Addressing Sleep Challenges During the Perinatal Period
It’s well established that the potential for sleep disturbances increases during pregnancy – 78% of women report sleep-related issues during this time. The reality is, once your baby arrives, sleep will temporarily be further disrupted as you’ll support the baby’s sleep and well-being during the night to feed, comfort and change them. As healthy sleep can mitigate both adverse prenatal and birth outcomes as well as lower the risk of developing postpartum depression, it’s an area of growing importance.
SLEEP CHALLENGES IN EARLY PREGNANCY
To start with, rising and fluctuating progesterone and estrogen levels can affect sleep in the following ways:
- Increase daytime sleepiness, which may lead to fragmented, poor-quality sleep at night
- Temperature regulation issues may cause hot flashes, sweating, swelling in the feet and legs as well as feelings of dehydration
- Increased urine production, which can mean more night-time bathroom trips
- Respiratory changes, such as nasal congestion or snoring, may put you more at risk of developing obstructive sleep apnea, a breathing-related sleep disorder
A variety of other physical changes and symptoms may also undermine sleep, including nausea and vomiting, back pain, breast tenderness, increased appetite, and anxiety.
SLEEP CHALLENGES IN LATER PREGNANCY
Many feel discomfort due to their growing belly and/or from movement from their baby and may find it hard to settle into a comfortable sleeping position.
Other challenges that affect sleep may include:
- Gastroesophageal reflux disease (GERD) – as your uterus gets bigger, it puts pressure on your stomach and esophagus, making acid reflux and heartburn more common
- Leg cramps and/or Restless Leg Syndrome (RLS) – RLS is a sleep disorder characterized by unpleasant feelings in the legs, such as tingling and aching; symptoms are worse in the evening
- Vivid dreams related to your baby – Frequent awakenings mean people are more likely to remember their dreams. While anxiety-provoking for some, pregnancy dreams have been hypothesized to be one of the ways your unconscious mind processes information and attempts to solve problems.
- Rising oxytocin levels, which cause more fragmented sleep and time spent in lighter sleep stages
As the pregnancy progresses, the risk continues to increase to develop sleep disorders such as RLS, insomnia and breathing-related sleep problems.
POSTNATAL SLEEP CHALLENGES
Studies show that new parents face up to 6 years of sleep deprivation after their children are born – sleep is worst at 3 months postpartum and has a stronger effect on women.
What’s going on and why?
Leftover evolutionary stress effect:
When babies are born, there is a flood of hormonal changes that happen postpartum that are designed to put them in a biologically hypersensitive state to respond to their babies’ needs. When a parent hears their baby cry, it triggers a physiological reaction in their body that is designed to wake them up quickly – they are rocked out of sleep with a racing heart rate, shallow breath, increased body temperature, tightening of the muscles and an activated mind (Which by the way is the exact OPPOSITE physiological state we need to be in to fall asleep!). Unfortunately for some, this constant pattern of waking up makes it hard to get back to sleep, and many find it difficult to exit that hypervigilant state, even once their children are sleeping through the night.
Inconsistent sleep and wake schedules:
Your body and brain like to have a consistent routine (just like your kids!) – with consistency, your sleep and wake times get regulated. Due to a waking baby in the night, long naps during the day, procrastinating your bedtime to catch up on some “me time,” and/or sleeping in, your body gets out of whack, and sleep suffers.
Improperly timed use of light:
Light plays a HUGE role in your sleep-wake cycle. It can affect and alter when you feel sleepy and when you feel alert. Not enough bright light (especially outdoor light) during the day can make you feel sleepy. Too much bright light (especially blue light) at night can trick your body into thinking it’s daytime, suppressing and delaying the release of sleep hormones, including melatonin.
Lack of a wind-down routine:
Sleep does not operate like a light switch. Getting to sleep is a transition. Your brain and body need calming signals to help you transition to sleep, and when you don’t allow yourself time to wind down before bed in an intentional way, it can become difficult to either fall asleep or stay asleep.
THE SLEEP/STRESS CONNECTION
Managing stress levels is key during the perinatal period, especially as there are so many unknowns and potential things to worry about during this time. Sleep and stress have a reciprocal relationship: Quality sleep helps to balance stress hormones, lower anxiety levels and improve mood and mindset, but stress and worry can interrupt sleep. Unaddressed anxiety and/or depression can be especially problematic because it may put you more at risk of developing insomnia and postpartum depression later on.
