It is well established that the potential for sleep disturbances increases during pregnancy – 78% of women report sleep-related issues during this period. The truth is, once your baby arrives, sleep will be temporarily interrupted because you will be supporting the baby’s sleep and well-being at night to feed, comfort and change them. Because healthy sleep can reduce both adverse prenatal and birth outcomes as well as lower the risk of developing postpartum depression, this is an area of growing importance.
SLEEP CHALLENGES IN EARLY PREGNANCY
To begin with, rising and changing levels of progesterone and estrogen can affect sleep in the following ways:
- Increase daytime sleepiness, which can lead to fragmented, poor-quality sleep at night
- Temperature regulation issues can cause hot flashes, sweating, swelling in the feet and legs as well as feeling dehydrated.
- Increased urine production, which can mean more trips to the bathroom at night
- Breathing changes, such as nasal congestion or snoring, can put you at greater risk of developing obstructive sleep apnea, a breathing-related sleep disorder.
A variety of physical changes and symptoms can also impair sleep, including nausea and vomiting, back pain, chest pain, increased appetite, and anxiety.
SLEEP CHALLENGES IN PREGNANCY
Many feel discomfort from their growing belly and/or from movement from their baby and may find it difficult to settle into a comfortable sleeping position.
Other challenges that affect sleep may include:
- Gastroesophageal reflux disease (GERD) – as your uterus grows, it puts pressure on your stomach and esophagus, making acid reflux and heartburn more common
- Leg cramps and/or Restless Leg Syndrome (RLS) – RLS is a sleep disorder characterized by unpleasant sensations in the legs, such as tingling and pain; symptoms are worse at night
- Vivid dreams related to your baby – Waking up frequently means people are more likely to remember their dreams. Although anxiety-provoking for some, pregnancy dreams are thought to be one of the ways your unconscious mind processes information and tries to solve problems.
- Increased levels of oxytocin, which causes more fragmented sleep and time spent in lighter stages of sleep
As pregnancy progresses, the risk of developing sleep disorders such as RLS, insomnia and sleep-related breathing problems continues to increase.
POSTNATAL SLEEP CHALLENGES
Studies show that new parents face up to 6 years of sleep deprivation after giving birth to their children – sleep is worst at 3 months postpartum and has a stronger impact on women.
What is happening and why?
Residual evolutionary stress effects:
When babies are born, there is a flood of hormonal changes that occur after birth designed to put them in a biologically hypersensitive state to respond to the needs of their babies. When a parent hears their baby cry, it causes a physiological reaction in their body designed to wake them up quickly – they sleep with a faster heart rate, shallow breathing, increased body temperature, tightening of the muscles and an activated mind (Which by the way is the exact OPPOSITE physiological state we need to fall asleep!). Unfortunately for some, this constant waking pattern makes it difficult to fall back asleep, and many find it difficult to come out of the hyper-awake state, even when their children sleep through the night.
Irregular sleep and wake schedules:
Your body and brain want a consistent routine (as do your kids!) – with consistency, your sleep and wakefulness are regulated. Baby waking at night, long naps during the day, delaying your bedtime to catch up on some “me time,” and/or napping can all stress your body out, making it difficult to fall asleep.
Improper use of lighting:
Light plays a big role in your sleep-wake cycle. It can affect and change when you are sleepy and when you feel alert. Insufficient bright light (especially outdoor light) during the day can make you feel sleepy. Too much bright light (especially blue light) at night can trick your body into thinking it’s daytime, suppressing and delaying the release of sleep hormones, including melatonin.
Lack of wind-down routine:
Sleep doesn’t work like a light switch. Sleep is a transition. Your brain and body need calming signals to help you transition to sleep, and when you don’t allow yourself time to breathe before bed in a deliberate way, it can be difficult to fall asleep or stay asleep.
THE SLEEP/STRESS CONNECTION
Managing stress levels is key during the perinatal period, especially as there are so many unknowns and potential things to worry about during this time. Sleep and stress have a reciprocal relationship: Quality sleep helps balance stress hormones, lower anxiety levels and improve mood and mindset, but stress and worry can disrupt sleep. Unaddressed anxiety and/or depression can be particularly problematic because you can put yourself at greater risk of developing insomnia and postpartum depression later on.
