Gina Johnson
Sleep is one of the three pillars of health, alongside a good diet and moderate exercise. Sleep is especially important during pregnancy, when the mother's body changes rapidly, and any health issues may impact the development and growth of the baby. However, sleep disturbances are common in pregnancy due to hormonal changes, physical discomfort, and stress. While daytime naps may be a useful strategy to deal with chronic sleep disturbances during pregnancy, excessive sleep during pregnancy could be a sign of underlying issues like depression. Furthermore, one study found that women who slept more than 9 hours per night during the last month of pregnancy had a greater instance of stillbirth.
| Characteristics | Values |
|---|---|
| Increased sleep | More common during the first and third trimesters |
| Sleep disturbances are common | |
| Occasional snoring is normal | |
| Sleep is often disrupted by frequent urination, particularly in the third trimester | |
| Restless leg syndrome is common | |
| Sleep is lighter and more easily disturbed | |
| Occasional breathing pauses are normal | |
| Sleep is important for the health of the mother and baby | |
| Lack of sleep is associated with higher risks of pregnancy complications | |
| Sleep deprivation is associated with increased serum levels of inflammatory biomarkers | |
| Sleep-disordered breathing may be related to an increased risk of preeclampsia | |
| Snoring is associated with an increased risk of preeclampsia, gestational diabetes, and unplanned Caesarean deliveries | |
| Sleeping more than 9 hours per night during pregnancy without disturbance has been associated with stillbirth | |
| Daytime naps may be a useful strategy to deal with chronic sleep disturbances | |
| Sleep issues could be a sign of underlying issues like depression |
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What You'll Learn
Increased risk of stillbirth
Pregnancy is a tiring time, and it is common to feel more fatigued than usual during the first and third trimesters. This is due to an increase in blood volume and progesterone levels, as well as the extra weight of the baby and emotional anxiety about the impending labour. However, while it is important to get enough sleep, too much sleep may be harmful.
Several studies have found an association between lengthy periods of undisturbed maternal sleep and stillbirths. One study of 153 women who had experienced a late stillbirth (on or after 28 weeks of pregnancy) and 480 women with an ongoing third-trimester pregnancy or who had recently given birth found that nearly 30% of those who had stillbirths reported long sleep in the last month of pregnancy, compared with only 16% of women with live births. Another study found that women who slept for more than 9 continuous hours without disturbance in the last month of their pregnancy had a greater instance of stillbirth.
The reason for this association is not yet fully understood, but researchers have suggested that it may be related to the autonomic nervous system and the hormonal system. Dr Louise O'Brien of the University of Michigan has hypothesised that blood pressure reaches its lowest point during sleep, but when someone wakes up, there is a surge in nervous system activity that causes transient increases in blood pressure. These transient increases in blood pressure may prevent extended periods of low blood pressure, which has been linked to fetal growth problems, preterm birth, and stillbirth.
While further research is needed to confirm this relationship and understand how it may impact pregnant women, it is important to note that stillbirth is a significant global health issue, affecting about 1% of all pregnancies, or about 24,000 babies annually in the United States alone. Therefore, understanding the role of maternal sleep may help identify interventions to improve fetal well-being and reduce the risk of stillbirth.
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Sleep apnea
The risk factors for OSA during pregnancy include weight gain, anatomical factors, and hormonal changes. Weight gain during pregnancy can increase the risk of OSA, as can the growth of breast tissue, which adds more weight to the chest. Anatomically, the presence of the baby pushing up into the chest cavity can change breathing dynamics and increase the risk of OSA. Hormonal changes, particularly increased levels of estrogen, can cause nasal congestion and make breathing more difficult, contributing to OSA. Additionally, a history of sleep apnea or snoring before pregnancy is a significant risk factor.
The most common symptom of sleep apnea during pregnancy is snoring. Other symptoms include daytime sleepiness, morning headaches, and physical features that suggest the diagnosis. OSA during pregnancy can lead to severe maternal and fetal complications, including an increased risk of preeclampsia, gestational diabetes, gestational hypertension, preterm delivery, and low birth weight. It is important to note that OSA is often underdiagnosed in pregnancy, and early diagnosis and treatment are crucial for improving outcomes.
The preferred treatment for sleep apnea during pregnancy is continuous positive airway pressure (CPAP) therapy, which provides continuous air pressure to keep the airways open during sleep. CPAP therapy is safe and recommended for pregnant women. It is important for pregnant women with sleep apnea to discuss treatment options and strategies with their doctors, as the condition may persist after childbirth.
While sleep apnea can interfere with getting adequate rest during pregnancy, it is important to prioritize sleep and manage stress to promote overall health and well-being.
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Underlying health issues
It is common to feel more fatigued than usual during the first and third trimesters of pregnancy. This can be due to hormonal changes, such as increased progesterone and oestrogen levels, as well as physiological changes. For example, the extra weight and emotional anxiety of impending labour in the third trimester can lead to a longing for more sleep.
However, some underlying health issues may be causing excessive sleepiness during pregnancy. One such issue is sleep-disordered breathing, which can develop during pregnancy and has been linked to an increased risk of preeclampsia. Preeclampsia is also associated with snoring, which is more common in pregnant women. Furthermore, sleep apnea, which restricts breathing while sleeping, can develop during pregnancy due to hormonal and physiological changes.
