Pregnancy Insomnia: Why Does it Happen, and How can It be Treated?
Insomnia during pregnancy is common but can be managed – experts share their tips.
Since you found out you are pregnant, the excitement may keep you up longer than usual at night, but how do you know when lack of sleep becomes a problem, and more importantly, what can you do about it?
Dr Ayanda Mini, an obstetrician-gynaecologist based in Pretoria, describes insomnia as a common sleep disorder that makes it hard to fall asleep, stay asleep, or get enough quality sleep. She adds that it can affect your mood, energy, health, relationships, and performance, and it often causes tiredness and fatigue the following day.
What could cause pregnancy insomnia?
Generally, says Dr Mini, insomnia can be due to medical conditions, such as major depressive disorder (or other mood disorders), obstructive sleep apnoea and restless leg syndrome (a strong, almost irresistable, urge to move one's legs, particularly at night). But, for pregnant women, she says, it is most likely due to night-time heartburn and gastro-esophageal reflux disease, back pain, and frequent night-time urination.
Dr Mokgohloe Phasha, an obstetrician-gynaecologist practising at Netcare Park Lane Hospital in Johannesburg, adds: "Babies in utero do not follow the same sleep-wake patterns as their mother. While it may be night-time for mom, it may very well be play time in utero. Vigorous foetal movements during this time may disturb sleep," says Dr Phasha.
How common is pregnancy insomnia?
"A majority of women experience insomnia during pregnancy with rates as high as 80%. A diagnosis is usually made by clinical history, where the pregnant woman reports a difficulty in falling asleep, staying asleep, or getting a good quality sleep," explains Dr Mini.
Is pregnancy insomnia more likely in certain trimesters?
Like many other pregnancy symptoms, problems with sleep seem to ease up in the second trimester with most of its effects generally seen in the first and third trimesters.
"Changes in sleep patterns usually start during the first trimester of pregnancy. These changes are most likely influenced by the rapid changes in reproductive hormone levels - in the first trimester of pregnancy, there is a rapid rise in progesterone levels," says Dr Mini, adding: "This rise in progesterone has been observed to have sedating effects and reduces wakefulness. That is why in the first trimester women usually need to sleep more than usual."
Dr Phasha agrees, and adds that studies have found that more women report insomnia in the third trimester than any other. This can be explained by a surge in progesterone and an enlarged uterus making it difficult to sleep on either side.
It is at this advanced stage that the safest sleeping position is not necessarily the most comfortable. "We discourage the pregnant women from sleeping on their back or belly which previously would have been the most comfortable positions to sleep in before pregnancy," adds Dr Phasha.
Added to this, the symptoms experienced in the last stretch of pregnancy also play a part. "Sleep disturbances are often due to general discomfort caused by backache, frequently waking up to urinate, the movements and kicks of the baby, heartburn, leg discomfort and anxiety about labour and delivery," Dr Phasha explains.
How can pregnant women improve their sleep?
Before you accept that your sleep will be disrupted every night, know that there are ways to manage insomnia.
Some of these include creating a comfortable bedroom with dim nightlights, avoiding the use of electronic devices in bed, and avoiding stimulants like caffeine close to bedtime. In addition to these general rules of good sleep, Dr Mini shares these tips:
1. Be mindful of your diet. Avoid spicy, heavy, and fried foods to decrease heartburn. Drink plenty of fluids in daytime but limit their intake after 5pm to decrease night-time urination.
2. Stay active. If your doctor has given you the go-ahead, exercise for 30 minutes every day, preferably 4 to 6 hours prior to bedtime.
3. Consider nap times. Try to take daytime naps in the earlier part of the day.
4. Do not force it. If you are unable to sleep, take a warm bath and do something non-stimulating such as reading a book.
When should you seek medical help for pregnancy insomnia?
Before you take any medication to help you sleep, you need to consult your doctor, advises Dr Mini. This is to ensure that the medication will not harm your baby.
"f you experience the symptoms of restless legs syndrome, have your physician evaluate you for folic acid or iron deficiency," she says. Although snoring is common during pregnancy, Dr Mini shares this advice: "Consult your doctor if there are pauses in your breathing between snoring episodes, as this might indicate possible obstructive sleep apnoea."
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