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Sleep Guide for Expecting Mothers

Pregnancy comes with a lot of challenges. One such big challenge that most expecting mothers go through is sleep disturbance.

Many physiological changes occur in the body under the influence of hormones. These physiological changes often lead to sleep disturbances. About 78% of pregnant women suffer from sleep issues as a result of this.

You may have insomnia resulting from stress and anxiety related to the pregnancy. Also, there may be other conditions that might cause you to have sleep disturbances.

Research has shown that poor sleep during pregnancy affects the outcome of pregnancy. It has been found that women who get less sleep during pregnancy are more likely to have a longer labor, and an increased chance of having a cesarean section for the delivery.

Therefore, prioritizing sleep during pregnancy is important, and the issues that affect your sleep should be properly addressed.

Common Conditions Causing Sleep Disturbances in the First Trimester:

The first trimester, i.e., the first 3 months of the pregnancy, can be very overwhelming for the expecting mother. Many changes start occurring due to the hormonal changes in the body.

There is a sudden rise in hormones like progesterone, estrogen, human chorionic gonadotropin, etc. These are the hormones that support pregnancy.

The common conditions that occur in 1st trimester of pregnancy are attributed to the sudden rise of these hormones in the body and are a major cause for sleep loss during early pregnancy.

Some of the common occurrences of the 1st trimester are:

1. Excessive Fatigue and Sleepiness:

You may feel excessively tired and sleepy right from the first trimester. This is caused by the heat-producing (thermogenic), and sleep-inducing (soporific) effects of the hormone progesterone.

Being fatigued and sleepy all the time, you may sleep a lot during the 1st trimester. But even though the total duration of sleep increases during the first trimester, the quality of sleep will be low due to the effects of progesterone.

What Can You Do About It?

• Having a proper sleep schedule helps to prioritize sleep. Sleeping at the same time every day is helpful to establish a healthy sleep cycle.
• Optimize the room temperature according to your comfort level to tackle the heat-producing effects of progesterone.
• Good exposure of sunlight during the day time is a good way to improve your circadian rhythm. Exposure to sunlight will also help you stay energized during the day and will improve your night time quality of sleep.
• Nap whenever you can in the day time. Napping is a good way to compensate for the disturbed sleep at night and will help with the fatigue that follows. However, avoid napping close to the night time, as that may disturb your sleep at night.

2. Nausea and Vomiting:

Commonly known as the Morning Sickness, this is also a common complaint in the first trimester of pregnancy. While it is not known why nausea occurs in pregnant women, it has been seen that they occur when the hormones progesterone and human chorionic gonadotropin (hCG) are at their peak levels.

Although they are called “morning sickness”, they don’t necessarily happen during the day time. Pregnant women can have severe episodes of nausea and vomiting at any time of the day, and they can also be a major cause of sleep disruption.

While morning sickness is common in early pregnancy, excessive vomiting should be brought to the notice of your doctor as it may result in electrolyte imbalance which can be life-threatening.

What Can You Do About It?

• Opt for simple, mildly flavored foods to prevent nausea. Also, low favored or no-flavored snacks throughout the day will help reduce nausea.
• Foods, drinks and any other substances with nausea-inducing scent should be avoided.
• Excessive vomiting should be brought to the notice of your doctor, as the electrolyte imbalance caused by it can be life-threatening. Severe cases sometimes require hospitalization as well. In these cases, some safe medications are used to manage excessive vomiting in a hospital setting, or a prescription for a few days may be given.

3. Increased Frequency of Urination:

Expecting mothers also experience increased frequency of urination during the 1st trimester. This happens as the hormones prepare your body to be able to excrete a high amount of toxins from the body. Since you will be supporting another human being that will produce its own waste, this change is an essential one.

Under the influence of hormones, your kidney expands and the blood flows to the kidneys increases. And as a result, the amount of urine that is formed and is excreted increases.

While this is an essential change, rapid formation and excretion of urine are some of the common causes of sleep disruption at night. And while you can’t do much about it, a certain practice that is discussed below will help you get a better, less interrupted sleep.

What Can You Do About It?

• Drink a lot of water during the day time, and less water near night time. This will reduce the number of trips you make to the bathroom during the night time to some extent. Also, drinking a good amount of water during the day will compensate for the water that is lost in vomiting.

Common Conditions Causing Sleep Disturbances in the Second Trimester:

By the second trimester, as the level of the hormones stabilizes, the morning sickness, the increased frequency of urination and excessive fatigue go away. You will start feeling better, but even then it is recommended that you get a healthy amount of sleep each day.

And while you may get relief from the early issues, you may develop a few conditions in the second trimester as well that may interrupt your sleep. These occur mostly as a result of the growing fetus. They include:

1. Heartburn:

About 30-50% of the pregnant women complain of heartburns in the second trimester. As the fetus continues growing, the diaphragm is pushed, resulting in restricted breathing and displacement of esophageal sphincters. The hormones also cause this sphincter to relax.

