WOMEN & SLEEP || Adventures in Sleep for the Pregnant Woman, Part Two: The Second Trimester

See Also:
Adventures in Sleep
for the Pregnant Woman, Part One:
The First Trimester
---
Adventures in Sleep
for the Pregnant Woman, Part Three:
The ThirdTrimester
---
Adventures in Sleep
for the Pregnant Woman, 
Postpartum Edition

So you've made it through the first 13-14 weeks, congratulations! You may find the second trimester much easier to cope with in regard to sleep issues. Less nausea and more energy are common improvements women enjoy as they move into the middle of their pregnancy. But sleep may still be disrupted, at least compared with how you slept before pregnancy. 

Potential sleep disruptions during the second trimester include: 

1. Sleep breathing problems
2. Charleyhorses and restless legs
3. Vivid dreams 

Let's take a closer look.

Sleep breathing issues can become more apparent during the second trimester. At this point, the pregnant woman has gained some necessary weight, and swelling and fluid retention have likely become the new "norm." 

Sleep breathing issues that can emerge include snoring, nasal congestion, upper airway resistance and obstructive sleep apnea. 

Body tissues during pregnancy soften due to hormone changes and retain more fluid, making the airway a target for airflow resistance. Mucus membranes may in fact be generating even more mucus than normal, which contributes to that resistance. Snoring reflects the vibrations and sounds that come from the friction inside the airway as the person breathes in and out. Nasal and sinus congestion can also be blamed on these hormonal shifts. Blood vessels will also expand, crowding your airway passages as well. 

Upper airway resistance syndrome is a sleep disorder in which the pattern of snoring and friction through the nasal passages and upper airway in general leads to micro-arousals, mini waking sessions which disrupt the architecture of sleep and can lead to sleep fragmentation, a cause of excessive daytime sleepiness. 

Finally, if the airway becomes blocked, either partially or completely, by enlarged or swollen tissues or due to fluid retention in the neck, obstructive sleep apnea can occur. OSA is especially concerning for pregnant women because it leads to lower blood oxygen saturation during the night which can have negative impacts on both mother and baby.

Solutions? Speak to your doctor about nighttime congestion, excessive daytime sleepiness or any reports from your sleep partner about gasping, loud snoring or choking sounds you might be experiencing during sleep. Other signs you might have a sleep breathing issue include waking up with dry mouth in the morning, headaches upon waking, and elevated blood pressure that can't be explained by anything else. 

Snoring and congestion can usually be corrected by simple treatments or behaviors like positional therapy or saline nasal spray. Try elevating the head of your bed by three inches to help with postnasal drainage, and learn how to sleep on your side, if you haven't already.

If your doctor suspects UARS and/or OSA, they may have you participate in a home sleep study and/or an overnight sleep study to identify what's going on so they can give you appropriate treatment.  This can include a trial on PAP (positive airway pressure) therapy or an oral device to reposition your jaw so that your airway remains clear throughout the night.

Nighttime leg cramps, sometimes called "charleyhorses," are a common complaint among women who are pregnant. You're sleeping just fine, then WHAM! your toe or calf muscle seizes up, sending you out of your bed to massage the rock-hard spasm or walk it off. The experience is painful and highly disruptive to sleep.
Similar to these leg cramps are restless legs. They occur just as you are going to bed; your legs begin to feel restless and you are compelled to walk to calm them down. Some people describe the feeling as crawling, tingling or burning sensations or an undeniable need to move the legs. As many as 16 percent of all pregnant women experience restless legs. Restless legs can happen during the day as well, especially after long periods of sitting. At night, however, they become a nuisance because they can force a delay in sleep onset and pregnant women need to get as much sleep as possible.

In either case, leg cramping may indicate a dietary imbalance in minerals like potassium, calcium, magnesium or iron. It could be that your enlarged blood vessels in your legs experience more pressure than usual, leading to these kinds of discomfort. Surges in estrogen and progesterone can lead to the experience of restless legs. Finally, restless or cramping legs may present in a way that is similar to "growing pains" in children. Many pregnant women literally feel their body growing while pregnant and these sensations in the legs might reflect that phenomenon. 

Solutions? Some simple habit changes can go a long way to help you prevent leg cramps at night, such as standing for long periods or sitting in a way that prevents good blood flow. You would be better off moving your body from sitting to standing to walking to elevating your feet throughout the day to improve circulation in your legs. Stretching your calves and moving your feet in circles in both directions also offers some relief; so does massage. Left side sleeping improves blood circulation while you sleep. 

