Sleep is extremely important to the human body at any age, and there is growing body of evidence showing that a lack of sleep can have long lasting and damaging effects on our health and well-being.
In the first part of this review, we’ve taken a look at the science behind how a lack of sleep during pregnancy can affect you, and ways to promote better sleep habits. In the second part of this review, we will be looking at the science behind how a lack of sleep can affect new parents and ways to improve it, and in the third and final part we will take a look at what research says about sleep and babies, and the ways in which we can promote healthy sleep for our little ones.
What is sleep?
Sleep is a natural state of being where eyes close, muscles relax and sensory activity is inhibited, taking us off to dreamland.
Sleep can be split into two types:
- REM (rapid eye movement): we are unconscious but the brain is very active – where most of our dreams happen, and our breathing rate and blood pressure rise. It first occurs about 90 minutes after falling asleep, and happens again three to five more times in a night.
- Non-REM sleep:
- NREM 1: Light sleep, several minutes where heartbeat, breathing and brain waves slow down
- NREM 2: heartbeat and breathing slow further, and temperature drops
- NREM 3: deep sleep where heartbeat, breathing and brain waves are at their slowest and you become less responsive to external stimuli. The body repairs itself, stimulates growth, boosts immune function and builds energy – this the sleep needed to feel good in the morning, but waking up in this stage can make us feel disorientated
While we sleep, our body goes through a cycle, moving through these four steps, every 90 minutes or so. Sleep is necessary to keep our body and mind healthy, and it has been found that most adults need around 7 – 9 hours of sleep a night.
Why is sleep especially important for pregnant women?
Getting the right amount of sleep has a large number of benefits for all adults including pregnant woman, such as improving memory, keeping you alert, promoting growth and development, reducing the risk of heart disease, etc., and we will take a closer look at these in the next instalment in this series.
During pregnancy, a woman’s body goes through number of changes and that impacts a lot of different aspects, including sleep. Around 78% of pregnant women experience sleep problems during pregnancy. These sleep problems are caused by many things, such as anxiety over the baby, frequent nausea and urination, physical discomfort, breathing and digestive problems, etc.
During pregnancy, your sleep needs should be looked at slightly differently, as the sleep cycle changes a little bit:
Sleep time increases but with more awakenings, and more naps may be needed due to the body’s reaction to higher levels of progesterone, and sleep disruption due to nausea and anxiety. Deep sleep time decreases, meaning women can feel more tired even if they are sleeping more. Many women also report vivid dreams during this time.
Sleep tends to improve at the start of the second trimester as the body has adjusted to rising levels of progesterone, but the number of night awakenings can increase towards the end of it. Increased awakenings may be because of changes in the size of your belly, fetal movement and needing to urinate more.
Even more night time awakenings and more naps, so sleep is of worse quality as there is more NREM1 and NREM2 and less deep sleep. Sleep is more fragmented and snoring can lead to obstructive sleep apnoea. The third trimester can also bring cramping (particularly leg cramps), restless leg syndrome, even more frequent urination and more fetal movement; all of these can disrupt sleep.
So, even though you may be sleeping more at some points, you may still feel tired due to not getting enough good quality sleep. Poor quality sleep can lead to complications, which is why it’s so important for pregnant women to understand their sleep problems and to take steps towards improving them.
Good sleep during pregnancy can reduce the risk of:
Prenatal and postpartum depression
Pregnancy is a wonderful, life changing experience which brings with it many emotional changes. Changes in sleep can lead to dysfunction, fatigue and anxieties over the little human that’s growing inside of you. It has been found that this can lead to feeling of depression, especially in the second and third trimesters.
Some studies suggest that there is a link between postpartum depression and lack of sleep during pregnancy: “The majority of studies in pregnant and postpartum women also suggest that difficulty sleeping and sleep deprivation are associated with greater depressed mood in the postpartum period.”
A study by Goyal et al looked at 124 first time mothers in their last month of pregnancy and first three months postpartum. They found that women with higher depressive symptom scores had more problems with sleep.
A lack of sleep can cause emotional problems for anyone, but problems are magnified when you are also creating a life inside of you, so it’s important to focus on your well-being right from the start of your parenting journey.
Some research has found links between sleep and the length of labour and type of delivery. A study by Lee and Gay found that, of the women they looked at, “Women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have caesarean deliveries.” And this increased for women with even more disrupted sleep. They advised that pregnant women should get at least eight hours of sleep a night.
Chang et al found similar links, which included more pain and discomfort during labour. Although it is unclear as to why poor sleep can lead to these complications, it is thought to be a result of inflammation triggering early labour.
High blood pressure and preterm births
Around 10% of pregnant women suffer from sleep apnoea, which has been found to lead to gestational diabetes, preeclampsia and preterm births.
It has also been found that a lack of sleep can inhibit the body’s regulation of stress hormones, leading to high blood pressure. High blood pressure can have a number of negative effects, including a higher risk of preeclampsia; research has found that pregnant women who sleep for less than five hours a night could have a ten times greater risk of developing preeclampsia. This can cause various complications including stroke, heart failure and preterm births, so it’s important to look out for the signs so that it can be monitored and treated quickly.
Gestational diabetes, leading to type 2 diabetes
Some studies have linked short sleep duration during pregnancy to elevated blood sugar levels; Reutrakul et al looked at eight of these studies and found that pregnant women who slept for less than 6.25 hours a night (compared to those who slept for more than 6.25 hours) had 2.84 fold increase in risk for gestational diabetes.
Gestational diabetes leads to an increased risk of getting type 2 diabetes after giving birth. Women who suffer from gestational diabetes have a 20-50% chance of developing type 2 diabetes after giving birth. This risk can last for up to ten years after pregnancy, so it’s important to get tested for type 2 diabetes every 1-3 years, even if the gestational diabetes goes away after giving birth.