SLEEPING TIPS
When I work with clients, I first like to build the foundation of good sleep, which includes:
Get the right light at the right time:
Upon waking, turn on the bright lights and, as soon as possible, go outside for 15-30 minutes and take off your sunglasses. Go out again every lunch (or any time of the day!). As the sun goes down, limit your exposure to bright light (lamps, dimmers or candles are good). Turn off your blue-light emitting devices about 30-60 minutes before bed.
Maintain a consistent sleep and wake schedule:
Wake up and go to bed at the same time every day (weekends too!). Anchoring your wake time first will have the most significant impact. If you need to rest during the day due to supporting your baby at night, keep naps short, between 20-30 min and earlier in the day (between 12-3 pm).
Create a nightly bedtime routine:
Implement a consistent 30-60 minute wind-down routine that includes relaxation. Choose enjoyable but not particularly stimulating activities – reading, listening to music, yoga nidra, thinking/meditating, prayer, guided imagery, deep diaphragmatic breathing exercises, journaling, bathing, etc.
For pregnancy in particular, these tips may help to alleviate sleep issues:
Keep comfortable:
Consider using pillows by placing one between the knees (either a regular or wedge pillow), under the abdomen, and/or behind the back to support and relieve any pain or pressure . To relieve heartburn, avoid lying down immediately after eating or sleeping with the head of your bed elevated.
Stay cool:
Adjust your room temperature between 17-21°C (62 -70°F). Sleep in natural sweat-wicking fibers. Natural cotton and bamboo make great PJs, and for bedding, try materials like Pima or Supima cotton, percale, Egyptian cotton, bamboo and linen, silk or jersey.
Keep hydrated:
Drink between 2-4 liters of water during the day. If you’re thirsty or hot at night, consider sucking on an ice cube – it helps keep you cool while limiting your fluid intake, preventing the risk of extra tips to the bathroom at night.
Keep the airway open:
People with stuffy noses can use nasal strips or sinus rinses to help open up their nasal passages and improve their breathing at night. Sleeping on your side may also reduce snoring and/or sleep apnea events.
Remove medical conditions:
Sleep disturbances can be caused by vitamin or mineral deficiencies (common culprits are magnesium, iron, potassium, calcium, B vitamins, and vitamin D). Restless Leg Syndrome can be linked to low iron or folate. If you show symptoms of sleep-disordered breathing, getting a referral for a sleep study to rule out sleep apnea is important. If you’re starting to experience anxiety or depression as a result of your poor sleep, it’s important to get screened for insomnia or mood disorders early.
Sleep is so deeply connected to our physical, cognitive and mental health that we need to sleep well to be our best selves so that we can represent our families. Laying the foundation for healthy sleep is key during the prenatal period as it will maximize your potential to get quality sleep during pregnancy and postpartum, reduce your chances of developing a sleep disorder as well as help to get you back on track for future sound sleep when you’re baby is sleeping through the night giving you the chance to do it on your own.
SOURCES
Baattaiah, BA, Alharbi, MD, Babteen, NM et al. The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health. BMC Psychol 11, 10 (2023). https://doi.org/10.1186/s40359-023-01043-3
Ghaedrahmati, Maryam et al. “Risk factors of postpartum depression: A narrative review.” Journal of Education and Health Promotion vol. 6 60. 9 Aug. 2017, doi:10.4103/jehp.jehp_9_16
Hashmi, Ali M et al. “Insomnia during pregnancy: Diagnosis and Rational Intervention.” Pakistan Journal of Medical Sciences vol. 32,4 (2016): 1030-7. doi:10.12669/pjms.324.10421
Pauley, Abigail M et al. “Relationships between prenatal sleep and psychological health: a systematic review.” Journal of Clinical Sleep Medicine: JCSM: official publication of the American Academy of Sleep Medicine vol. 16,4 (2020): 619-630. doi:10.5664/jcsm.8248
University of Warwick. “New parents face 6 years of sleep disruption.” ScienceDaily. ScienceDaily, 25 February 2019. www.sciencedaily.com/releases/2019/02/190225192116.htm
Ask for help
Learn More About Perinatal Mental Health
