The causes and the cures of insomnia

Insomnia is never a good thing, but when a woman is in the early stages of pregnancy, insomnia can make for long nights and tired days. In a recent poll conducted by the National Sleep Foundation (NSF), 78 percent of women reported more disturbed sleep during pregnancy than at other times. Sleep-related problems also became more prevalent as the women’s pregnancies progressed.

Dr. Jill Powell, assistant professor in the Department of Obstetrics, Gynecology and Women’s Health at St. Louis University School of Medicine, says she finds most sleep disturbances follow the pattern found in the NSF’s poll. In other words, sleep problems can develop early on but usually aren’t too bad and abate as the pregnancy progresses. Later, other issues can cause insomnia to reoccur.

Early Insomnia

In the first trimester, insomnia is relatively common and is caused by the hormonal changes of pregnancy. Dr. Powell says there are a couple of reasons for this. “Early in pregnancy women tend to feel very fatigued because of what I call the progesterone phenomenon,” says Dr. Powell. “Progesterone is a natural sedative, and a woman may be so tired she has this sensation of not being able to keep her eyes open. She may react by napping during the day or falling asleep on the couch after work. This then gets her out of her normal sleep patterns.”

In the first trimester, insomnia is relatively common.

The result is she may not be able to fall asleep that night, which then just sets in place a vicious cycle of exhaustion. To avoid this, Dr. Powell suggests trying to avoid long naps during the day. Try taking a walk or finding some other activity instead of sleeping. Go to bed at the same time every night; even if it’s earlier than your “normal” pre-pregnancy schedule to get some extra sleep.

In addition to hormonal changes, Dr. Powell notes there is often a lot of anxiety in the first trimester. A woman may have concerns about her health or the baby’s health and may worry about miscarriage. There may even be more specific reasons for anxiety, such as financial worries if the pregnancy was unplanned. For this type of emotion-related insomnia, Dr. Powell suggests trying to find someone to talk to who may help ease your worries, such as a friend, clergyman or your doctor.

The other common reason for insomnia is sleep disturbances due to having to urinate frequently. At this point in the pregnancy, the uterus is still fairly small and has not yet pushed up out of the pelvis. As a result, it pushes against the bladder and can cause frequent urination. This will resolve itself in the second trimester as the uterus grows and pops up out of the pelvis.

Later Insomnia

Dr. Powell says women usually don’t exhibit many sleep problems in the second trimester, what she calls “the honeymoon trimester,” but insomnia often occurs in the third trimester. “As the third trimester progresses there’s more pressure on your lungs and you fatigue more easily but start sleeping more poorly,” says Dr. Powell. “The cause for virtually all of the sleep disturbances at this phase can be traced to the increase in size of the abdomen.”

In the case of the third trimester, it’s not so much inability to sleep or being out of rhythm with sleep cycles as it is sleep disturbances. For example, the bladder once again starts feeling the pressure of the enlarging uterus and the mother-to-be may find herself up and down several times a night.

Sleep disturbances are common for other reasons. Rolling over is not as easy as it once was, and for women who prop themselves with several pillows, it may involve enough readjusting to cause them to wake up. Heartburn can also be severe enough to awaken you from sleep.

Another common problem is trouble getting comfortable. Some people only get their best sleep in certain positions, so back sleepers or stomach sleepers have to adjust to sleeping on their sides. However, as Dr. Powell points out, this may actually be a good thing, as it’s not good for the baby to sleep on your back.

At this point in the pregnancy, there’s not a lot that can be done about some of the things causing insomnia. For heartburn, your doctor can recommend a safe antacid or other medication. Exercise may also help with insomnia.

Other Issues

Dr. Ken Sassower is a staff neurologist at Massachusetts General Hospital working in the sleep disorders unit. He says the most important thing for a pregnant woman to do to ensure good sleep throughout her pregnancy is to maintain good sleep hygiene. This includes the following:

  • Go to bed and wake up at about the same time every day.
  • Don’t nap during the day.
  • Avoid alcohol and tobacco. Pregnant women should do this anyway.
  • Don’t drink caffeinated beverages four to six hours before bedtime.
  • Avoid spicy foods.
  • Get regular exercise but not too close to bedtime.
  • Do not watch TV or read in bed. Go to bed only when you’re sleepy, and use the bed only for sleep or sex.

Insomnia is rarely a serious problem, but there are two issues that may start in pregnancy and continue after the baby’s birth. These are sleep apnea and restless leg syndrome.

Sleep apnea is often associated with excess weight but can be brought on by the edema of the nasal structures brought on by pregnancy. If insomnia due to sleep apnea becomes a serious problem during pregnancy or persists afterward, Dr. Sassower says it needs to be evaluated in a sleep study. Restless leg syndrome, the urge to move your legs when you’re at rest, can manifest itself in pregnancy but often clears up afterward. If it doesn’t, see your doctor.

In general, both Drs. Powell and Sassower agree that insomnia during pregnancy is transient and the conditions causing it quickly dissipate after the baby is born. It’s then, says Dr. Powell, that you may be able to sleep, but the baby may have other ideas!

One Mom’s Battle with Insomnia

Katherine Bishop from Pennsyvania knew she was pregnant with each of her children before she ever took a pregnancy test or saw a doctor because of her terrible insomnia. She’d be so tired she could barely keep her eyes open but couldn’t sleep more than an hour or two at a time day or night.

She consulted her doctor, but he was reluctant to give her anything medicinal at all. This was the early ’90s, when the DES babies of the 1960s and 1970s were coming into adulthood. There was a lot of press about the long-term effects of being exposed to drugs in utero that had been thought to be safe at the time. It scared him, and he told her that.

During her first pregnancy, Bishop suffered. “I remember lying on the floor in the afternoon, so tired and never able to sleep,” says Bishop. “It was like a nightmare except that I wasn’t sleeping. When I did occasionally fall asleep, my husband would run around the house unplugging all the phones so no one would call and wake me up.”

Like her morning sickness, the insomnia did pass within about six weeks, and, although she still had it with her next two pregnancies, it wasn’t quite as bad. What also helped her was an awareness and acceptance of the fact that this was simply the way her body reacted to the early hormonal changes of pregnancy. It also helped that she didn’t work outside the home at the time and didn’t have to worry much about being alert and active.

Although Bishop is aware that her case was extreme, she notes that the advice her doctor gave her way back then still has a lot of value for a pregnant woman today: Try to rest but not nap during the day, drink chamomile tea before bed, use the bed only for sleeping, be sure to have comfortable bedding and try to avoid reading or watching anything too stimulating before bedtime.

I Still Can’t Sleep

So you’ve tried the basic advice to get complete sleep during pregnancy, and yet you are still spending your nights tossing and turning or staring at the ceiling. Dr. Traci Kurtzer, an OB/GYN in Chicago, Ill., shares her tips for women who thought they had tried it all:

  • Make sure to get daily exercise, ideally in the morning hours.
  • Try drinking a warm glass of milk before you go to bed.
  • Take a warm relaxing shower before you go to bed.
  • Have your husband or partner give you a shoulder or back massage.
  • Keep a notepad by your bed to write down any worries you have, or things you are trying to remember for tomorrow that you might be dwelling on – get them on paper and out of your mind.
  • Last but not least, if the above measures don’t work, ask your doctor for a prescription sleep aid, like Ambien, to use every once in a while just to get a full night’s sleep.