Episode 38: Sleep in Pregnancy
Sleep problems are common in pregnancy and change as pregnancy evolves. What happens to sleep during pregnancy? What is the best way to deal with sleep through pregnancy? In this episode we tackle these questions with the help of Dr Liora Kempler of Integrated Sleep Health.
Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) host the monthly podcast, Sleep Talk, talking all things sleep.
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Audio Timeline / Chapters:
00:00 – 02:17 Introduction
- 02:17 – 26:54 Theme – Sleep in Pregnancy
- 26:54 – 28:48 Clinical Tip
- 28:48 – 31:52 Pick of the Month
- 31:52 – 32:50 What’s Coming Up?
Next episode: Menopause
Links mentioned in the podcast:
- Parliamentary Inquiry in to Sleep Health
- Integrated Sleep Health
- Sleep tips for new parents – blog
- Sleep in new parents – podcast
- Effects of rumination and worry on sleep – journal article
- Orthosomnia: Are Some Patients Taking the Quantified Self Too Far? – journal article
Dr Liora Kempler graduated from a Bachelor of Advanced Science with a major in Psychology at the University of New South Wales. She is a Psychologist at the Woolcock Institute of Medical Research, Glebe and at the Integrated Sleep Health Clinic. Liora specialises in treating adults with sleep disorders, insomnia, depression, postnatal depression and anxiety as well as specialising in sleep during pregnancy and with infants and toddlers. Her preferred treatment practices include cognitive behavioural therapy, mindfulness, acceptance and commitment therapy and psychotherapy. Liora’s PhD project investigated the efficacy of a novel sleep intervention in helping first time expectant mothers better manage the changes and challenges in their sleep, both during pregnancy and as new mothers.
Dr Moira Junge is a health psychologist working in the sleep field, who has considerable experience working with people with sleeping difficulties in a multidisciplinary practice using a team-based approach. Moira is actively involved with the Australasian Sleep Association (ASA) and a board member of the Sleep Health Foundation. She has presented numerous workshops for psychologists and is involved with Monash University with teaching and supervision commitments. She is one of the founders and clinic directors at Yarraville Health Group which was established in 1998. In addition to her expertise in sleep disorders, her other areas of interest and expertise include smoking cessation, psychological adjustment to chronic illness, and grief and loss issues.
Dr David Cunnington is a sleep physician and director of Melbourne Sleep Disorders Centre, and co-founder and contributor to SleepHub. David trained in sleep medicine both in Australia and in the United States, at Harvard Medical School, and is certified as both an International Sleep Medicine Specialist and International Behavioural Sleep Medicine Specialist. David’s clinical practice covers all areas of sleep medicine and he is actively involved in training health professionals in sleep. David is a regular media commentator on sleep, both in traditional media and social media. David’s recent research has been in the area of non-drug, psychologically-based treatments such as cognitive behavioral therapy and mindfulness in managing insomnia, restless legs syndrome and other sleep disorders.
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Intro:Welcome to Sleep Talk, the podcast developed all things sleep brought to you by SleepHub.com.au. Here are your hosts, Dr. David Cunnington and Dr. Moira Junge.
Dr. David Cunnington: Welcome to Episode 38 of Sleep Talk, the podcast talking all things sleep and welcome Moira.
Dr. Moira Junge: Hello, David. Good to be back. Hello, everyone.
Dr. David Cunnington: In this episode, we are going to be talking about sleep and pregnancy and we’ve got Dr. Liora Kempler from the ASA Working Group on sleep and pregnancy and she gives some really great advice about managing sleep throughout pregnancy.
Dr. Moira Junge: So before we get into that, can we have a little brief chat about the parliamentary inquiry because the recommendations are out. Have you read those?
Dr. David Cunnington: I have. And what a fantastic effort by the whole sleep community in Australia one, to get the inquiry in the first place, and then to make such a great breath of appearances before the inquiry and to really sort of give a good briefing to guide the recommendations.
Dr. Moira Junge: Across the patient groups and different professionals, different research groups, and there are some – that they’ve called it bedtime reading. I’ll put a link to this in the show notes. And there are 11 recommendations and I think they’ve summed it up really. They have summed it up and they have summarized everything that they have heard and everything they have read. And what do you think of the recommendations?
Dr. David Cunnington: I really like them. There’s a real focus on – an education focus, so the need for educating lots of different groups including health professionals about sleep and sleep disorders and how to then provide services for sleep in the community.
