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During pregnancy the number of comfortable and safe sleeping positions decreases as your body grows and changes. Sleep disorders expert Meir Kryger, MD, joined us to discuss getting extra Z's for expectant moms, as part of our online sleep conference in partnership with the National Women's Health Resource Center.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Member question: I have always been a back sleeper. Now that I'm pregnant I've been told not to sleep on my back. How dangerous is it to my baby, and how can I condition myself not to roll onto my back when I'm asleep?
Kryger: Initially during pregnancy, it is probably not dangerous, however, later on it can be. There are several reasons for that. As the baby enlarges in the uterus, it does two things. One, is it pushes up on the diaphragm, which makes breathing difficult and can actually interfere with breathing, and the weight pressing straight back can press on the aorta -- which is a major blood vessel -- as well as other vessels as well.
Most women learn to sleep on their side automatically. It's almost impossible for women carrying multiple babies to sleep on her back because of these effects.
Member question: What about lifelong stomach sleepers?
Kryger: Lifelong stomach sleepers have the same problem, and at the end of their pregnancy they will not be able to sleep on their stomachs. They will find it much more comfortable to sleep on their sides. It's usually an automatic thing that happens with pregnancy. Some women have to experiment. Sometimes sleeping with a pillow beneath their legs will help keep you from flipping over.
Member question: Does it matter which side I sleep on in the later months of pregnancy?
Kryger: I think your own body will tell you which is the best side for you. There is no best side, right side or left side, everyone's body is a little different. You may have to experiment. In some women, generally if you're sleeping on the side, the uterus will not press back on anything, so the most important thing is to not lie flat on the back, especially at the end, because the uterus is pressing on a bunch of structures.
Member question: My sister seems to prefer sleeping in a La-Z-Boy in the living room since she hit the third trimester. Is this safe?
Kryger: It certainly is safe, and it's, again, as I mentioned before, the body will find the most comfortable position. Being a little upright, as one would be in a La-Z-Boy chair, would help with breathing because there is less pressure on the diaphragm.
Member question: I am sleeping at least 10 hours a day and I have difficulty keeping to a good sleep schedule. Is there such a thing as too much sleep for the baby and me?
Kryger: I don't think so. Basically, the amount of sleep someone will have with pregnancy will almost always match the amount they need. Women are more fatigued during pregnancy. Now, for example, a poll by the National Sleep Foundation (NSF) found that about 80% have disturbed sleep. In other words, the sleep that a woman is getting may be disturbed, especially toward the end of pregnancy. So they will spend more time in bed while pregnant, but not necessarily sleeping soundly.
One of the things pregnant women have to realize if they have excessive amounts of sleepiness during the daytime, is they may have developed a sleep disorder, and it is now not the pregnancy making them sleepy, but a disorder. The one we worry the most about is sleep apnea, which can develop during pregnancy.
Member question: Can pregnant women take/eat anything that will enable us to fall asleep easier? Sometimes, although I'm extremely tired, I can relax enough to fall asleep.
Kryger: Well, as a general rule, and this is important, women should not take any medications whatsoever to try to fall asleep, including alcohol. The reason being, we don't know if it's safe to use any sleeping pill during pregnancy, and that includes over-the-counter medications. Some people believe that over-the-counter meds or something they obtain in a health food store would be safe. But in general we don't recommend anything to help a pregnant woman sleep.
I think unfortunately, having difficulty sleeping during pregnancy is extremely common, and is something women may have to tough through, especially toward the end of pregnancy. There are some women who may have to stay up an entire night or two. But there is nothing you should be taking to counteract that.
Kryger: Is melatonin safe to take while pregnant?
Member question: No. I don't recommend the use of melatonin in pregnancy. Even though it is produced in people when they sleep, the amounts they may be using when buying over-the-counter, for example, would be much more than what the brain would produce. Because we don't know the effect of melatonin in pregnancy, we cannot recommend it.
