How to deal with insomnia during pregnancy

Main causes of sleep problems

Insomnia (asomnia) is a sleep disorder in which the time of full night sleep decreases, a person has difficulty falling asleep, and often wakes up. After waking up, I am bothered by a feeling of weakness and exhaustion, and constantly fall asleep.

Some physiological and psychological changes can provoke sleep disturbances during pregnancy, but the main reason is rapid hormonal changes and emotional instability.

Why does insomnia occur in pregnant women?:

• convulsive syndrome - develops due to calcium deficiency;
• shortness of breath – consequences of a sharp increase in body weight;
• frequent urge to empty the bladder - the uterus increases in size and puts pressure on nearby organs;
• movement of the baby in the stomach;
• discomfort in the sacrum and lower back;
• chronic fatigue syndrome – often an exhausted woman finds it difficult to fall asleep, she constantly tosses and turns;
• unpleasant, scary dreams - the reason lies in increased emotional excitability;
• heartburn, other pathologies of the digestive system;
• As the abdomen grows, stretch marks appear, which causes itching.

Among the psychological factors of insomnia are constant worries about the baby, fear of childbirth, and a state of tension caused by the anticipation of the birth of the child.

Causes of sleep disturbances during pregnancy

• Difficulty breathing in a pregnant woman. Sleep promotes the release of hormones in greater quantities than during the day, and this in turn leads to rapid breathing. A pregnant woman wakes up due to lack of air.

• The growing fetus increases the load on the lower back. Finding a comfortable position while sleeping becomes difficult for a pregnant woman. The corpus luteum of the ovary secretes the substance relaxin, which softens the bones and muscles of the pelvis, thereby preparing the body for future childbirth. This can also cause lower back pain and cause calf muscle cramps during sleep.

• During pregnancy, the functions of the digestive system slow down. Food stays in the stomach for a longer time, which leads to heartburn or bloating.

• Mild sinus tachycardia without obvious causes is a common symptom in pregnant women. Increased heart rate (90 or more beats per minute) can be explained by the stress of working for two.

• As the size of the abdomen increases, the need for frequent urination increases. The uterus puts pressure on the bladder, both day and night.

Problems with sleep at different times

Insomnia often or periodically bothers 85% of expectant mothers; sleep problems most often occur in the first trimester, shortly before childbirth.

Causes of asomnia in the I, II, III trimester

1. Insomnia in the early stages develops due to the active production of progesterone - this hormone prepares a woman’s body for bearing a child and prevents complete relaxation around the clock. Another reason is severe toxicosis, which often makes you feel nauseous even at night.
2. Insomnia during pregnancy in the second trimester is rare - the body already has time to adapt to its new state. Sleep disturbance during this period is associated with non-compliance with the daily routine, increased emotionality, consumption of drinks with a tonic effect, too dry or hot air in the room, and anemia.
3. Insomnia in pregnant women in the 3rd trimester is associated with severe discomfort in the lumbar region, active movements of the baby in the abdomen, heartburn, shortness of breath, and it is very difficult to find a comfortable sleeping position.

Immediately before giving birth, pregnant women's sleep becomes especially sensitive and anxious - women are afraid of missing the time when the birth process begins. Training contractions are also a concern - what kind of sleep is there after them?

Criteria for good sleep

Living without adequate sleep ultimately leads to dire consequences. A person's cognitive abilities decrease, stamina decreases and appetite is disrupted. For a pregnant woman, everything can end in the loss of the child. Expert advice will help you avoid complications:

For a healthy person, the recommended amount of sleep is 6-8 hours. It is advisable for pregnant women to sleep at least 8-10 hours, especially in the early stages. The increase in the norm is justified by the process of adaptation of the body to surges of hormones. If necessary, you can take a 1.5-2 hour nap at lunch. You should not devote more time to daytime sleep, so as not to disrupt natural biological rhythms. The first trimester of pregnancy is characterized by hormonal changes. Progesterone begins to be actively produced. Against the background of these changes, the likelihood of disruption of the sleep-wake cycle increases.

Doctors advise treating insomnia using relaxation methods, exercise and compliance with the criteria for adequate sleep. Additionally, you can use folk remedies. Only a specialist can prescribe drug therapy, based on the condition of the pregnant woman.

