Every expectant mom knows that sleep will be catch-as-catch-can after their baby is born. But sleepless nights plague women throughout pregnancy, too.
A National Sleep Foundation poll found that over three-quarters of women slept worse during pregnancy than they did when they weren't pregnant. What's more, new moms and pregnant women were more likely to suffer insomnia than any other group of women.
The reason: Pregnancy is uncomfortable. The discomforts that come with having a baby growing inside you don't go away when you turn out the light.
If you're accustomed to sleeping on your stomach or on your back, you must adjust to sleeping on your side. It will be physically impossible to lie on your stomach when you are heavy with child, and doctors warn against sprawling flat on your back. "There's some concern about that in the latter part of pregnancy," says Richard Henderson, MD, an obstetrician/gynecologist at St. Francis Hospital in Wilmington, Del. When you lie on your back, the weight of the pregnant uterus slows the return of blood to your heart, which reduces blood flow to the fetus. That means the baby is getting less oxygen and fewer nutrients.
Henderson says occasionally lying supine will not harm a developing fetus, but sleeping that way every night might. Nevertheless, you'll probably find that it's easier to sleep on your side as your tummy grows and grows.
Conventional wisdom holds that it's better to sleep on your left side than on your right. "For many, many years, the left side has been the preferred side," says Anne Santa-Donato, RN, spokeswoman for the Association of Women's Health, Obstetric, and Neonatal Nurses. "It became a habit" to tell women that. But she says it really does not matter which side you sleep on: "It's what the science has borne out over the years."
Placing a pillow between your legs or sleeping with a body-length pillow can make you more comfortable. Some women may prefer to give up the bed entirely, and instead sleep in a reclining chair. "That's perfectly acceptable," Santa-Donato says.
A bulging tummy isn't the only thing that gets in the way of a good night's sleep. Heartburn is a common problem during pregnancy. Henderson says hormonal changes relax the muscle between the esophagus and the stomach, allowing stomach acid to burble up, causing acid reflux or heartburn. "Treat it as it occurs," he says. Take an over-the-counter antacid, and prop up your head with pillows to keep the stomach acid down.
"In some instances, heartburn is simply heartburn," Santa-Donato says. But it can also be a sign of other, more serious health problems, so you should mention it at your next checkup.
The need to urinate frequently -- because the uterus presses on the bladder -- may also keep you up during the night. This may be less of a problem if you simply limit what you drink before bed.
Some women say their dreams become more vivid and intense when they are pregnant, which further disturbs sleep. Carolyn D'Ambrosio, MD, director of the Center for Sleep Medicine at Boston's Tufts University, says she has heard of this, but she doesn't know of any scientific studies that have shown why, or how common it is. "I'm not sure that's absolutely established," she says.
The most serious sleep disorder a pregnant woman can develop is sleep apnea. In sleep apnea, the airway closes and breathing stops many times during the night. The ensuing lack of oxygen can be harmful to the developing fetus. It also causes sudden awakenings, which makes for fitful, restless sleep and fatigue the next day. What's more, D'Ambrosio says there is some evidence that sleep apnea is linked to another condition called preeclampsia, in which a pregnant woman has abnormally high blood pressure, swelling, and protein in their urine. Preeclampsia can lead to low birth weight, premature delivery, and in some cases, death.
Loud snoring is a symptom of sleep apnea. Women who didn't snore before becoming pregnant and who have trouble breathing at night may have the condition. "They should get that evaluated," D'Ambrosio says. Those who suffer from sleep apnea usually don't notice the symptoms. It's their bedmates -- awakened by their ripping snores and gasping for air -- who bring the problem to their attention.
Pregnant women commonly suffer nasal congestion that can also make it difficult to sleep. During pregnancy, the body releases hormones that can sometimes dry out the lining in the nose, making it feel inflamed and swollen. Fortunately, there are some natural remedies than can help:
- Try wearing nasal strips to widen your nasal passages at night. Studies show these strips can make it easier to breathe when congested.
- Apply a warm, wet washcloth to your cheeks, eyes, and nose to reduce congestion.
- Don't use over-the-counter nasal decongestants; they can aggravate your symptoms.
- Drink plenty of fluids (at least six to eight glasses of fluids a day) to thin mucus.
- Elevate your head with an extra pillow while sleeping to prevent mucus from blocking your throat.
- Use a humidifier or vaporizer to add moisture to the air.
Restless legs syndrome is another sleep problem that may be brought on by pregnancy. People with this problem describe having an unpleasant "creepy crawly" sensation in their legs that only goes away when they move them. It's worst when the sufferer is relaxed, so it disturbs sleep. Lauren Broch, PhD, a sleep specialist at New York Presbyterian Hospital, says restless legs syndrome during pregnancy may be related to iron deficiency, but that's not known for sure. "I don't think we understand it yet," she says.
Taking folate supplements may help restless legs syndrome, Broch says. Doctors urge all women to take folate during pregnancy to prevent birth defects, too.
Prescription sleep aids are out of the question for pregnant women, unfortunately. Over-the-counter sleep aids like Sominex and Nytol, and the allergy remedy Benadryl (all of which contain the same active ingredient, diphenhydramine) may be safe in the later stages of pregnancy but Broch says she does not generally recommend them. Diphenhydramine stays in the body for about 12 hours, which can make you feel drowsy and sedated all morning if you take it late at night. And like all medications (including vitamins and herbal supplements), these over-the-counter drugs should be approved by your doctor before taking.
Exercise is a good substitute for sedatives. Exercise during the day -- not right before you go to bed -- and you will sleep better for it.
Originally published Sept. 2, 2002.
Medically updated February 2005.