Warm skim milk is about as far as I would go. Not regular, because some women may put on too much weight, if they don't normally drink milk at night. Women that may be having problems falling asleep, there are things women should do:
Women should realize that caffeine is not just found in coffee, but in a lot of products, and if you go to the National Sleep Foundation web site www.sleepfoundation.org, there's a caffeine calculator that will allow you to calculate the amount you are having a day. In general, you should have no more than a couple of cups, if that, while pregnant.
Member question: Can you explain what sleep apnea is? My doctor says I may have it and it's related to my pregnancy.
Kryger: The word apnea means stopping breathing. Sleep apnea is a condition where people stop breathing repetitively during the night. The most common cause of sleep apnea is being overweight. Women who put on too much weight during pregnancy can develop sleep apnea during pregnancy. Some women will have sleep apnea even before they become pregnant, and the pregnancy simply makes it worse. Sleep apnea is a potentially dangerous situation, depending on how severe it is, and will usually have to be treated.
Member question: I've been having heartburn the last week or so which makes it hard to sleep. What is safe to take for it, and will I have to deal with this the rest of my pregnancy? I'm only four months along.
Kryger: Probably it will be present for the rest of pregnancy, unless the heartburn is made worse by spicy foods. For example, acidic juices and eating late at night are the main things people need to avoid.
We don't recommend prescription meds that are available for heartburn and ulcers during pregnancy, and those are not recommended. Your family doctor, if it's not treatable by the means I've mentioned, may mention something like Tums. Tums also contains calcium, and is also recommended for this situation. But you should talk to your doctor about that.
Some women find they have temporary relief with milk. The problem with that is if women start to drink too much regular milk to avoid heartburn, you may put on too much weight. If you choose to use milk, try to use skim milk. The other problem with regular milk is that regular milk, the fat, can actually paradoxically increase acid production and make it worse. Originally it may help, but after awhile the symptoms get worse.
Member question: I am six months pregnant. I sleep OK, but what bugs me is how often I have to get up to use the bathroom! I don't want to dehydrate myself, but cutting back on liquid seems like the only way to deal with this. Do you have any other suggestions?
Kryger: I would get up and go to the bathroom and then go right back to sleep. Going to the bathroom is the No. 1 complaint during pregnancy, and it's probably not a good idea to stop drinking water to deal with that. Although it's a pain to have to get up and go the bathroom, most women can fall asleep pretty quickly after. So I wouldn't consider something that I would treat.
Now, women, however, if they go to the bathroom too frequently to urinate, that may indicate they have developed a diabetic syndrome during pregnancy. If it's a problem at night and during the day, it is something you should bring to your doctor's attention.
Member question: I accept that I have to get up to go to the bathroom several times a night during my pregnancy. But I can't fall back to sleep. How do I fall back to sleep?
Kryger: There's no great advice about that, except that most of the time women will fall asleep, and your body is good at making sure you receive enough sleep so that the baby thrives and nourishes. It's a situation where most of the time the body is on biologic autopilot, and the more we interfere with things the more things could go wrong. If you are sleepy enough, you probably will fall asleep. Most women at the end of pregnancy have trouble falling asleep, but most women, a month after pregnancy, won't remember how hard it was.
Moderator: Can you explain restless leg syndrome? Does this affect many women in pregnancy?
Kryger: RLS is basically an irresistible urge to move one's legs, which can be severe at bedtime and can keep you from falling asleep. It affects many pregnant women. One study suggests it affects 15% of pregnant women. Another recent study said that 23% of women who did not have RLS before pregnancy developed it during pregnancy.
Most people think of RLS as a disorder that makes it more difficult to fall asleep. Most of them, even while asleep have twitches in their legs that occur every 20 to 40 seconds and these twitches can actually cause the person to temporarily wake up. Often, the bed partner will notice that the pregnant woman is moving or kicking a great deal while sleeping.
