If you are pregnant, you already know that sleep patterns change during pregnancy. About 75% of pregnant women, in fact, report a disturbance in their sleep patterns during pregnancy. You might find yourself waking up too early or too many times during the night. You might find it hard to fall asleep, oftentimes with thoughts racing. You might even feel physically uncomfortable. All of these things may lead you to waking up not feeling refreshed.
Why does sleep change during pregnancy?
The short answer is hormones. Generally speaking, people sleep in cycles throughout the night, progressing through various stages of light sleep, deep sleep, and dream sleep. The amount of sleep an individual requires varies, but on average 7-9 hours are recommended every night. In pregnancy, there is a decrease in the amount of restful sleep, deep sleep and dream sleep, and an increase daytime sleepiness and fatigue. The decrease in dream sleep, in particular, is thought to be related to pregnancy hormones like progesterone.
Pregnancy can also be associated with the development of certain sleep disorders, such as sleep apnea and restless legs syndrome. In addition, many women report that frequent urination, heartburn, and physical discomfort are reasons for poor sleep. Many also cite anxiety and emotional problems that may or may not be related to the pregnancy as the reason for an inadequate night’s rest.
Why does it matter that sleep patterns change?
Sleep is an essential human function, and poor sleep can severely impact daily functioning and mental health. It is torturous to sleep restlessly night after night and wake up unrestored. There are many theories about the reasons why sleep is so essential, but medical researchers are in agreement that without sleep, people cannot function adequately.
Sleep disturbance during pregnancy is associated with a number of negative outcomes. These include smaller babies, preterm deliveries, higher rates of high blood pressure and pre-eclampsia, increased risk of cesarean, higher risk of gestational diabetes, and increased rates of depression and anxiety. Furthermore, changes in sleep are actually a key feature in the diagnosis of a depressive or anxiety condition, both of which are often misdiagnosed or under-diagnosed in pregnancy, and can have their own consequences and effects on the pregnancy and in the postpartum period.
How can I tell if my sleep disturbance is due to anxiety or depression?
Ask yourself these questions…
Is it hard to fall asleep because of anxious thoughts on my mind rather than because I am physically uncomfortable?
When I get up in the middle of the night to use the bathroom, how long does it take me to fall back asleep?
If it takes longer than 15 minutes, is it because I’m worrying or ruminating on negative things?
If I’m waking up too early, when I wake up do my thoughts immediately turn to worries for the day or the future?
Am I being kept awake because of evening anxiety attacks or am I waking up in the morning feeling tense with worry or sadness?
If the answer to some of these questions is “yes,” then your sleep disturbance could be related to an undiagnosed mood or anxiety condition. This is essential to recognize and address in order to find the most appropriate treatment.
The good news is insomnia during pregnancy is quite treatable!
The first treatment for insomnia is ensuring good sleep hygiene. Good sleep hygiene refers to all the specific interventions one uses to ensure a good sleep. These include:
*A consistent bedtime weekly and weekends
*Avoiding naps late in the day
*Ensuring the bed is used only for sleep (and sex) – that means no electronics, no television, etc. so that the mind and body learn to associate the bed with only sleep
*Avoiding substances that can impact sleep such as caffeine late in the day
*Giving yourself 15-20 minutes to fall asleep, and if that is not working, leaving the bed to do something else and then returning. Again, this is so the body associates the bed with just sleep.
*Having comfortable pillows, blankets, and also ensuring the room is a good temperature, as body temperature needs change during pregnancy
Next, cognitive-behavioral therapy for insomnia is highly effective and can be adapted to the pregnant woman. This therapy involves providing the woman with information about sleep, behavioral strategies and skills, changing unhelpful beliefs and thoughts about sleep, and education on relaxation techniques. It can be done with a trained clinician or on your own with a workbook (I recommend the series Treatments that Work).
Also, many women find mindfulness-based relaxation exercises, meditation, and yoga to be helpful. These methods can help immediately to induce a calm state prior to bedtime and as well in the long term by allowing for the development of a mental and physical state that is better adapted to good sleep.
Finally, if the above approaches do not work, you can explore medication options. Because so many women experience sleep problems during pregnancy, the number of women who take sleep aids during this time is high. Studies report about 1 in 25 women take medication several times per week and 1 in 10 take medication at least monthly. This includes both over the counter and prescription medications.
The most common nonprescription medications that can help with sleep in pregnancy are antihistamines such as Benadryl (diphenhydramine) and Unisom (doxylamine). The antihistamines like Benadryl are safe in pregnancy, not associated with birth defects, and are used quite frequently. There are other prescription medications as well that are relatively safe. Before taking any medication, you should speak with your obstetrician, primary care physician, or psychiatrist.