One of the first steps towards having a happy and healthy baby is making sure that the mother is also happy and healthy. Pregnancy can have a big impact on your health and, sadly, some problems can’t be avoided. If you are having problems with your sleep, emotions or anything else, it is important that you contact your healthcare professional.
Sleep tips for mums-to-be
There are some general sleep tips (that we will discuss in the next post), but we’ve put together some specific things that might help you catch a few more Zs to improve your well-being during those exciting yet exhausting nine months.
Try to relax
It might be difficult, but taking steps to keep calm can help you to drift off and stay asleep for longer. Try some breathing techniques or take a warm bath. Spend time with loved ones or ask for space for some ‘me’ time when it’s needed. Keep a pad and pen next to your bed to write down any worries that might come to you in the middle of the night – knowing that you can come back to them may help you sleep better.
Take the time to learn about what’s happening to your body and what you should expect. There’s a huge amount of information out there on blogs, podcasts, forums, in books, etc. but don’t overdo it; try limiting your time spent learning so that you don’t get too overwhelmed. You could also try an antenatal class which will also allow you to meet other parents in similar positions, helping to ease your anxieties further.
Create a sleep sanctuary
Try only using your bed for sleep and sex so that your brain will begin to associate your bed with sleep. Keep yourself at a comfortable temperature by using just a blanket or a low tog duvet, or keeping a fan in the bedroom. Get some extra pillows (or a U-shaped pregnancy pillow) to help with getting into comfortable positions. Use dim lamps free from fluorescent light and blackout blinds if the sun creeping in wakes you up. You could also try using candles or oils to create a pleasant smell; peppermint, ginger, lemon and lavender oil have been found to help reduce anxiety and nausea.
Keep hydrated at certain times
This might be an obvious tip for everyone, but pregnant women may find that they need to urinate more often (due to hormones, blood flow and the pressure of the uterus on the bladder) so it’s even more important for you to try to reduce waking up in the night to use the toilet.
A study by Mindell et al found 83% of women find that frequent urination is one of the factors that disturbs their sleep.
It’s important to make sure you keep hydrated in the day, but try not to have any liquids from around two hours before bed, and lean forward while urinating to try to empty the bladder before going to sleep.
Also, make sure to avoid caffeine in the afternoon and evening as this can disrupt your sleep further. Caffeine doesn’t only mean coffee – it is in tea (including green tea), soft drinks, energy drinks and chocolate.
Watch what you eat
During pregnancy, as your baby grows, the uterus can push up on your stomach which makes you more likely to suffer from heartburn. If you do suffer from heartburn during pregnancy, avoid spicy, acidic or fried foods. Having your dinner at least couple of hours before going to bed and staying in sitting position could help. Also, sleep with your head elevated on pillows to try to reduce the effects of heartburn.
Reduce night time nausea by eating something bland (like crackers) in the daytime to stave it off, and eat light evening meals to settle your stomach for sleep. If you want to eat something small before bed to keep your tummy feeling full and reduce nausea further, try eggs on toast, warm milk, or a bowl of porridge; things that contain protein are great for keeping you full, and calcium is good for both you and your baby.
Sleep on your left side
It is advised that you sleep on your left side during the third trimester to increase the amount of blood and nutrients that reach your baby. If you’re worried about being able to do this when the third trimester comes, start sleeping in this position earlier to train your body to feel comfortable with sleeping that way. Keep your knees bent and try using a pillow between your legs to allow for a more natural position.
Sleeping on your left side improves your circulation, so it may be helpful if you experience swelling in your hands, feet or ankles. Avoid sleeping on your back as it can increase chances of muscles aches and pains, hemorrhoids and poor circulation. It can also create a drop in blood pressure which can make you feel disorientated.
Keep a log of what you eat and drink, and how much you sleep. Use this to figure out if there are certain things disrupting your sleep that may not be obvious. This can also be therapeutic – try bullet journaling to turn it into a relaxing activity, and to plan and track more pregnancy based things, such as keeping track of appointments and events, exercise, fetal movement, baby names, when you feel certain pregnancy symptoms, etc.
You may not want to if you feel sluggish, but exercise can actually improve these feelings. Some gentle exercise in the morning can help you to maintain a healthy sleep cycle, as well as improve circulation which can promote a more comfortable sleep. Try not to exercise too late, but just some light stretches before bed can help you fall asleep.
Try yoga, swimming or aerobics, but keep it gentle, especially as you grow or if you are not used to exercising. The NHS advises things such as walking for half an hour a day, making sure to warm up and cool down and avoiding contact sports and sports that may include a risk of falling (horse riding, skiing, gymnastics, etc.).
Ultimately, you need to find exercise that works for you and that you feel comfortable doing, and remember that even a little bit of movement can help with your sleep cycle and the way you feel from day to day.
Pregnancy can cause many discomforts, so it’s important to create a sleep environment that suits you. Try wearing loose, cotton clothing, get some extra pillows for support, use a hot water bottle for aches and try a sleeping bra and maternity belt for extra support.
The bed may not always be the most comfortable place to sleep, so test out to see what works for you. Try sofas, chairs and (if available) different surfaces such as air beds.
If you suffer from cramping, try a warm shower or bath and, if possible, a massage before bed.
We hope this has helped you to understand why we need sleep, how important it is no matter what age we are, and how it is especially important during pregnancy. Keep an eye out for the second and third parts of this post, in which will look at the importance of sleep for new parents and babies.
We’ve touched on a few sleep tips, but there are many more that can be used to ensure a good night’s sleep while your bundle of joy grows inside of you.