80% of women report that the amount and quality of their sleep declines during pregnancy, with similar numbers describing increased daytime fatigue. Getting the right amount of sleep results in easier delivery, fewer complications and, most importantly, healthier babies. Mothers- and fathers-to-be stand to benefit from knowing the causes of poor sleep, as well as what can be done to improve sleep health. It’s also important to know that difficulty sleeping is not abnormal during or after pregnancy.
Sleep and Fertility
While research is still uncovering the specific interactions between sleep health and fertility, it’s generally accepted that healthy sleep is necessary for optimal fertility. It is well understood that shift workers, from medical residents to night-shift factory workers, tend to be significantly less fertile than their non-shift working counterparts. This is likely due to the role of sleep and circadian rhythm in regulating the production and synchronization of hormones, including luteinizing hormone, prolactin, melatonin and progesterone, that are essential to fertility. Women with atypical work schedules are at a higher risk for reproductive difficulties at all stages, from conception to birth. There is solid evidence that sleep disorders contribute to, and occur alongside, fertility problems. The most well-established association is between Obstructive Sleep Apnea (OSA) and Polycystic Ovary Syndrome (PCOS), the most common endocrinopathy in women and one of the leading causes of female infertility. Evidence indicates that OSA drives metabolic abnormalities, inflammation and hypertension that contributes to PCOS. OSA has also been linked to male infertility through different mechanisms.
The best way to overcome sleep-related fertility issues is to focus on sleep quality. Accurate identification and treatment of sleep disorders, maintaining a standard schedule and reducing stress and anxiety all contribute to improved sleep that supports fertility and a healthy pregnancy.
Sleep During Pregnancy
Pregnancy itself generally disrupts sleep. The sheer number and amount of hormonal changes virtually guarantee that sleep will be a challenge at some point during gestation, to say nothing of the stresses related to growing and planning for a new baby. The main hormonal culprit is progesterone, which disrupts regular sleep patterns by making expectant mothers sleepy during the day while contributing to nasal congestion and heartburn. Estrogen can also contribute by facilitating uncomfortable swelling of feet and ankles. In the third trimester, regular nightly increases in oxytocin can cause short contractions. The energy needs of the fetus, especially when organs are initially developing during the first trimester, also induce daytime sleepiness and perturb normal patterns of sleep and wake. As the pregnancy progresses, the uterus presses on the bladder, increasing the frequency of urination at night, and the stomach, causing uncomfortable gastric reflux and round ligament pain during the third trimester of pregnancy. When combined with the nausea, cramps and joint aches that are experienced by the vast majority of pregnant women, as well as fetal movements and sleep position restrictions experienced by all, regular quality sleep can be elusive.
Despite the challenges presented by the common sleep consequences of pregnancy, getting healthy sleep is not impossible. First, it is of the utmost importance that expectant mothers (and fathers) start to value and make time for sleep. Much like eating and drinking water, expecting mothers should be aware that they’re sleeping for two and should expect to spend more time resting. Establishing or reinforcing bedtime routines will also aid in a consistent transition from waking to sleeping. Sleeping on the left side increases blood flow to the fetus as well as the mother’s internal organs. Most importantly, be aware that sleep disruption is normal and avoid succumbing to the vicious cycle of sleep-related anxiety, which itself can prevent sleep.
Clinical sleep disorders may also arise during pregnancy, and are more common in pregnant women. Routine pregnancy-related sleep disruption can progress to clinical insomnia if stress and anxiety aren’t addressed. Often, simplified routines and a focus on meeting the basic biological needs of energy, hydration and sleep can be sufficient to eliminate insomnia. In addition, cognitive behavioral therapy, which includes relaxation therapy and other well known behavioral techniques to quiet the mind and body, can dramatically help with the psychological and physical stresses that result in insomnia. Restless Legs Syndrome (RLS), a feeling of nervous discomfort coupled with an impulse to move around while trying to relax or during sleep, can result from changes in iron metabolism and is noted to develop in 25% of pregnant women. Meeting dietary iron and folate needs, which increase during pregnancy, will often help to resolve RLS, allowing for more restful sleep. OSA can also develop as body weight and the work of breathing increases during pregnancy. Untreated OSA has been linked to an increased risk of pregnancy complications such as gestational diabetes and premature contractions. While the body naturally becomes resistant to insulin in order to more effectively nourish the fetus, this predisposes the mother to developing diabetes if too much weight is gained. It’s important to remember that, while the first trimester requires a significant increase in energy intake, the needs of the fetus in the 2nd and 3rd trimesters are much more modest. If OSA does develop during pregnancy, treatment has been shown to reduce the risk of gestational diabetes and immediately cut down on the fetus’ exposure to inflammation and hypoxia, which are thought to predispose to ADHD.
Bringing Home Baby
Now that the baby’s been delivered the real challenge begins. New mothers need adequate sleep in order to ensure production of prolactin, which is essential for breastfeeding. During the first week or so after bringing baby home, focus on getting as much rest as possible: sleep when the baby sleeps, have dad or family members give bottles during the night feedings or during the day in order to minimize the impact of sleep deprivation during the first few weeks. Experts agree that breast milk is healthier, and less expensive, than formula, so focusing on rest, and facilitating lactation, pays off quickly. While mom’s focus may center on the practical aspects of infant care, this time period is also an opportunity for new dads to take on the mantle of “sleep general”. By taking control of sleep-related distractions and providing support for the new routine around baby’s eating and sleeping needs, dads can improve the sleep of both their partner and their newborn.
Sleep training your baby is another challenge. Newborns generally require between 14 and 17 hours of sleep per day, spread across a number of short daytime naps and only slightly longer nighttime sleep periods. While it’s generally recommended to allow the newborn to determine their own sleep schedule for at least the first 3 months, it can be beneficial to begin defining and introducing a structured sleep schedule as they become infants and require slightly less sleep, between 12 and 15 hours each day. While methods differ, the ultimate goal is to provide the baby, and parents, with a regular sleep routine that results when an infant learns to “self-soothe” into sleep rather than requiring parents to engage the child every time they wake up from sleep. When attempting to sleep train, remember that each baby is different and that the same baby may respond better to different techniques as they develop. Keep at it, listen to the baby, and soon everyone will be sleeping through the night again.
References: Brigham & Women’s Hospital, Georgetown University, NYU School of Medicine, Tel Aviv University, University of Barcelona, University of Chicago, University of Ottawa, University of Pennsylvania, University of Pennsylvania and Vanderbilt University.
Originally published at medium.com