Consequences of insomnia

Regular sleep problems during pregnancy negatively affect the functioning of the central nervous system and performance; with frequent lack of sleep, attention and memory deteriorate, and the body’s resistance to pathogenic bacteria and viruses decreases.

Why is insomnia dangerous in pregnant women?:

• chronic fatigue and depression develop;
• the functioning of the heart and blood vessels is disrupted, which is dangerous due to the development of hypoxia;
• chronic insomnia is accompanied by increased anxiety and irritability;
• hormonal imbalance often develops against the background of chronic lack of sleep, which is fraught with increased uterine tone;
• jumps in blood levels, increased heart rate.

According to doctors, the optimal duration of sleep during pregnancy is 9 hours.

Kinds

Insomnia during pregnancy is a very common phenomenon. In the early stages, 8 out of 10 women experience sleep disorders. Sleep disturbances are even considered by doctors to be one of the signs of pregnancy, along with the cessation of menstruation. In the third trimester, almost 100% of women have some kind of sleep problems.

Depending on the disorder, the following types of sleep disorders during pregnancy are distinguished:

• presomnia disorder – manifests itself in the form of difficulties falling asleep (most often due to increased anxiety);
• intersomnia disorder - it causes disturbances in the sleep process, expressed in the form of periodic awakenings in the middle of the night, after which it is difficult to fall asleep again;
• Postsomnia disorder is a consequence of early awakening in the slow-wave sleep phase, which leads to weakness, fatigue, and loss of strength during the day.

Expectant mothers in different trimesters of pregnancy suffer from all 3 types of insomnia. If in the early stages, due to stress and increased nervousness, presomnia disorder most often manifests itself, then at the end of pregnancy, intersomnia and post-somnia disorders usually occur (due to hormonal changes, restructuring of all body functions).

Based on the duration of the disorder, the following types of insomnia are distinguished:

1. Transient insomnia is a disorder that lasts from 1 day to 1 week. It is usually associated with stress and increased anxiety of the expectant mother. In this case, the help of a doctor is not required. To get rid of the problem, it will be enough to improve sleep hygiene, normalize your daily routine and diet, and eliminate physical and emotional overload.
2. Short-term insomnia lasts from 1 week to a month. It is a fairly serious condition that can negatively affect the health of the expectant mother and baby. With this problem, it is better to contact a gynecologist so that he can help determine the cause and prescribe appropriate treatment.
3. Chronic insomnia is a sleep disorder that lasts more than a month. It has an extremely negative impact on the quality of life of a pregnant woman, on her psycho-emotional state, performance and readiness to give birth to a child. In this case, a visit to a doctor (preferably a sleep specialist) is mandatory.

How to deal with sleep disorders - basic recommendations

The best way to prevent insomnia is to create optimal conditions for night rest. Pregnant women have very sensitive sleep, a woman reacts to all external stimuli - be sure to ventilate the bedroom for 10-15 minutes in the evening, humidify the air in the room, use special protective eye patches or hang thicker curtains on the windows.

It is also important to adhere to a daily routine - gradually learn to go to bed and get up at the same time, even if you have the opportunity to sleep longer, do not get carried away; sleeping too long also negatively affects your health, just like lack of sleep.

Insomnia during pregnancy - what to do

1. Find a comfortable position - doctors recommend that expectant mothers sleep on their left side so as not to disrupt the normal blood flow. If you have heartburn, it is better to sleep in a slightly elevated position.
2. You can place small soft pillows under your legs and stomach.
3. Start getting ready for bed at 19-20 hours - take a relaxing warm shower, remember, hot baths are contraindicated for expectant mothers, especially in the first trimester. Listen to calm music, stop watching TV, or rather read a sentimental novel. Go to bed no later than 11 pm.
4. 40-60 minutes before bedtime, add a few drops of lavender essential oil to the aroma lamp - this will help you relax and calm down. You can lubricate your temples with this oil before going to bed.
5. Try to do all the necessary things in the first half of the day. If you want to take a nap during the day, sleep, but no more than an hour.
6. Walk more, do moderate sports - swimming, yoga, special gymnastics for pregnant women.
7. Do not eat at night; dinner should be no later than 3 hours before going to bed. If you really want to have a snack, a glass of kefir or natural unsweetened yogurt will help you satisfy your hunger; those with a sweet tooth can treat themselves to a baked apple.
8. Don't drink a lot of fluids before bed. If you absolutely cannot give up tonic drinks, drink them only before lunch, and no more than 200-250 ml.
9. If stretch marks appear, lubricate the skin with special moisturizers to prevent night itching.
10. The child often begins to actively move in the stomach at night due to hypoxia, so if the baby kicks, walk around a little, stand near an open window.

