Get Some Sleep: Pregnant and tired
April 26th, 2011
01:31 PM ET

Get Some Sleep: Pregnant and tired

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.
Poor sleep is such a common complaint during pregnancy that probably many women and even their doctors think it's is a normal part of pregnancy.
While it is true that pregnancy has a significant impact on the quantity and quality of sleep, it is also true that many of the sleep problems that arise during pregnancy can be treated or ameliorated.

It is common for women to feel extreme sleepiness and fatigue in the first trimester, which is assumed to be secondary to rising progesterone levels because progesterone is known to have a hypnotic affect. Progesterone levels continue to rise throughout pregnancy yet in the second trimester most women report feeling more daytime alertness and they feel that their sleep quality is improved compared with the first trimester.

The third trimester ushers in a host of problems that are mostly connected to the increased girth. During the later months, women often experience shortness of breath and reflux because  their diaphragm is elevated, pressing on the lungs and the stomach. They also have to urinate frequently during the night. That alone is quite a disruption to sleep.

These are normal problems encountered during pregnancy and there is not a lot a doctor can do about it. However, there are other sleep problems that represent the emergence of a bona fide sleep disorder and these can be treated.

For example, research has shown that approximately 10 to 20 percent of pregnant women develop obstructive sleep apnea in pregnancy. The risk increases as the pregnancy progresses. The characteristic symptoms of daytime sleepiness and fatigue are often overlooked both by the patient and her doctor because, as I discussed above, there are a number of reasons why a pregnant woman would have disrupted sleep and would feel sleepy during the day. The hallmark symptom that should be a clue to pregnant women and their doctors is the development of snoring.

There are many factors that increase the likelihood of sleep apnea in pregnant women. It is not all mediated by weight gain, although pre-gestational obesity significantly increases the risk of OSA with one study showing that nearly 40% of obese pregnant patients developed OSA by the third trimester.

The hormonal changes of pregnancy create the perfect set up for OSA. While progesterone increases swelling in the throat tissues, estrogen causes relaxation of the blood vessels, which leads to further swelling. There is even a hormone that is released only during pregnancy that is called relaxin, and, as the name denotes, it causes muscle relaxation.

Untreated sleep apnea during pregnancy has been associated with increased risk of high blood pressure, pre-eclampsia, as well as low birth weight in the infants and low APGAR scores at birth. One interesting study found that fetal movement in women who had OSA was decreased by 50% during non-REM sleep and by 65% while in REM sleep. Fetal movements increased significantly when women’s breathing was normalized with  a continuous positive airway pressure machine, known commonly as CPAP.

There are some studies suggesting that untreated OSA in the mother puts the child at future risk for cardiovascular and metabolic. Much more research needs to be done on the prevalence of OSA in pregnant women and on the health consequences it poses to them and their unborn children.

For now, I urge women with risks factors for gestational OSA to have an overnight sleep test. To summarize, the risk factors include: pregestational obesity, excessive weight gain during the pregnancy, large neck, small throat, snoring, daytime sleepiness or fatigue, high blood pressure, development of pre-eclampsia.

OSA is one of the few medical disorders that if we diagnose it in pregnant women, we actually have treatments that are safe for her and her baby. The two main therapies, CPAP and the oral appliance, are both non-pharmacologic (they're not drugs) and perfectly safe in pregnancy. Because gestational OSA often resolves after the birth of the child, most women would probably not want to spend thousands of dollars on the oral appliance.

The CPAP, which is the gold standard therapy and which should be the first line therapy for anyone who is severe, is probably the best treatment for OSA in pregnancy. The therapy can get started immediately after the sleep test is interpreted and it can be billed through insurance as a rental and the machine can be returned if the woman’s OSA resolves after delivery.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

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Filed under: Pregnancy • Sleep

soundoff (32 Responses)
  1. Katie

    Yes, yes, just get some sleep. Oh wait, what if you have other little kids who keep you up at night? A husband who snores fit to wake the dead? Two jobs? An uncomfortable mattress? Severe reflux? I hate articles like this. It's like telling the jobless to just go to work or the homeless to just find a place to live.

    April 26, 2011 at 14:31 | Report abuse | Reply
    • LEB

      Did you actually read the article, or just the headline? She suggested some perfectly valid solutions to sleep problems during pregnancy, as well as medical advice to seek in case lack of sleep indicates more serious health problems. Some of the information in this article is not exactly common knowledge to pregnant women, so someone will probably find this info helpful.

      April 26, 2011 at 14:58 | Report abuse |
    • Schuyler

      LEB, lay off. The article also says that OSA affects 10-20% of pregnant women. A CPAP is not going to help reflux or frequent restroom trips, or the other sleep disruptions Katie mentioned.

      Katie, your husband might benefit from the CPAP. Best of luck to you.

      April 27, 2011 at 08:42 | Report abuse |
    • Preg in Cincy

      I agree Katie. Since I am pretty sure my insurance company wouldn't pay for sleep testing or the CPAP machine that I might only need for a few months these suggestions aren't very actionable.

      April 27, 2011 at 10:12 | Report abuse |
    • SoundGuy

      Here's a great tip to help you reach a deep sleep, fast: listen to the sounds of nature using comfortable headphones and pay attention to every detail very, very carefully. Sounds of nature are flowing, but at the same time very random, so that you can't anticipate anything. This helps you to keep focused on the sounds, rather than wonder off with some other thoughts (conscious or unconscious), which might me preventing you from relaxing and thus falling asleep. Sites such as TranscendentalTones offer such sounds, which you can easily download to your mp3 player.

