Evie Summers
Sleep is a common concern for people in the first trimester of pregnancy. Many people experience insomnia during pregnancy, with about 25% of people reporting insomnia in early pregnancy, and up to 80% by the end of the third trimester.
Pregnancy is a common cause of insomnia, with changing hormone levels and a body adapting to a growing foetus causing various discomforts, including insomnia. Progesterone, in particular, is known to make people feel more tired and uncomfortably warm.
It is recommended that adults get seven to nine hours of sleep a night, but pregnant people may need eight to ten hours.
It is important to manage insomnia during pregnancy, as it has been linked to gestational diabetes, high blood pressure, and self-reported stress and depression.
| Characteristics | Values |
|---|---|
| Sleep duration | 10-14 hours |
| Fatigue | Extreme |
| Nausea | Throughout the day and night |
| Vomiting | Throughout the day and night |
| Heartburn | Throughout the day and night |
| Insomnia | Common |
| Sleep quality | Poor |
| Sleep disturbances | Common |
| Napping | Common |
| Sleepiness | Extreme |
| Sleep deprivation | Common |
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What You'll Learn
Progesterone levels and their effects on sleep
Progesterone is aptly named the "hormone of pregnancy" as it is critical to the survival of a pregnancy. It inhibits the rejection of T cell-mediated tissue, decreases myometrial activity and sensitivity throughout pregnancy, and thickens the uterine lining so a fertilized egg can attach and develop.
During pregnancy, progesterone levels increase dramatically, reaching 200 to 400 mg/day at term. Until approximately 7 weeks' gestation, increased progesterone production is dependent on the corpus luteum, and thereafter on the placenta, in what is known as the "luteal-placental shift" which occurs between 7 and 10 weeks.
Progesterone levels can confirm ovulation, help to uncover an ectopic pregnancy, and predict viability. Progesterone measurements are also useful in the diagnosis of luteal phase defects, which refer to below-normal levels of progesterone produced by the corpus luteum, causing delayed endometrial development.
Progesterone has a soporific effect, promoting daytime sleepiness and early sleep onset. However, it also causes nocturnal sleep fragmentation, which may explain why many pregnant people experience fatigue during the day while also having trouble sleeping at night.
Progesterone levels have been found to be lower in pregnant women with obstructive sleep apnea (OSA) compared to those without. This may be due to a few reasons. Firstly, obesity is a risk factor for OSA, and higher weight in pregnant women is generally associated with lower progesterone levels. Secondly, placental damage from OSA may lead to reduced progesterone production.
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Morning sickness and its impact on sleep
Morning sickness, which affects around half to two-thirds of pregnant women, can significantly impact sleep quality during the first trimester. It involves nausea and vomiting that can occur at any time of the day or night, contrary to the term "morning sickness." This can make it challenging for pregnant women to fall asleep or result in frequent awakenings.
The exact cause of morning sickness remains unknown, but it is believed to be associated with hormonal changes, particularly increased levels of estrogen and human chorionic gonadotropin (HCG). Additionally, blood pressure fluctuations and changes in carbohydrate metabolism may contribute to this condition.
The impact of morning sickness on sleep can be profound. The nausea and vomiting associated with morning sickness can make it difficult for pregnant women to get comfortable and fall asleep. It can also lead to dehydration, which further exacerbates fatigue and sleep disruption. Severe cases of morning sickness, known as hyperemesis gravidarum, may require hospitalization and intravenous fluids.
To manage morning sickness and improve sleep during the first trimester, the following strategies can be considered:
- Eating dry crackers or plain biscuits before getting out of bed
- Consuming small meals and snacks throughout the day to avoid an empty stomach
- Choosing high-protein and high-carbohydrate foods
- Staying hydrated and drinking plenty of fluids
- Avoiding triggers such as certain foods, odors, and emotional stress
- Practicing relaxation techniques like deep breathing or meditation
- Using acupressure wristbands or trying acupuncture
- Taking vitamin B6 supplements or prescribed medications like doxylamine
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Sleep positions and their comfort
During the first trimester, sleeping on your back or stomach is usually still comfortable. However, sleeping on your side is recommended during pregnancy, as it enhances blood circulation to the placenta and foetus, lowering the risk of stillbirth. Sleeping on the left side is generally considered the ideal position, as it improves blood flow to the uterus, placenta, and baby, ensuring optimal oxygen and nutrient supply. It also helps alleviate pressure on the liver and reduces the risk of swollen ankles. Nevertheless, sleeping on the right side is also acceptable, and alternating between sides at night can help prevent discomfort and excessive pressure on any one side.
If you are a front sleeper, you may find it difficult to get comfortable as your breasts may be tender. Tender breasts can make it difficult to sleep on your front, especially if you are used to sleeping in this position.
To get comfortable, you can try using pillows for support. Place pillows beneath your belly, behind your back, and between your legs for extra comfort. There are even special pillows designed for pregnant women, such as U-shaped and C-shaped pregnancy pillows, or wedge pillows.
Sleeping with one or both knees bent (as in a foetal position) can also help support your back and relieve back pain. For best results, sleep on your side with both knees bent.
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Frequent urination and its disruption of sleep
During the first trimester, hormonal changes increase the frequency of urination. This can play havoc with your sleep. Your growing womb puts pressure on your bladder and sends you rushing to the loo more often. This can be very disruptive to your sleep, especially when you need to get up for the toilet at night.
You may have a more restful night if you cut down on drinks during the evening. Make sure you still drink plenty during the daytime, though, as it's important to stay hydrated.
To prevent increased urination at night, try not to drink too much water just before going to bed. Staying hydrated by drinking eight to 12 cups of water per day is vital during pregnancy. However, there are a few things a pregnant person can do to ease the flow, including cutting down on fluids before bed and avoiding caffeinated drinks.
You can also try leaning forward when urinating and keeping a bladder journal or recording bathroom breaks.
While you can't do much to reduce your need to urinate often, you can strengthen your pelvic floor muscles. The best way to strengthen your pelvic floor muscles is through exercise. Exercising your pelvic floor muscles will also offer a sturdy support system for your bowel, uterus, and bladder.
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Heartburn and indigestion
To avoid heartburn or indigestion during pregnancy, it is recommended to make changes to your diet and lifestyle. Eating small meals more often, eating slowly, and avoiding lying down or exercising after meals can help. It is also advisable to avoid foods and drinks that trigger heartburn, such as fatty or spicy foods, caffeine, chocolate, and citrus fruit juice.
If you are experiencing heartburn or indigestion, there are medicines available to control these symptoms. Antacids can relieve your symptoms quickly and are safe during pregnancy if taken as directed. If antacids do not help, your doctor can prescribe other medications that are safe for use during pregnancy.
It is important to note that while heartburn and indigestion can be uncomfortable, they will not cause any problems for your baby. However, if your symptoms do not improve with treatment, it is recommended to consult your doctor as it may be a sign of a more serious condition.
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Frequently asked questions
It is normal to feel a sudden need to nap in the first trimester. High levels of the hormone progesterone can make a normal day at work seem as taxing as running a marathon. It is recommended that adults get seven to nine hours of sleep per night, but pregnant people should aim for eight to ten hours.
"Morning sickness" is a misleading term, as nausea can strike at any time of day or night. Night-time queasiness is especially unpleasant, as it can keep you from falling asleep or wake you up.
Your newly tender breasts may make it hard for you to find a comfortable sleeping position if you're used to sleeping on your front. You may also suffer from backache as your body changes in the first few months.
