Sleep Disturbance in Pregnancy
Authored by:
Anna Glezer, M.D.
In pregnancy, sleep can be significantly altered. You might find yourself waking up too early, or too many times. You might find it hard to fall asleep, with thoughts racing. You might feel physically uncomfortable. And you might wake up not feeling refreshed.
In fact, more than three quarters of pregnant women report a change or disturbance in their sleep pattern. It is very important to understand sleep function and its disturbance in pregnancy because poor sleep can lead to worse pregnancy outcomes.
In fact, sleep disturbances have been associated with complications such as:
Smaller babies
Preterm birth
High blood pressure and pre-eclampsia
Risk of cesarean and longer cesareans
Higher rates of gestational diabetes
Increased rates of depression or anxiety
This article focuses on these emotional and psychological elements: depression and anxiety.
Sleep changes during pregnancy
It is first helpful to understand how sleep works outside of pregnancy to better understand how it is different during pregnancy.
There is a reason sleep deprivation is used as a torture device! Sleep is an essential human function, and poor sleep can severely impact functioning and mental health. It is torturous to sleep restlessly night after night and wake up unrestored. There are many theories about the reasons why sleep is so essential, but medical researchers are in agreement that without sleep, people cannot function.
Generally speaking, people sleep in cycles throughout the night, progressing through various stages of light sleep, deep sleep, and dream sleep. The amount of sleep an individual requires varies, but on average, 7-9 hours are recommended every night. In pregnancy, there is a decrease in restful sleep and in the amount of deep sleep and dream sleep, and an increase daytime sleepiness and fatigue. The decrease in dream sleep, in particular, is thought to be related to pregnancy hormones like progesterone.
Additionally, pregnancy can be associated with the development of certain sleep disorders, such as sleep apnea and restless legs syndrome. Many women report that frequent urination, heartburn, and physical discomfort are reasons for poor sleep. Many also cite anxiety and emotional problems as the reason for an inadequate night’s rest.
Sleep is essential to good mental health
In fact, changes in sleep and insomnia are key symptoms of major depression and anxiety disorders. These changes in sleep can be varied:
Difficulty falling asleep (both at the start of the night and after waking in the middle of the night)
Early morning awakening (and inability to fall back asleep)
Racing anxious thoughts
Excessive sleep (in certain forms of depression)
A key question to evaluate is whether the poor sleep is, in fact, a symptom of a mood or anxiety condition, rather than an independent insomnia disorder. This is a valuable distinction to make because the treatment will be different for a mood disorder, an anxiety condition, or insomnia unrelated to emotional distress. You can ask yourself four questions to tease this out:
Is it hard to fall asleep because of anxious thoughts on my mind rather than because I am physically uncomfortable?
When I get up in the middle of the night to use the bathroom, how long does it take me to fall back asleep? If it takes longer than 15 minutes, is it because I’m worrying or ruminating on negative things?
If I’m waking up too early, when I wake up do my thoughts immediately turn to worries for the day or the future?
Am I being kept awake because of evening anxiety attacks or am I waking up in the morning feeling tense with worry or sadness?
If you answered “yes” to one or more of these questions, it could be that you are struggling with more than just poor sleep. You could be struggling with an anxiety or mood condition that warrants treatment.
The relationship between mood/anxiety and sleep is a two-way street: poor sleep leads to worse mood and higher anxiety, and anxious thoughts and depressed mood hinder sleep. Given the impact that poor sleep can have on both you and you baby, it is important to understand why you might be having difficulty with sleep in order to guide treatment and prevent complications during pregnancy and postpartum.
Selected References:
Palagini, L., et. al. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Medicine 15 (2014) 853–859.
Bei, B., Coo, S., Trinder, J. Sleep and mood during pregnancy and the postpartum period. Sleep Med Clin 10 (2015) 25–33.
Mindell, J., Cook, R.A., Nikolovski, J. Sleep patterns and sleep disturbances across pregnancy. Sleep Medicine 16 (2015) 483–488