RLS can be caused by folic acid deficiency or iron deficiency, both of which can be a problem in a pregnant woman. The baby uses some of the mother's iron to develop it's own red blood cells, so iron deficiency is very common. Folic acid has been added to most cereals in North America. So folic acid deficiency is unusual, but can still happen in people with unusual diets. It's recommended by the U.S. Public Health Service that women, even when planning to become pregnant, should begin taking folic acid. A folic acid deficiency can lead to a baby being born with malformations in the nervous system.
The bottom line for women is that if they have RLS during pregnancy they should let their doctors know about it.
Member question: I'm four months pregnant. My doctor told me my baby is healthy and nothing wrong with her or him. But I don't know what to do sleep better because I think my baby is not comfortable and always moving when I want to sleep at night. What is the best position to make the baby feel more comfortable so that I can sleep well?
Kryger: You are probably aware of the sensation of the baby moving and that can cause difficulty falling asleep because they are random. There is nothing that anyone can do to keep the baby from moving. And you don't necessarily want the baby to stop moving, that is not a good thing. Most women get used to it and it becomes a normal state, and some will later on notice if the baby stops moving. It just may be something that you have to get used to.
Moderator: How does sleep deprivation hurt the baby?
Kryger: We don't know much about what impacts of sleep deprivation will have on the baby. There's no evidence that indicates that would be a problem. It's a much bigger problem for the mother. The baby receives its nourishment and so forth from the umbilical cord, so it's the mother paying the price for sleep deprivation.
Member question: I get so tired I need an afternoon nap. But that interferes with my nighttime sleep. It has gotten worse throughout my pregnancy. By the time the baby gets here my sleep will be turned around completely. Help!
Kryger: People that are napping should make sure their naps are not long. If someone is napping, the best duration is 15 to 30 minutes. Twenty minutes is a good number. If you sleep an hour or two, you may have trouble falling asleep at night and be stuck in the vicious circle of having trouble falling asleep at night and then taking longer naps. Some people who get so tired during the day use excessive amounts of caffeine. So the best advice that I have is to keep the naps short.
Member question: What is the best way to sleep when your upper back is what is hurting?
Kryger: It depends on what you mean by upper back. Most pregnant women have lower back pain. It's the structures that are changing because of the enlarging baby. Upper back pain may be a little different than the straightforward effects of the uterus.
One thing that happens during pregnancy is the release of hormones that relax certain structures. The structure of the pelvis changes so the baby can be born. In some women, there is relaxation of the joints in the upper back, and that may be what you're talking about. There's not much that can be done for that.
But if you have unusual pain, your doctor needs to know. You may be subject to certain kinds of medical conditions that give pain in the chest, for example. Women who are pregnant are much more likely to develop blood clots in the legs. If this happens and the clot travels to the lungs, that can cause problems, including the development of pain in the chest. So if you have any unusual pain in the chest area while pregnant, especially if associated with shortness of breath, bring it to your doctor's attention immediately.
Member question: I'm taking a pregnancy fitness class. You'd think that working out would make me tired, but it energizes me. The class is in the early evening and I can't get to sleep as early as I'd like on days when I have class -- I'm still too jazzed. I can't change class times. Any suggestions?
Kryger: That kind of problem occurs not only in pregnant women, but everyone. If people exercise vigorously in the evening they will be "jazzed" up. There are chemicals that the body releases, adrenalin type chemicals that do "jazz" you up and makes it difficult to fall asleep. It may be best to try to reschedule things, because you will probably continue having the problem of falling asleep.
Moderator: Do you have any final words on sleep during pregnancy, Dr. Kryger?
Kryger: Women who are pregnant are going to have a tough time during parts of the pregnancy, and it's important to get information. An excellent place for information is the National Sleep Foundation web site, which is www.sleepfoundation.org.
I have authored a book about sleep disorders in women, which will be coming out in the early spring of 2004. It is titled A Woman's Guide To Sleep Disorders, and will be published by McGraw Hill.
WebMD does not provide medical advice, diagnosis or treatment. See additional information.
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