Pregnancy and Sleep

If a pregnant woman is ‘eating for two’ whenever she sits down for a meal, then it’s also true that she is ‘sleeping for two’ every time she goes to bed. Pregnancy can significantly reshape the sleep architecture of expecting mothers, often for the worse. Sleep disorders such as insomnia, sleep apnea, and restless leg syndrome are somewhat commonplace. Up to 94 percent of pregnant women experience sleep disturbances.

Physical symptoms of pregnancy like cramps and nausea, as well as the general discomfort of carrying a child to term, can greatly exacerbate sleep-related conditions. Many pregnant women suffer from back pain, heartburn, and anxiety, which may make getting good quality sleep difficult.

Treating sleep disorders in pregnant women is more complicated since the most commonly prescribed sleeping aids may be dangerous to take while pregnant.

Pregnancy in measured in three stages known as trimesters, beginning with the first day of the woman’s last menstrual cycle and ending with the birth of the child roughly 40 weeks later. This guide to pregnancy and sleep will discuss the various sleep developments and concerns that arise during conception and each individual trimester, and postpartum sleep issues.

Conception

Sleep is a vital aspect of our mental and physical health. Studies are increasingly linking sleep quality to menstrual health and fertility, leading doctors to believe a correlation exists between sleep quality and conception success. Poor sleep quality can negatively impact a woman’s menstrual cycle as seen often in women who work night shifts. This study found a higher rate of erectile dysfunction in men with sleep disorders than those who slept well, indicating that poor sleep can impact both female and male reproductive health and subsequently rates of conception.

While stress negatively affects fertility, insomnia may do the same, leading to a cycle of stress, insomnia, and infertility. Targeted treatment for insomnia or other sleep disorders may reverse stress levels as well as infertility issues. With sleep playing a vital role in mood, cognition, and quality of life, treating a sleep disorder will enhance the body’s functionality. Effectively treating a sleep disorder may also help with conception.

First Trimester

The first trimester spans the initial 12 weeks of a standard pregnancy. Within days of fertilization, the fertilized egg will grow into a larger cellular body known as a blastocyst and attach itself to the inner wall of the uterus.

This implantation will trigger a spike in the body’s level of progesterone, a natural hormone that regulates the various stages of the reproductive cycle.

Progesterone keeps the uterus muscle relaxed and boosts the body’s immune system. This hormone is considered a soporific hormone, meaning that it can induce early sleep onset. As a result, higher levels of progesterone can lead to both excessive daytime sleepiness and disrupted sleep at night. These feelings of fatigue can be strong enough that a pregnant woman may mistake them for cold or flu symptoms.

Hormonal changes may cause a pregnant woman to develop insomnia symptoms. Sleep onset insomnia refers to difficulty falling asleep at normal bedtimes, while sleep maintenance insomnia is the difficulty remaining asleep. Increased progesterone levels can lead to either type of insomnia.

Additionally, the blastocyst will apply pressure on the uterine wall, which is located near the bladder. This pressure, along with the progesterone boost, will increase urination frequency. Nighttime bathroom visits may become more frequent during the first trimester, which may impact the ability to remain asleep through the night.

The third through eighth weeks of the first trimester, known as the embryonic stage, are characterized by significant bodily changes for the mother and baby. As the embryo’s major organs begin to develop, it will grow to up to one inch in length. These adjustments will cause the pregnant women to experience serious cramping, particularly in the pelvic region.

The mother’s breasts will also begin swelling as the body prepares for nursing. These aches and pains can easily contribute to disrupted sleep. Additionally, pregnant women in their first trimester often experience excessive nausea, an affliction commonly called morning sickness.

By the ninth week, the embryo will have grown into a fetus, and the uterus will be the size of a large tomato. More cramping, swelling and discomfort typically occur in the four remaining weeks of the first trimester.

Sleep Tips for the First Trimester

Here are a few tips for reducing physical pain and getting enough sleep during the first trimester:

• Nap frequently to counteract the effects of rising progesterone levels during the first trimester. Experts suggest napping in the afternoon in order to maintain a standard nighttime sleep cycle; two catnaps, each lasting between 30 minutes to an hour, are considered more effective than one long nap.
• Exercising in the morning can also help you maintain healthy sleep cycle.
• Avoid consuming large amounts of fluid in the evening. This should reduce your urge to urinate in the middle of the night.
• If you experience morning sickness, try snacking on light, salty foods like popcorn or pretzels.
• If you’re looking to buy a new mattress, some are better for pregnant women than others. The ideal mattress for pregnancy will conform to the body, keeping the spine aligned while providing enough support to remain comfortable. Temperature neutrality is also an important consideration, as many pregnant women sleep hotter than normal.

