Pregnancy can pose serious challenges to sleeping well. Poor quality and too little sleep are common during pregnancy, when many women experience fragmented sleep and symptoms of insomnia. Even women who don't generally experience sleep problems find that during pregnancy they have difficulty falling asleep and staying asleep, as well as trouble getting enough sleep.
We talk a lot about sleep issues for new mothers. But new research suggests we should be paying more attention to the sleep health of expectant mothers as well.
Researchers at the University of Pittsburgh Medical Center found links between both the quality and quantity of pregnant women's sleep and complications at birth, including low birth weight and pre-term births. The link between birth complications and expectant mothers' sleep appears to be in disruptions to normal immune system function, caused by insufficient and low-quality sleep.
Depression during pregnancy is another risk factor for birth complications. Researchers sought to understand how poor sleep among pregnant women might influence birth-related complications, and what, if any, role depression might play in this relationship. Researchers included 168 pregnant women in their study. Some were depressed and others were not. At 20 weeks and again at 30 weeks gestation, researchers evaluated the women's sleep and immune system functioning. They collected information about sleep through interviews. In order to assess the women's immune function, researchers measured levels of cytokine production. Cytokines are communication molecules that are involved in regulating the body's immune responses. The over-production of certain cytokines is a sign of elevated levels of inflammation in the body, and a signal that the body's immune system is not working properly. Researchers found:
- Poor sleep and depression were both associated with increased risk for birth complications, when found separately and together.
- Among the women evaluated, those with both depression and poor sleep were at the greatest risk for complications including pre-term birth and low birth weight.
- At 20 weeks of pregnancy, depressed women had higher levels of cytokines than non-depressed women. By 30 weeks, the differences in cytokine levels between depressed and non-depressed women had disappeared. Researchers concluded this was likely because of a natural rise in cytokine production over the course of pregnancy.
What we're seeing here is evidence of the complicated, dynamic relationship among sleep, immune function, and depression. These conditions often can be found together in both women and men. Research suggests that these conditions can influence each other in multiple ways:
- There's compelling evidence indicating that sleep plays a critical role in immune health, and that insufficient and poor quality sleep contributes to elevated levels of inflammation in the body.
- Sleep and depression have a well-documented and complex relationship, with sleep disruption contributing to depressive symptoms and depression interfering with sleep.
- Research also shows that inflammation may be a significant risk factor for depression, with and without the presence of sleep problems.
Understanding more about the ways sleep interacts with immune function and depression is important in general -- but it may be particularly important for pregnant women. Women face particular challenges to sleep during pregnancy. Fatigue is a common issue for pregnant women, and one many women know to expect. But sleep problems and sleep disorders are also can be more likely to occur during pregnancy. Women are more at risk for restless leg syndrome, sleep-disordered breathing, and insomnia during pregnancy. In a National Sleep Foundation poll, 78 percent of women reported experiencing more disrupted sleep during pregnancy than when not pregnant. There are several factors that can contribute difficulty sleeping during pregnancy, including:
- Hormonal changes. Pregnancy is a time of many hormonal shifts, which change sleep cycles and can disrupt sleep. Rising levels of progesterone can cause respiratory changes that disrupt sleep, as well as more sleepiness during the day, leaving women unusually wakeful at night. Fluctuating levels of estrogen also cause physiological changes that interfere with sleep.
- Pain and discomfort. Lower back pain, nausea, heartburn and other physical discomforts can often interfere with sleep. Having to get up to go to the bathroom frequently throughout the night is another common hazard to sleep during pregnancy.
- Anxiety. Pregnancy can be a wonderful and exciting time of life. Women also experience anxiety about the pregnancy itself as well as about managing all the aspects of their lives alongside the impending arrival of a new baby. Feeling anxious can make falling asleep and staying asleep more difficult.
Sleeping well during pregnancy is a challenge -- but it doesn't have to be impossible. For many women, it may mean taking some extra time and paying extra attention (good ideas for pregnant women in general) in order to protect both quantity and quality of sleep as a pregnancy progresses. As this study shows, protecting sleep during pregnancy is not only good for a mother's health, but her child's health as well.
Michael J. Breus, PhD
The Sleep Doctor®
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