SLEEP AND PREGNANCY

You’re pregnant, congratulations!  Maybe someone has already told you that sleeping after your baby arrives is going to be tricky.  But you are also not alone if you are already feeling tired and finding it hard to get a good night’s sleep before your baby is born.  Or perhaps you’re finding that the sleep difficulties you were experiencing prior to being pregnant, have intensified.  This is because your body is going through a huge transformation, physiologically, mentally and hormonally, so it’s quite normal that your sleep patterns and sleep quality are changing as well.  

Some sleep issues can last the length of pregnancy, but many sleep challenges depend on the trimester you are in.  Let’s have a look at what’s happening to your sleep in each trimester and the connection between pregnancy and sleep.

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FIRST TRIMESTER

In the first trimester, your body is undergoing enormous hormonal changes so it’s not uncommon to feel exhausted. These hormones are incredibly important for a healthy pregnancy, but unfortunately they have some unwanted side effects on your pregnant sleep and energy levels.

Progesterone production rises rapidly at the beginning of pregnancy, as it is vital in keeping the placenta functioning properly and the uterus lining thick and healthy. It also plays a key role in keeping the muscles in the uterus relaxed so it can expand for your growing baby.  However, progesterone is a soporific hormone, which means it makes you feel sleepy.  So, it’s only natural that increased progesterone equals increased sleepiness! 

Progesterone also increases your body temperature and secretions from your sweat glands, making you feel hot and sweaty, which can disrupt pregnancy sleep. Progesterone’s role as a muscle relaxant is important for your expanding uterus, but it also relaxes other muscles and ligaments in your body, such as your digestion muscles. These usually contract to keep your food and gastric acids in your stomach however, when they relax, the contents of your stomach can move up into your throat and mouth, causing heartburn and reflux.

You’ll produce more estrogen during one pregnancy than you will over the course of your life. Estrogen increases blood flow in the placenta and uterus, which allows the transfer of nutrients to your baby and creates a healthy uterine lining. Estrogen stimulates your baby’s hormone production, which triggers their organs to develop. The rapid rise of estrogen is thought to be the main reason why women can feel so nauseous in the first trimester (morning sickness). The severity and frequency of nausea varies enormously, and while it generally lessens in the second trimester, it can sometimes persist throughout pregnancy.  Persistent nausea at any stage of your pregnancy can make you feel incredibly tired.  

Estrogen also promotes breast growth as your milk ducts develop, which can make them feel tender.  This can make it difficult to find a comfortable pregnancy sleep position, or you may find you wake at night. Finally, estrogen can trigger mucous production, which can affect your sleep by causing nasal congestion when you’re lying down.

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SECOND TRIMESTER

The second trimester may welcome relief if you have had a difficult first few months.  Progesterone and estrogen levels will stabilise and for many women this means more energy and less sleepiness compared to the first trimester. However, towards the end of the second trimester, heartburn, nasal congestion, back, neck and joint pain, Braxton Hicks contractions, leg cramps or restless leg symptoms can start to disrupt sleep. Your baby’s movements may start to wake you as they get bigger too. The second trimester is also when many women experience vivid dreams — and snoring.  

In the second trimester, from around 28 weeks, it becomes more important to try sleeping on your side. This is because the weight of your baby can restrict the flow of blood in the large vein (called the inferior vena cava) that takes blood back from the lower body to the heart.

For your main night’s sleep and any day naps, going to sleep on your side reduces the risk of stillbirth. But it’s important not to worry if you wake up on your back; it’s natural to change sleeping positions when you sleep. Just roll onto your side and try going back to sleep.  It can help to put a pillow behind your back to provide more support and to prevent you from rolling onto your back. Or you could try lying with your legs and knees bent, with a pillow between your knees and a pillow under your stomach.

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THIRD TRIMESTER

Getting good-quality sleep in the third trimester can be tough. Just like the first trimester, your body is going through some huge changes. It has to make room for your baby’s rapid growth, and you will expend a huge amount of energy to keep up with your body’s physical requirements.

Emotionally, the countdown to labour and becoming a new mum can feel quite exciting but sometimes overwhelming, too.  Because of all the changes, your pregnancy sleep can become more restless, and you may be awakened by noises that you would normally sleep through. In the third trimester, almost all women wake up multiple times — three times per night on average — and the awakenings usually last longer. This can leave you exhausted and drowsy during the day, and also affect your memory, concentration and mood.

Nearly half of all pregnant women worry about their sleep in the first and second trimester or experience insomnia. This can increase to three-quarters of women in the third trimester.  Insomnia is regularly having difficulty with sleep, caused by problems falling asleep, staying asleep, waking up too early and/or not feeling refreshed after waking. It is very common to have a busy mind when you hop into bed. Maybe you’re having anxious thoughts about the health of your baby, the birth, your work, or how you might balance work or finances with a new baby. Or you may be feeling excited about meeting your baby, getting baby clothes or thinking of names. Or you might just be thinking about your to-do list.

The impact of pregnancy on your sleep may sound a bit disheartening but knowing what ‘normal’ sleep looks like in pregnancy can also help form realistic expectations about your sleep over the next few months.  And remember that not all women will experience poor pregnancy sleep.  Some challenges will be short-lived, and unfortunately some disruptions may be a bit more stubborn and harder to manage.  There are ideas and strategies which can help (see below) but it’s also really important to talk to your healthcare provider if any of your worries or thoughts are causing you any concern. 

Strategies to help get a better sleep during pregnancy

  • Look for opportunities to sleep. Napping can be a helpful way to increase how much sleep you’re getting now and when your baby arrives. Even a short nap or rest can improve alertness for a few hours and get you through the afternoon and evening.
  • Your body likes routine, so try and keep a consistent bedtime and waketime. Going to bed and waking up at the same time each day sends important signals to your body, allowing sleep to come more readily at night and helping you feel more alert when you wake in the morning.
  • Because light is a strong alerting signal to your body, try to keep your bedroom as dark as possible. Also try to keep the environment as quiet as possible.  This is because pregnant women spend more time in lighter sleep stages and are therefore woken more easily.  Turn your phone notifications off (or use the do not disturb function) or try using pink/white noise apps.
  • Maintaining gentle, regular exercise routines and using relaxation strategies can be an effective way of helping to calm those busy thoughts. There are also a range of mindfulness and relaxation apps available such as Mind the Bump, Smiling Mind, Headspace or Calm that can help.
  • Plan and prioritise your sleep! Just as you might plan and schedule other facets of your life, it’s time to think about your sleep. What works well and what could be better?  It’s a way of signalling to yourself and those around you that sleep in important, so that you and your baby can stay as healthy as possible.

Pregnancy is an amazing life event and one that brings enormous change. Having the same sleep as before you were pregnant can be difficult - some nights will be great, and some nights will be tricky - please know that this is okay.  Be gentle on yourself.  This can be challenging because you might be feeling tired, sore or nauseous, and being pregnant does not mean that work, family, household and social responsibilities can just be put on hold for an extended period of time. But pregnancy is an important time to pay special attention to your needs and prioritise your sleep.

Read more at Sleeping Better in Pregnancy.

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