Dr. Moira Junge: Yup.
Dr. David Cunnington: It was a great representation from the hypersomnia and narcolepsy patient groups which has led to some specific recommendations about access to treatments for narcolepsy and hypersomnia as well as more focus on research in those areas which is very fantastic.
Dr. Moira Junge: Yeah, because there has been – it’s really important. That has been an area that has been neglected I think. And then – so it’s interesting now to see what will be done with it.
Dr. David Cunnington: Thankfully, it has got bipartisan support so each side is committed to taking these recommendations forward. So unlike other inquiries, we hope they just don’t go into the trash bin and move on to the next thing, that we will actually see some of these rolling out.
The theme for this month’s podcast is sleep and pregnancy. And as we are hearing and as is common knowledge with people, sleep problems are really common in pregnancy. And also, from a physiological point of view, sleep changes a lot across pregnancy so it’s not just as if just pregnancy is a single state and sleep is the same throughout the whole pregnancy.
And for people to sleep well in pregnancy, they do have to shake up some of their beliefs and thoughts about sleep. And their strategy coming into pregnancy for managing sleep has been, “I’m going to control or I’m going to really keep a tight rein on sleep,” be prepared for things to shake up a bit because you can’t control it quite as well.
Dr. Moira Junge: That’s right.
Dr. David Cunnington: So in people you might see about pregnancy and insomnia, Moira, what are some of the things that you say?
Dr. Moira Junge: Well, I suppose I can comment even on a personal level because my kids are growing up. I guess the first time I ever had sleep difficulties was with my first pregnancy and in the subsequent ones as well. And luckily for me I think because I was already a health professional, already had stacks of older sisters, cousins, I just normalized it. I didn’t really worry about it that much. I just considered, “Oh well, I go with this.” But I do see that it does cause a lot of anxiety in people.
And on reflection in my clinical practice over the years, if I’m thinking about it especially preparing for this podcast, a lot of people I see are actually people I’ve seen early on. They might have had a lot of difficulty after their first baby or during the pregnancy of the first baby and we get that sorted. And so then we are on to a little bit more with the second or subsequent babies. So I might see them during pregnancy.
But apart from that, I actually don’t see a lot of women specifically for sleep during their pregnancy. It’s generally maybe about anxiety or other things. And of course, opening sleeping to them and normalizes and trying to teach them to just go with it a bit more.
What about you?
Dr. David Cunnington: I agree with that. Maybe that’s another one of the educational imperatives in the same way people might have pre-pregnancy counseling or go to prenatal classes and get sleep there unless we’re upscaling the people about better sleep and different ways of thinking about sleep and an approach to sleep in pre-pregnancy or early on in pregnancy.
Dr. Moira Junge: But it’s a bit of – you really have to be careful, don’t you? Because what happens with the more information you have and if you go too hard on talking about how important sleep is, that can backfire and people can get really a bit worried then about, “I’m not sleeping therefore I’m going to harm the baby.” And so yeah, that’s why we’ve got the expert, Liora, to talk through these sorts of things.
Dr. David Cunnington: It’s a nice segue. So Liora does point that out a bit about how we have to sort of soften the way we think about sleep. Dr. Liora Kempler is a psychologist who specializes in sleep and peri-natal health and she is at the Woolcock Clinic in Sydney as well as Integrated Sleep Health. Thanks a lot for helping us out, Liora. It’s great to have you as part of the podcast.
Dr. Liora Kempler: Thank you for having me today.
Dr. David Cunnington: One of the things I wanted to open with is what actually happens to sleep in pregnancy.
Dr. Liora Kempler: Well, a lot happens to sleep in pregnancy. And I think that the important thing to remember is that actually, a lot of changes happen to your body and your appetite and your metabolism and I think it’s logical to realize that sleep is part of all of that. So a lot of people are very open to those changes in metabolism or their general feeling of health but they are much less open to the changes of sleep, and that’s what can kind of be related to the anxiety that might come with that.
The first thing to say is yes, changes will occur. It’s very natural for changes to occur. And if you expect that hopefully the impact will be less, eventually the changes that occur usually sleep duration I believe in the first trimester and usually within the normal range of about 7 hours a night. People may start waking more frequently specifically to use the bathroom especially in the first and the third trimester. They also can have increased sleep latency or the amount of time that it takes for them to fall asleep.