To ensure a comfortable sleep, choose comfortable pajamas and soft-touch bedding made from natural materials. Don't forget about relaxation - a light massage of the feet, lower back, if there are no contraindications, have sex.

Ways to combat insomnia

Among the means of combating insomnia, non-drug ones should be considered first. Fortunately, most sleep problems that pregnant women experience tend to go away once the baby is born. Practicing good sleep hygiene can significantly improve your sleep quality without the need to resort to medications. They include:1

Sleep hygiene

• Maintain a healthy sleep schedule: You should go to bed at the same time every night and wake up in the morning. This helps the body's biological clock work more efficiently. Sometimes a warm bath before bed can be helpful.
• Try to avoid napping during the day if you have trouble sleeping at night.
• Avoid drinking caffeine-containing drinks (tea, coffee, cola), especially in the evening.
• Don't drink too much liquid in the afternoon. This will help reduce the frequency of getting up at night to satisfy the need to urinate. This means it will also help with sleep disturbances.
• Avoid watching TV, working on the computer for long periods of time, or using the phone before bed.
• Read books or listen to soothing music to help you fall asleep quickly.
• Avoid strenuous exercise/workout in the late afternoon or evening.
• It is important to find a comfortable sleeping position. This can sometimes be achieved by using extra pillows or special pregnancy pillows.2

Behavioral therapy

Behavioral therapy for insomnia, in addition to sleep hygiene, includes: relaxation, sleep restriction, cognitive therapy, and cognitive behavioral therapy for insomnia.

• Relaxation techniques , for example, try alternately squeezing and relaxing different muscle groups each time you go to sleep. This is called progressive muscle relaxation. Deep abdominal breathing with relaxing thoughts can also help you relax before falling asleep.
• Limiting sleep (i.e., not lying in bed for a long time) prevents disturbances in the biological rhythm and helps prevent insomnia. This method helps improve sleep efficiency. To calculate this efficiency, you need to divide the duration of sleep by the time spent in bed. Once this figure reaches 85%, you can allow yourself to spend 15-30 minutes more in bed.
• Cognitive therapy aims to reduce anxiety, negative thinking associated with lack of sleep, and develop realistic expectations for the patient's sleep duration. Some people have preconceived misconceptions about the amount of sleep needed for the body to function properly. This should be resolved with this therapy.
• Cognitive behavioral therapy for insomnia includes all of the above methods, which are carried out in a certain sequence over several sessions under the supervision of specialists.

However, there are no studies showing whether these methods improve insomnia in pregnant women.1

Drug therapy

Sleep hygiene is very important in the fight against insomnia. However, in some cases, pharmacological agents may be required for treatment.2

Most insomnia medications pose a risk to the developing fetus. Therefore, taking any medications is possible only after consulting a doctor.

Low levels of folic acid and iron during pregnancy increase the risk of developing restless legs syndrome, which also leads to insomnia. Therefore, you can take a prenatal vitamin and iron complex. Folates (a natural analogue of folic acid) are better absorbed from foods such as grains, cereals and breads than from tablet supplements. Coffee consumption reduces, and vitamin C increases their absorption from food.

Gastroesophageal reflux disease (heartburn) can be treated with over-the-counter antacids.

There are no safe medications for pregnant women who experience frequent urination at night. Therefore, the best way is the limited fluid intake described above.

For moderate to severe sleep disturbances associated with anxiety disorders during pregnancy, pharmacological treatment is often important also to reduce the risk of prenatal mental illness.

Do pregnant women need medications for insomnia?

Frequent sleep disturbances during pregnancy cannot be ignored. But almost all sleeping pills and sedatives are contraindicated for expectant mothers; they are prescribed by a doctor only in very advanced cases.