Second Trimester

The second trimester is the longest, usually lasting from the 13th week to the 27th week. An expecting mother’s experience during the second trimester will largely depend on whether or not this is her first pregnancy.

First-time mothers often begin to feel the baby move at around 20 weeks, but women who have already given birth may notice these sensations earlier in the trimester. At any rate, the fetus will grow considerably over the course of this trimester; by week 27, the average fetus is 10 inches in length and weighs more than a pound.

The second trimester is considered the best trimester in terms of the mother’s sleep patterns. The body will be mostly acclimated to the rising progesterone levels, so daytime fatigue and sleep onset problems are usually less prominent. Morning sickness is also uncommon after the first trimester. This is the best time to establish a healthy sleep schedule that can be maintained into the third trimester.

However, some pregnant women may encounter some physical symptoms during the second trimester that negatively impact sleep quality and quantity. Heartburn, for one, is quite common during this period, and lying down can often increase the discomfort of acid reflux.

Nocturnal leg cramps can also be an issue, particularly pains in the calf muscles. Although these will probably become more pronounced during the third trimester, cramping often begins during the second. Many pregnant women experience cramping at night, which can lead to sleep disruption. If an expecting mother is prone to lucid dreams, these may intensify during the second trimester, as well.

Another concern during the second trimester is preeclampsia, a complication characterized by high blood pressure. Preeclampsia symptoms typically begin to materialize after 20 weeks of pregnancy; these symptoms include headaches, light sensitivity, nausea, shortness of breath and decreased urination. Preeclampsia is somewhat rare, but the condition can be fatal for both the mother and the fetus.

Sleep Tips for the Second Trimester

Follow these guidelines to sleep soundly and remain healthy during the second trimester:

• Avoid eating and drinking certain things to ensure these second-trimester symptoms won’t be too severe. Spicy or fried food can lead to heartburn flare-ups, while soft drinks and other carbonated beverages can worsen the effects of leg cramping.
• Try to stand or sit upright for at least four hours after eating in order to ease the digestive process and mitigate your heartburn.
• If you experience a leg cramp in bed, try flexing your leg and/or foot muscles to relieve the temporary pain.
• Consult your physician immediately if you begin to experience symptoms of preeclampsia, or notice a sharp rise in your blood pressure levels.

Third Trimester

Last is the third trimester, which begins during the 28th week and lasts until childbirth. The average pregnancy spans 40 weeks in length, but some mothers may deliver as late as week 42 or 43.

The third trimester is a period of extraordinary fetal growth. Unfortunately, these developments can cause major aches and pains for expecting mothers. The majority of pregnant women experience severe lower back pain during the third trimester due to the excess weight around their midsection. Expecting mothers are also most likely to have nightmares during the third trimester.

Leg cramping may become more intense. Frequent urination spells will also return as the fetus grows and eventually settles in the lower pelvic region. All of these factors can disrupt sleep routines; the vast majority pregnant women wake up between three and six times each night during their third trimesters. For this reason, the third trimester is considered a more extreme version of the first.

In addition to insomnia brought on by physical discomfort, pregnant women in their third trimester are also prone to other serious sleep disorders. Up to 34 percent of pregnant women will experience restless leg syndrome (RLS), a condition characterized by painful tingling or itchy sensations beneath the skin. RLS is most prevalent in the third trimester.

RLS symptoms can strike at any time, but are most commonly reported at night or after long periods of sitting. RLS has been linked to iron and folate deficiencies. A doctor may prescribe supplements to alleviate some of the symptoms. However, there is no cure for RLS. The good news: in most cases, RLS symptoms disappear after childbirth.

Obstructive sleep apnea (OSA) is another commonly reported sleep disorder among women in their third trimester. OSA occurs when the airway is partially or completely blocked, causing shallow breathing or loss of breath during sleep. Many women snore during pregnancy due to swollen nasal passages, and snoring can quickly evolve into OSA, particularly in women who were obese prior to their pregnancy weight gain.

OSA in pregnant mothers is a serious issue because the lost air supply can lead to hormonal surges powerful enough to compromise fetal health. OSA has also been linked to an increased risk for preeclampsia.

Sleep Tips for the Third Trimester

During the third trimester, it’s important to prepare for the worst sleep of your pregnancy and make yourself as comfortable as possible leading up to bedtime. Here are a few tips for making it through the third trimester as comfortably as possible.

• Reduce fluid intake in the late afternoon or evening.
• Make sure to completely empty your bladder during your final urination before bed. Leaning completely forward while peeing can help.
• Avoid anything that irritates your digestive system, and consume plenty of iron-rich foods to help stave off RLS and excessive leg cramping.
• Stretching, light exercise, and meditation before bed can help you fall asleep more quickly.
• Sleeping on your left side may relieve pressure on your lower back. This will also boost your breathing circulation and help prevent apnea. Blood flow to the fetus, uterus and kidneys is best when laying on your left side.
• For maximum comfort in bed, place pillows between your knees, behind your back and beneath the underside of your stomach.