They may also become more aware of their nocturnal awakenings partly because they might be uncomfortable or they might be nauseous. A lot of people, about half of people, report that they have nausea effects to their sleep. And so for some, that may subside for the second trimester when the nausea improves, 82.5% report urination is a cause of sleep disturbance. It seems like that’s not something people can escape from.
I think what really compounds the problem is that in addition to poor sleep or at least nearly poor sleep, people are much more tired when they are pregnant because of the increased progesterone. And because of that, they are attributing a lot of those problems to their poor sleep when actually they are much probably going to be tired anyway.
Dr. David Cunnington: That’s a really nice point because obviously that side of pregnancy and the work we do, that attributional bias about the entirety must be the sleep. So I really like that point about there are other factors about pregnancy that will make you tired.
Dr. Liora Kempler: Oh, absolutely. But look, at the end of the day, I think that if you do have that opportunity and ability to get more sleep and you do feel you need it then by all means people should strive for that. Why not?
The other one that I wanted to mention actually is body temperature. And again, that’s hormonal and very normal when you’re pregnant particularly again in that early period. But when you’re hot, it’s much harder to get to sleep.
Dr. David Cunnington: Yeah, and that’s interesting too. So we see that outside of pregnancy that sometimes people find they just don’t get that cooling off, which is part of the normal falling asleep process. So I can imagine in pregnancy, that would only be more exacerbated and more of a problem.
Dr. Liora Kempler: Yeah, absolutely. And especially I think people find it difficult when they wake through the night. It’s really hot. And they are certainly not accustomed to that in the past or before pregnancy.
Dr. David Cunnington: Then what about later on in the pregnancy? Once people really closer to delivery?
Dr. Liora Kempler: So look, I really hate to be the bearer of bad news and I often feel like that’s part of my job. For some people, sleep will improve in the second trimester particularly if nausea is a large cause of their poor sleep then obviously when the nausea subsides, their sleep will improve. But actually, studies have shown that for many, sleep does not improve and actually as pregnancy progresses, the sleep can get worse and worse particularly when pain and discomfort become more prominent, increased fetal movement, people find the baby can be waking them.
I like to remind people that actually, that’s a really good indication that your baby is healthy. So maybe that’s just a different way of seeing things. Of course, people also can heartburn as the baby gets bigger. As they get bigger, they are more likely to snore which means they’re also more likely to get something like obstructive sleep apnea, not always the case. And sometimes it’s positional but it’s certainly relevant for more people than prior to pregnancy. And sleep efficiency and slow wave sleep are actually lower in the final trimester relative to the first trimester and before pregnancy as well.
Dr. David Cunnington: How does the social situation interact with that? Because there is that social thing of by the time you’ve made it to the third trimester, you’re visibly pregnant and people seem to cut you some slack. It’s more socially acceptable to be tired in your third trimester.
Dr. Liora Kempler: It’s a really fair point actually. And often in the first trimester, people don’t even know that you’re pregnant. So you can certainly be suffering quietly in that way. And by third trimester, people are much more accommodating and open to people being tired and allowing them that space at work for that. But I think that doesn’t necessarily mean they’re going to take that opportunity. I don’t really know any people that clock out for a quick nap and then come back or anything like that. I think it would be lovely if that’s something we could do. But I don’t think society is at that point yet.
Dr. David Cunnington: I can’t wait for that. We need to get to that because the data is good. It shows …
Dr. Liora Kempler: I was just going to say actually, it’s really independent of pregnancy that we should all have a little napping clubs in the office. I’m just going to add to that because as I was saying about the third trimester but I think those final days and weeks of pregnancy are quite a different thing all together because the body starts to prepare to give birth essentially. And so you get these peaks in oxytocin and we see most women essentially go into labor at night time and it’s really important to kind of realize that woman have had 9 months of poor sleep then in labor overnight often, so you’ve kind of lost another night of sleep.
So a lot of women, probably a large majority of women will go into motherhood quite severely sleep deprived, and this might be a whole podcast epidose but it may not necessarily improve much from there.
Dr. David Cunnington: Now, for women who are pregnant, you’re giving us the bad news. A thing that’s not necessarily going to be great in terms of sleep. So, what can women do?
Dr. Liora Kempler: Look, I think the most important thing is to number one, really normalize the process. Like I said at the beginning, your body is changing basically in every possible way. So it’s only logical that your sleep is going to change too. And if you can have realistic expectation with regard to that, at least that will reduce the effects that anxiety might have in compounding the problem of poor sleep.