Conditionally safe sedatives during pregnancy:

• Glycine;
• Persen;
• Motherwort;
• Valerian tablets;
• Nervochel;
• Magne B 6.

It is strictly contraindicated for pregnant women to take any pharmaceutical or folk remedies based on vodka and alcohol, but you can inhale the vapors of the tinctures if you can’t sleep for a long time.

The effect of insomnia on pregnancy

The effects of lack of sleep on pregnancy are not fully understood. According to the 2004 Sleep in the Last Months of Pregnancy study, having insomnia at 38 to 39 weeks of pregnancy increases the average length of labor from 20 to 29 hours and increases the likelihood of a cesarean section by 37%. A high percentage of this type of delivery occurs in women who sleep less than 6 hours a day.

In 2011, specialists from the Department of Social Medicine Fr. Crete published a study on the effects of insomnia on fetal development and labor. According to the data presented, the risk of underweight and growth retardation of the newborn was observed in women with severe forms of snoring. Also, insufficient sleep increased the likelihood of premature birth for medical reasons by 2.4 times.

If insomnia occurs at any stage of pregnancy, and especially insomnia during pregnancy in the third trimester, a mandatory consultation with a therapist, neurologist or psychologist is required. Restoring sleep and wakefulness will help the expectant mother avoid further serious health problems.

Folk remedies for normalizing sleep

There are many proven and safe methods of alternative medicine to eliminate and prevent insomnia, but they should not be thoughtlessly used during pregnancy; be sure to consult your gynecologist.

How to deal with insomnia using folk remedies:

1. Before going to bed, drink a glass of warm milk with 5-10 ml of honey in small sips; this drink not only promotes sound sleep, but also strengthens the immune system and contains many useful substances.
2. Mix 1 tsp. crushed valerian and oregano, add 150 ml of water, simmer the mixture over low heat for 5 minutes, leave in a sealed container for an hour, strain. Drink the decoction in the evening in small portions.
3. Crush fresh cranberries and mix with an equal amount of honey. Eat 1 tbsp. l. mixture every day before dinner.

If sleep doesn’t come, try doing a few simple exercises - alternate shallow and intermittent breathing, hold the air as you inhale for 15-20 seconds, raise your legs a little, imitate walking.

This type of gymnastics is simple and safe for mother and unborn baby.

Monotonous activities help to cope with insomnia - reading a complex book, knitting, painting a mandala with small details.

How to “treat” insomnia in early pregnancy?

Transient or situational insomnia does not need to be treated. It is enough to wait until the emotional state stabilizes. Such insomnia can last no more than 7 days; then, if efforts are not made to stabilize the emotional background, insomnia moves into other categories. By the way, expectant mothers should avoid any strong emotions: do not watch overly “whiny” movies, do not meet people who cause a strong reaction, and so on.

Short-term insomnia should last no more than one month. If more, this is a reason to consult a doctor. Often this type of insomnia is caused by toxicosis at the beginning of pregnancy. Unpleasant sensations accompany the expectant mother at night. Sometimes this type of insomnia is caused by taking special medications - as a side effect. Tell your doctor about this, he will change your medications.

The most dangerous type of insomnia for mother and baby is chronic. With it, a woman cannot sleep for many months. The result is extreme nervous exhaustion and the risk of premature birth. This insomnia can only be treated by a doctor.

Insomnia during pregnancy or where did your sleep go?

Long-term medical research in the field of studying the processes of pregnancy and childbirth shows that changes occur in the body of a pregnant woman at the level of biochemical, hormonal, and nervous regulation, which in turn leads to changes in the functions of all organs and systems.

It is during this period that a significant proportion of expectant mothers, especially those living in large cities, where environmental disturbances and a frantic pace of life are commonplace, experience changes in the processes of sleep regulation (simply put, insomnia), which, under unfavorable circumstances, can lead to a number of other disturbances in the normal course of pregnancy and postpartum recovery.

When we sleep, various hormones begin to be produced in the body, processes of accumulation of energy reserves, regeneration, plastic metabolism occur, and resources depleted during the day are restored. During sleep, temperature, pulse, pressure, and the nature of nervous activity change, and sleep itself has several phases that change cyclically with a frequency of 90–120 minutes. These are alternating phases of slow, or orthodox, and fast, or paradoxical, sleep.

