Pregnancy and Sleep Disorders

Both physical and physiological changes occurring during pregnancy and immediately following it adversely affect the quality of sleep. Beginning with the first trimester rising progesterone levels may cause increased daytime sleepiness. This improves during the second trimester, only to worsen again in the third trimester. By this time the movement of the fetus and the pressure it places on the bladder may disturb sleep significantly. The craving for naps is now at its peak and remains so for about a month following delivery. There is an increased risk of cesarean section, and longer duration of labor associated with sleeping less than 6 hours a night during the days just preceding labor and delivery. Breastfeeding is associated with a greater amount of deep, more refreshing Stage 3 sleep, thereby improving sleep quality. The demands of caring for the newborn and other young children, however, may continue to have adverse effects on the mother’s sleep.

The incidence of snoring, sleep apnea, restless leg syndrome, periodic limb movement disorder, and nocturnal leg cramping all increase during pregnancy. Most of these disorders are not harmful to the mother or fetus, but may cause misery by sleep disruption. Sleep apnea, however, is never benign and when it occurs during pregnancy it may cause significant harm to both the mother and fetus.

Sleep apnea is associated with an increased risk of hypertension, and during pregnancy this also increases the risk of pregnancy induced hypertension (preeclampsia), gestational diabetes, fetal hypoxemia, decreased birth weight, intrauterine growth restriction, early delivery, and cesarean section. A recent study published in 2014, in the journal, “Sleep”, found a strong association of apnea with maternal mortality. Sleep apnea should always be treated in pregnancy to decrease the risk of these complications.

All women, but especially those who are pregnant should be screened with a sleep study if they have a history suggestive of apnea. Snoring, awakening with a sensation of choking or gasping for air, cessation of breathing during sleep witnessed by a bed partner, obesity, increased neck circumference, small mouth, or receding chin, and fatigue are some of the reasons to investigate further.

Home sleep studies are easily accomplished in the comfort and privacy of your own bedroom by wearing a small device, usually on your forehead. CPAP titrations may also be done at home by wearing a mask with an autotitration setting which determines the amount of pressure required and automatically adjusts it while you sleep. Unless the apnea is severe, oral appliances are sometimes a more comfortable option.