Pregnancy and Sleep Problems

Okay. So you’re tossing and turning, snoring and snorting, aching, kicking, getting up to go to the bathroom, and trying every which way to find a comfortable position. It’s not easy to sleep through the middle of all that—and some nights it seems downright hopeless. But here’s what will give you the best chance.

1. SKIP THE NAPS. Daytime sleepiness, particularly in the first trimester, encourages almost every pregnant woman to nap. But naps make it more difficult to sleep at night because they take away some of the sleep pressure that builds up over the day. “It’s like snacking,” says Grace Pien, M.D., a sleep researcher at the University of Pennsylvania’s Center for Sleep and Respiratory Neurobiology. “Eating even a small amount of food before a meal can take away your appetite.”

2. CANCEL THE SLEEP DEBT. Most women sleep only 6½ hours a night, so they head into pregnancy with a sleep debt. Fortunately, it’s possible to repay that debt and bring your body back into balance before pregnancy makes sleeping harder.

To avoid napping, try going to bed an hour earlier than usual on a regular basis. If 11 o’clock is your usual time, head into the bedroom at 10. So maybe you’ll miss your favorite TV show or that report you were working on just won’t get done. Just keep in mind the University of California, San Francisco (UCSF), study that found that a woman who sleeps less than 6 hours a night quadruples her risk of a C-section and can add up to 10 hours to her labor. That’s a great incentive to end the day early.

3. ADDRESS ANXIETY; BUFFER STRESS. Both anxiety and stress have very real physiological components, says sleep researcher Kathryn Lee, Ph.D., the UCSF professor who uncovered the relationship between poor sleep and length and complications of labor. In fact, she’s betting that it was anxiety and stress that kept the women in her study from sleeping and, ultimately, led to increased labor and a complicated delivery.

“When you’re exhausted, your muscles are tired,” explains Dr. Lee. So if women are losing sleep because they’re worrying about the baby, or anxious about their new roles, or anxious about how they’re going to earn a living, or any one of the million and one things that run through an about-to-be mom’s head at 2 in the morning, it’s likely that the women were going into labor with tired muscles. “And if those muscles were tired, there’s a good chance they might not have been pushing as well as they needed to,” she says.

Talk to friends and family about any concerns that are keeping you up at night, or schedule a few quick visits to a therapist who can help you address the anxiety they may be generating. And learn how to use prayer, yoga, or meditation to connect with the calming stillness that lies at the very center of each and every one of us. The fruits of your efforts may be a shorter and safer labor.

4. BUY LOTS OF PILLOWS. No matter how you lie, you’ll need lots of support to get comfortable by the third trimester. Start with a full-length body pillow, then add smaller pillows for extra support. Some women like pillows under their heads and under their arms; others also like them stuffed between baby belly and bed, wedged between knees, and snuggled into the small of their backs. Suit yourself.

5. DON’T SWEAT THE DREAMS. A Canadian study recently revealed that 59 percent of pregnant women have horrific dreams that their baby is in some kind of danger. The dreams are normal, apparently part of a woman’s instinct to protect her child. If one wakes you up, don’t think it’s a premonition. Just roll over and go back to sleep.

6. WARM THE LAVENDER. Some pillows come microwave-safe and scented with natural lavender. Follow package directions for heating, then lie down, tuck the pillow wherever you ache, close your eyes, and relax into the warm scent. You’ll be asleep in no time.

7. HOLD THE LIQUID AFTER 4:00 P.M. As any potty-training mom knows, you fill your kid full of water and juice all day long until around 4 o’clock. Then you give him liquids only when he asks for them, and then in quarter-cup amounts. As a result, your kid can sleep through the night and wake up dry, rested, and proud the next day.

The same thing works with pregnant moms, says Dr. Pien. Some of those nighttime trips are due to your physiology. But there’s also another reason: Most pregnant women are busy all day long and don’t take time to drink and stay hydrated. So when they get home, they tend to tank up. The fact that they need to get up and urinate during the night is a natural consequence. A better approach is to carry a large water bottle with you all day—and finish it before you leave work.

