Sleep Disorders During Pregnancy
Pregnancy is a time of widespread physiological changes in most organ systems of the body. Sleep disorders during pregnancy are very common, under diagnosed and under treated and can contribute to significant impact on the health of an expectant mother and her baby. Researchers are now studying the relationship of sleep disturbance on maternal health and fetal outcomes. Sleep disorders are thought to have significant impact on the mother and the child through a variety of inflammatory pathways, which affect blood pressure, blood glucose and depression. Most sleep disorders are easily treatable, usually without prescription medications.
About 75% of women complain of sleep problems during pregnancy. Most common sleep disorders during pregnancy are: Insomnia, poor sleep quality, restless legs syndrome (RLS) and sleep disordered breathing (SDB). The duration of sleep at night progressively decreases over the pregnancy. The sleep qualities decrease and sleep fragmentation increases with the progression of pregnancy.
Restless Legs Syndrome (RLS) is characterized by: strong or irresistible urge to move legs with inactivity, often associated with abnormal sensation, temporarily relieved by activity and usually worse in the evening. About 25 % of women suffer from RLS. It is commonly associated with low iron stores in the brain. Of note is that blood count and iron stores in the blood may be within the normal limits and the person can still have low iron in the brain. One commonly measured laboratory value is serum ferritin. A level below 50 (even though within the normal limits) is associated with RLS. The prevalence of RLS increases with the progression of pregnancy. The percentage of women reporting severe RLS (symptoms occurring more than 5 times a week) almost doubles from about 15 % in first trimester to about 27% in the third trimester. Non-medication treatments for RLS are available, like sequential compression devices and are effective in treating RLS.
Sleep Disorded Breathing (SDB) increases by about 20% during the pregnancy. The most common form of SDB is obstructive sleep apnea (OSA). Increased swelling of upper airways during the pregnancy is thought to predispose women to SDB. Women with BMI of > 30 and African- American ethnicity are at increased risk of developing SDB; however, the majority of these women will not develop SDB during pregnancy.
Women with SDB have increased risk of preeclampsia, gestational hypertension, gestational diabetes, unplanned Cesarean sections and small-for-age infants. OSA causes repetitive drops in oxygen followed by normal oxygen— something the scientists call hypoxia-normoxia cycle and is thought to contribute to damage of the inner lining of blood vessels, called endothelium. Endothelium is crucial in regulating the tone of muscles in the blood vessels and damage to the endothelium results in impaired relaxation of the smooth muscles of the blood vessels, predisposing the individual to development of high blood pressure. Snoring is the most frequent symptom of OSA and its prevalence increases with the progress in pregnancy. About 16 % of women report snoring during sleep in their third trimester. The presence of witnessed pauses in breathing by bed partner (apneas) or excessive daytime sleepiness, are not reliable symptoms of OSA during pregnancy. Excessive sleepiness during pregnancy is common even in the absence of OSA. Some studies have shown beneficial effects to treatment of sleep apnea on the gestational hypertension; however, a sleep specialist experienced in managing pregnant women should only make diagnosis and treatment of sleep apnea during pregnancy. Sleep laboratories commonly have their patients sleep on their back during the sleep studies, a situation which must be avoided in pregnant women. Home sleep testing is now available and offers a very convenient way to study sleep apnea in the comfort of one’s own bedroom.
Insomnia is very common among pregnant women. About 40% of pregnant women report short sleep duration in their third trimester (sleeping < 7 hours). Some recent studies have suggested that short sleep duration is associated with increased incidence of gestational diabetes. Pregnant women also complain of decreased continuity of sleep across all three trimesters, partly due to frequent urination. Frequent sleep discontinuity may eventually lead to the same side effects as short sleep duration.
Sleeping Tips for Pregnancy
- Sleep on your left side, especially during the third trimester
- Drink lots of fluids during the day, but cut down in the evening.
- Exercise regularly to help you stay healthy, improve your circulation, and reduce leg cramps.
- Use pillows to support your body and help you sleep better.
- Naps may help.
- Learn to relax with relaxation and breathing techniques.
- Take a warm bath or shower before bedtime.
- Stretching your calves before bedtime can help with cramps.