Part I: Sleep Disruptions in Pregnancy
Time of significant change
Pregnancy is a time where the body undergoes many physiological, biochemical and physical changes and the mind may be faced with emotional stressors associated with this important transitionary period. As a result, the potential for sleep disturbances increase and it’s no wonder that 78% of women report sleep-related issues during pregnancy.
And the reality is, once your baby arrives, sleep will temporarily be further disrupted as you'll be supporting their sleep and well-being during the night to feed, comfort and change them. So laying the foundation for healthy sleep is key during the prenatal period as it will maximize your potential to get quality sleep during pregnancy and postpartum, minimize your chances of developing a sleep disorder as well as help you get back on track for future stabilized sleep once your baby sleeps through the night and you have the opportunity to do so yourself.
As a sleep coach, it’s important to educate my clients about typical sleep and how it can change during pregnancy, inform them of any red flags to watch out for during this time as well as set them up with evidence-based, sleep promoting strategies and practices.
First Trimester (weeks 1-12)
The growing fetus is very small, but it is developing rapidly and requires a lot of energy. Due to rising progesterone levels, total sleep time may increase because of frequent daytime naps but many women complain of poor quality sleep, with frequent awakenings.
Rising progesterone levels along with your enlarged uterus pressing on the bladder causes you to produce more urine, making it more likely to get up more during the night to go to the bathroom. Elevated levels of this hormone can also cause respiratory changes that disrupt sleep, such as nasal congestion or snoring, putting you more at risk to develop obstructive sleep apnea. Sleep apnea is a potentially serious sleep disorder in which your breathing stops and restarts many times while you sleep, preventing the body from getting enough oxygen. During pregnancy, 1 in 5 have sleep apnea due to weight gain and/or nasal congestion.
Fluctuating levels of estrogen can also affect sleep during pregnancy. Estrogen plays an important role in temperature regulation, and during pregnancy, changing levels may lead to hot flashes, sweating, swelling in the feet and legs as well as feelings of dehydration.
A variety of other physical changes and symptoms may also undermine sleep, including nausea and vomiting, back pain, breast tenderness, increased appetite, and anxiety. Unaddressed anxiety and/or depression can be especially problematic because it may put women more at risk to develop insomnia and postpartum depression later on.
Second Trimester (weeks 13-26)
Sleep tends to improve with better sleep efficiency and less time spent awake after going to bed at night. By the end of the second trimester, however, the number of awakenings during the night again increases.
Many women feel discomfort due to their growing belly and may find it hard to settle into a comfortable sleeping position. As your pregnancy progresses and your uterus gets bigger, it may put pressure on your stomach and esophagus, making acid reflux and resulting heartburn more common. 30-50% of women experience gastroesophageal reflux disease (GERD) during pregnancy, which tends to be worse at night while lying down.
Leg cramps may occur (especially for those with low iron levels) and women are more at risk to develop Restless Leg Syndrome (RLS). RLS is a sleep disorder characterized by unpleasant feelings in legs such as tingling and aching, which is relieved by stretching or movement, and symptoms are worse in the evening, making it difficult to fall asleep and/or stay asleep. During pregnancy, approximately 26% report symptoms of RLS and the risk may increase as the pregnancy progresses.
Frequent awakenings during the night mean people are more likely to remember their dreams if they wake up in the middle of a dream cycle, so some women might start experiencing strange and vivid dreams related to their baby. While anxiety-provoking for some, pregnancy dreams have been hypothesized to be one of the ways your unconscious mind processes information and attempts to solve problems. There are a lot of unknowns so these dreams may reflect thoughts and feelings about your pregnancy, childbirth and the postnatal period.
Third Trimester (weeks 27-term)
Women report more trouble falling asleep and the number of night time and early morning awakenings increase. The hormone oxytocin can add to more fragmented sleep and you may spend more time in lighter sleep stages. You also may nap more frequently during the day, so sleep efficiency may again be reduced. Frequent trips to the bathroom are common, partly due to a higher overnight sodium release.
Many women will feel more kicking and moving from their baby at night and may suffer from backache and discomfort. Leg cramps may continue to persist or develop, and may be caused by low vitamin or mineral levels, circulation changes, dehydration, muscle fatigue or weight gain.
As the pregnancy progresses, women’s risk continues to increase to develop sleep disorders such as RLS, insomnia and breathing related sleep problems (eg. snoring and obstructive sleep apnea).
Getting ahead before falling behind
Sleep plays a crucial role in mood, cognition and physical health and every parent wants to be as physically and mentally prepared and balanced as they can for when their baby arrives.
Sleep deprivation and/or poor quality sleep in pregnancy may lead to complications such as high blood pressure, gestational diabetes and an increased chance of having a preterm birth. Poor maternal sleep is also associated with an increased chance of having a cesarean delivery and having a baby with low birth weight. Because sleep plays a major role in balancing stress hormones and mood, not getting enough sleep has been linked to mood disorders, such as anxiety and depression, and these symptoms may put women more at risk to develop postpartum depression, a condition that already affects 1 in 7 women.
The road to parenthood is a long and arduous one so laying the foundation for healthy sleep early on is key. To find out how to optimize your sleep in pregnancy in order to keep you on track for the long term, read Part II: Supporting Sleep in Pregnancy.