8. REMEMBER MAMA. When your mom’s back ached, she likely reached for a heating pad and put it on her hips. You should do the same. Just keep it set on low, and don’t fall asleep while it’s on.

9. GET OUT THE BATH TOYS. Slide into a tub of warm water before bed and splash around, suggests Dr. Pien. Avoid hot water since some studies indicate that it can cause vasoconstriction, which can lead to miscarriage.

10. KEEP A REGULAR SLEEP SCHEDULE. Yes, even on weekends. Your body uses light to regulate its sleep/wake cycle. If it gets confused, you could be tossing and turning for hours.

11. DEAL WITH NAUSEA. Munch on a few crackers several times during the day. Daytime munching seems to head off nighttime nausea.

12. BAG THE FRIED FOOD. Also, spicy or acidic anything. Heartburn at 3:00 A.M. is not a good life choice.

13. EAT SMALL. Several small, light meals during the day instead of a heavier one at night will encourage deeper sleep.

14. KICK BUTTS. Say yes the next time someone asks, “Mind if I smoke?” A study of more than 35,000 pregnant women conducted at Nihon University in Tokyo found that women exposed to secondhand tobacco smoke were more likely to have trouble falling asleep and staying asleep than women who weren’t. They also had breathing difficulties and were more likely to awake at the crack of dawn.

15. WORK OUT. A 30-minute daily workout will strengthen your body and get you in shape for labor and delivery. Brisk walking, lap swimming, stationary or recumbent biking, and a low-impact aerobics class designed for pregnant women are best. Check with your doctor before you start.

If you haven’t been exercising regularly, begin slowly, say, 5 minutes a day. Add 5 minutes a week until you’re up to 30 minutes a day. Avoid exercising in hot weather, and after the first trimester avoid doing exercises while lying on your back. Otherwise, you go, girl!

16. BASK IN THE SUN. A little natural-light exposure during the afternoon will help your body clock understand when you’re supposed to be awake—and when you’re supposed to be asleep.

17. KEEP THE PARENTING BOOKS IN THE LIVING ROOM. If you read parenting books right before you turn out the light, chances are you’ll be running if-then and what-if scenarios in your head for hours to come. This is daytime work.

18. PUT AWAY THE PAINT CHIPS AND CATALOGS. Okay, we know you love poring over paint chips and baby furniture catalogs and making plans for the nursery. But right before bed? Isn’t that a little stimulating?

19. STRIP THE BEDROOM. “The bedroom is for sleep and sex,” says Dr. Pien, repeating the mantra of sleep medicine specialists everywhere. Remove the TV, computer, Palm Pilot, cell phone, and anything else that’s unrelated to those two most pleasurable activities.

As fatigued as you may feel, start figuring out how you’ll deal with sleep issues while you’re still in the third trimester. Here’s what we mean.

1. RECOGNIZE THE IMPORTANCE OF SLEEP. Sometimes it seems as though our culture has begun to view sleep as a sign of weakness. It’s the new macho—and women are buying into it big-time.

“I can stay awake through anything.” “I can stay awake longer than you can.” “I can run on dead brain cells, sheer guts, and sheep entrails.”

That’s the kind of talk you often hear in the latte line at Starbucks. But your body was programmed to spend one-third of its life asleep, and to sleep in specific cycles of light sleep, deep sleep, and active-brain sleep. Each cycle takes 90 minutes, and each has a specific assignment that affects thinking, memory, growth, your immune system, and even your weight. Trying to tuck anything that important into an hour here and an hour there just won’t get the job done. Especially not when you’re also trying to nurture a new life.

2. SCHEDULE A DRESS REHEARSAL. “Starting during the last trimester, have your partner get out of work an hour early and pick up dinner on the way home,” says Kathryn Lee, Ph.D., a sleep researcher at the University of California, San Francisco. “It sounds simple, but in our culture most guys haven’t had the responsibility of thinking about what’s for dinner, shopping for the ingredients, and delivering it to the table.” The practice not only smoothes things out, she adds, it also gives you a break toward the end of pregnancy, when you’re most likely to be exhausted and in need of a nap.