Practical things you could do, so of course, it depends on what the cause of the poor sleep is. If nausea is a problem for example, a lot of people find it is useful to have a bit of food in the stomach. So having a little carbohydrate or a low GI snack before bed or some great yogurt or a banana and that it helps you sleep anyway. And just have some food before bed, between dinner and bed so that you are lining the tummy a little bit and not waking with an empty stomach. That can help if nausea is the problem.
If frequent urination is the problem and for most people that is the case, I never tell people not to drink. I think it’s really important to drink but you can certainly be aware of the schedule of your drinking throughout the day and try and have more of it towards the beginning of the day and ease off towards the end of the day. It might be easier to drink when we get home. But I think if you’ve got water on the desk at work that might encourage you to kind of consume your liquids during the day rather than later.
I think this is for really not even just pregnant people but just all of us in general at the moment. Sleep is a really negotiated behavior. And I use that word because people will wake up early to do exercise or go out late to see friends. And it’s always the sleep that gets sacrificed. And pregnancy is just not the time in your life to be doing that type of thing. I think it is important to exercise. I think it is important to see your friends but if you’ve identified that you have poor sleep, it’s the time to prioritize your sleep rather than those other things.
Dr. David Cunnington: Yeah. I really like that point because pregnancy as well as other phases in life, it’s a busy time.
Dr. Liora Kempler: Yeah, it’s a very busy time.
Dr. David Cunnington: There is a whole lot going on. And yes, recognizing that sleep can’t be pushed to the sides or people can’t roll with it or don’t have the capacity to just go with it or cope with it if they are sleep deprived as they would be outside of pregnancy.
Dr. Liora Kempler: And to be honest with you, I think that everybody needs to know their own limit. And if you’re having a second and third child, you might have disrupted sleep in addition to the pregnancy. So you really need to know what’s healthy for you and make those changes according to that.
As your pregnancy progresses and obviously the causes of your poor sleep changes, it’s something like discomfort or pain is the cause of your poor sleep, a gentle massage or a warm shower before bed can help you just with the sleep on if you’re not in too much pain before that.
I did mean to mention it earlier but sleep disorders are much more common in pregnancy as well. So it’s important to identify if that’s an issue for you. Of course, restless leg syndrome is more common in pregnancy, sleep apnea like I said is more common in pregnancy. If you have restless legs, magnesium and iron supplements could be useful but that’s the type of thing you need to be discussing with your GP or your midwife or your obstetrician.
But certainly, trying to solve any physical causes of poor sleep, it would be important like I started to say earlier, I guess when you’re baby is what’s keeping you awake, rather than seeing it as an annoyance that, “Oh, this baby is already waking me up,” I think it’s really encouraging way of saying, “OK, I’m growing a healthy baby here,” and thinking of it that way and going to sleep with a smile on your face rather than, “This baby is already waking me.”
Dr. David Cunnington: And then that’s about through the pregnancy. What about more proactive things? So just say for example, and this is something I see, someone who had real trouble after the delivery of their first baby and struggling with insomnia with their newborn, they’re almost dreading what’s going to happen with sleep coming into a second pregnancy and then postpartum, what sort of things could they do in preparation for that?
Dr. Liora Kempler: That’s a really important issue and I’m really glad that you’ve brought that up because I also see a lot of patients like that but there aren’t that many people around that can treat that type of patient. So I think on the one hand, you need to have a look at your toddler or your first child and see how much of their sleep is causing your poor sleep or contributing to your poor sleep and trying to manage that first.
Now, that sounds very simple and of course anybody listening to that would be thinking, “Well obviously, we are going to try and improve our sleep.” But I really do mean being proactive about it. I think it’s important to be able to identify, “OK, what we are doing in our life isn’t currently working. We need to make quite a significant change in order to improve the family so to speak and improve the health of the family.” And so, if that’s an issue for you, you know you can get help.
If it’s insomnia that’s the issue, again, this is a really big gap in the health system as far as I’m concerned. There are a number of psychologists that offer cognitive behavioral therapy for insomnia and it’s can be very useful for pregnant women with another child as well but it needs to be delivered by a person who really understands what’s going on for the patient as well. So hopefully, it can be delivered by a person who understands the needs of a pregnant woman as far as sleep goes and the needs of a baby or a toddler or whatever the first child is as well and just kind of the family dynamics and the boundaries around that.
But in terms of managing the anxiety, the CBT could certainly be affected with that as well.
