Pregnancy and sleep
Sleep during pregnancy can be influenced by various physiological, hormonal, and psychological factors, leading to changes in
Aetiology
Anatomic and metabolic changes
Pregnancy brings about significant and dynamic physiological changes that can impact sleep and contribute to
Hormones
The secretion of sex hormones like
Sleep disorders
Sleep disorders are frequently experienced during pregnancy, impacting over 50% of all pregnancies.[18] These issues tend to become more prevalent as pregnancy advances. The most commonly observed sleep disorders in pregnant women include insomnia, obstructive sleep apnea, and restless legs syndrome.[18] The American Academy of Sleep Medicine has officially recognized 'pregnancy-associated sleep disorder' as a distinct condition, encompassing both insomnia and increased daytime sleepiness occurring during pregnancy.[19][20]
Parasomnias
Parasomnias represent a notable concern in pregnancy, with somnambulism, nightmares, night terrors, and vivid dreams being frequent occurrences.[9][21] The disrupted sleep experienced during pregnancy, along with sleep disorders like sleep-disordered breathing and movement disorders, can act as substantial triggers for parasomnias, leading to an elevated likelihood of experiencing such episodes during pregnancy.[9]
Insomnia
Pregnancy-related insomnia is quite common.[22] As pregnancy advances, both subjective and objective assessments reveal a notable increase in sleep disruptions.[5][23][24][25] Researchers who have used polysomnography to study sleep in pregnant women have observed distinct patterns. These patterns include more wakefulness after initially falling asleep, reduced rapid eye movement sleep, and a greater amount of time spent in lighter sleep stages compared to non-pregnant women.[5][26][27] Furthermore, as pregnancy progresses, women tend to experience less total sleep time, increased wakefulness after falling asleep, more time in lighter sleep stages, decreased periods of deep and rapid eye movement sleep, and more frequent awakenings compared to earlier stages of pregnancy.[23][28] Additionally, it's common for pregnant persons to express dissatisfaction with the quality of their sleep, with almost half reporting poor subjective sleep experiences.[4]
Restless legs syndrome
Restless legs syndrome is a condition characterized by uncomfortable sensations in the legs and an irresistible urge to move them, particularly during periods of rest or inactivity.
The condition is more common among pregnant women than in the general population.[7] Research studies have reported varying prevalence rates, with estimates ranging from 10% to 34% of pregnant individuals experiencing RLS symptoms at some point during their pregnancy.[29]
Sleep-disordered breathing
Snoring and sleep-disordered breathing are significantly more common in pregnant women, being 2–3 times more prevalent than in nonpregnant females.[30] These changes are associated with alterations in upper airway anatomy and tend to return to nonpregnant levels after childbirth.[30]
Obstructive sleep apnea is a condition where breathing repeatedly stops during sleep due to the collapse of the upper airway, often leading to a decrease in oxygen levels. It is a prevalent health concern among pregnant women and is linked to various pregnancy-related health consequences.[6][31] The condition is more prevalent in pregnant women who are obese.[32][33] Pregnancies where obstructive sleep apnea is a complicating factor face a higher risk of developing conditions like intrauterine growth restriction, pre-eclampsia, and stillbirth.[32]
Management
The management of sleep disorders during pregnancy may require the use of psychopharmacological drugs.
Sleeping positions
The National Health Service (NHS) advises pregnant individuals to sleep on their side, either the left or right, for optimal safety during pregnancy.[36] Research indicates that beyond the 28th week, assuming a supine (back) sleeping position can result in a twofold increase in the risk of stillbirth.[36] This increased risk may be attributed to potential disruptions in fetal blood circulation and oxygen supply.[36] Sleeping on the back can also give rise to various complications, including back pain, respiratory issues, hemorrhoidal problems, low blood pressure, gastrointestinal discomfort, and reduced blood flow to both the maternal heart and the developing fetus.[37] Furthermore, the weight gain associated with pregnancy may heighten the likelihood of developing sleep apnea when sleeping on the back.[37]
Dreams
During pregnancy, a significant period of emotional adjustment occurs, involving thoughts, feelings, and relationships regarding oneself and the unborn child, which often find expression in
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External links
- "Pregnancy: Tiredness and sleep problems". nhs.uk. 2023-05-17. Retrieved 2023-09-03.