By Kate RopeUpdated Jun 20, 2018
Photo: Stocksy United
Five months into her pregnancy, Danielle Boudreau’s legs started bothering her at night. “I’d wake up with an urgent need to move them and have to get up, walk around and almost have to kick something to make it stop,” says Boudreau, who lives in Halifax. “That combined with other pregnancy issues like heartburn and having to pee constantly made me a sleepless mess. But my doctor said it was normal and didn’t have any practical advice on how to get rid of it.”
In fact, Boudreau was experiencing restless leg syndrome, which affects as much as a quarter of pregnant women and can safely be treated during pregnancy. But few mothers-to-be seek help for their sleep problems. “I get the sense that a lot of obstetricians perceive sleep deprivation in pregnancy as normal,” says Leslie Swanson, a sleep specialist at the University of Michigan. “So we tend to minimize the effects of sleep disruption or insomnia during the prenatal period.” But we should be doing more, says Swanson.
More than half of pregnant women experience insomnia, because pregnancy creates “the perfect storm for it,” says Swanson. Start with the fact that being female is a major risk factor for insomnia. (One study published in the journal Sleep found that 12.8 percent of women experienced insomnia compared to 9.7 percent of men.) Add in a significant life change, which increases your risk (hello, pregnancy!) and hormones that wreak havoc with circadian rhythms (the biological clock that tells you when to go to sleep and wake up). Sprinkle in the physical discomfort of pregnancy, and getting a good night’s sleep can feel like an unreachable aspiration.
As many as one in four pregnant women develop restless leg syndrome (RLS) like Boudreau. Uncomfortable sensations (some describe them as feeling like pins and needles or being touched) in the arms, legs or both can hit in the middle of the night and produce the urge to move your limbs to relieve it. One of the most effective treatments for RLS is iron, which can be safely supplemented in pregnancy under the care of an expert, says Katherine M. Sharkey, an associate professor of medicine at Brown University. “Prescription medications may also be warranted in certain situations.”
Sleep-disordered breathing, such as snoring and obstructive sleep apnea, is also common in pregnancy because of weight gain, throat swelling and pressure on the diaphragm from the uterus. Snoring is usually treated as an annoyance, but it’s actually a symptom of a medical problem that should be evaluated by a medical professional, says Sharkey. These conditions can be treated safely during pregnancy with a continuous positive airway pressure, or CPAP, machine, in which a mask worn over your nose and mouth blows air to keep your throat open.
In bed Keep your bedroom cool and dark. Prepare your body and mind for sleep by reading something relaxing or practising calming techniques, such as breathing exercises or meditating. Have a notebook by your bed to off-load your mental to-do list and try aromatherapy essential oils like lavender. Support your growing belly with extra cushioning or a pregnancy pillow. If you have heartburn, elevate the head of your mattress or bed frame.
Before bed Avoid caffeine from the afternoon onward and liquids close to bedtime (so your bladder won’t wake you). Go to bed and wake at the same time each day to strengthen your circadian rhythms, and don’t watch TV or use computers or phones—which emit a blue light that disrupts the production of melatonin, a hormone that helps regulate sleep cycles—an hour before bed.
What if I still can’t sleep? Doctors diagnose chronic insomnia when someone experiences one of three things—trouble falling asleep or staying asleep, or waking too early—for three or more nights a week for at least three months. But pregnant women don’t have time to wait for a diagnosis. “If a pregnant woman considers it a problem, we want to address it,” says Swanson.
The medications used to treat sleep disorders, such as zolpidem (under the brand name Ambien), have not been well-studied in pregnancy, so some obstetricians will opt for over-the-counter antihistamines such as Benadryl, which have been widely used during pregnancy. But the most effective treatment for insomnia—cognitive behavioural therapy—involves no medication. A sleep specialist works with you to pinpoint what in your habits or home could be changed to solve your sleep problems.
Boudreau is getting much better sleep since giving birth. The irony of that does not escape her. If, like Boudreau, your obstetric provider has no answers for you, Swanson recommends consulting your primary care physician or contacting a specialist directly through the Canadian Sleep Society. “It is crucial that you get your sleep problems addressed,” advises Swanson.
Preparing for better sleep in parenthood Of course, sleep becomes even more important after your bundle of joy arrives, which is why Kathryn Lee, a registered nurse and professor emerita at the University of California at San Francisco School of Nursing, has devoted her career to helping expectant and new moms get some Zzzs. In one of her studies, she created some of the conditions moms would experience in the newborn period so that women could practice during pregnancy.
Using only first-time moms, Lee randomly gave half of them a bedside bassinet, a nightlight, and a sound machine. She instructed them to put the nightlight and sound machine on a power strip under the crib to allow a little light, so moms would be able to feed and diaper her baby safely during night wakings. The sound machine was to help mask the little noises babies make—gurgling, heavy breathing—but wouldn’t mask the louder cries of hunger or distress. Members of the control group in the study were given educational information about good sleep habits and the effects of alcohol and caffeine on sleep.
She found that the dry run to prepare for infant care during the night were effective in getting more sleep in the newborn period. At one month and three months after birth, the moms who practiced for the newborn period were getting thirty minutes more sleep a night.
Kate Rope is the author of Strong as a Mother: How to Stay Healthy, Happy, and (Most Importantly) Sane from Pregnancy to Parenthood.