People with restless legs syndrome are plagued by crawling, tickling, or itching sensations that cause an irrepressible urge to move the legs. The symptoms are more severe when you are at rest. RLS has been associated with iron deficiency anemia and a reduced serum folate level (16). Ask your practitioner about being tested for iron-deficiency anemia. In the meantime, it’s always a good idea to include iron-rich foods in your diet and consider a supplement such as Hello Vitality Liquid Iron.

 

Sleep and breathing

Some research suggests sleep-disordered breathing may be a risk factor for miscarriage (17). Sleep apnea, in particular, can be a risk factor for preterm delivery, preeclampsia, and gestational diabetes mellitus (18). Pregnant women who experience insomnia or habitual snoring appear to be more likely to give birth to a baby that is too large or too small for gestational age (19).

Nasal congestion and the extra weight of pregnancy can lead many women to start snoring, which may be a risk factor for high blood pressure. Some women go on to develop obstructive sleep apnea (OSA), a condition characterized by snoring, gasping, and repeated lapses in breathing that disrupt sleep quality. OSA may impede oxygen flow to the fetus and increase the risk of preeclampsia, gestational diabetes, and cesarean sections. It is thought to affect as many as 1 in 5 pregnant women. Treating sleep-disordered breathing can be beneficial to avoiding negative outcomes (20).

 

Sleep and GERD

Another common cause of insomnia during pregnancy is gastroesophageal reflux disorder (GERD). Otherwise known as heartburn or acid reflux, GERD causes an uncomfortable burning sensation in the esophagus, especially when lying down. It’s thought to affect one-quarter of pregnant women in the first trimester and as many as one-half in the third (21). 

 

Vivid dreams during pregnancy

You may notice more active dreaming and even more anxious or fearful dreams. This, too, is normal, especially in the third trimester. Sleep experts say that late pregnancy is a period of markedly increased dysphoric dream imagery that can impair your sleep (22). Remember they are only dreams and the result of changes in your body and practice self care to bring calm.

 

How much sleep do you need?                

The ideal sleep for a pregnant mama tends to be about 9 hours a night. Surprisingly, too much sleep has the same effect on blood pressure as too little. Both increase blood pressure. Experts at the Alaska Sleep Education Center say to watch out for less than 6 hours and more than 10 hours.

Tips for a good night’s sleep

  • Make sleep a priority. Try going to bed and waking up at the same time each day and allot more than eight hours of time in bed to allow for some inevitable disruptions.
  • Try side-sleeping on your left side. Sleeping on the left side improves blood flow to the heart, kidneys, uterus, and to your baby because it keeps baby from putting pressure on the vein carrying blood back to the heart from your legs. You’ll also be more comfortable on your side with your knees bent. It’s okay to switch sides, but it’s best not to sleep on your back.
  • Try a sleep pillow. Using pillows under your belly or between your legs can make you more comfortable. Relieve pressure at the small of your back by adding a pillow or rolled-up blanket. A special foam mattress pad can give extra relief if your hips get sore and there are several pillows designed specifically for pregnancy to help you sleep more comfortably.
  • Avoid caffeine, sugar, and simple carbohydrates. 
  • Avoid drinking too much liquid in the hours just before bed to manage how much you awaken to use the bathroom. 
  • Avoid heavy meals or spicy foods close to bedtime, especially if you experience reflux. Some women find it helpful to eat a big breakfast and lunch, then have a smaller dinner. If nausea is keeping you up, try eating a few crackers before you go to bed. 
  • Exercise. Regular daily exercise can help you sleep but avoid doing it right before bed since exercise raises body temperature which affects your ability to sleep. 
  • Relax before bed. Take the time to unwind from your day. Try soaking in a warm bath for 15 minutes, or having a warm, caffeine-free drink.
  • Create a comfortable environment. Make your bedroom dark, quiet, and set a comfortable temperature. Avoid blue light from screens in the hour before bedtime.
  • Nap during the day if you can.
  • Make sure you’re getting enough iron and folate — anemia can contribute to restless legs syndrome
  • Manage stress. Try writing down your worries in a journal, so you can let go of them before you sleep. Childbirth classes can help you prepare for the life changes ahead.
  • Don’t rely on sleep medications, as they may have side effects.



Sleep and nutrition: nutrients for better sleep

A healthy diet will support your pregnancy in many ways, including helping you get better sleep. Here are some important nutrients to look for.

Vitamin D has both a direct and an indirect role in the regulation of sleep. Vitamin D receptors and the enzymes that control their activation and degradation are expressed in several areas of the brain involved in sleep regulation. Vitamin D is also involved in producing melatonin. There is some new exploration suggesting that vitamin D might affect sleep indirectly by helping with restless legs syndrome and obstructive sleep apnea syndrome as well (24). Spend some time outside every day if you can and  look for ways to include vitamin D in your diet as well as supplements like Sunny Skies Vitamin D Drops.

Folate has been shown to help with sleep. Among key findings, there is an inverse association between folate and sleep disturbance (25). 

Vitamin B12. B-12 deficiency can be linked to insomnia in several ways, including altered sleep patterns, difficulty falling asleep, or lack of sleep. Proper levels of serum vitamin B-12 has been associated with sleep duration. Vitamin B-12 also works closely in the body with the hormone melatonin. Melatonin is responsible for regulating the circadian rhythms within our bodies, affecting our sleep patterns. High levels of vitamin B-12 can increase your melatonin production, causing you to go to sleep sooner (26). 

In addition to a healthy diet, look for prenatal multivitamins that include these important nutrients like Mama Bird(R) Prenatal Multi+ and Mama Bird AM/PM Prenatal Multi+.

Getting a good night’s sleep isn’t always easy while you’re pregnant, but follow some of these tips, pay attention to healthy nutrition, and do what you can to get your best rest. You’ll feel better and be better prepared for baby’s arrival.


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