SLEEP TIPS
When I work with clients, I like first to stabilize the foundation of good sleep, which includes:
Get the right light at the right time:
Upon waking, turn on bright lights and, as soon as possible, get outdoors for 15-30 minutes and remove your sunglasses. Go outside again around lunchtime (or anytime during the day!). As the sun goes down, limit your exposure to bright light (lamps, dimmers or candles are great). Put your blue-light emitting devices away approximately 30-60 minutes before bed.
Keep a consistent sleep and wake schedule:
Wake up and go to bed around the same time each day (weekends, too!). Anchoring your wake time first will have the most significant impact. If you need to rest during the day due to supporting your baby at night, keep naps short, between 20-30 min and earlier during the day (between 12-3 pm).
Create a nightly bedtime routine:
Implement a consistent 30-60-minute wind-down routine that integrates relaxation. Choose enjoyable but not particularly stimulating activities – reading, listening to music, yoga nidra, mindfulness/meditation, praying, guided imagery, deep diaphragmatic breathing exercises, journaling, a bath, etc.
For pregnancy in particular, these tips can be helpful to alleviate sleep issues:
Keep comfortable:
Consider using pillows by placing one between the knees (can be a regular or wedge pillow), under the belly, and/or behind the back to support and relieve any pain or pressure. To alleviate heartburn, avoid lying down immediately after eating or sleeping with the head of your bed elevated.
Keep cool:
Adjust your room temperature between 17-21°C (62 -70° F). Sleep in natural fibers that wick away sweat. Natural cotton and bamboo make great PJs, and for bedding, try out materials like Pima or Supima cotton, percale, Egyptian cotton, bamboo and linen, silk or jersey.
Keep hydrated:
Drink between 2- 4 liters of water during the day. If you’re thirsty or hot at night, consider sucking on an ice cube – this helps keep you cool while limiting your fluid intake, preventing the risk of additional nighttime bathroom tips.
Keep airway passages open:
People with stuffy noses can use nasal strips or a sinus rinse to help open up their nasal passages and improve their nighttime breathing. Sleeping on your side may also reduce snoring and/or sleep apnea events.
Rule out medical conditions:
Sleep disturbances may be caused by vitamin or mineral deficiencies (common culprits are magnesium, iron, potassium, calcium, B vitamins, and vitamin D). Restless Leg Syndrome may be linked to low iron or folate. If you’re showing symptoms of sleep-disordered breathing, getting a referral for a sleep study to rule out sleep apnea is important. If you’re starting to experience anxiety or depression as a result of your poor sleep, it’s essential to get screened for insomnia or a mood disorder early on.
Sleep is so deeply connected to our physical, cognitive and mental health that we need to sleep well to be our best selves so we can show up for our families. Laying the foundation for healthy sleep is key during the prenatal period as it will maximize your potential to get quality sleep during pregnancy and postpartum, minimize your chances of developing a sleep disorder as well as help you get back on track for future stabilized sleep once your baby sleeps through the night giving you have the opportunity to do so yourself.
REFERENCES
Baattaiah, B.A., Alharbi, M.D., Babteen, N.M. et al. The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health. BMC Psychol 11, 10 (2023). https://doi.org/10.1186/s40359-023-01043-3
Ghaedrahmati, Maryam et al. “Postpartum depression risk factors: A narrative review.” Journal of Education and Health Promotion vol. 6 60. 9 Aug. 2017, doi:10.4103/jehp.jehp_9_16
Hashmi, Ali M et al. “Insomnia during pregnancy: Diagnosis and Rational Interventions.” Pakistan Journal of Medical Sciences vol. 32,4 (2016): 1030-7. doi:10.12669/pjms.324.10421
Pauley, Abigail M et al. “Associations between prenatal sleep and psychological health: a systematic review.” Journal of Clinical Sleep Medicine: JCSM: official publication of the American Academy of Sleep Medicine vol. 16,4 (2020): 619-630. doi:10.5664/jcsm.8248
University of Warwick. “New parents face 6 years of disrupted sleep.” ScienceDaily. ScienceDaily, 25 February 2019. www.sciencedaily.com/releases/2019/02/190225192116.htm
About the Author
Talia Shapero
Talia Shapero is a Certified Adult Sleep Coach and Consultant. She is also a sleep educator and trained to deliver Cognitive Behavior Therapy for Insomnia. She has a private practice and also works at Inspired Wellness, HealthOne, and Inkblot Therapy.
Talia helps her clients understand how their sleep patterns, behaviors, lifestyle choices and other conditions may be impacting their sleep and helps them apply evidence-based solutions that are simple, specific, achievable and long-lasting. She offers 1:1 consultations and runs group and corporate sleep workshops.
Learn more at taliashapero.com/
IG/FB: @taliashaperosleep
