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Sleep & Pregnancy

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Many changes in sleep occur during pregnancy. Physical, psychological, and hormonal changes that occur during the three trimesters all affect your sleep. These changes also occur at birth and during the postpartum period after birth. Hormone levels change dramatically during pregnancy. Some hormones cause sleepiness and others cause poor sleep.

Also, pregnant women may have any of these new symptoms:

  • Awakenings
  • Disturbed sleep
  • Napping
  • Sleepiness
  • Fatigue
  • Snoring
  • Restless legs (the urge to move your legs at night)
  • Leg cramps
  • Back pain
  • Frequent urination
  • Reflux (heart burn)
  • Nausea/vomiting
  • Breast tenderness
  • Breathing changes
  • Nasal congestion
  • Worrying or anxiety about the pregnancy and the baby’s health

Some women have vivid dreams and sleepwalk. These symptoms vary from woman to woman. Symptoms also vary through the three trimesters, at birth, and after the baby’s birth.

First Trimester (Months 1 to 3)

Many women report sleepiness, fatigue, and changes in their sleep. Progesterone hormone levels rise and cause increased sleepiness. Many women report increased napping. Many women experience unexplained awakenings. It is also common to wake up because of these physical symptoms:

  • Nausea
  • Vomiting
  • Back pain
  • Frequent urination
  • Nasal congestion

Second Trimester (Months 4 to 6)

Many women report some improvement in their sleep despite an increasing size of the uterus. Many women report increased daytime energy and less nausea. Some women report more nasal congestion, snoring, or awakenings from heartburn. The baby’s movements may wake you up as the pregnancy progresses.

Third Trimester (Months 7 to 9)

Most women report worsening sleep as the last trimester progresses toward delivery. Sleep loss may cause irritability and moodiness. Symptoms vary with each pregnancy but may include the following:

  • General physical discomfort
  • Difficulty falling asleep
  • More frequent and longer awakenings
  • Difficulty staying asleep
  • Difficulty getting comfortable in bed
  • Overall less nighttime sleep
  • Leg cramps
  • More frequent urination
  • Feeling hot and sweaty
  • More heartburn
  • Vivid dreams
  • Changes in breathing
  • More awakenings from baby movements
  • Disorganized contractions of the uterus:
    False labor contractions (Braxton-Hicks contractions) increase as the delivery date approaches.
  • Restless legs syndrome (the urge to move your legs at night)
    Restless legs syndrome also is more common with anemia. Anemia may develop during pregnancy. Taking your prenatal vitamins and iron as directed by your doctor may help in these ways:

    *Reduce symptoms of restless legs
    *Improve anemia
    *Promote the healthier growth of the fetus

Labor and Delivery

For most women, sleep worsens before labor. The length of labor affects the amount of sleep loss. There may be more sleep loss if labor occurs during the night. After delivery, sleep is disturbed the first night. It generally improves over the following days.

Postpartum Period (From delivery to 6 months after delivery)

Many women continue to have awakenings and disturbed sleep. You may sleep later or may nap to make up for lost sleep. Some women have continued fatigue and decreased energy. Sometimes a depressed mood also occurs.

Continued fatigue may result from the loss of pregnancy-related hormones. It can also be a symptom of anemia. This occurs when there is a lack of red blood cells in your bloodstream. Anemia may also be a sign that your body is low on iron. Blood loss during childbirth makes anemia very common. Some women continue to take their prenatal vitamins.

One of the main causes of awakenings is to breastfeed or to give a bottle to the baby. Many babies do not get used to sleeping during the night until about 4 to 6 months. It takes time for them to develop a circadian rhythm of sleep. To catch up with lost sleep, many mothers nap when their babies nap.

What You Can Do to Sleep Better During and After Pregnancy

  • Many women experience awakenings, disturbed sleep, and sleep loss. It is good to nap to catch up on any lost sleep.
  • Stay healthy and eat good foods. Go for your scheduled prenatal visits. Take prenatal vitamins as directed by your doctor. Some women develop anemia that may increase restless legs symptoms.
  • Follow a regular schedule and practice good sleep hygiene. This will improve your circadian rhythm to sleep better at night.
  • Make yourself comfortable with extra pillows to help any back or leg discomfort.
  • Elevating the head of your bed may help with reflux (heartburn). Do not eat meals before bedtime.
  • Drinking fluids is good, but try to avoid drinking large amounts of fluid before bed. This will keep you from waking up to go to the bathroom at night.
  • As the pregnancy progresses, many women sleep on their left side for comfort. This can also improve blood flow.
  • If you have any known medical or psychiatric disorders, make sure to tell your doctor. It is important to continue good treatment of your medical disorders during pregnancy. Also your doctor may want to change some of your medications. Some medications can affect the growth of the fetus. You should discuss this with your doctor before making any medication changes.
  • If you have sleep apnea or another sleep disorder, make sure to tell your sleep doctor that you are pregnant. Treating sleep apnea is important for you and your baby. This will help you maintain normal oxygen levels as you sleep. Normal oxygen levels are important for the growing fetus.

    Some women may develop sleep apnea during pregnancy. If you suspect that you may have sleep apnea, see a sleep doctor. Common signs of sleep apnea are loud snoring and pauses in breathing during sleep. These are some other factors that can be related to sleep apnea:

    *Obesity or a large weight gain
    *An increase in your neck size
    *Excessive nasal congestion
    *High blood pressure
    *Excessive leg edema (fluid)
    *Unusual headaches
  • After delivery, catch up on any lost sleep with naps. Many mothers nap when their babies nap.
  • If possible, take your baby out for a walk every morning. This will help improve your circadian rhythms.
  • Discuss any concerns or unusual symptoms with your doctor.

    By Sharon L. Schutte-Rodin, MD
    Updated on June 9, 2006

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