What happens to sleep in pregnancy? Is there anything that can be done to improve sleep?
Sleep problems are a normal part of pregnancy. Some polls report that 80% of women report disturbed sleep during pregnancy. There are a range of reasons for sleep disturbance such as the need to urinate, tiredness, low back pain, restless legs symptoms, leg cramps and snoring. These symptoms vary throughout the pregnancy depending on the stage or trimester.
First trimester (0-12 weeks)
There’s a wide variation in how women feel in the first trimester. Most of the effects are due to hormonal changes, as the foetus is small and not causing pressure symptoms at this stage. Some women feel great when they first become pregnant, and don’t have any problems. However, others can get a range of symptoms including:
- Tiredness – rising progesterone levels can cause tiredness throughout the day
- Morning sickness – can cause women to wake up with nausea, sometimes in the early morning before they are ready to wake up
Second trimester (13-28 weeks)
Increasing demands on the body with the foetus and uterus enlarging can cause a range of symptoms during this phase of the pregnancy:
- Tiredness – is still a common symptom, but more related to the demands of carrying extra weight, and trouble finding a comfortable sleeping position
- Restless legs symptoms – often begin to develop as iron stores in the body are utilised by the growing foetus and extra blood needed to support mother and baby. These symptoms are an uncontrollable urge to move or unpleasant sensations in the legs that are often worse at night or when sitting still. (More on restless legs syndrome in this post.)
- Heartburn – can begin to develop as pressure on the stomach from the uterus can allow acid from the stomach to reflux back in to the oesophagus
Third trimester (29-40 weeks)
By this stage of the pregnancy, most women are having trouble with sleep. Many of the symptoms are related to the size of the uterus, with other symptoms related to increased blood flow and airflow needed to support mother and baby:
- Nasal congestion – increased blood and air flow through the nose can lead to a blocked nose and difficulty breathing, particularly during sleep
- Snoring and sleep apnea – increased oedema doesn’t just occur in the legs and hands, but can also occur in the upper airway. This can lead to snoring and symptoms of waking with choking and gasping during sleep. (More on sleep apnea in this post.)
- Difficulty breathing – as the uterus increases in size it can push the diaphragm up in to the chest, compressing the lungs making it feel difficult to breathe. This is particularly so when women lay on their back
- Low back pain – becomes more of an issue late in pregnancy as the enlarging uterus places strain on the lower back
- Baby movements – Babies that are restless can seem like they move all night, adding to the general restlessness that women can experience in the third trimester
- Heartburn and restless legs symptoms are also common in the third trimester
What can be done to improve sleep in pregnancy?
Ultimately, the most effective treatment for sleep problems during pregnancy is delivering the baby. But there are a number of general measures that can help with sleep during pregnancy:
- Find a comfortable sleeping position – This can be one of the most helpful strategies to help manage sleep, particularly in the third trimester. For most women, sleeping on their side is most comfortable during pregnancy, and putting a pillow between the knees can help
- Embrace the nap – short naps through the day are a great way of coping with tiredness and catching up on lost sleep
- Reduce heartburn – by avoiding large meals or spicy foods in the hours prior to going to bed. Sleeping propped up on pillows can also help. If heartburn is severe despite these measures, talk to your doctor about medications which may help
If specific sleep disorders cause problems during pregnancy there are things that can be done:
- Snoring and sleep apnea – can be managed with use of continuous positive airway pressure (CPAP) for the remainder of the pregnancy. I’ll use this if women are getting significant symptoms of waking with choking and gasping at night that doesn’t settle with sleeping on the side or propped up
- Restless legs symptoms – Iron replacement is the first step to reduce restless legs symptoms, particularly if iron stores are low. Some women can also find magnesium helpful. Most of the medications used to manage restless legs symptoms aren’t safe to take during pregnancy
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