3. INVESTIGATE WORK OPTIONS. “Most women today are getting the message that they can do it all,” says Dr. Lee. “And they can. They can be a mother really well, and do their job really well, and juggle everything.”

“In fact,” she says, chuckling, “I think there’s some gene in there that allows women to multitask.”

That’s not to say that women shouldn’t try to strike some kind of reasonable balance between work and family, adds Dr. Lee. Especially if they want some sleep. A poll for the National Sleep Foundation found that women who work full-time and have kids got the least sleep of all moms surveyed. Some 54 percent said they frequently woke during the night, and 56 percent said they often woke up feeling unrefreshed. Most kept going by downing caffeinated beverages and by giving up sleep (60 percent), exercise (60 percent), time with family and friends (52 percent), leisure activities (49 percent), and sex (44 percent).Their partners must be thrilled.

But women who stay at home with their kids also don’t sleep too well, according to the survey. A whopping 74 percent said they frequently had insomnia. Researchers suspect that it’s because they don’t set their body’s internal clock by getting up at the same time every morning as would someone who had to be at her desk at a particular time.

Only mothers who work part-time seem to have it all together. A relatively small, 16 percent reported a sleep problem. The other 84 percent seemed to be doing just fine.

4. FOLLOW YOUR BODY’S NATURAL RHYTHMS. When deciding who’s going to get up with the baby at night, keep in mind your natural programming, says Dr. Lee. “Your body is hormonally programmed to wake up at the least little gurgle, and the hormone prolactin causes your breasts to fill up and get uncomfortable just about the time the baby gets hungry.” That doesn’t mean you have to be on call 24/7, she adds, but it’s something you need to factor into your decision.

5. LET DAD PINCH-HIT. One option is to put the baby to bed at night after the 8 o’clock feeding and go to bed yourself. Your partner can use a bottle of expressed milk to feed the baby around 10. Afterward your partner can go to bed and you can get up for the 2 to 4 feeding. That way, each of you will have the opportunity to have an uninterrupted six-plus hours of sleep.

6. MEND FAMILY FEUDS. You’re going to need every hand on board if you plan on getting any sleep. In other cultures, grandparents are much more involved with new babies than they are in the United States, says Dr. Lee.

But there’s no reason why it has to be that way. Especially if you have other children, why not ask one set of grandparents to come and help for a couple of weeks after the baby’s born? Ask the other set to come for the following two weeks. Heck, invite any unencumbered aunts and uncles to come lend a hand as well—for a short time. Just make it clear to everyone that they’re coming to make dinner, wash dishes, change diapers, give baths, and clean the house. An hour cuddling your baby is their reward. Plus, of course, a happy, well-rested new mom.

7. SLEEP WHEN BABY SLEEPS. A new baby will sleep 16 to 17 hours a day for a maximum of 4 to 5 hours at a time, pediatricians say. Once awake, a newborn will stay awake for only 1 to 2 hours max. Sleep while you can. Put your head down when your baby goes down. You might actually get a full cycle of sleep a couple of times a day.

8. UNPLUG THE PHONE. Aside from food, the most important thing to your health and the health of your baby may well be sleep. It affects your ability to function—to think, remember, heal, and take action—while it affects your baby’s ability to grow physically and mentally. Sleep is sacred. Naps—both the baby’s naps every couple of hours or yours, also hopefully every couple of hours—should not be disrupted just because someone outside the house has decided he or she needs to talk with you.

9. LEAVE DAD IN BED. Since it’s usually Dad who gets up and goes off to work in the early weeks while Mom is on maternity leave, why not leave Dad in bed when the baby gets up during the night and have him come home an hour early from work to take responsibility for baby and dinner, suggests Dr. Lee. Not having to think about what to make for dinner, or make sure the groceries are in the kitchen, or actually prepare the meal is a nice chunk of time that you can use to shower, nap, or otherwise nurture yourself later in the day.