Such cycles are repeated 4–6 times per night. In turn, the slow-wave sleep phase consists of four stages:

1. The first stage corresponds to drowsiness. The muscles relax, but the consciousness is still working. Brain biorhythms are irregular and fast.
2. The second stage represents the beginning of sleep proper.
3. The third and fourth are the deepest and are called delta sleep. During it, the rhythms of the brain gradually slow down, the reaction of the eyes to external stimuli stops, and the body plunges into a state of deep peace. The senses do not react to the environment.

Then all changes occur in the reverse order, but not until full awakening, but to the REM sleep phase. The pupils of the eyes begin to move quickly, body temperature and blood pressure rise, breathing becomes more frequent and less regular, gastric juice and adrenaline are released faster. If you record an encephalogram at this moment, the electrical impulses of the brain will be similar to the biorhythms reflecting daily life. But this is a special state of the body, as if turned inward. This is why REM sleep is called paradoxical sleep. During this stage, dreams occur. It lasts about 10 minutes, again giving way to deep sleep.

Modern doctors distinguish three main types of insomnia:

1. The first is the so-called starting insomnia , when a person cannot fall asleep for a long time, remembering the events of the day, experiencing thoughts about what he should have done or said, or worrying about the future.
2. The second type is the inability to maintain the sleep state. Such a person wakes up repeatedly throughout the night and for varying periods of time. This condition leads to divided sleep and does not allow deep rest.
3. And the third type, in which a person wakes up early in the morning and is unable to fall back to sleep, is final phase insomnia.

During pregnancy, due to the characteristics of the nervous system, there is a change in the rhythms of excitation and inhibition in the brain, a symptom of limb movement in sleep appears, and the need for oxygen increases.

• It becomes more difficult for the stomach to cope with its work as the uterus increases in size and begins to take up more space. Therefore, you should not eat heavy food at night or, on the contrary, remain hungry. It is best to have dinner a couple of hours before bedtime and drink a glass of milk with honey. But you must definitely drink it in small sips.
• Due to the growth of the uterus, there is less space for the bladder. Therefore, pregnant women have to run to the toilet more often. Try to drink more during the day and less at night. When you are pregnant, the best sleeping position is on your side. You can add pillows to make it more comfortable. But you shouldn’t sleep on your back even if that’s what you’re used to. In this position, the uterus with the child and all other organs lies on the intestines, spine, and presses on the diaphragm. Because of this, back pain occurs, it becomes difficult to breathe, and digestion is disrupted.
• Try to spend less time in stuffy rooms. It is better to dress warmly and sleep under a warm blanket, but with the window slightly open. Insomnia often occurs due to intellectual fatigue, so during pregnancy you should not subject yourself to intellectual overload at work. Now you are many times more sensitive and vulnerable to all kinds of stress.
• Also, expectant mothers often worry about the upcoming birth and the unborn child. Try to disconnect from everyday worries and thoughts at night so that your brain can rest peacefully. Walk more often, talk to your baby, sing songs to him, dance. During the day, our subconscious accumulates a lot of negative and useless information, which it seeks to get rid of by “working through” it in the form of a nightmare image in a dream. Do not attach much importance to such dreams, do not solve them, and especially do not consider them “prophetic”!
• Before going to bed, take a warm bath. Cosmetic procedures will also bring a lot of positive emotions; it is better to apply the cream some time before going to bed. Sometimes a pregnant woman says that after waking up at night, she no longer wants to sleep. What to do in this case? Often people build stereotypes for themselves, because of which they themselves suffer. Once it’s night, it means you need to sleep. Are you awake? Find something interesting to do! You can read, draw, write poetry, water flowers, bake pies, listen to music. Don’t get attached to the time of day, especially since after the birth of your baby, the time of day will change its significance for you.
• There is another reason for insomnia. It is possible that the body “trains” in this way before sleeping together with a child, when it will be necessary to sleep very lightly and wake up at the baby’s every call. That is why insomnia should be treated with extreme caution and, if possible, not use sleeping pills. Your body is preparing to switch to a new sleep pattern: intermittent sleep at night and catching up on sleep during the day. And in this you should help him, and not interfere: if possible, sleep during the day, and do not worry about your insomnia. Imagine that very soon you will be breastfeeding your baby during these hours. What condition should you be in? Of course, the most peaceful one. Therefore, now choose an activity that will help you quickly achieve this state.

