Pregnancy, Sleep Disorders and Fetus Health

For ideal health, it is necessary to have long hours of sound sleep. We all know the refreshing effects that sleep has on us, yet sometimes in life, we are deprived of this essential daily revitalization. The reasons could be various health problems like, anxiety, hormonal changes, or sleep apnea. Whatever be the reason of the sleep deprivation, it is destructive for many aspects of health, making us feel irritated and fatigued. In some cases, it may be the cause of blood pressure, diabetes, or even more serious cardiac problems.

Pregnancy is normal, but still an extraordinary physiological condition, with special needs owing to various changes in the body. Sleep is the time of rejuvenation and growth. In pregnancy, there is an increased need for sleep. For most adults, normal sleep can be regarded anything between 7-9 hours. But in pregnancy it may be more, a pregnant woman may require frequent naps (1). Though very little is known about the changes in sleep and pregnancy, but still, we know that the sleep pattern does change is almost every pregnant woman. It is caused due to hormonal, physiological and behavioral changes in pregnancy (2). It has been noticed that need for sleep increases in the first trimester, with lesser changes in a second and third trimester.

Risks of sleep disorders in pregnancy

Though this theme has still not been fully understood and studied, it would be logical to conclude that pregnant women carry a greater risk, being a carrier of additional life, and sleep disorders may affect both the mother and the fetal health. That is why the American Academy of Sleep Medicine has classified pregnancy related sleep disorders as a separate entity. Some of the risks of sleep deprivation in pregnancy are (3);

• Less sleep during pregnancy has often been associated with lower fetal weight.
• Recent research indicates that sleep deprivation during pregnancy may result in higher risk of pre-term birth, which means lower birth weight and higher risk for life of a newborn (4).
• There are studies that suggest that sleep disturbances may result in longer duration of labor and increased rate of cesarean section, especially if sleep deprivation is close to term (5).
• Sleep deprivation may result in higher inflammation and perception of pain during labor.
• Though the research is limited, it is quite possible that sleep disturbance may affect the mood after birth, and may be one of the reasons for postpartum depression.

Irrespective of the causes, sleep disturbances may have grievous consequences for the maternal and fetal health.

Reasons for sleep disorders in pregnancy

Before we look into the possible solution to the sleep disorders in pregnancy, let us look more deeply into the possible common causes of change in sleep pattern during pregnancy (6);

• There are lots of hormonal changes going on in a pregnant woman, and each hormone has a different effect on the sleep architecture. Moreover, these changes vary in each trimester. Hormonal changes are known to be highest in the first trimester. Some of the hormones known to influence the sleep pattern in the pregnant women are; human chorionic gonadotrophin (HCG), progesterone, estrogen, prolactin, and oxytocin. Other hormones such as cortisol and growth hormone rise in pregnancy and may also modify sleep pattern.

• There are anatomical and physiological changes in women, there is weight gain, and some of these physiological changes are bound to affect the sleep pattern.

• In pregnancy, gastroesophageal reflux disease is common and starts in the early stage. It is related to the relaxation of the esophageal sphincter, a slow down in gastric emptying, stomach displacement by the enlarged uterus. Moreover, nocturnal gastroesophageal refluxes are common, leading to sleep disturbances.

• Usually, urine excretion decreases at the night time. But in pregnant women due to reduced bladder capacity, there may be more frequent urge for urination both during the day and night.

• Another common symptom related to pregnancy is leg cramps, they tend to occur at night.

• Other reasons of sleep disturbances could be increased fetal movement at night, especially in the third trimester, and night-time uterine contractions due to the peaking of oxytocin at night.

Thus the discomfort and frequent awakening due to the factors mentioned above may result in decreased sleep duration, poor quality of sleep. Finally, having a negative effect on the health of pregnant women and the fetus.

Improving the quality of sleep

Considering the various adverse effect of sleep deprivation, it is necessary to take measures to improve the quality of sleep in the pregnant women. Though it may not be possible to get rid of all the factor that disturb sleeping. Further, the things are complicated by the fact that women cannot take drug therapy for sleep disorders due to the risk of side effects. Thus the best solution for improving the sleep quality is cognitive behavioral therapy (7), it guides people suffering from sleep disturbances in making certain changes in sleep behavior for improving the sleep quality.

Cognitive behavior therapy for sleep has five major components (7);

1. Stimulus control -  it may involve changing few habits before going to bed. Like having meals 2-3 hours before going to bed to avoid esophageal reflux, avoid drinking too much fluid before going to bed, take medications (if any) few hours before going to sleep.
2. Sleep hygiene education - avoid sleeping in the evening, maybe remove the television from the bedroom, the bedroom should be dark enough without too much noise from outside.
3. Relaxation techniques - doing some relaxation exercises in the evening like breathing exercises, or even practicing mindfulness. Using visual imagery to reduce anxiety.
4. Cognitive therapy – It included changing the beliefs and thoughts that disturb a person going to sleep. Or controlling the thoughts that keep a person awake in the bed.
5. Sleep restriction – It is one of the controversial methods in pregnancy, thus one may better consult a specialist before practicing it. This method involves sleeping less in the initial phase. Women suffering from insomnia often lie awake for a long time in the bed, so this method involves going to bed at the real time of falling asleep. And then slowly increasing the time in bed by going earlier.

For most women, these simple measures will work. Research has also shown the effectiveness of various methods delivered through the internet or with the help of other electronic resources. It is always best to control the sleep disorder with the help of behavioral therapy, but few serious cases may need medications. Especially if the cause of the sleep disorder is some more serious mental distress like depression or severe form of anxiety, and there is a grave threat to the maternal health.

References

1. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015 Mar;1(1):40–3.

2. Sahota PK, Jain SS, Dhand R. Sleep disorders in pregnancy. Curr Opin Pulm Med. 2003 Nov;9(6):477–83.

3. Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship? Sleep Med Rev. 2010 Apr;14(2):107–14.

4. Felder JN, Baer RJ, Rand L, Jelliffe-Pawlowski LL, Prather AA. Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth. Obstet Gynecol. 2017;

5. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol. 2004 Dec;191(6):2041–6.

6. Bourjeily G. Sleep disorders in pregnancy. Obstet Med. 2009 Sep;2(3):100–6.

7. Siebern AT, Manber R. New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychol Res Behav Manag. 2011 Feb 25; 4:21–8.