The displacement and relaxation of the esophageal sphincter make it easier for the content of the stomach to back-flow, resulting in heartburns. This especially happens when you sleep on your back.

What Can You Do About It?

• Avoid eating large spicy and acidic meals for dinner. Also, avoid eating way too close to bedtime.
• Eat multiple small meals, composed of simple food items throughout the day is a good way to control heartburns.
• Opting for fluid-based foods like soups, yogurt, smoothies, etc would help with it as well.
• Sleeping on your side will avoid the reflux of gastric content.
• Consider keeping an extra pillow to elevate your head a little. This will prevent acid reflux.
• If the problem is very severe, consider seeking medical help.

2. Nightmares:

This is another common thing that women in the second trimester go through. You may experience very realistic nightmares that are bizarre in nature.You may dream about the gender of the baby, about the delivery, about harming your baby, forgetting about the baby, giving birth to inanimate objects, or any other such bizarre dreams. It may sound weird, but it’s quite common among pregnant women.It is mostly linked with the anxiety that revolves around pregnancy and labor, and the thoughts and fears you have deep down in your subconscious mind.

What Can You Do About It?

• If it’s an occasional occurrence then you don’t have to do anything about it.
• If the nightmares are too bothersome, you should consider going to your doctor, to speak about your concerns. Your doctor may refer you to a therapist to help find out the root cause of your concerns as well.

 

Common Conditions Causing Sleep Disturbances in the Third Trimester:

The third trimester is the most uncomfortable time of the entire pregnancy. The enlarging fetus pushes the diaphragm further, making breathing a bit more difficult.

The uterus also starts pushing down the bladder, resulting in the return of increased frequency of urination yet again. Also, the constant kicking of the fetus disrupts the sleep of the expecting mother.

Sleep disturbance is commonest in 3rd trimester of pregnancy. Around 97% of the pregnant women complain of sleep disturbance, with an average of 3 times awakening during the night.

The issues of the 2nd trimester may continue in the 3rd trimester as well or may start appearing in the 3rd trimester.

Besides the above issues, you may also develop certain other conditions that might disrupt your sleep.

1. Generalized Discomfort:

As the baby continues growing, you might start feeling huge and extremely uncomfortable all the time. The increased weight might cause to have low backache and generalized muscular pain. You might feel fatigued. Sleeping may, thus, be not comfortable as well.

What Can You Do About It?

• Sleep on your side, rather than on your back. This will reduce the excess pressure over your lower back and thus help with the low backache and other types of muscular pain.

1. Snoring/Sleep Apnoea:

Around 27% of pregnant women start snoring in the third trimester; the most important risk factors being obesity, excessive weight gain during pregnancy and older age. Many changes occur in the respiratory system as a result of a growing fetus pushing up against the diaphragm, and high levels of estrogen and progesterone. These include reduced lung capacity and nasal congestion. This nasal congestion as a result of hormone change and compression of the diaphragm results in snoring.

If the nasal congestion is too severe, you might also develop sleep apnoea. Sleep apnoea is characterized by snoring and periods of absent breathing while sleeping.

Snoring and the periodic absence of breathing are also known to disrupt sleep.

A study has shown that snoring increases the risk of the development of hypertension, pre-eclampsia and fetal growth restriction by 2-folds. Therefore it’s important to see a doctor if you suddenly develop severe nasal congestion with snoring any time during your entire pregnancy.

What Can You Do About It?

• If you develop snoring all of a sudden, inform your doctor about it. An appropriate treatment option will be suggested by your doctor for your sleep apnoea.
• It is also likely that you develop high blood pressure because of it, so make sure you get your blood pressure and urine protein checked.
• Also, headaches, blurry vision, sudden swelling of the lower limbs should be immediately brought to the attention of your doctor. These symptoms are associated with pre-eclampsia and high BP and require immediate management.

3. Leg Cramps:

This is another common condition that may arise and may result in frequent sleep disruption at night. Leg cramps are common in both the 2nd and 3rd trimester but mostly occur in 3rd.

It is not known well why leg cramps occur in pregnancy, however, it is speculated that it occurs as a result of changes in blood circulation and because of the added weight putting extra stress on the legs.

These may also result from the imbalance in the levels of calcium and phosphorus.

Although these cramps last for a few minutes, they may be severe enough to disrupt your sleep. They may occur multiple times each night.

What Can You Do About It?

• Massaging your calf gently when you get cramps will help the muscle relax. Flexing your foot upwards a few times before going to bed helps prevent the night time cramps as well.
• Avoid carbonated drinks to avoid cramps.
• Drink plenty of water. This will help hydrate the muscles, and thus, will prevent spasm.
• The cramps may worsen following sitting or standing for a long time. Therefore, make sure to avoid those, and keep yourself active.
• Walking during the day and taking a warm bath also relaxes the muscles, and thus prevents spasms.