Another potential issue is restless legs syndrome (RLS), which is a common cause of sleeplessness in pregnant women. RLS is often linked to anaemia, which is common in pregnancy, and can be triggered by a lack of folic acid and iron. Experiencing RLS during pregnancy can be uncomfortable, but it usually does not last beyond the first week after delivery.
Additionally, insomnia can be a factor in excessive sleepiness during pregnancy. This can be caused by pregnancy-related aches and pains, as well as heightened stress and anxiety levels. Establishing good sleep habits and routines can help mitigate the effects of insomnia and improve overall sleep quality.
While it is important to be aware of these potential underlying health issues, it is also crucial to note that the amount of sleep necessary for good health varies by age and individual sleep needs and habits. Therefore, if you are feeling fatigued during your pregnancy, it is generally recommended to prioritise getting sufficient sleep and creating a supportive sleep environment.
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Pregnancy complications
Sleep disturbances during pregnancy have been associated with a multitude of negative maternal and fetal outcomes. Lack of sleep during pregnancy has been linked to longer labor, higher rates of Cesarean sections, and restless leg syndrome (RLS). RLS is an uncontrollable urge to move the legs while at rest and is associated with anemia, which is common in pregnancy.
Pregnancy-related discomforts, increased stress and anxiety levels, and physiological changes can also result in restless nights and fatigue during the day. This can be due to increased bladder pressure, vaginal pressure, and pregnancy-related aches and pains. Sleep-disordered breathing that can develop during pregnancy has also been linked to an increased risk of preeclampsia. Snoring, which is more common in pregnant women, has been associated with preeclampsia and gestational diabetes.
According to a US study, sleeping for more than nine hours per night during pregnancy without disturbance can be associated with stillbirth. Researchers suggest that lengthy periods of undisturbed sleep can lead to stillbirths as blood pressure reaches its lowest during sleep. However, when the body wakes up, there is an increase in blood pressure that helps prevent a long period of relatively low blood pressure.
Breathing pauses, snoring, and other sleep disorders can increase the health risks of pregnancy for the mother. This includes high blood pressure, diabetes, or preeclampsia. Mothers who don't get enough sleep may also feel anxious and depressed, which may persist after giving birth. Acting on these problems early can help simplify treatment.
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Restless leg syndrome
It is common to feel more fatigued during the first and third trimesters of pregnancy. This can be due to an increase in blood volume and progesterone levels, the extra weight of carrying a baby, and the emotional anxiety of impending labour. In addition to these hormonal and physiological changes, pregnancy-related discomforts, increased stress and anxiety levels, and restless leg syndrome (RLS) can also result in restless nights.
RLS is a common sleep disorder that may be associated with pregnancy. It is characterised by an uncontrollable urge to move the legs while at rest, often causing discomfort and interrupting sleep. The exact cause of RLS is unknown, but it is believed to be related to a variety of factors, including hormonal changes, dietary factors, physiological changes, and genetic predisposition. It is also linked to anemia, which is common in pregnancy, and low iron levels. Nearly a third of pregnant women experience RLS, with symptoms typically appearing in the third trimester.
The symptoms of RLS can range from mild to severe and may include uncomfortable sensations such as itching, pulling, burning, or a creepy-crawly feeling in the legs. These sensations can be worse just below the knee, but they may also be felt in the thighs, feet, and arms. While RLS can be frustrating and uncomfortable, it is important to note that it does not typically affect the health of the mother or fetus. However, it can cause sleep disturbances, which may impact a pregnant person's daily life.
There are several strategies to manage RLS during pregnancy. Lifestyle changes, such as reducing caffeine and alcohol consumption, regular exercise, and establishing a sleep routine, can help reduce symptoms. Leg massages, warm or cold compresses, and leg stretches before sleep may also provide relief. In some cases, iron supplements may be recommended to address anemia and low iron levels associated with RLS. However, medication to treat RLS during pregnancy is challenging due to potential risks to the fetus, and non-pharmacological approaches are typically prioritised.
While RLS can cause sleep disturbances, it is important to prioritise sleep during pregnancy. Sleep deprivation during pregnancy has been linked to various complications, including longer labour, increased rates of Cesarean sections, and increased serum levels of inflammatory biomarkers. Therefore, it is crucial to address sleep disturbances and practice good sleep hygiene during pregnancy.
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Frequently asked questions
Yes, it is common to feel more fatigued than usual during the first and third trimesters of your pregnancy. This is due to an increase in blood volume and progesterone levels.
Lack of sleep during pregnancy has been associated with a multitude of negative outcomes. Sleeping less than 6 hours during the last month of pregnancy has been associated with longer labour, higher rates of caesarean sections, and an increased risk of developing pregnancy complications such as preeclampsia.
Oversleeping during pregnancy could be a sign of underlying issues such as depression. Sleeping for more than 9 hours per night during pregnancy without disturbance has also been associated with an increased risk of stillbirth.
Lifestyle changes such as abandoning television and electronics before bed, limiting liquid intake before bed, and reducing caffeine intake can help improve sleep during pregnancy. Stress reduction techniques are also important, as stress can impact your sleep.
If you start snoring while pregnant, or experience breathing pauses, you should speak to your doctor or midwife. These could be signs of other medical problems such as high blood pressure, diabetes, or pre-eclampsia, which may affect your health and the health of your growing baby.