      April 27, 2011 at 11:40 | Report abuse |
  2. Rachel

    What "perfectly valid solutions to sleep problems during pregnancy" did she actually suggest? I sure didn't see any...All she talked about was OSA and urged women with risks factors for gestational OSA to have an overnight sleep test.

    April 26, 2011 at 16:36 | Report abuse | Reply
  3. Cindy

    Perhaps Rachel didn't read the "whole" article. Near the bottom Dr. Lisa talked about CPAP machines and dental appliances to STOP the OSA and improve sleep. I use CPAP and it really works.

    April 26, 2011 at 16:57 | Report abuse | Reply
  4. Rachel

    Yes, I read the whole article. The headline was misleading and suggested to the readers at first glance that the article was actually going to offer some practical solutions to pregnant women being tired and getting some sleep without having to undergo overnight testing and the aid of applicances!!! Get real.....

    April 26, 2011 at 17:12 | Report abuse | Reply
  5. Mandee

    Every pregnancy is different, every woman is going to have different sleeping patterns. No one thing is going to work for everyone.....Just sayin

    April 26, 2011 at 17:31 | Report abuse | Reply
    • nina786

      i agreed with Mandy.....not all the things are the same for everyone....^_^


      May 9, 2011 at 20:51 | Report abuse |
  6. Margaret

    I wish I had known....and had a CPAP.

    My sleeplessness during my pregnancy was terrible. My snoring was so loud that when I finally got to sleep I would wake myself up. I got sicker and sicker.

    I had near fatal preeclampsia. (There is no known cure for preeclampsia at this time, other than delivery; there is no knowledge of preeclampsia's cause, either, but I can tell you first hand that it hurts terribly, and that it will kill you, give you a stroke, and can kill the baby, or leave the baby terribly damaged).

    My daughter was delivered via c-section 12 weeks early at 2 pounds, five ounces, because my preeclampsia had progressed so that I was so toxic my organs began to shut down, and I was within thirty seconds of drowning from flash pulmonary edema. My daughter was born blue with an apgar of 6 that with O2 support restored to a 9. I was on a respirator/ventilator for three days after delivery.

    You may not have the basic understanding of perinatal and prenatal medicine to understand just how serious this is, but instead of making snap comments, read carefully and educate yourself.

    Rachel, you may not understand how dangerous preeclampsia is, and maybe you cannot understand from the article that perhaps some of the issues can be resolved with CPAP, but please read the last part of the article carefully. If this data had been known during my pregnancy, a lot of risk to me and my baby and a lot of cost (some $700,000.00 in hospital bills for the two of us) might have been avoided, with the rental of a small machine, and my ordeal would have been so much less painful.

    April 26, 2011 at 17:32 | Report abuse | Reply
  7. Shogan

    You try getting some sleep when your hips are killing you, you have to use the loo every two seconds, you have major charlie horses in your calves and legs, you have to try to remember to sleep the majority on your left side–never on your back. Need I go on? I'm an extremely healthy 9 month pregnant woman, and the ONLY complaint that I have had the past 9 months, is lack of sleep. Men couldn't handle being pregnant for two seconds, they would complain and kick and scream the entire time.

    April 26, 2011 at 17:37 | Report abuse | Reply
  8. Martini

    Dear Dave and Mikey B,

    Thank you so much for telling me that this bloaty emotional rollercoaster of hormones that I endure is only in my head! You two are Geniuses! You should have your own show where you can tell all of us women exactly what we need to do to get right. I guess all those tests I had telling me I have a hormonal disorder were just wrong. My life is now complete now that I have read your posts. Again thank you for everything.

    April 26, 2011 at 17:38 | Report abuse | Reply
  9. Cindy

    What rock did you crawl out from under? Quick, go back under it before the sun comes out and you start to melt.

    April 26, 2011 at 17:39 | Report abuse | Reply
  10. Meg

    Too bad Mikey B and Dave's mom's didn't choose to keep thier legs crossed.

    April 26, 2011 at 17:41 | Report abuse | Reply
  11. Meg

    I really hope if you are in a relationship with a woman that she runs away...quickly. Please do not reproduce with anyone...ever. Loser.

    April 26, 2011 at 17:44 | Report abuse | Reply
  12. Tired Prego Woman

    I hope Dave and Mikey die in their sleep.

    April 26, 2011 at 17:52 | Report abuse | Reply
  13. Nathan

    Good article and posts (except for the two morons trolling around here). My wife had these symptoms (sleeplessness, acid reflux, etc). She is in her third trimester now and we are looking forward to bringing a beautiful new baby into our lives.

    April 26, 2011 at 17:54 | Report abuse | Reply
  14. nina786

    my sis is pregnant ...and she has a 3years old little girl also....she couldn't get a quality of sleeping....not only due to the hormonal problem but the situation at home also ....


    May 9, 2011 at 20:47 | Report abuse | Reply
  15. Owen Lembcke

    The amount of sleep we need, and its pattern, changes with age. Small babies spend most of their time asleep; children need more sleep than adults, and small children need a nap during the day. Sleep patterns change again during adolescence. Most adults need about 7 or 8 hours sleep per night, although some people seem to need less, and some a bit more. Older people often go back to sleeping for shorter periods and have a nap during the day..-;^

    Our very own homepage <http://healthmedicine101.com

    July 4, 2013 at 10:26 | Report abuse | Reply
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    December 3, 2013 at 20:57 | Report abuse | Reply
  17. Leah wawira psychologist

    The main problem why pregnant women complain for their tiredness is because of change in hormones progesterone and relaxin hormens.

    May 21, 2014 at 04:31 | Report abuse | Reply
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