Postpartum Sleeping

The period immediately following the birth of the child is commonly referred to as the fourth trimester. This trimester, like the three trimesters of pregnancy, is often characterized by sleep-related issues. However, these issues have less to do with physical changes of a pregnant woman’s body, and more to do with the newborn’s sleep schedule.

As any new parent will attest, caring for a newborn can be an exhausting task. On average, babies wake up every three to four hours, although this varies considerably from child to child; some newborns will wake up on an hourly basis. Attending to the baby’s needs can quickly take its toll on parent’s minds, bodies and moods, not to mention sleep schedules.

Postpartum depression (PPD) is another important concern during the fourth trimester. PPD is characterized by extreme anxiety and/or depression in mothers who have recently given birth, although roughly half of women diagnosed with PPD begin experiencing symptoms during pregnancy.

Crashing progesterone levels and other hormonal changes can lead to PPD, as well as genetic predisposition, stress, and other environmental factors. Like any other major stressor, PPD can lead to severe insomnia when left untreated.

Sleep Tips for the Fourth Trimester

Here are a few final tips for getting an adequate amount of sleep during the crucial phase known as the fourth trimester.   

• Allow your baby to sleep in a crib or bassinet near your bed. This allows you to easily tend to your baby in the middle of the night, rather than getting up and walking to a different area of your home.
• Breastfeed if possible. Natural breastfeeding triggers a hormone called prolactin, which can induce sleepiness.
• Alternate nighttime duties if you are raising the baby with a partner. This will allow both of you to get more sleep on a weekly basis.
• Don’t ignore the early warning signs of postpartum depression. These include sadness, irritability, loss of appetite, inability to concentrate and sleep onset problems. Consult a physician as soon as you begin to experience these symptoms.

Sleep Tips for Infants

Here are a few final tips for helping infants get adequate amount of sleep. This will also help new parents sleep well at night, waking up feeling rested and refreshed.

• Create a safe sleep environment: Dim the lights in the room for bedtime preparations, provide a quiet and calm environment, and try swaddling or a pacifier to help the baby feel secure.
• Establish a nighttime routine: Babies feel comfort and security in routine. This could be bonding time like cuddling, rocking, or reading after bathtime. This helps the baby learn the same general schedule comes before bedtime.
• Consider a sleep training method when the baby is about four to six months old, when the circadian rhythm begins to develop.

Conclusion

During your pregnancy, it is imperative for you to get enough sleep – difficult as that may be at times. A pregnant woman can greatly reduce the risks of insomnia and other sleep disorders by following the guidelines listed above throughout all three trimesters of your pregnancy, as well as the critical fourth trimester period. If you have a newborn or infant at home, check out our Parent’s Guide to Healthy Sleep.

Recommended Resources

General Information

• Pregnancy and Sleep: From the University of Utah health blog that takes a closer look at what pregnant women should know about sleeping on their backs.
• 8 Best Ways to Improve Sleep During Your Pregnancy: The Cleveland Clinic outlines eight tips to sleep better while pregnant, common sleep disorders, and what to expect with sleep in each trimester.
• How to Keep Your Sleeping Baby Safe: AAP Policy Explained: The American Academy of Pediatrics outlines its guidelines for safe sleeping conditions for babies. Safe and comfortable sleep for baby means better and more restful sleep for parents.

Scientific Studies

• Sleep Medicine Review: This 2016 study examines the relationship between sleep during pregnancy and the medical outcomes for both the mother and her fetus.
• Journal of Family Planning and Reproductive Health Care: For this 2013 study, three researchers from the Tehran University of Medical Sciences looked at quality of life expectations for pregnant women with sleep disorders.
• Early Human Development: Researchers at the University of Michigan led this 2015 study to determine the most effective sleep positions for pregnant women throughout all three trimesters.
• Paediatric and Perinatal Epidemiology: This 2010 study explores the impact that exercise and physical activity can have on a pregnant woman’s sleep cycle.
• Sleeping for Two: The Great Paradox of Sleep in Pregnancy: This 2015 study from the Journal of Clinical Sleep Medicine provides an overview of sleep while pregnant. It emphasizes that chronically disrupted sleep while pregnant should not be considered normal.
• Sleep Quality During Pregnancy: Associations with Depressive and Anxiety Symptoms: A comprehensive study from 2016 by the Nordic Federation of Societies and Obstetricians and Gynecology that outlines how sleep quality in pregnant women impacts depression and anxiety symptoms.
• Managing Sleep Disorders During Pregnancy: This 2017 study from Northwestern University Feinberg School of Medicine outlines four sleep disorders during pregnancy and how to manage them.