Sleep Disorders in Pregnancy and the Postpartum Period
Pregnancy is associated with a host of physical and emotional
changes. Physical changes include morning sickness, body
aches including back pain, heartburn and of course foetal
movement. Emotional changes include a huge range including
anxiety, fear and depression. Emotions can swing wildly.
According to a National Sleep Foundation poll as well as
other research, 78% of women experience more disruption
of sleep than they normally experience. These changes vary
with the stage of pregnancy:
In the first trimester there are high levels of progesterone.
This may be associated with increased sleepiness. Some of
the physical changes may also disrupt night time sleep,
leading to further increases in daytime sleepiness.
The second trimester usually has less severe disruption
of sleep than earlier or later stages, but still not normal
The third trimester is associated with the most significant
changes in sleep. The physical changes of pregnancy are
their greatest and include general discomfort, increased
nocturnal urination, heartburn, back pain and nasal congestion.
Studies have suggested that virtually all women have some
disruption of their sleep in the third trimester.
In addition to the disruption of sleep that is a consequence
of the physical and hormonal changes, certain specific sleep
problems may also occur in pregnancy.
Because of the increased weight and the swelling of tissues
that occurs in pregnancy, many women have the onset of snoring
for the first time in pregnancy. If the airway obstruction
is significant enough and in particular if there is a predisposition
due to genetic factors, obstructive sleep apnoea may also
occur. This condition is not only characterized by loud
snoring but by obstruction of airflow which in turn leads
to significant interruptions of sleep and drops in oxygen
level. The interrupted sleep can lead to marked daytime
sleepiness. If daytime sleepiness does occur and is more
severe than might be reasonably expected from hormonal changes
alone, the diagnosis of sleep apnoea should be considered.
In the third trimester as many as 15% of woman may also
experience a sensation of discomfort, often described as
a "creepy crawly" sensation in the legs which
leads to a need to move, kick or even get out of bed and
walk. This condition also occurs commonly in non-pregnant
men and women but there seems to be an increase due to pregnancy.
The consequence can range from being slightly annoying to
severely disruptive of sleep.