Strategies to improve, maintain and sustain ZZZZZs during your pregnancy.

Pregnancy has a profound effect on sleeping. Whatever trimester you’re in, hormones and your changing body can have a dramatic effect on your ability to sleep. Often, preexisting sleep difficulties may worsen. You could say that you are sleeping for two, and although you may not have experienced sleep problems in the past, issues can manifest during pregnancy that can change a woman’s sleep patterns. In fact, in an informal poll of moms, 100% reported at least some changes in their sleep routines or positions, with nearly 80% reporting disturbed sleep, according to a National Sleep Foundation poll.

Why and how does sleep change during pregnancy?

The full effects of pregnancy on sleep cannot be overstated and these changes start early. Pregnancy can create both physical discomfort and psychological changes, with many women reporting feeling the subtle differences in their bodies before they have official confirmation of their pregnancy. Changes in the quality, quantity, and attributes of sleep have been well documented through sleep studies, or polysomnography. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study. In general, sleep patterns degrade and change throughout pregnancy.

During the first trimester, the total sleep time actually increases. Many women take daytime naps. Sleep, however, becomes less efficient with frequent awakenings and a decrease in deep sleep. There is somewhat of a reprieve during the second trimester. Women report they spent more time asleep and experience less awakenings. Then, the last trimester arrives and sleep becomes lighter with increased awakenings.

Normal pregnancies create changes in patterns of sleep. Some of these changes can become problematic. Women with a pre-existing sleep disorder such as sleep apnea or restless leg syndrome may find these problems getting worse.

There are many changes that can become problems during pregnancy and can occur during all three trimesters. Some of these possible problems range from anxiety to excessive daytime sleepiness. Nearly 40% of women report an unusual sleepy state during the day. Physical changes and symptoms such as morning sickness, back pain, breast tenderness, increased appetite, fluid retention, increased urination and anxiety may undermine sleep.

Although some of these issues equalize as the pregnancy progresses, other changes are beginning. During the second trimester, women often experience irregular contractions. The fetus is often active and can be felt. Many women have heartburn and nasal congestion.

Sleep becomes more interrupted, restless, and inefficient during the third trimester. There are plentiful issues that may affect sleep at this time. They include: vivid dreams, joint pain, back pain, anxiety, body position problems, breast tenderness, frequent trips to the bathroom, leg cramps and heartburn.

Hormones and sleep

One early sign of pregnancy and one of the reasons for sleep problems is changing hormones. Experts note that many of your body’s hormones and those of the fertilized egg begin affecting your body in the first week! The hormones being produced come from you and your baby working together, and the mix of hormones adjusts during each trimester.

Hormones are often to blame for the rapid and significant changes that modify many aspects of the body and brain. These alterations include changes in disposition, appearance, and metabolism.

Progesterone is the hormone that helps maintain a pregnancy. It is produced in the placenta, adrenal glands, and in a woman’s eggs. It has a relaxing effect and contributes to increased trips to the bathroom, heartburn and nasal congestion, which may interfere with sleep. It has also been linked to changes in sleep cycles.

Another key hormone is estrogen. Although estrogen is a normal female hormone, production increases exponentially during gestation. It supports the tissue growth through increased blood flow and relaxes smooth muscles. It is partially responsible for the swelling many women experience during pregnancy. Both progesterone and estrogen can decrease the amount of REM sleep.

Many other hormone levels change causing various effects. Research has shown that melatonin levels increase during pregnancy, which is often considered a sleep hormone. Simultaneously, higher levels of oxytocin and later, cortisol help stimulate contractions and may disrupt sleep. Many of the active hormones in a woman’s body during this time are sending mixed messages. Some are increasing activity and anxiety while others are relaxing the mind and body.

How to improve sleep during pregnancy

Sleep profoundly changes during the course of a pregnancy. Physical changes, ailments, and hormones impact the structure of sleep. However, there are things you can do to improve your sleep patterns and quality.

Create a time to wind down. Give yourself time at the end of the day to calm your mind and let go of the day’s worries. Put this wind-down time high on your priority list. The unfinished chores can wait. Create soothing rituals that help quiet your mind and body. This can include a warm cup of caffeine-free tea, a warm bath, or reading a good, calming book. Meditation or a time of quiet music can set the tone for a good night’s sleep.

Learn relaxation techniques such as visualization and meditation. Spend 20 minutes a day breathing slowly and deeply, progressively relaxing all the muscles in your body.

Exercise is another way to promote healthy sleep. Exercising early to allow your body time to return to normal state. Exercise is safe during most pregnancies and it also may ease many pregnancy discomforts and possibly shorten your labor and delivery and recovery time.

Exercise moderately for at least 30 minutes on most days, according to the American College of Obstetricians and Gynecologists. Low-impact exercises such as walking, yoga and swimming are best. Stay cool and drink plenty of water. Dehydration can lead to overheating, which is dangerous for the fetus. Drink before, during and after exercise. It is recommended to drink less water as bedtime approaches to minimized nighttime bathroom trips.

Stretch before and after exercise. Prenatal yoga is a great way to stay flexible and strong. Do Kegel exercises daily to help prevent urinary incontinence. They’re simple: Repeatedly contract and relax your pelvic-floor muscles as though you’re stopping and starting the flow of urine.

Sleep with your head elevated. Heartburn or GERD (gastro-esophageal reflux disease) can be eased by staying upright for a couple of hours after a meal, avoiding certain high acid or spicy foods and using a pillow to sleep with your head elevated.

Take short naps. Experts have mixed ideas about napping. However, short naps earlier in the afternoon may alleviate some of the fatigue most women experience.

Support your body with pillows. Try different sizes and degrees of firmness. A pillow under a knee and another under your belly may provide the stability you need.

Get the necessary nutrition, as this can help you sleep more soundly. Keeping your stomach slightly full with bland snacks throughout the day can help with nausea. Eat a well-balance diet and try not to skip meals.

Sleep issues are likely to occur during pregnancy. As your body changes to support your baby, you may face sleep challenges. Many doctors are recommending Cognitive Behavior Therapy as an effective intervention during pregnancy. Be sure to talk to your doctor along the way or if you suspect that you have developed sleep apnea, insomnia, or restless leg syndrome. There are professionals available to help you improve your sleep.

Being pregnant is a wondrous, exciting and—let’s face it—exhausting adventure. It’s important to take of yourself and your growing baby during this time. With a few proactive steps, you can increase the likelihood that you will fall asleep quickly, sleep deeply, and through the night. Sweet dreams!

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