Sleep during Pregnancy

Pregnancy is a wonderful and exciting time, but many women suffer from disruption to their sleep.

In the first trimester, sleep can be interrupted by nausea, vomiting and having to go to the toilet during the night. These symptoms continue throughout pregnancy, but later in pregnancy sleep may become worse, due to heartburn, the baby moving around and kicking, as well as backache, leg cramps, snoring and shortness of breath.

Most pregnant women have many interruptions to their sleep throughout the night, so pregnant women often suffer from considerable daytime sleepiness and fatigue. This sleep disruption and fatigue can affect a woman’s mood state, causing depression, they may become more emotionally sensitive and struggle with personal and work relationships. Pregnant women also complain of difficulties with attention, concentration and memory due to insufficient sleep.


Common Sleep Disorders in Pregnancy


Insomnia

The majority of pregnant women report sleep changes, likely as a result of hormonal changes and physical discomforts. In the first 3 months of pregnancy, many women find that they need more time asleep, either by spending more time in bed at night or by having a daytime nap. However although they spend more time asleep, they usually have less deep, refreshing sleep and more light sleep. In the last 3 months of pregnancy, they often have short awake periods during the night and have even less deep sleep. Unusual dreams, often associated with anxiety about the birth and the baby, are often reported by pregnant women. Frequent dreams may be caused by emotional stress, sleep disruption or changes in hormone levels.

Many pregnant woman have difficulty going to sleep, waking frequently during the night or waking too early in the morning. If this occurs for at least 3 nights per week for 2 months, then they may need treatment for this insomnia.

A very effective treatment for this is available from psychologists, called Cognitive behavioural therapy (CBT) and should be the first treatment option. It is often rapidly effective with improvements in both sleep and mood. Medications should be considered carefully and only after reviewing the risks and benefits.


Obstructive Sleep Apnoea

Snoring and shortness of breath are common during pregnancy.

However, as pregnancy progresses, breathing difficulties at night may develop into obstructive sleep apnoea (OSA), where breathing pauses, small falls in oxygen levels and sudden awakenings due to choking sensations occur.


Snoring and shortness of breath are common during pregnancy.

However, as pregnancy progresses, breathing difficulties at night may develop into obstructive sleep apnoea (OSA), where breathing pauses, small falls in oxygen levels and sudden awakenings due to choking sensations occur.

OSA during pregnancy can be caused by normal changes such as weight gain, nasal blockage, fluid accumulation and the growing womb pressing on the lungs and airways when lying down. However it is more common in women who are overweight or obese and in women with high blood pressure.

Although sleep apnoea is not common during pregnancy, it may be associated with complications for the mother and baby, including high blood pressure, pre-eclampsia, diabetes, pre-term birth and lower birthweight.

OSA is a treatable condition and can be safely managed (with no drugs) during pregnancy.


Restless Legs Syndrome

Leg cramps are common during pregnancy and can occur in up to 75% of women by the third trimester. Restless legs syndrome (RLS) is a movement disorder that is 2-3 times more common during pregnancy. There are uncomfortable sensations in the legs, which are relieved by moving them around. These symptoms are worse in the evening or at night. RLS is typically most severe in the third trimester of pregnancy and resolves around delivery. A lack of iron and folate may be a cause of RLS, and other risk factors include older age, family history, and RLS in a previous pregnancy.

These unpleasant sensations may disrupt sleep, resulting in less time asleep, a longer time to fall asleep, overnight awakenings and daytime sleepiness.

Useful treatment options include cold and hot compresses, leg massage, relaxation techniques or gentle stretching exercises before bed.


Ways to Improve Sleep during Pregnancy

  1. Plan a regular sleep-wake schedule and make sleep a priority. 
  2. If you are sleepy during the day, take a nap for less than 30 minutes, if you can. 
  3. Make the bedroom dark, cool, and comfortable and use a nightlight in the bathroom rather than a bright light. 
  4. Practise relaxation and deep breathing to reduce tension and anxiety.
  5. Don’t lay in bed, trying to go to sleep. If you cannot sleep, after about 20 minutes, go and sit somewhere else in the house that is quiet, dark and comfortable. Do not watch TV, check your phone or do household activities. Read quietly or listen to the radio, then when you feel sleepy again, go back to bed. 
  6. Being a healthy weight prior to pregnancy and gaining weight appropriately during pregnancy will reduce the risk of OSA.
  7. Raise the head of your bed to prevent or reduce heartburn and snoring. Many women put a brick under the legs of their beds or sleep on extra pillows.
  8. Relieve a blocked nose with nasal saline washes.
  9. Avoid smoking yourself or breathing in smoke from others.
  10. Eat a healthy, balanced diet providing magnesium, potassium, calcium and vitamin C and take folate and iron supplements to decrease leg cramps and RLS.
  11. Engaging in regular exercise may help to control excessive weight gain and improve circulation to reduce leg cramps.
  12. Sleeping on your side is recommended. This may improve blood flow to the baby. Use pregnancy support pillows between the knees, under the abdomen and behind the back to sleep comfortably.


If you think you may be experiencing a sleep disorder during pregnancy, discuss this with your GP for an appropriate referral for diagnosis and management.