Why restful nights are important for pregnancy, especially during COVID-19

Pregnancy and Sleep During COVIDA good night’s sleep is important for overall health and wellness. In fact, getting enough sleep plays a more critical role in how our bodies function than many people realize. Achieving quality sleep is often difficult for expectant mothers, and these days the added stress from the pandemic makes it even more challenging.

“Quality of sleep and daytime sleepiness affect both physical and mental health,” says Sandra M. Hurtado, MD, an obstetrician affiliated with Memorial Hermann Health System. “Being sleep deprived can lead to pregnancy complications like hypertension, gestational diabetes and postpartum depression.”

Sleep and pregnancy: a challenging combination

It often starts with hormonal changes. “Increases in estrogen and progesterone levels lead to a decrease in wakefulness,” says Dr. Hurtado. “Higher estrogen levels can also reduce the amount of rapid-eye-movement (REM) sleep, which can lead to sleep disturbances.”

In addition to the challenges associated with elevated hormone levels, the physical reality of carrying a growing fetus often creates back and joint pain, which make it difficult to find a comfortable sleeping position.

Four conditions are common during pregnancy due to hormonal and physical changes:

1. Gastroesophageal reflux (GERD)

Indigestion while lying down is a common problem. As the uterus expands, it constricts the space available for the stomach and intestines. At the same time, increased progesterone causes the digestive system to function more slowly and lowers the esophageal sphincter tone. The combination may lead to increased gastroesophageal reflux, which makes it difficult to stay asleep. Dr. Hurtado says:

  • Try to avoid eating too late at night and avoid heavy evening meals, including fried or fatty foods.
  • Elevating your back while you sleep can help with indigestion. Use a triangular or wedge-shaped pillow to lift your head and upper body to about a 30-degree angle.
  • Ask your healthcare provider about taking antacids. Some over-the-counter antacids help by neutralizing the acid in your stomach, and other antacids work differently by decreasing the amount of acid secreted into the stomach.

2. Nocturia (excessive urination at night)

During pregnancy, the growing uterus puts pressure on the bladder, resulting in a more frequent need to urinate. Also, pregnant women experience increased blood flow and renal perfusion, which ultimately creates additional urine.

Dr. Hurtado says to avoid liquids before bedtime. “Especially avoid caffeinated beverages, and go to the bathroom right before sleep, even if you don’t feel like you need to,” she says.

When you wake up during the night to urinate, try to decrease the stimulation your body receives. “Have a nightlight in the bathroom so you don’t have to turn on lights, and use hand sanitizer instead of spending time to wash your hands. The faster you get back in bed, the more likely you are to fall asleep quickly,” says Dr. Hurtado.

3. Snoring and sleep apnea

“The third trimester is marked by weight gain and fluid retention, and these physical changes increase the incidence of snoring and sleep apnea,” says Dr. Hurtado. Often, you can stop snoring just by changing positions. “Your partner may be able to identify a certain sleeping position you are in when you snore, and repositioning may help open up the airway,” she says.

If you wake during the night and can’t catch your breath, you may be dealing with a more serious condition. “Sleep apnea is more than just snoring. It causes a decrease of oxygenation in your body,” says Dr. Hurtado. “Your healthcare provider may recommend a sleep study and a CPAP [continuous positive airway pressure] machine to ensure you get enough oxygen while sleeping,” she says.

4. Restless leg syndrome

Tingling feelings in your legs, with an urge to get up and move, is a sign of restless leg syndrome. “This can happen because of iron deficiency anemia, which is common during the third trimester,” Dr. Hurtado says. She recommends taking iron supplements if your hemoglobin or ferritin levels are low, which may relieve the problem by correcting the underlying anemia. “Also, there is some good evidence that magnesium supplements, yoga, massage, or leg-compression devices can help.”

What you can do: Ways to wind down

Whether you are pregnant or not, good sleep habits are important for your health. Dr. Hurtado says it is important to take steps to relax before bedtime, and offers these tips:

Discontinue stimulating activity.

Turn off the television and read a book or listen to peaceful music. “There are countless apps for relaxation and breathing exercises,” she says. “Do this for 5-20 minutes prior to sleep to help empty your brain.”

Exercise at the right time.

“It’s true that exercise promotes healthy sleep, but it is best to avoid excessive activity right before bedtime,” says Dr. Hurtado. “Morning or early afternoon is better for exercising.”

Go to bed when you are sleepy.

When you start to feel drowsy, that is the time to go to bed. Remember to turn off lights and electronic devices, including your phone.

After the baby arrives: Navigating postpartum sleep

Once your baby arrives, you may wonder if the days of sleeping soundly are behind you. “Postpartum uninterrupted sleep is very difficult, mostly due to the baby’s sleep pattern and feeding schedule,” Dr. Hurtado says.

The more rested you are, the better able you are to care for your newborn. “If possible, parents should share infant duties and take turns sleeping in a separate room from the baby,” says Dr. Hurtado. “Mom should be responsible for breast feeding, and allow the partner or a relative to help with changing and comforting the baby so mom can get some sleep.”

If sleep deprivation is getting in the way of your health or caring for your baby, it’s time to ask for help. “Poor sleep can contribute to postpartum depression,” says Dr. Hurtado. “If you are feeling sad or anxious, or if you are unable to sleep even when exhausted, you should contact your healthcare provider.”

The information in this article was accurate as of August 3, 2020.