Nearly 40 million Americans suffer from sleep disorders, with women reporting insomnia more than men. According to the 2002 National Sleep Foundation's "Sleep in America Poll," 63% of women reported insomnia, as opposed to 53% of men. Sleep is important, yet many aren't getting enough.
In my practice, the majority of my patients are women. I'm often asked by patients (and friends!) why insomnia is more common in women. As a result, I'm going to dedicate my first few posts to sleep disorders common to women, discussing problems that can occur throughout her life.
Fluctuating hormone levels (such as estrogen and progesterone) set the stage for sleep disorders in women during the month and over the lifetime. Insomnia commonly occurs during pregnancy due to physical discomfort, hormonal changes and the stress of a major life change. Sleep quality also changes dramatically during the three trimesters of pregnancy.
During the first trimester, many women find that they may have an increased need to wake up at night due to urination, stress, and nausea. Women often report daytime sleepiness, with an urge to nap more than ever before. Although sleep may be interrupted, women in the first trimester tend to sleep more than usual (both at night and during the day). A newly pregnant mom's body is working in overdrive to nurture the developing baby as the placenta (the organ that feeds the baby until birth) is forming and requires more energy from the body.
The second trimester is often a time of relief for pregnant women. Nighttime urination is less of a problem as the growing fetus moves above the bladder and places less pressure on it. Nausea also becomes less of an issue. Women typically report more "normal" sleep patterns during this time.
The third trimester is likely the most stressful for many pregnant women. A growing belly can cause physical discomfort and women tend to report more heartburn, sinus congestion, back pain, constipation, shortness of breath and leg cramps. Nighttime urination returns as the baby begins to put pressure on the bladder. Evolutionary theorists believe (as do I) that the pregnant mom's sleep becomes more broken as a way to prepare mom for the disrupted sleep that's about to happen when baby arrives.
Despite the fact that sleep can be hard to come by during certain parts of pregnancy, there are things that women can do to help alleviate the problem. Expecting to have a perfect night of sleep every night during pregnancy is likely unrealistic for most women. However, there are things that can help.
1. Find a good sleep position. Lying on your side with knees bent is often the most comfortable position as the belly gets larger. If you're not someone who usually is a side sleeper, I recommend you get into this habit early on in the pregnancy. Side sleeping helps alleviate pressure to the inferior vena cava (a large vein that carries blood back to the heart from your lower body). Some doctors recommend that pregnant women sleep on their left side to help improve circulation and reduce pressure on the liver.
That being said, please don't obsess about your sleeping position if you happen to move throughout the night (as we all do!). When you wake up, just move back to the side position. You can also try to help stay on your side by putting pillows by your back.
2. Pillows are a pregnant woman's best friend. Experiment with extra pillows to help support your lower back and stomach. A pillow between the legs can help support the lower back. A number of companies sell full-body pregnancy pillows that help support the head, belly and lower back. Pregnancy wedge-shaped pillows are also helpful to support the body.
3. Eat right. A warm glass of milk is often recommended to help induce sleepiness, but I find that it also increases the likelihood of having to urinate at night. Instead, try a snack that's a mix of carbohydrates and protein to help promote sleep and keep blood sugar levels level. A half of a banana with some peanut butter or a whole-wheat cracker with some cream cheese can both be good options. If nausea wakes you at night, a bland snack of crackers can help.
4. Limit caffeine. Avoid soda, coffee, and tea as much as possible as it can disrupt nighttime sleep. If you must have caffeine, speak with your doctor first to see if it is OK, and consume it only in the morning.
5. Avoid liquids and heavy meals at night. Heavy nighttime meals within three hours of bedtime can increase the occurrence of heartburn. Drinking liquids right before bed can increase the need to urinate.
6. Pay attention to your legs! If you suffer from leg cramps at night, make sure you are getting enough calcium in your diet. Pregnant women report more restless legs syndrome (RLS) during this time (an uncomfortable feeling in the legs that worsens as nighttime gets closer, interfering with the ability to relax and go to sleep). If you have trouble sleeping because of RLS, talk with your doctor since there are effective treatments available for this. A simple blood test to check your iron levels may be all that you need and your doctor might recommend a specific supplement to help.
7. Exercise. Exercise is great during pregnancy (talk with your doctor first though to make sure), but the timing of it is key when it comes to sleep. Twenty minutes of exercise five hours before your usual bedtime can help promote sleep. Avoid rigorous exercise at night before bed. Prenatal yoga is especially great!
8. Snore much? Recent research has noted an increase in obstructive sleep apnea in pregnant women. This is likely due to the associated weight gain and hormonal changes. If you snore and choke/gasp or stop breathing during your sleep, talk with your doctor. Sleep apnea can lead to premature births and pregnancy complications in women, so have it checked out. Effective treatments are available. Many times, people don't know they snore, stop breathing or choke/gasp during sleep—either have someone listen to you or record yourself if you suspect this might be an issue.
9. Get out of bed if you can't sleep. The tried and true rule of having the bed only for "sleep and sex" is very important. Laying in bed frustrated, thinking about things, and possibly even getting more stressed is only going to worsen the problem. There's nothing to be gained by lying in bed, tossing and turning. Instead, get up, go in another dimly-lit room, and do something quiet, calm and relaxing. You might even miss that quiet time once baby arrives!
10. Work on your worries. If you find that psychological stress, such as worries about having a baby, are keeping you awake at night, consider joining a pregnant moms' group. Enrolling in childbirth and parenting classes can help allay some fears as knowledge is power. Plus, you might even get to meet new people who are in the same situation and can understand what you're going through.
11. Relax. Make sure to schedule in time to relax. A calm mind will lead to a calm body. Set aside as much time as you possibly can to do a relaxation exercise (such as deep breathing), read your favorite magazine, or do a hobby you love. Making time for yourself will serve to energize you during the day, lowering stress levels, and help promote sleep at night. Enlist the help of others to allow you to set aside even 20 minutes of quiet time for yourself (I'll talk more about this in future posts).
I hope that these suggestions help you pregnant moms out there. If you continue to struggle with sleep issues after trying these suggestions, consult with your doctor to see if anything else can be done to help.