Sleep in Pregnancy: Physical
Pregnancy affects a woman’s body in so many incredible ways. Often, these physiological changes can lead to the development of sleep disturbances, or exacerbates pre-existing sleep conditions. Fatigue and interrupted sleep are amongst the most frequent and persistent complaints reported by pregnant women; more than 80% experience insomnia symptoms, and more than 75% complain of disturbed sleep and an urge to nap during the day, with the highest prevalence of disturbances occurring in the third trimester.
The principles of good sleep during pregnancy encompass all the tricks of ensuring good sleep outside of pregnancy: switch off electronic devices, have some “wind down” time prior to sleep, and make sure the bedroom 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 physical side of sleeplessness and pregnancy.
As your uterus grows, and your breasts become more tender, sleeping on your front becomes uncomfortable. Back and hip discomfort related to the musculoskeletal changes of pregnancy can also result in sleep fragmentation. In addition, regular kicks and wriggles from the baby mean that a restful night’s sleep can prove elusive.
Lying flat on your back after about 16 weeks should be avoided as in that position, the weight of your uterus presses on your spine, back muscles, intestines and major blood vessels, which can decrease blood flow to the uterus. Sleeping on your side is more comfortable and safe, but if you wake up to find yourself on your back, don’t fret! Just turn over onto your side again. Some researchers have suggested that left-sided lying is the best position for your baby, but the reality is that there is very little evidence to show that one side is better than the other.
Try using a few pillows to help you feel comfortable: one between your legs, one under your bump, and one behind your back, for example. If you find it helpful, there are specially designed pillows which provide support for your growing bump and legs, and many of these can also be used to help with breastfeeding after delivery.
Restless legs syndrome (RLS) is characterised by an urge to move the legs because of an unpleasant sensation; the urge is worse during periods of rest or inactivity, and during the evening or at night, and is relieved by movement. RLS is common in pregnancy, with more than a quarter of pregnant women reported to suffer in some studies. Symptoms are usually most severe in the third trimester but for most women, symptoms resolve shortly after delivery.
RLS probably occurs more frequently during pregnancy because there is a threefold to fourfold increase in iron requirements in pregnancy. Iron supply to the growing baby is prioritised, often at the expense of the mother’s stores. Folate deficiency may also play a role, which should increase 8-10 times during pregnancy.
The incidence of RLS is significantly lower in women who use vitamin supplementation throughout pregnancy, and so treating folate and iron deficiencies can result in a significant improvement in the symptoms. It’s worth seeing your GP for a blood test to assess your levels of iron and folate, and improve your diet accordingly. Caffeine and smoking are known triggers for RLS and should be eliminated if possible. Finally, gentle stretching, moderate exercise (but not immediately prior to bed), massage therapy and acupuncture may also be helpful.
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.