4. Restless Leg Syndrome (RLS):

Around 15% of women develop restless leg syndrome during pregnancy. Though it can appear in the first trimester as well, it most commonly appears in the 3rd trimester of pregnancy.It is a neurological disorder characterized by a tingling, itchy and burning sensation in the legs, followed by an uncontrollable urge to move the legs. They mostly occur while at rest or during sleep.You may feel like something is crawling up your leg. The sensations stop once the leg is moved.

It may also be painful in a small percentage of people and is usually discomforting enough to disrupt sleep.

While it is not known why restless leg syndrome occurs,  it has been found that most women who develop RLS are deficient in iron and folate. Also, deficient dopamine levels, increased levels of estrogen and thyroid deficiency could be the reasons for the same.

However, for most women, the discomfort is rather mild.RLS associated with pregnancy is only temporary and resolves itself with childbirth. But some of the women may develop RLS later in life.

What Can You Do About It?

• If you have an extremely bothersome restless leg syndrome, inform your doctor. They may ask for an iron profile and may proceed to the management according to the reports.
• Excessive consumption of caffeine can worsen the sensations; therefore avoiding caffeinated drinks will help as well.
• Consuming green leafy vegetables sometimes help with RLS, as they are rich in magnesium. Magnesium helps relax the muscles and prevents the sensations.
• Warm or cold compresses to the affected leg(s) and massaging the legs also provide some relief from RLS.

The Best Sleeping Position for Pregnant Women:

The most ideal position of sleep during pregnancy is sleeping on your side. However, research has shown that sleeping on the left side is even better as it increases the blood flow to the uterus providing higher nutrition and oxygen supply, and also promotes excretion of wastes through the kidney.

Sleeping on the side also reduces the pressure over the major arteries in your body, and also reduces poor outcomes of pregnancy like stillbirth.

Sleep on your left side, with knees bent. Put a pillow between your legs, under your abdomen, and behind your back. This will provide support to your lower back, and help back muscles too. Use as many pillows as you like to make yourself comfortable.

Use a double pillow for your head if you have severe gastric reflux at night.

Sleeping on the side is the most beneficial in the 3rd trimester. But start practicing sleeping on the left side right from the 1st trimester itself. This way, by the time you reach the 3rd trimester you will be habitual of sleeping on your side.

You can also consider using specialized pillows and mattresses meant for pregnant women to aid your sleep.

What Are the Other Things That You Can Do to Improve Your Sleep During Pregnancy?

 

• Exercising helps improve circulation, cramps and RLS. 30 minutes of simple exercise like walking would be enough. Avoid exercising near to bedtime as that may disrupt your sleep.
• Simple stretches will warm up and relax your muscles. Spend 15 minutes each day to stretch your body.
• Nap whenever you can, irrespective of which trimester you are currently in. It’s important to get at least 8 hours of good quality sleep each day, including naps.
• Anxiety is a common issue during pregnancy as well. Discuss all of your concerns with your doctor. The doctor will be able to help you get your answers and relieve you of any fears and concerns.
• Bright lights are disrupting the sleep cycle, therefore putting up a night bulb in the bathroom will be a good idea.
• Indulge in relaxing activities like taking a warm bath and reading a book. This will help in sleep induction.
• If you don’t feel sleepy when you go to bed, don’t force it. Instead, engage in something relaxing, like taking a warm bath or reading. These activities will stimulate sleep.
• Deep breathing exercises will help relieve anxiety. Performing deep breathing for 10 minutes would be greatly beneficial.

What You Should Avoid Doing?

Following are some of the things that might disrupt your sleep:

1. Avoid sleeping on your back. This will worsen your sleep apnoea, snoring, and gastric reflux. Sleeping on your back compresses your major blood vessels compromising your blood circulation.

2. Avoid caffeine near bedtime.

3. Avoid exercise near bedtime.

4. Avoid using digital gadgets at least 1 hour before bed.

5. Avoid napping in the late afternoon or evening, as this will also disrupt your nighttime sleep.

 

Further Reading

“Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship?” – Sleep Medicine Reviews

“Getting Sleep When You’re a New Parent” Charles Schaeffer, Ph.D. and published by Seleni

“Exercise After Pregnancy” by the American College of Obstetricians and Gynecologists

“Postpartum Care” from the National Institutes of Health’s MedlinePlus

Mobile Apps

Baby Shusher: this app, available for a small fee on both Android and iPhone, provides a rhythmic “shushing” sound to help calm your baby.

The Bump: this app for expecting moms covers numerous topics with quality information presented in a fun and accessible way.