Dr. David Cunnington: Feeling like you’re coming into it with at least some skills, some tools in your toolkit that you would be able to put into place.
Dr. Liora Kempler: Absolutely. And I say this to everybody about everything, the worst thing you can do is nothing. The worst thing you can do is realize that there’s a problem in your life that’s not working and sit with it. The best thing you can do is something. Identify there’s a problem, “OK, I need to do something about this. I need to book an appointment with someone I need to see, someone that I need to make some changes,” because these things don’t change themselves.
Dr. David Cunnington: That’s a really good point rather than just hoping the next one will be different. Recognizing, see that last experience wasn’t that pleasant and the high likelihood that similar thing may happen again. What could I do with the intervening period to change the outcome?
Dr. Liora Kempler: That’s exactly right. And I’ve heard – I’ve certainly heard people say to me, “Well, I deserve a sleep this time so I would probably get one of those good sleepers.” Wouldn’t that be nice?
Dr. David Cunnington: Another subtlety is sometimes for me I think, particularly once the baby is born, having a pretty fluid way of thinking about sleep, sleep whenever, wherever, whenever opportunities arise is a much more sort of helpful way of thinking about sleep rather than being very rigid. It must occur in this way and under these circumstances.
Dr. Liora Kempler: I think you’re probably familiar with the CBTI program but I don’t know about the listeners but a lot of the kind of boundaries that CBTI and general sleep hygiene will place on you, they’re great in many ways but they can be counterproductive in the circumstance of being woken through the night or having the opportunity to nap during the day. Often they will say to you, “Oh, mustn’t nap because it’s going to destroy your night of sleep,” when in reality, your schedule doesn’t allow for a solid night of sleep. So napping during the day could potentially be very helpful in that circumstance.
And the other thing is some of those guidelines can increase your anxiety if they are not put into context of your situation which like I said, CBTI is wonderful but it’s not in the context of pregnancy or with the baby.
Dr. David Cunnington: Exactly. And that’s like the point you made before about you see someone for CBT but they’ve got to soften that if you like or got to sort of understand that those hard behavioral strategies bully sleep into place like sleep restriction and stimulus control strategies are not appropriate in all circumstances, in pregnancy and postpartum are examples of these situations.
Dr. Liora Kempler: Absolutely. And look, I must say, we’ve developed a program that fills that gap but we’re just not at the point yet. I mean we’re trying to publish it at the moment. We’re not at the point yet where we are able to offer it to the masses. This type of research is being done not even just by me but we’re not quite there yet as far as the research community or a health community goes. But we are headed in that direction.
Dr. David Cunnington: That will be great to be able to have either an online resource or readily available resource for women who are planning for pregnancy or pregnant can access to good evidence-based information and walks them through some skill development in this area.
Dr. Liora Kempler: Absolutely. Look, that’s exactly where we are headed but we’re just not quite there yet. But I think the other kind of thing to consider with all of these is that women are generally at least in metropolitan Sydney and I would say metropolitan Melbourne as well, we are having children later in life. We have got these fantastic careers and we are accustomed to being able to control things.
And then you fall pregnant, that does fall apart a little bit. You can’t control the way your body is going to react to pregnancy. You can’t control your sleep. You certainly can’t control your baby so to speak. And that change in ability to control their circumstances, that also really increases anxiety. And because of the way we live these days, we are not watching our aunts and uncles and brothers and sisters bring up their children as closely as what we used to. A lot of it is a real shock to the system and the expectations are very unrealistic.
Dr. David Cunnington: That’s really a nice point because exactly those same traits are the ones that we would see as being a risk factor for developing insomnia outside of pregnancy.
Dr. Liora Kempler: That’s right.
Dr. David Cunnington: And then you add the challenge of pregnancy and someone who has already got those predisposing traits, it just reinforces what’s coming into pregnancy and doing some work to soften those traits or develop skills to help manage those traits and sort of leap out and be a bit more comfortable with loss of control.
Dr. Liora Kempler: And like you say, it’s all about attitude of fluidity and adaptability and parenting is much the same really. And so, if you can have that open mind from the get-go, it will certainly help.
Dr. David Cunnington: You talked about some research you’re doing in programs that may roll out. What are some of the other things that have been thought about or being developed in this area?
