Sleep disturbances are common during pregnancy. As expecting mothers experience hormonal changes, increased anxiety around labor and delivery, and concerns about caring for a newborn, it is easy to understand why this can occur.

Sleep disturbance evaluation should be a part of regular antepartum and postpartum visits. There are several sleep disorders, which may occur during pregnancy. If left untreated, there may be more to worry about than just a miserable patient. There could be complications and harm to the developing fetus.

Snoring is a common occurrence in pregnancy. Elevations in progesterone levels can cause an increase in respiratory rate and shortness of breath. Weight gain can cause snoring in women who did not snore prior to their pregnancy, especially during the second and third trimester. About 15% to 20% of pregnant women will report new onset snoring.

Another sleep problem during pregnancy is restless leg syndrome (RLS), due to the low ferritin levels that some patients experience. RLS may occur only for the duration of the pregnancy or for the rest of patient’s life. If there is a positive family history of RLS, risk for RLS during pregnancy is increased, which suggests that pregnancy facilitates the expression of RLS rather than causing it.

During the second trimester, there is an increased risk for obstructive sleep apnea (OSA). We see this often in our clinic. Most cases resolve after the patient delivers. Often sleep apnea in pregnancy is overlooked, as the symptoms of unrefreshing sleep, insomnia, fatigue, snoring and hypersomnia can also occur during a normal pregnancy. Unfortunately, if OSA is left untreated, there is potential risk to the mother and developing fetus.

Insomnia is a very common during pregnancy. Not only is there anxiety surrounding the birth of the baby, but women also experience nausea, backaches and leg cramps, and frequent urination that can contribute to awakening during the night. Hypnotic sleep aids are contraindicated in pregnant women. Even after delivery, hypnotics may not be the best choice of treatment, as mothers may not be able to awaken or to be able to perform responsibilities in the middle of the night.

Quality of sleep is usually worst during the third trimester mostly due to physical discomfort comfortable. There is more difficulty falling asleep and staying asleep. Leg cramps increase.

Unfortunately, sleep problems may continue even after pregnancy. Nearly 30% of new mothers report disturbed sleep due to hormone changes and caring for the baby. Bed sharing is another reason new moms and dads may not get proper sleep.

Having a new baby is an exciting time in a patient’s life but it also means constant changes for the expecting mother. Be sure to monitor your pregnant patients for sleep disorders during and after their pregnancies.

Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

References

  1. Wolfson AR, Lee KA. “Pregnancy and the Post Partum Period.” Principles and Practice of Sleep Medicine. Fourth Edition. Philadelphia: Elsevier Saunders, 2005. p. 1278-1286.