Plan, Schedule & Prioritize: Sleep and Pregnancy


by Connie Mitchell
Posted: Thursday, April 23, 2015 12:00 pm

Ask any woman who has given birth, and she’ll likely tell you that sleep is one of the things she missed the most during and immediately after pregnancy. Especially during the first and third trimesters, sleep may be disrupted, and pregnant women sho uld “plan, schedule and prioritize” sleep, says Dr. David Weinstein, chief of obstetrics and gynecology at Missouri Baptist Medical Center.

“Although pregnancy is a time of great joy, excitement and anticipation, it can also be a time of serious sleep disturbances, even for women who have never had a sleep problem in the past,” Weinstein says. He cites a poll showing that 78 percent of women reported more sleep disturbances during pregnancy than at any other time in their life.

pregnant-woman-laughingEarly on, hormonal changes are the culprit. “Women often experience profound tiredness in the first trimester, though body changes  are  not  profound  just  yet,”  says  Dr.  Andrea  Stephens,  an  obstetrician  and  gynecologist  at  St.  Luke’s  Hospital. Progesterone, which increases during the first trimester, encourages drowsiness and also relaxes muscle tissue, contributing to an increased need to urinate and to acid reflux, both of which can disturb sleep.

Neck muscles also relax due to progesterone, increased blood flow to sinuses can narrow breathing passages, and some women gain excess weight during pregnancy, all of which contribute to obstructive sleep apnea. “Obstructive sleep  apnea  can  be  dangerous  as  it  may  increase  the  risk  for  gestational diabetes and high blood pressure,” says Dr. Joseph Ojile, CEO and founder of the Clayton Sleep Institute. “There was a ‘look back’ study published last year based on 55 million maternal-related hospital discharges from 1998 to 2009 (women who gave birth in a hospital) where researchers identified those with sleep  apnea  and  examined  links  with  poor  pregnancy  health  outcomes, including in-hospital deaths.”

Fortunately, sleep apnea can be treated without medications, so it’s important for women to be diagnosed. “Sleep apnea comes with some key symptoms,” Ojile says. “If a woman is experiencing an increase in snoring, or if her bed partner tells her she stops breathing while sleeping, or if she’s experiencing daytime fatigue or sleepiness that she hasn’t had previously. Also, if her primary care physician or ob-gyn sees an increase in blood pressure or blood sugar without a solid explanation, she should be evaluated for sleep apnea.”

Third-trimester sleep disturbance often is due to the increased size of the uterus and fetal movement, Weinstein says. Pillows m ay become a woman’s best friends at this stage, and a pillow used to tilt the pelvis about 15 degrees to the left will help ensu re the uterus does not put pressure on a key blood vessel and cause problems with blood flow. “Pregnant women tend to love body pillows,” he says. “It helps with the aches and pains of pregnancy, and it also keeps them from lying flat on their back.”

All the experts interviewed for this article emphasize the importance of good ‘sleep hygiene’ during pregnancy. “You want to cre- ate a sleep space in your bedroom, and that means being focused completely on sleep: no television, no smartphone, no iPad — nothing you have to charge or plug in—at least one hour before bed time,” Ojile says. “You also want to make sure you’re going to bed and waking up about the same time every day. This will get your body into a rhythm.”

Stephens adds that women need to listen to their body and be kind to themselves during pregnancy. “We go through the rest of our lives pushing ourselves to do more,” she says. “At this time, when your body is doing such a vital and energy -consuming job, it’s crucial to give it the nutrients and sleep it needs so that you can stay healthy and grow a healthy baby.”