Pregnancy and Sleep
Sleep problems in pregnancy are common and may affect pregnancy. Some more common disorders include Restless legs syndrome, Shorter sleep duration, Snoring and obstructive sleep apnea (OSA). Some of these may be associated with increased risk of gestational diabetes, preeclampsia, and pregnancy-induced hypertension.
Approximately one-third of pregnant women may report some type of sleep problem. However, “reported” is the key word. Sleep disorders are common in general, and most women do not receive information about sleep in pregnancy.
There are a number of physical and physiological changes that occur during pregnancy that can disrupt sleep and affect sense of wakefulness versus fatigue.
Sleep duration generally initially increases in the first trimester. Later sleep returns closer to prepartum values by the second trimester, but then decreases. Once the baby is born, sleep deprivation may take a different level depending on the amount of help.
Nocturnal awakenings are common in pregnancy. Causes may include urinary frequency, frightened dreams, leg cramps, reflux, discomfort, and sometimes fetal movements.
Short sleep duration (less then 5 hours) is associated with higher blood pressure in third trimester and risk of preeclampsia. Less than 7 hours of sleep is associated with increased incidence of gestational diabetes mellitus.
Sleep disorders during pregnancy also affect sleep duration and quality.
Insomnia may be directly related to pregnancy because of the adjustments to physical, hormonal, and metabolic changes. Insomnia may also coexist with psychiatric conditions, such as anxiety. Sleep initiation difficulties are a significant predictor of depression and anxiety in pregnancy.
RLS is the most extensively studied sleep disorder in pregnancy. RLS is characterized by a compelling urge to move more often than in other conditions. Pregnancy is a risk factor for the emergence or worsening of RLS. Symptoms usually develop or increase with advancing pregnancy. Transient RLS resolves quickly postpartum within the first month but can recur with subsequent pregnancies. Pregnancy-related RLS may be associated with increase in estradiol levels. The antidopaminergic effects of estrogen may account for increasing RLS toward the end of pregnancy when estrogen levels are the highest. It has been suggested that hemodilution and increased fetal demand imply a possible role for iron in RLS, however many women have normal levels of iron and appropriate iron intake.
OSA may develop or worsen during pregnancy and affect maternal-fetal health. The prevalence of OSA in pregnancy is unknown. Snoring nearly doubles from prepregnancy to the final month of pregnancy along with other emerging symptoms, such as witnessed Apneic episodes. BMI and large neck girth are risk factors for symptom development as well as severity and worsening of OSA symptoms in pregnancy.
There may be negative consequences of OSA on maternal-fetal health. Snoring and OSA in pregnancy are associated with increased risk of gestational diabetes, preeclampsia, and pregnancy-induced high blood pressure. Habitual snoring is associated with increased cord blood levels of inflammatory markers.
Postpartum, OSA symptoms often improve or resolve. However treatment of the symptoms may also improve some of the negative outcomes discussed above.
Hypersomnia, or excessive daytime sleepiness (EDS), is defined as the inability to maintain a wakeful and alert state during the usual waking portion of the day. Narcolepsy is characterized by a pentad of hypersomnia, disturbed nocturnal sleep, sleep-related hallucinations, sleep paralysis, and cataplexy, as a result of an inability of the wake and sleep promoting pathways in the brain to stabilize the sleep-wake cycle. Significant cataplexy may affect labor and delivery. Reports of labor-induced cataplexy have lead to the need for cesarean delivery.
In contrast to the prevalence of narcolepsy in the general and pregnant population, nonspecific hypersomnia commonly affects pregnant women. Most daytime impairment from hypersomnia is reported in the first trimester. Sleepiness may also be a consequence of other sleep disorders as discussed above, or independent of the pregnancy itself.
Consult with your primary care physician and your OB/GYN physician to see if a sleep medicine consultation would be right for you.