If Dad doesn’t feel like making dinner, says Dr. Lee, he can pick up an extra quart of soup from the company cafeteria at noon and stick it in the office fridge until he goes home. Or he can bring home a roasted chicken and some veggies and a container of fresh fruit from the neighborhood market. Or he can pick up Chinese. Whatever. The point is that you don’t have to think about it, shop for it, or make it.

10. DISCOURAGE VISITORS. Everybody wants to see the new baby, of course. And you, you conscientious person, will feel the need to make sure the house is clean and there’s something to offer them when they come—your home-baked pound cake, some sandwiches, a little coffee, and maybe some tea, right? Wrong. Unless your family has moved in to take over such chores, ask visitors to hold off for a week or so, then have them come one or two at a time for only an hour a couple of days a week. Anyone who’s had kids will understand, and those who haven’t will learn soon enough.

11. IGNORE FADS. Whatever you do, don’t try to be politically correct at the expense of common sense. “I don’t know how this all started, but there’s this trend here in California where a husband and wife do this kind of contract with each other before the baby is born,” says Dr. Lee. “The contract is that the father will get up during the night and bring the baby to the mother so that she can breastfeed. Afterward he changes the baby and everyone goes back to sleep.

“I guess it’s one way of thinking that everybody’s participating in child care,” says Dr. Lee, “but what it means is that nobody’s sleeping and everybody’s tired.

“It could make sense in some families,” she adds, “but to me it means that none of the adults is sleeping. That means that no one is able to make a coherent decision—and that sounds really dangerous.”

12. SLEEP TOGETHER. In the past, studies have linked the practice of sleeping with your baby to maternal insomnia. But in many of these studies, a mother’s insomnia was caused mainly by her fear that the baby would be smothered by the sheets, roll out of bed, or be rolled upon by one of the parents.

In a soon-to-be-released study of 140 couples and their babies, Dr. Lee has discovered that moms actually sleep better when the baby sleeps in a bassinette next to the parents’ bed rather than in his or her own room down the hall.

“The idea is that the baby’s within easy reach, the mother doesn’t have to be aroused by the baby’s screaming, and she doesn’t have to get up, turn on the lights, and go down a hallway,” says Dr. Lee. That makes it easier to slide back into sleep after the feeding.

The trick is to put a white-noise machine and a night-light at the foot of the bed, says Dr. Lee. The night-light allows the mother to check on her child without rousing both of them with bright lights, and the machine masks the little noises that babies always make, so they don’t disturb the mother—particularly in her hormone-influenced hyperalert state. It’s only when the baby starts to fuss that the mother is actually awakened. The baby doesn’t have to work him- or herself into a window-rattling cry to get fed, so mom is less aroused. What’s more, it turns out that babies like this little routine, too. Dr. Lee’s data show that babies seem to slide back into sleep much easier as well.

What’s more, the white-noise machine filters out Daddy’s snoring—a little extra benefit.

13. EXPECT THE BLUES. When all those hormones surging through your body to help maintain your pregnancy are suddenly shut off at birth, your body’s going to react. In fact, in some cases it almost seems akin to drug withdrawal. Possibly as a consequence, some 35 to 80 percent of women get the blues, which start three to five days after birth and last roughly a week.

Unfortunately, somewhere around 10 percent of new moms will actually tumble into a postpartum depression that begins somewhere between the second and fourth week. The difference between the blues and postpartum depression? It seems to be a question of degree–and only a doctor should judge the difference.

No one knows what causes postpartum depression. Some researchers think it’s the postpartum drop in hormones, but then why don’t we all get it? Other researchers feel it’s a lack of support at home, and a few think it occurs because society “expects” us to be depressed. And some, perhaps mothers themselves, feel that researchers should try to toss and turn for the last three months of pregnancy as most women do, experience 15 hours of labor, then top it all off by having to wake up three times a night for the next three months and see how happy and even-tempered they are.

In fact, there are now a couple of studies that are beginning to support precisely that notion.

14. FIND YOUR BABY’S RHYTHM. Pediatricians tell us that up until three or four months of age, a baby’s sleep is determined purely and simply by its biological needs, and the best thing for both you and the baby is to simply roll with those needs. Your baby will grow and you’ll get a good night’s sleep. Eventually.

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