A ReLACSing Blog #9: On Mother's Day, 4 Essentials of Sleep Health for Pregnant Women
A Happy Mother’s Day to all the mothers out there reading this, including those about to become mothers, and of course, all readers, as all of you have mothers! Today seemed fitting to discuss women’s sleep health during pregnancy, which has its own unique features. Here are 4 essentials to remember for pregnancy:
Avoid sleeping on your back. This may be true for many other conditions aside from pregnancy (not really a condition but more a different physiological “situation”). Many have experienced gastro-esophageal reflux disease (GERD) and find that sleeping on the left side or with the head slightly inclined is helpful for symptoms of GERD and heartburn. Others have positional obstructive sleep apnea (OSA) in which snoring, gasping, choking, and pausing of breathing occurs either exclusively or at least much more often on the back than on either side of the body (more on OSA below). However, it is universally accepted that women should sleep in the lateral position during pregnancy particularly in late second through third trimester. It is thought that sleeping on your back can cut off some of the blood flow from the major blood vessels traveling in the back of the belly called the vena cava and abdominal aorta and can significantly increase risk of a stillbirth of the baby. It is also possible that this position may reduce the baby’s movement and affect the baby’s heart rate. Pregnant mothers should keep an eye on body position along with their spouses. If you find yourself unable to keep off your back, you could consider a device to help with preventing back-sleep. Some are just big pillows for pregnancy like this and this. Others are positional therapy devices that can be used for the above variety of conditions as well, for example this and this. Even more sophisticated are electronic devices that track sleeping position and send a stimulus like a vibration that can get you to turn off your back like this.
Watch out for obstructive sleep apnea. Speaking of obstructive sleep apnea, if you have been diagnosed with OSA or have the risk factors for this condition, it should be identified and treated before or even during pregnancy, if it emerges. Recent studies have shown a strong linkage of OSA with risks to the pregnancy and health of the baby including preeclampsia, gestational diabetes, and early-term birth. Risk factors may include obesity (body mass index > 30 kg/m2) prior to pregnancy and loud snoring. Pregnancy may worsen OSA due to a variety of factors not limited to an increase in body mass, pressure of the placenta on the chest and breathing, and swelling of the passageways of the nose and throat that further reduces airflow. If you have been diagnosed with preeclampsia in your current pregnancy or in past pregnancies, talk to your husband or bed partner about whether there are observations of snoring, choking, gasping for air, or other body movements suggestive of difficulty breathing. If present, then see your doctor about whether a sleep apnea test may be needed. The condition can worsen quickly over the third trimester so diagnosis should be made expeditiously and treatment with modalities including CPAP should be instituted quickly, as pregnancies last, what, 40-42 weeks at the most these days?
Use iron to control those restless legs. Restless legs syndrome (RLS) can occur in up to 20% of pregnant women. In large part, the uptick in RLS during pregnancy is due to fluctuations in iron levels, as this neurological condition is fundamentally due to low iron levels in the brain. Think of it as the baby is stealing your iron to grow. If the urge to move your legs, typically occurring at night or near bedtime, is bothering you and affecting your sleep, get your iron levels checked. For typical RLS, iron supplementation is usually recommended if ferritin < 75 ng/mL or iron saturation (iron/TIBC or total iron binding capacity) is < 20%. Many pregnant women have iron levels much lower than these levels, so if it leads to RLS, iron supplementation may be beneficial. For those with more severe RLS, IV iron infusion is a safe and highly effective procedure to boost iron levels rapidly and can provide significant relief of RLS during pregnancy. Though medication options exist, iron is getting at the root cause of the condition and is much safer than even short term exposure of the baby to more medications than needed.
Though pregnancy can be disruptive to sleep, try to keep a consistent sleep schedule. Whether it is nausea, hormonal fluctuations, back pain from carrying around the weight of the placenta all day, or even the baby staying up all night, kicking your liver and kidneys, pregnancy can cause significant disruption to sleep. Pregnant women may need slightly more sleep for a variety of reasons including to catch up from the added disruption to sleep on previous nights. Despite these challenges, it will be best for you to maintain a consistent sleep schedule, as detailed in blog #7, particularly a consistent wake up time. You don’t want to add circadian rhythm disruption on top of all the disrupters above. If you have a poor night of sleep, consider taking a brief midday nap of no more than 20-25 minutes with an alarm to recharge your brain without disrupting sleep for the next night. In hopefully rare cases in which you have a really poor night, such as only 4 hours of sleep, it may be reasonable to take a 90 minute nap and go through one sleep cycle during the day. Try not to get into a habit of these long naps as they can affect your sleep at night and disrupt sleep on future nights. You can also consider going to bed a little earlier the next night, but maintaining the same wake up time in lieu of the naps, if you can make it through the day safely without one.
There, some general education on sleep for those of you soon-to-be or future mothers for your pregnancy. Again, on this Mother’s Day, we thank our mothers for choosing life and if no longer with us or around us, we reflect with gratitude on all that mothers have sacrificed to provide for the lives we have now.
-Andy Berkowski, MD, a neurologist only a mother could love
ReLACS Health
