Pregnancy Sleep: Why Am I Sleeping All Day?

Feeling sleepy during pregnancy is common, especially in the first and third trimesters. Hormonal changes, nausea, and vomiting can make you feel tired. As your bump gets bigger, it can be difficult to get a good night's sleep. You might find it uncomfortable to lie down or need to use the bathroom a lot. In the third trimester, it can be hard to find a comfortable sleeping position.

Hormonal changes in the first trimester

At the same time, the increase in progesterone can disrupt your sleep at night, causing even more fatigue during the day. This is where the paradox comes in: you may feel tired during the day but struggle to sleep at night. Progesterone can also cause other discomforts, such as breast tenderness, making it hard to find a comfortable sleeping position.

Additionally, your blood volume increases during the first trimester, which can also contribute to feeling tired. Your blood sugar and blood pressure levels decrease, which can further add to feelings of fatigue.

The first trimester is a time of significant hormonal changes, and these changes can have a direct impact on your sleep patterns and energy levels. It's important to listen to your body and rest as much as possible during this time.

Restless leg syndrome

RLS is commonly associated with pregnancy, with approximately 10-34% of pregnant women experiencing it. It usually occurs during the third trimester, and the symptoms appear to be the most intense during the last three months of pregnancy. The exact cause of RLS in pregnancy is unclear, but it might be triggered by rising estrogen levels, a lack of folic acid or iron, or vitamin D deficiency.

If you are experiencing RLS, there are some things you can try to ease the symptoms:

• Avoid drinking coffee, soda, and other caffeinated beverages.
• Exercise every day, but stop a couple of hours before bedtime so you don't get too wound up to sleep.
• Get into a regular sleep routine. Go to bed and wake up at the same time every day, if possible. Before bed, relax with a warm bath or by snuggling up in bed with a good book.
• Apply a warm or cold compress to your leg muscles.
• Get up and walk or stretch your legs.
• Stop smoking.
• Wear elastic compression stockings.
• Take iron supplements if you have an iron deficiency.

Gastroesophageal reflux disease (GERD)

The treatment for GERD during pregnancy follows a step-up approach, starting with lifestyle modifications and dietary changes. Elevating the head of the bed and sleeping on the left side can help reduce reflux. Avoiding reflux-triggering foods such as fatty, spicy, or citrus foods, carbonated beverages, and alcohol is also recommended. If symptoms persist, antacids are the first-line medical treatment, with calcium-containing antacids being preferred due to their additional benefits in preventing hypertension and preeclampsia. Sucralfate can be introduced if symptoms are still not adequately controlled. For more severe cases, histamine-2 receptor antagonists (H2RAs) can be combined with antacids, and proton pump inhibitors (PPIs) are reserved for the most intractable symptoms or complicated reflux disease. PPIs are generally considered safe during pregnancy, with the exception of omeprazole, which is classified as a category C drug by the US Food and Drug Administration (FDA). However, recent studies suggest that all PPIs, including omeprazole, are safe for use during pregnancy.

Insomnia

Tips to Cope with Pregnancy Insomnia

• Sleep Aids and Melatonin: While pregnant people produce higher levels of melatonin, taking melatonin supplements may deliver too much to the baby and interfere with their sleep-wake cycle development. Experts recommend avoiding sleep medications and consulting a doctor before starting sleep supplements.
• Cognitive Behavioural Therapy (CBT-I): CBT-I can help change unproductive thoughts and behaviours affecting sleep. Therapists may address anxious thoughts, discuss realistic sleep goals, and suggest relaxation techniques such as meditation and progressive muscle relaxation.
• Managing Heartburn and Acid Reflux: Gastroesophageal reflux disease (GERD) is common in pregnancy. Eating smaller meals, avoiding greasy or spicy foods, and leaving time after a meal before lying down may ease GERD symptoms. If nighttime heartburn occurs, try raising the head of the bed or using a wedge pillow.
• Addressing Leg Discomfort: Pregnancy can cause leg discomfort, including restless legs syndrome and leg cramps. Gentle stretches and calcium supplements can help reduce the chances of leg cramps.
• Keep a Regular Sleep Schedule: Maintain a consistent sleep schedule by going to bed and waking up at similar times daily. While naps can help make up for lost sleep, avoid napping in the afternoon and evening.
• Create a Comfortable Sleep Environment: Opt for a cool, dark, and quiet sleep environment, and keep electronic devices out of the bedroom. Use a nightlight instead of the overhead light to avoid excessive brightness during bathroom trips.
• Use Pillows: Support your midsection, lower back, and knees with pillows to reduce back pain. Pregnancy pillows are specifically designed to accommodate the changing body.
• Avoid Stimulants: Refrain from nicotine and alcohol during pregnancy, and limit caffeine consumption to before noon.
• Exercise in the Morning: While regular exercise is important during pregnancy, it's best to do so earlier in the day. Consult a doctor for specific exercise guidance.
• Try Relaxation Techniques: Relaxation techniques or soothing activities like warm baths or massages may aid sleep. Consult a healthcare provider about safely participating in relaxation activities during pregnancy.
• Sleep on the Left Side: Sleeping on the left side facilitates blood flow to major organs and the fetus. It also reduces swelling in the legs and ankles and is easier on the lungs and heart. Back sleeping in late pregnancy is generally not recommended as it may carry risks for the fetus.
• Treat a Stuffy Nose: Manage congestion with nasal strips, nasal sprays, or nasal irrigation.
• Address Emotional Concerns: Pregnancy and impending parenthood can cause worry, affecting sleep. Making time for enjoyable activities, seeking emotional support from trusted friends or family, attending childbirth classes, and sharing concerns with a healthcare provider can help reduce stress and improve sleep.

Sleep apnea

OSA can develop during pregnancy due to hormonal and physiological changes. Higher levels of estrogen during pregnancy can cause the mucus membranes in your nose to swell, leading to nasal congestion and a narrower airway. As the pregnancy progresses, the pressure of the uterus on the diaphragm leads to decreased lung function residual capacity, which contributes to an increased collapsibility of the airways.

Other risk factors for OSA during pregnancy include being overweight or obese, gestational diabetes, congestion caused by allergies or illness, and certain physical attributes such as a receding chin, enlarged adenoids, a large tongue, a deviated septum, or an above-average neck circumference.

The biggest symptom of OSA during pregnancy is snoring. Other symptoms include feeling extremely tired during the day, waking up with a headache, atypical weight gain, choking during sleep, and elevated blood pressure.

If you suspect you have OSA, it is important to consult your doctor. Treatment for OSA usually starts with lifestyle changes, such as sleeping on your side and using adhesive breathing strips or a saline spray for congestion. If OSA is moderate to severe, a continuous positive airway pressure (CPAP) machine may be recommended to provide a gentle flow of air and keep the airways open.

Frequently asked questions