Pregnancy can be hard on a woman’s body, and it can be particularly bothersome to sleep. Pregnant women frequently experience difficult falling or staying asleep, a condition known as insomnia. What causes insomnia in pregnancy? What treatment options are available for insomnia while pregnant?
How Common Is Insomnia in Pregnancy?
Insomnia is the most common of the sleep disorders. It is most often defined as difficulty falling or staying asleep. It also includes sleep that is simply not refreshing in the absence of another sleep disorder. Insomnia affects nearly everyone at some point in life. So it should be of no surprise that it is also incredibly common among pregnant women. But how common is it?
Studies suggest that 84% of pregnant women report one or more symptoms of insomnia at least a few nights each week. By the third trimester, more than half of women are worried about their sleep. Some 30% of pregnant women report that they rarely or never get a good night’s sleep. As you can gather, it is a major complaint during pregnancy, but what is the cause?
What Causes Insomnia Among Pregnant Women?
The causes of insomnia in pregnant women are not that different from anyone else who might develop the condition. The understanding of why insomnia occurs is summarized by considering a predisposition, provoking factors, and precipitating factors.
It seems that some people are more prone to developing insomnia. This predisposition likely has a genetic influence as a tendency toward insomnia often runs in families. It may relate to the degree that a neurotransmitter that works as an alerting signal is present. This makes it easier to stay awake during the day, but also more likely to be a light sleeper at night. Sleep becomes more easily disrupted at night by the sleep environment. In addition, it is harder to fall back asleep. This predisposition is present throughout life, including during periods of pregnancy.
As part of the predisposition towards insomnia, insomniacs have an increased level of arousal. Pregnancy may enhance this tendency. When scientists look at how the body functions while pregnant, they find that the systems seem to be in overdrive. There is an elevation in the heart rate and body temperature. The body’s use of energy, or metabolism, is enhanced. There may be increased muscle tension. In addition, emotional distress may manifest as anxiety or depression, especially as the time for delivery approaches. This state may make it easier to provoke insomnia.
Pregnancy itself may be one of the provoking factors. Pregnant women are more likely to complain of disrupted sleep during the first and third trimesters. There may be hormonal effects, including the role of progesterone in sleep fragmentation. Restless legs syndrome (RLS) can be a frequent cause of difficulty falling asleep in pregnant women. Some women develop sleep apnea and this can also disrupt sleep. Anxiety related to the pregnancy may also disrupt sleep. Many physical changes may also lead to insomnia, including: back pain, joint pain, forced body position in bed, heartburn, leg cramps, and frequent urination.
These various disruptions may lead to symptoms characteristic of insomnia, including:
- Poor sleep quality
- Difficulty falling asleep
- Frequent awakenings
- Early morning awakenings
- Feeling unrefreshed
- Daytime fatigue
- Poor concentration or attention
The emotional or behavioral response to these symptoms may prolong the difficulties. These changes are called precipitating factors. For example, if you have trouble sleeping at night, you may decide to go to bed earlier. Then, before you know it, you are spending an hour trying to fall asleep at the start of the night. The harder you try to fall asleep, the more difficult it becomes. You might also try to nap or rest during the day. This may diminish your ability to fall asleep by undermining your sleep drive. Sleepiness or fatigue during the day may prompt the use of caffeine that may further disrupt sleep at night. Fortunately, there are treatment options available to break the cycle of insomnia.
Treatment Options for Insomnia in Pregnancy
For pregnant women who have difficulty falling or staying asleep at night, there are treatment options that can improve this condition. Many women wish to avoid the use of medications during pregnancy, as the effects of the drugs on the fetus may be undesirable or unknown. This may make alternative therapies more appealing.
The most recommended treatment for insomnia in pregnancy is cognitive behavioral therapy for insomnia (CBTi). CBTi is "talk therapy" that is led by a specially trained psychologist or medical doctor. It may occur with a group in a classroom setting. It may also be arranged with one-on-one session. There is a focus on sleep education and on targeted changes to sleep patterns, behaviors, and thoughts or emotions surrounding sleep. The sessions generally occur on an interval basis over several months and are highly effective at resolving insomnia.
Other alternative treatment options may include optimizing sleep hygiene, including minimizing the amount of wake time in bed through sleep restriction and stimulus control. Some women enjoy setting aside some relaxing time before bed to unwind as a buffer zone before sleep. A warm bath, soothing music, or a nice cup of chamomile may be incorporated into this relaxation. Acupuncture has also been suggested to alleviate insomnia, though further research is needed into its effectiveness.
If you find yourself bothered by insomnia during pregnancy, you should start by speaking with your doctor about ways to improve this condition. Fortunately, there are effective therapies available to help you sleep easier and wake feeling more refreshed. It will make your pregnancy more tolerable and will ensure the health of yourself and your baby.
Kryger, MH et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011, pp. 1580-1582.