But now the nightly ritual of getting ready for bed is completed, and you are already in bed. How to fall asleep faster?

1. Try to “disconnect” from the problems that worried you during the day. Leave them on paper overnight. List the problems that concern you, describe your attitude towards them, you can paint your feelings. And leave it. You can come back in the morning if you want. Make yourself a comfortable, beautiful bed, dim the lights, turn on an aroma lamp with relaxing essential oils, take a nice warm bath, turn on calm music or meditative text. Or just listen to the ticking of the clock.
2. Usually, before falling asleep, we begin to go through all our problems in our heads, and our facial muscles tense, reflecting all these experiences. Notice how tense the forehead is, the lips are compressed, the eyebrows are knitted. In order to turn off the emotions that prevent you from falling asleep, you need to relax your facial muscles. If it is difficult to do this right away, relax gradually, controlling each muscle. Pay attention to the neck and throat. Relax your lower jaw and root of your tongue. If the brain is active, the eyeballs harden, and the eyes become unfocused, make sure that the pupils remain in the same position. Relax the skin over the facial muscles, which in turn will relax the sensory organs. Relax your fingers; your palms should be thin and soft. Mentally direct your eyes and ears inward and merge at some point in the center of your chest, where they will not be disturbed by external noises.
3. Breathe slowly and calmly, focusing on the sensation of the air inhaled and exhaled. Feel that the exhaled air becomes warmer. After you have relaxed as much as possible, it will be good to do the following meditation: Become aware of your body. Try to mentally recreate its picture or feel it. Become an observer. Try to realize (catch) the sensations that arise during perception. For a short period of time, try to notice as many sensations as possible throughout your body.
4. Then, after about a minute, begin to become aware of the sensations in the skin of your right foot, although this may seem difficult at first. Is your foot cold, warm, tense, or something else? You need to feel it. Then slowly move your awareness (the ray of attention) to your calves and thighs, becoming aware of the skin sensations. Repeat the same with your left leg, starting from the foot. Then begin to become aware of the fingertips of your right hand. Feel: are your fingers hot, cold, or something else? Slowly move your awareness through your palm, wrist, upper arm, and upper arm toward your shoulders, all the while being aware of the mental picture and sensations. Repeat the same with your left hand, be aware of it.
5. Now feel the sensation of your cheeks - this is a very sensitive part of the body. Do your cheeks feel warm, cold, or something else? Be aware for a minute or so. Then repeat the same with your lips. Are they dry or wet? Be aware of the ears. What sounds are being picked up? Be aware of them, feel that they do not affect you; you just watch them. Be aware of the eyes. You can roll your eyes a little with your eyelids closed and catch any sensations that occur. Observe various visual forms that pass before your closed eyes. Try to relax as much as possible.
6. Your breathing slows down, becomes calm, deep. Observe your breathing. Allow yourself to simply exist, flowing from one sensation to another. During inhalation, the chest rises, filling with a clean flow of air. It passes through your body, supplying oxygen to every cell and every organ. The chest drops and the air flow moves in the opposite direction. Perhaps your baby is showing up in some way now - moving more actively or becoming quiet, listening, feeling your attention, breathing. The stomach warms up with a pleasant deep warmth. How are you feeling now? A feeling of warmth, heaviness, bliss, languor or bodily lightness - the absence of body boundaries?
7. Observe, peer into your inner background, which is now in front of your inner gaze, into its color and depth. Gradually, pleasant relaxation comes to you. You shift your attention easily and freely. Imagine yourself in a meadow. Sunny day, deep blue sky. You peer into this depth. White cirrus clouds. Clouds are like our thoughts - they float, float and float away. Flowers, lush green silky grass gently touches your skin and smells spreading over the ground. You smell those sweet smells. Birds are singing, you can hear the sound of a waterfall flowing somewhere and lots and lots of light filling the space.

The main thing is to remember that everything is in your hands and in your power to make sure that your sleep is calm and pleasant!

Sweet dreams!