Sleep during pregnancy
Q:: Should I really only sleep on my left side while pregnant – because it’s just so uncomfortable.
A:: You can sleep in any position up until 20 weeks. After 20 weeks, we recommend avoiding sleeping on your back. Sleeping on your back can place the weight of your uterus on your vena cava (the vein that returns blood from your legs and uterus to your heart) causing compression and decreasing pre load to your heart. This can make you feel dizzy, light headed or breathless. So it’s OK to sleep on your right or left side. It’s also OK to sleep on your stomach if you can cushion your abdomen comfortably. If you find yourself waking up on your back, just roll over and go back to sleep without worry. For patients who just can’t get away from back sleeping, I recommend putting a wedge perpendicular to their spine to allow them the sensation of laying on their back, while keeping their hips tilted to avoid compression of the vena cava.
Q:: I’m only in my first trimester but already having problems sleeping. I wake up multiple times a night to go to the bathroom and most of the time, I go right back to sleep but then I’m wide awake from 3 to 5 a.m. every night. I only drink milk and water and eat dinner 3-4 hours before bed – what gives?
A:: Getting a good rest while pregnant can be tough! With a fetus rolling around and kicking your insides, endless heartburn, frequent trips to the bathroom, thoughts about delivery, and feeling just plain uncomfortable, there are a lot of factors preventing you from getting a good night’s rest!
A few tips to help:
We sleep in 90-minute sleep cycles when our level of sleep varies from light sleep to deep sleep. When we connect those 90-minute cycles, we sleep through the night. When your sleep is disrupted, take care of your immediate needs (take a tums, drink water, empty your bladder) and then try to go back to sleep. Recognize that this is just a normal break in your sleep cycle and get settled back in to resume your next REM cycle. Often times we wake up, get frustrated, turn on the lights and then start thinking (making lists of things to do tomorrow, worrying about work, worrying about being tired because you are up thinking, etc). Try to avoid this runaway train of thought. Avoid turning on lights, don’t look at the clock, and don’t look at your phone. Keep the lights dim which will help send the signal to your brain that it’s not yet time to wake up.
It’s also important to try to keep the same sleep schedule (weekdays and weekends) to help prevent fatigue. Naps can be very helpful, but make sure they are not compromising your evening sleep (try not to sleep any later than 3:30 to 4 p.m.). Recognize that sleep while pregnant is not going to be perfect – and you will adjust over time. Your body is growing and changing and so is your sleep cycle. Getting up every few hours now is how your body prepares to take care of a newborn. While most sleep issues in pregnancy are normal, there are a few symptoms that should prompt a discussion with your physician.
Repeated early morning awakenings can be a sign of depression or anxiety. If you feel you are experiencing the signs and symptoms listed below* along with waking very early and inability to fall back asleep, please discuss with your doctor.
- I am not able to laugh or see the funny side of things
- I do not look forward to doing activities I once enjoyed
- I blame myself unnecessarily when things go wrong
- I have felt anxious or worried for no reason
- I have felt scared of panicky for no really good reason
- I feel that things are piling up on me
- I have felt sad and miserable
- I have been so unhappy that I have been crying
- The thought of harming myself has occurred to me
If your partner notices you snoring loudly or gasping for air, you may be suffering from sleep apnea. The increased progesterone levels in pregnancy causes relaxation of the muscles in our mouth and tongue which can lead to obstruction during sleep. This problem can worsen in pregnancy when women gain weight rapidly. Talk to your provider if you have experienced the following**:
- You snore loudly (loud enough to be heard in the next room)
- Do you often feel tired, fatigued, or sleepy during daytime?
- Has anyone watched you stop breathing while asleep?
- Do you have high blood pressure?
- Are you overweight?
Sleep after baby
Q:: How do you combat postpartum insomnia? Even when the baby sleeps, I can’t.
Q:: Is it’s normal to become an insomniac after dealing with a baby who was a bad sleeper? After 10 months of my baby waking up 4 – 10 times a night, she started sleeping through the night and I did not. It’s been 7 months since she started sleeping through the night and I still cannot get a restful sleep or take naps. I have tried Zoloft, Trazodone and melatonin without significant results. I don’t eat sugar at night and do quiet activities before bed. But I am still struggling.
Q:: I find it hard to get to sleep and I wake with any little noise my toddler or baby makes. How can I sleep better?
Q:: Now that my 5 month old is sleeping through the night without waking up until after 9-10 hours to feed, I cannot get back to sleep myself after the feeding to save my life! What are some tips to quickly fall back into sleep cycles after being awake for 20 minutes to feed baby?
Q:: Isn’t it true that although we’d like our sleep to be all consolidated, that sleeping in chunks (thinking waking at night to breastfeed but going right back to sleep because of bedsharing etc) can still be very effective for getting rest?