Dr. Liora Kempler: To be quite honest with you, a large majority of the research that exists in the prenatal field is in the postpartum period. So new mothers, new babies or in that first year for infancy specifically have poor sleep. There are a lot of programs. The one that we are doing is a little bit more unique in terms of targeting the pregnancy as well, where people have more time when they are pregnant than they do when they had the baby. They also were already having all of these sleep problems.
So like you say, is there a way to prepare? This is the way that we thought, “OK, well, if you can combat the insomnia and the anxiety when you actually have the time and opportunity to do that and you’re not being woken through the night by an external baby, maybe that’s a good opportunity to practice these things.”
The program that we developed is designed to be delivered in pregnancy and it’s designed to help throughout pregnancy and in the postpartum period. And we did find that it was successful in improving sleep quality and insomnia symptoms four months postpartum. So we were really pleased with that. But I’m not aware of many programs that’s targeting the same thing.
Dr. David Cunnington: If people are looking for more resources and information or where are some places they could look?
Dr. Liora Kempler: I think it’s always useful to talk to the midwife as far as pregnancy and the immediate postpartum period goes. I think it’s quite useful to understand your parents’ experience because a lot of these things do have a genetic factor and not just a genetic factor but a cultural influence. If you come from a certain type of family, you’re likely the parent in that same way. The way that you mother parented will have a large impact on the way you choose to parent most probably.
Now obviously, that’s not going to give you any research but it will give you an idea of what to expect.
Dr. David Cunnington: There people have got that information but still feel like they really want to see a healthcare professional. How should they access the healthcare system for this type of care?
Dr. Liora Kempler: So usually, primary care is the best starting point. So going to the GP, if you have a GP that specializes in pregnancy or women’s health, that’s a really good starting point and your GP may give you a mental healthcare plan if you’re in Australia and you would be able to go and see a psychologist. I think it’s important to realize that sleep is a very specific type of treatment and a very specific cognitive behavioral therapy although that’s available in lots of different domains. Cognitive behavioral therapy for insomnia is very specific so I would highly recommend seeing a psychologist which specializes in sleep. If you can find one that specializes in sleep and understands pregnancy as well, that’s a no brainer. But I think most psychologists would be able to look at your particular context and be able to adapt it to you anyway.
Dr. David Cunnington: Great. Thanks very much for your help, Liora.
Dr. Liora Kempler: My pleasure. Thank you.
Dr. David Cunnington: Moira, having heard of what Liora said, how does what she says gel with the approach you would normally take?
Dr. Moira Junge: Oh, I love that interview. Thank you. And thanks, Liora. That was excellent. I really appreciate her expertise and her approach is so sensible. It’s very empathic, understanding of the position that really what she is saying is normalize it, don’t make a pathology out of sleep being a bit different during pregnancy because look at everything else that goes into it. It’s incredible time for your body and your hormones and just have more flexibility with it a bit.
So yes, I am totally aligned with that approach. And the thing we need to talk about more on the podcast in probably a different time, that idea of getting access to a psychologist who has got sleep specific experience. It’s hard. There’s not many of us. And it’s also hard for access. So the thing that just highlights and what we need to do so much more is the education for every single psychologist, every single GP that they have a really good hands experience in these slightly nuanced messages we have about sleep but not to go too hard on rules and sleep hygiene and education around that. It’s actually often the opposite. It’s like, “You know what? It’s normal. Just go with it a bit.”
Dr. David Cunnington: And when I think of talks I give to health professionals about sleep, that’s actually the one key messages pretty much in all my talks to health professionals is don’t hammer people about sleep hygiene. People have already given themselves a hard time about that and trying almost too hard.
So if people are looking for more information, I will put some links in the show notes of where there are some resources about sleep in pregnancy. And we have also done a previous podcast on something we haven’t talked so much about is sleep in new parents, so some strategies once babies come about, managing sleep. So have a look for that as well.
So as we had Liora with us this we took the opportunity to get her expertise for our clinical tip.
Dr. Liora Kempler: I think there’s a pretty broad range of the types of clinicians that do work with pregnant women especially when you are talking specifically about sleep. Obviously, you’ve got midwives, you’ve got obstetricians, you’ve got GPs, you’ve got physiotherapists that often accommodate people during pregnancy and just advise them about all sorts of things.
I assume we are talking about a very broad of clinicians here but one of the things that I think is the first step with sleep is to normalize it, normal to wake a few more times than you used to through the night. It’s normal to need the bathroom in the night. It’s normal to be a bit more anxious than you used to be. All this stuff can be quite scary for someone who is not prepared or not aware of it. It’s normal to feel nauseous day and night and it’s not just morning sickness.
