News & Views

Sleep disturbances during pregnancy and postpartum period

By Zach Pearl, PhD Staff


A majority of women experience sleep problems during pregnancy and postpartum periodwith rates as high as 80% 1 . During early pregnancy approximately 28%-38% of women suffer from sleep deficiency (short sleep duration, insufficient sleep, or insomnia). The hormonal changes and the physical discomforts associated with pregnancy can affect a pregnant woman’s quality of sleep. Moreover, stress or anxiety about labor, delivery and/or balancing work and motherhood may result in significant sleep loss and might cause insomnia during pregnancy. As pregnancy progresses, sleep quality continues to deteriorate; and during the third trimester, over 50% of the women report poor quality of sleep 2 .

Sleep in the First Trimester

During the first trimester there is a rise in progesterone levels that may cause excessive day time sleepiness, decreased muscle tone, increased risk of sleep apnea (pauses in breathing or periods of shallow breathing during sleep), snoring and sleep interruptions. There are frequent waking due to an increased need to go to the bathroom, nausea and vomiting. Disruptions in sleep can also be a result of physical and emotional stress associated with pregnancy and discomfort like back pain, fetal movements and gastroesophageal reflux disease (GERD), known as acid reflux. GERD is the return of the stomach’s contents back up into the esophagus. Symptoms might include burning chest pain, pressure or pain and they are worsened when lying down to bed.

Sleep in the Second Trimester

In this phase, sleep improves a bit for many women, as nighttime urination becomes less frequent. Still, the quality of sleep may remain quite poor as a result of the pregnancy progress and associated emotional stress.  In the late phase of the second trimester the total sleep time falls 3 . There is an increased complaint of interrupted sleep due to GERD (acid reflux) symptoms 4 .

Sleep in the Third Trimester

Most pregnant women experience sleep problems in the third trimester with over 98% reporting night-time awakenings and a reduction in the deep part of the sleep (slow waves sleep) 4 . Sleep disturbances are result of the following: discomfort due to gaining more weight, heartburn, leg cramps, and sinus congestion. Frequent nighttime urination returns, because the baby’s changing position puts pressure on the bladder once again. 15 % of pregnant women suffer from Restless legs syndrome (RLS) in this phase. Additional Symptoms include unpleasant sensation of the legs, sometimes described as creepy, tingly or achy. These feelings tend to worsen at night or in the hours before bed and they are temporarily relieved by movement or stretching 5 . As women gain more weight in the third trimester, sleep apnea might also be worsening. Moreover, Pregnancy and the postpartum period are recognized as times of increased vulnerability to psychiatric disorders, including mood, anxiety and psychotic disorders. Many of these focus on the dramatic changes in sex steroids concentrations in the body that occur during pregnancy and in the immediate postpartum period. Others draw attention to nonbiologic variables, such as sleep deprivation, lack of social support, marital or relationship conflict, and the stress of child care 6 .

Postpartum period

Sleep efficiency improves over time. Women experience dramatic changes during the postpartum period involving not only hormones and physiology, but also changes in lifestyle, sleep patterns, responsibilities, and interpersonal relationships. All of these changes can influence sleep patterns and sleep quality. Indeed, new mothers generally experience sleep disruptions increase in the first 6 months after child birth for up to 1 year or more with less than 6 hours of sleep per night 7 . Of particular concern are postpartum depression and psychosis, which may not reach peak intensity until 3-5 months after delivery. These conditions should be treated aggressively but cautiously, and in consultation with a specialist who is familiar with these conditions and their treatment.

What’s the best sleeping position during pregnancy?

Sleeping on the left side (which may improve the flow of blood and nutrients to the developing fetus and to a woman’s heart, uterus and kidneys) with the knees bent may be a better position for pregnant women 7 . Lying on your back in a half-sitting position, propped up against some pillows is also fine and can be helpful if you suffer from heartburn or acid reflux.

When pregnancy progresses, women needs to avoid lying on the back. In that position, the weight of the uterus presses on the spine, back muscles, and major blood vessels, which can slows the return of blood to the heart, which reduces blood flow to the fetus. That means the baby is getting less oxygen and fewer nutrients 8 .

Good night sleep during pregnancy is highly important, not only physically but also psychologically. A good sleep pattern plays an important role in the preparation for birth and protects both mother and baby from the psychological stresses and anxieties of pregnancy.







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