A:: It’s normal for newborns to wake up every couple of hours to eat. When they eat, they often dirty a diaper, need to be burped, need to be re-swaddled, and put back to bed. And if you are pumping, this exercise takes even longer. 60-90 minutes goes by and then you’re up again – rinse and repeat! Anyone who lives with a newborn knows, no one in the house is getting a whole lot of consolidated sleep. The good news is that this is temporary, and as your baby grows, she will not need to wake every 2-3 hours for sustenance. The following tips can help you and your family get through the early months and beyond:
- If someone is willing to help, let them
Take up the offer for your spouse to take on half the night. It may mean you miss one feeding, but the amount of sleep you get in result may improve your milk supply and your psyche. If you have a friend or family member that will come over to help you, feed your baby, take a hot shower, and go to bed for a few hours. Raising a baby is not the work of one person. Accept help that is offered.
- Spend 10-12 hours in bed to account for all of the interruptions
You might be “in bed” for 8 hours, but if you have a newborn, you aren’t sleeping for more than 4 unconsolidated hours. Make up the difference by sleeping more. This can be a necessity after going back to work.
- Take naps in the morning or early afternoon when the baby sleeps
Taking naps or just lying down and closing your eyes can help give you a burst of energy to get through the day. Don’t worry about the laundry, the dishes, and organizing the linen closet…. It will all be there when you wake up!
- Take warm baths or a shower to relax you before bed or before a nap
Drink hot tea, darken your room, avoid TV, telephone, iPads, etc for 45 minutes before bed. Read a book for pleasure to stop your mind from wandering.
- Be realistic about your sleep needs
It’s safe to say, we all need sleep. How we function with altered sleep can vary from person to person. Be honest with yourself about how much sleep you need to safely do your job, operate a vehicle etc. Your baby needs you to be healthy and rested to take care of her.
- Talk to your pediatrician about sleep
Bring up the conversation if you, your baby or your family is struggling with sleep. Your pediatrician knows your baby and can help guide you toward remedies that are safe for your infant and that will help your family function better. Encouraging good sleep hygiene for your infant isn’t obvious – and having the conversation can make a huge difference.
- Consider hiring a “sleep consultant”
Sleep consultants are a wonderful resource. They typically start by doing a consultation to assess your needs, and then make a plan with you. They then help you implement the plan and help you stay on the right track. When the baby starts to sleep consistently, usually mom and dad do too.
- “Do what works for you and your family”
Today, there are so many “do’s and don’ts” about parenting. And when the information is conflicting, it is confusing and frustrating to new parents who are trying to do everything right. Talk to your pediatrician and your doctor about what might work best for your family. I tell my patients that sometimes you have to employ the “do what works” methodology. Every baby is different, every mom is different, every family is unique. What worked for your neighbor, might not work for you. That’s okay. Provided it is a safe option for you and your baby, make choices that help you be your best. You, your family, and your baby will benefit.
If sleep is your only problem, implementing daily exercise, strict sleep/wake cycles, avoiding stimulants like caffeine, and meditation can help.
Chronic sleep deprivation has been strongly linked to depression and anxiety. Inability to sleep when your baby sleeps, sleeping to much or too little, and inability to fall asleep even when tired are all concerning signs and symptoms. Feeling overwhelmed, hopeless, sad, guilty, numb, experiencing difficulty concentrating, lack of connection with your baby or friends/family, and difficulty eating or eating too much are all signs of postpartum depression and anxiety. If you are experiencing sleep disturbances along with these symptoms, please talk to your obstetric provider. The sooner depression and anxiety are diagnosed and treated, the easier it is to treat, and the sooner you will start to feel better.
Diane Christopher, MD is an OB/GYN at UCHealth’s University OB practice and a Senior Instructor at the University of Colorado School of Medicine. Dr. Christopher is board certified in Obstetrics and Gynecology and earned her bachelor of science in biochemistry from the University of Colorado in Boulder. She went to medical school at the University of Colorado School of Medicine and completed her residency at Northwestern University in Chicago.
Dr. Christopher chose OB/GYN as a specialty because she likes to help women through all periods of their lives, from menarche to menopause. She also enjoys the continuity of care that OB/GYN provides. Diagnosing, treating and then following patients through a specific medical problem is very rewarding for her.
Dr. Christopher says delivering babies and guiding women through pregnancy and all aspects of birth is by far the best part of her job. Women are often scared or nervous in anticipating their delivery and she likes to provide education to help allay those fears.
A true woman’s advocate, Dr. Christopher says she will never recommend a medication, surgery or treatment that she would not also recommend to her own mother, sister or friend.
“I think it’s very important that a patient feels she is being heard by her physician and finds satisfaction with her visit,” says Christopher. “I know I’ve reached a patient when she recommends her mother or sister to me.”
Sources:
* Modified from the Edinburgh Postpartum Depression Criteria:
1 Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786 .
2 Source: K. L. Wisner, B. L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199
** Modified from the STOP-BANG Sleep Apnea Questionnaire
Chung F et al Anesthesiology 2008 and BJA 2012