So really normalizing everything that they’re going through without belittling their suffering is a good starting point. Trying to give them realistic expectations without terrifying them by saying, “OK, well, your sleep is changing and that’s a normal part of this. It will possibly continue to change. It may even get worse. Is there anything you can in a practical sense that can help with that? Is there something your partner can do to help you sleep in or can you change your work schedule?”
So just little practical tips that they can take away. I think it’s important to give them the realistic expectations without increasing their anxiety if that’s possible.
I think another good tip is to aim for relaxation and calmness as opposed to sleep particularly later in pregnancy, women are a bit more open to napping but they say, “Oh, I can’t nap. It’s just something I’ve never been able to do.” If they’re saying something like that, OK, well, don’t nap. Just lie down. Just relax. Close your eyes. It doesn’t matter if you don’t nap. It doesn’t matter if you don’t sleep. It’s still good for your body to relax.
Dr. David Cunnington: So Moira, time for pick of the month. What’s your pick?
Dr. Moira Junge: Well, I came across a very interesting journal article that was published just recently in the journal Cognitive Behavioral Therapy and it was called the Effects of Rumination and Worry on Sleep by a group atSuffolkUniversity. It was really interesting. In a nutshell they talked about that pre-sleep arousal that we see all the time. They’ve noticed that cognitive arousal has a stronger mediating effect than somatic arousal.
So the cognitive arousal being just your mind going a bit crazy, people talk about, “I can’t switch it off.” And they’re just going mental gymnastics all over the place. And rather than the somatic arousal of just being tied – your muscles are tired and you’re just really feeling very tired in your body. It’s a really interesting point particularly when we think about mindfulness meditation and we know that it works for sleep. We have noticed with the research that we’ve done that it is very much an effect on the cognitive arousal although mindfulness talks a lot about the pre-sleep arousal with the somatic, than the physiological.
So just a really interesting article I think that people with an interest in the area of sleep and rumination and worry and mindfulness, I think it’s just a good read. We recommend it and we will put a link in the show notes.
Dr. David Cunnington: Yeah. Thanks to Hailey Meaklimfor sending that through to us. It really home for all of us because it resonates with what we see in clinical practice.
Dr. Moira Junge: Absolutely. It’s exciting part of – I think more and more of this type of research will catch our eye. And what about you? What’s your pick of the month?
Dr. David Cunnington: So it’s an article from a couple of years ago but it’s a word. So think of it as word of the month rather than the article itself. So the word is orthosomnia.
Dr. Moira Junge: What?
Dr. David Cunnington: Kelly Baron and a couple of authors from Rush and Northwestern Universities in the US coined it in an article they wrote about people taking a quantified self too far, really trying to talk about are people getting too anxious about sleep, monitoring it too carefully to make sleep perfect? And they got the term from another term called orthorexia, which describes people who try to eat a perfect diet for good health.
Dr. Moira Junge: Right.
Dr. David Cunnington: So based on that, they took off the rexia and added in somnia around sleep and have coined the term orthosomnia for trying to achieve perfect sleep, which is a pathway to achieve anxiety and then insomnia.
Dr. Moira Junge: And then disaster as consequences.
Dr. David Cunnington: Right. So there we go. Word of the month: Orthosomnia.
Dr. Moira Junge: I’m going to read that for sure. In fact, anecdotally, I haven’t got a paper yet on this but I’ve got a new word for you, asomnia.
Dr. David Cunnington: Nice.
Dr. Moira Junge: Rather than insomnia. And I will talk about that further. I think we could do – just unpack it a bit more.
Dr. David Cunnington: All right. We will hear more about that. So that particular article on orthosomnia is in the Journal of Clinical Sleep Medicine in 2017 and the link will be in the show notes.
Look out for our next episode which is going to be sticking with the theme of pregnancy and will be on menopause and sleep. So sleep at a different phase of life for women and some of the issues associated with menopause.
Dr. Moira Junge: So thanks for listening. It’s always great to have your company. Please don’t forget to send us any suggestions at podcast@SleepHub.com.au. And if you like the podcast, review us on iTunes or subscribe to the podcast.
Dr. David Cunnington: All right. Thanks a lot.
Dr. Moira Junge: See you.
Outro:This podcast is not intended as a substitute for your own independent health professional’s advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with inclusions you may have regarding a medical condition.