Sleep challenges are some of the most common — and most frustrating — issues in pregnancy. For some women, changes in sleep can occur before they are even aware of the tiny human growing inside; others may not notice a difference until they approach their due dates.
In the first trimester, most pregnant women will experience a significant increase in daytime fatigue. Difficulty in getting through the workday without heavy eyelids or staying awake past even seven in the evening are almost universal complaints.
If you are struggling with profound fatigue, try listening to your body and taking a short nap after lunch (if possible) and/or actually turning in for the night a few hours earlier than usual. Try to resist the urge to sleep all day, as it may make for a night of tossing and turning. The good news is that most women will notice a huge improvement in their energy levels when they reach the second trimester.
Making the Most of Your Slumber
After a honeymoon period of increased energy, many expectant moms will start to have trouble with sleep at night. The following tips can help you ensure that you are maximizing your sleep hygiene — healthy practices that may bring about good nighttime sleep quality and daytime alertness.
• Try to go to sleep at the same time each night and to wake up around the same time each morning.
• Maintain a healthy diet — full of protein, fresh fruits and vegetables, and complex carbohydrates. Avoid eating too close to bedtime. Well-balanced meals can help to decrease rapid rises and falls in blood sugar, which can affect fatigue and sleep.
• Exercise regularly, but not too late in the evening. Being physically active can decrease stress, help with aches and pains that prevent sleep and necessitate good recovery with restorative sleep. However, exercise does tend to give a boost of energy shortly after completion, so time it well.
• Avoid screen time too close to turning in. The light of television, smartphones and tablets is very activating to the brain and has been shown to increase the time it takes to fall asleep. If you need something to wind down, try reading an actual book or magazine.
• Ensure that your bedroom is a comfortable temperature — aim for 60 to 67 degrees — and that your sleepwear and your bedding are appropriate for this climate. Things like blackout curtains, white-noise machines, fans and humidifiers can also make the room more relaxing.
Achieving Restorative Sleep
There are also more specific issues unique to pregnancy that can pose a challenge to getting a good night’s sleep. Some of these issues and what you can do about them follow.
Problem: General discomfort. The growing uterus causes a change in the center of gravity, so finding a comfortable position may get harder as your baby gets bigger.
Solution: Most women find it easiest to sleep on their sides, and this is also the position that maximizes blood flow to your baby. Using pillows for support under the belly, the back and between the knees may be helpful. There are many versions of pregnancy pillows available, and you may need to experiment to identify the best shape or size for you, or to find a pillow that actually fits in the bed with you and your partner!
Problem: Heartburn. This miserable symptom is usually worse while lying down.
Solution: Elevating your head and shoulders with a few pillows or the head of your bed with a block can help improve heartburn, as can avoiding triggers such as acidic, fried and spicy foods and not eating right before bed. Ask your healthcare provider about medications that can help combat heartburn, which often worsens as you get closer to your due date.
Problem: Anxiety. Sometimes it can be hard to turn off your brain at the end of a long day. Wondering when your baby will come, how your life will change and whether you’re ready, in addition to the usual prepregnancy stressors, can be overwhelming.
Solution: Meditation, yoga, regular exercise and sharing your thoughts with a partner or close friend may decrease the after-dark anxieties. If you find that these interventions are not beneficial and you are really struggling, talk to your provider.
Problem: Fetal Movement. Many babies are more active in the evening hours, and their acrobatics often keep their expectant mothers awake.
Solution: While there is not much you can do to change fetal activity, following the tips above for good sleep hygiene often can improve the chances that you will be tired enough to sleep through the in utero dance party.
Problem: Frequent urination. This is an inevitable part of pregnancy, and most women will need to get up a few times a night by full term.
Solution: In an effort to decrease your trips to the bathroom, try to limit fluid intake for a few hours before bed, and avoid caffeine in the afternoon or evening. (You should limit your daily caffeine intake to 200 mg or about a 12-oz cup of coffee while pregnant anyway.)
If sleep is still elusive despite trying all of these techniques, talk to your provider about whether there may be any other safe interventions. It is best to maximize your slumber now because once your baby is born, restorative sleep may be even harder to achieve for a few months!
Lynsey Caldwell Owen, MD, FACOG, is an ob/gyn at Arlington Women’s Center and Virginia Hospital Center in Arlington, VA.
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