Recognizing sleep disorders in pregnancy

Image of Professor Colin Espie
by Professor Colin Espie

Breathing-related sleep disorders, restless legs syndrome, and insomnia become more common during pregnancy. The good news is that they are all treatable, and symptoms usually disappear when your body gets back to normal postpartum (at least until the new arrival causes a new wave of sleep deprivation challenges!)

If you suspect that you're suffering from any of these sleep disorders, ask your doctor for advice.

It's common to feel unusually sleepy during the day when you're pregnant, but if you or your partner also notice that you have started snoring noisily, or that you are pausing or gasping during your sleep, you may have developed a breathing-related sleep disorder. These include snoring, upper airway resistance syndrome (requiring greater than normal effort to breathe), and obstructive sleep apnea (OSA). In OSA, the walls of the throat narrow during sleep and temporarily obstruct normal breathing repeatedly through the night.

Estimates vary, but as many as 1 in 3 women start snoring in pregnancy, and 1 in 10 may develop symptoms of OSA. Causes include weight gain, the changed position of the diaphragm and fluid accumulation in the breathing passages due to hormonal changes.

Research shows that women with breathing related sleep disorders are more likely to suffer from preeclampsia (high blood pressure) and gestational diabetes, but the relationship may not be a causal one.

Restless legs syndrome

Restless legs syndrome (RLS) is defined by a strong urge to move the legs while at rest, accompanied by unpleasant feelings. Some people describe the sensation in their legs as itchy, creepy, crawly, jittery or burning. The need to move your legs gets worse at night and is only relieved by movement. Many people also experience jerky movements of the legs, called periodic limb movements.

Up to 30% of pregnant women experience symptoms of RLS, especially in the third trimester. Most experts agree that women with iron or folate deficiency are at greater risk. RLS makes getting to sleep more difficult and has been linked to depression. Symptoms in pregnancy usually disappear after delivery.

Insomnia disorder

Difficulty getting to sleep, staying asleep, waking too early and non-restful sleep are all symptoms of insomnia. In medical terms, insomnia disorder is defined as chronic sleep problems which interfere with normal daytime functioning, despite adequate opportunity for sleep.

In pregnancy, aches and pains, leg cramps, hormonal changes and emotional stress can all increase the risk of developing insomnia. The short term consequences include fatigue, feeling low and irritable, memory and concentration problems, and strained relationships.

There is some evidence that sleep deprivation in the third trimester is associated with a longer labor and higher perceptions of pain during labor, so it's important that you seek medical help if you're suffering with insomnia.

Treatment can involve both drug and non-drug therapies, but many sleeping pills are not recommended during pregnancy. Research shows that the most effective long-term solution for insomnia is Cognitive Behavioral Therapy, or CBT. This 'talking therapy' approach targets the behaviors and thoughts that interfere with good sleep.

Is Sleepio suitable for pregnant mothers with insomnia?

The Sleepio course is based on proven CBT techniques, and includes information about the lifestyle habits and environmental factors that influence sleep, cognitive techniques to tackle the racing mind, relaxation techniques and a daily sleep diary. These aspects of the course could be helpful, whether or not you're pregnant.

However, some aspects of the Sleepio program are less relevant in pregnancy. In session 3, a technique called 'sleep restriction therapy' is introduced, in which adults who spend a long time unable to sleep at night are advised to reduce the overall window of time they allow for sleeping, and to avoid napping during the day. This is because sleep restriction increases your biological need for sleep.

Mothers-to-be already have a strong sleep 'need' – they simply need more sleep – so deliberate sleep restriction is not recommended during pregnancy. If you are pregnant, Sleepio contains some useful audio techniques to help with relaxation and the racing mind, and lifestyle advice, but please consult a doctor before implementing changes to your sleep routine.

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