Sleep in Pregnancy: Emotional

I may be a sleep expert, but during my first pregnancy, even I found it difficult to get a good night’s sleep. So when it came to expecting my second child, I was determined to do everything in my power to ensure I got a better night’s rest; not least because this time round I had a toddler to deal with, too! Here’s what I learnt:

Pregnancy is a unique, short-lived state that is associated with profound changes in your body that can lead to the development of sleep disturbances, or exacerbates pre-existing sleep conditions. Sleep disturbances and fatigue are amongst the most frequent and persistent complaints reported by pregnant women; more than 80% experience insomnia symptoms at some point during pregnancy, and more than 75% complain of disturbed sleep and an overwhelming need to nap during the day, with the highest prevalence of disturbances occurring in the third trimester.

And despite these fluctuations in sleep patterns, the principles of improving sleep and reducing fatigue during pregnancy encompass all the principles of ensuring good sleep outside of pregnancy. In other words, switch off electronic devices at least an hour before bedtime, have some “wind down” time prior to sleep, and make sure the bedroom environment is comfortable, quiet, dark and cool.

But when it came to those nine months before baby number two, I made some special changes which specifically tackled the emotional side of sleeplessness and pregnancy.

Hormones galore
In the first trimester, high levels of progesterone can cause daytime drowsiness and paradoxically disturb night time sleep. Higher levels of oestrogen decrease the time in restorative rapid eye movement sleep. In the second trimester, as hormone levels rise more slowly, sleep quality and duration usually improves (although not always to pre-pregnancy levels) and daytime energy levels rise. In later pregnancy, oxytocin (the hormone responsible for uterine contractions, which peaks at night) is known to cause sleep fragmentation.

The best way to deal with this hormonal rollercoaster? Get to bed early and take daytime naps if needed.

There is good evidence to suggest that daytime naps reduce fatigue in pregnancy, particularly if sleep duration is normally compromised (by early starts for work, or by disturbed night time sleep). If you have another child, try napping whilst your toddler does. If you’re working, consider your commute prime nap-time, or try having a short nap when you get in from work. Try to keeps to 15-20 minutes long, to optimise the benefit and maintain night time sleep quality.

Stressed to impress
Worries about pregnancy, birth and managing with a young child can all result in interrupted sleep and vivid dreams. If anxieties and worries tend to prevent you from falling asleep, or getting back to sleep once you’ve woken, try keeping a notebook and pencil by the bedside, and write down your concerns before you go to bed or when you awake. Then physically and metaphorically close the notepad until the morning. Your midwife and GP are also well-versed in the anxieties that can come with pregnancy and birth, and it can be helpful to write a list of your concerns before your appointments, to ensure you remember to cover them all.

Acupuncture and relaxation techniques such as yoga and massage may also be helpful in managing anxiety and improving sleep during pregnancy. Finally, if you or your partner are concerned about anxiety or low mood, then you should certainly speak to your GP or midwife; mood and sleep are closely interlinked and untreated depression can worsen sleep, and vice versa. Recognising and treating depression can improve both sleep quality and mood.

Just remember…
Sleep disturbances and daytime fatigue in pregnancy are common, so you’re not alone in wandering the hallway at night or tossing and turning to find the most comfortable position! The key is to find time to relax, take a nap if you need to, eat well, and don’t be afraid to discuss your issues with your GP or midwife.

Author

Dr Alanna Hare

MA (Cantab) MB BS MEd MRCP Consultant Physician & Specialist in Sleep Medicine

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