Don't forget to drink you water as dehydration can be a direct cause of leg cramps. If you drink a lot of tea or coffee during the day, you may rethink this habit; both have a diuretic effect on the body and can lead to unintentional dehydration. If you don't want to exclude these beverages from you diet, at least consider chasing each glass or cup of tea or coffee with an equal amount of water to replace your fluids. Remember, dehydration can also lead to ongoing fatigue.

How to fix a charleyhorse: Stand upright and straighten your affected leg, flexing your heel so that your toes are pointed back toward your shins. Breathe through the pain this might cause at first; it will subside as the spasm lets go of the affected calf muscle. Walking a few minutes to improve mobility of the muscle, or using a hot pad or heating ointment on the muscle can also help.

Be wary of any swelling or tenderness in your leg that may accompany the cramping. With the larger volume of blood circulating in your blood vessels, the odds naturally increase for blood clots. Though these are rare, they still require immediate identification and treatment. 

For people with restless legs, a massage or warm shower at bedtime can be extremely helpful for calming those uncomfortable sensations. Taking a short, slow walk can also help. It may be that an increase in light exercise during the day can counteract some of the restlessness that some feel in their legs at night.

Finally, many women will swear on supplements for minerals like magnesium, calcium, potassium or iron; you are best advised to discuss these possibilities with your doctor. For most pregnant women taking an iron-fortified prenatal vitamin, the amounts dosed in this daily supplement should be enough to supplement their needs. However, eating foods high in these minerals is still a better way to improve their levels in your bloodstream, since eating mineral-rich foods makes many minerals and vitamins more bio-available, which is better for both mother and baby. 

A vivid dream life may continue into your second trimester (see our comments on what this means in Part One). Again, go with the flow and try not to let this bother you. Dreams are a great release for anxiety and you shouldn't worry about them too much.

WOMEN & SLEEP || Adventures in Sleep for the Pregnant Woman, Part One: The First Trimester

See Also:
Adventures in Sleep
for the Pregnant Woman, Part Two:
The SecondTrimester
---
Adventures in Sleep
for the Pregnant Woman, Part Three:
The ThirdTrimester
---
Adventures in Sleep
for the Pregnant Woman,
Postpartum Edition

The first trimester may be smooth sailing for you or it may lead to all kinds of surprises. Knowing what to expect can help to offset the worst things that could happen to your sleep. Now is the time to get into the practice of listening to signals from your body: if you're tired, sleep. If you're hungry, eat. If you feel overwhelmed, slow down. Learn your cues now; this is a skill you will need from here on out, not only for helping yourself but also in your role as a future mother.

The main problems women have with sleep during their first trimester fall into the following categories:

1. Insomnia or daytime sleepiness, or both
2. Swelling and excess bodily fluids
3. "Morning sickness"
4. Nightmares
5. Changes in appetite

Let's take a closer look.
Sleep problems (insomnia or daytime sleepiness) can be blamed mostly on surging hormones (namely, progesterone). This is because your body is in constant chemical flux while it adjusts to the ongoing changes taking place not only in your womb, but in your brain, your blood, nearly every other organ. 

If you can't sleep at night, check in with yourself to make sure it's not due to any stress or anxiety brought about by the uncertainties of pregnancy and future motherhood; these will also interfere with your ability to sleep well.
Solution? Progesterone levels can lead to daytime drowsiness and nighttime restlessness; it's just part of the territory.

Take naps when you can. If you are working while pregnant, ask for a private space to nap during the day; many offices are now more open to cat naps as a way to refresh employees, leaving them more productive. 

Also, don't let insomnia stress you out, and if you find you are worried about your pregnancy and the future, find someone to talk to about it. 

Learn new ways to relax at bedtime and practice simply resting if you can't sleep so that your body still gets a physical reprieve. Being flexible is key.

Extra body fluids means you have more blood in your body as well as more fluids collecting (you'll notice this mostly in your feet or your breasts). The extra body fluids may mean you need to use the bathroom more often at night and find it hard to get in a comfortable position due to the discomfort of swelling. Breasts may feel tender. If you sleep on your stomach, any swelling there could make it hard to achieve a comfortable position for sleeping. 

You may also find it harder to breathe at night; this is because your nasal passages may also be swollen, or you may be collecting the day's swelling in your neck tissues, leading to potential airway blockage as you sleep.

Solution? If you have extreme swelling, mention it to your healthcare professional. Edema can signal potential problems that should be addressed right away. 

If it's just an annoyance, but does not alarm you, then keep drinking your water as a way to flush out your system. Becoming dehydrated will just make you more fatigued. Your body is built to collect some extra fluid during pregnancy so that it can help build the amniotic sac. If that means you need to use the restroom more often at night, then it's something you'll need to adjust to (cutting back at night can help, if need be). 

Also, learning how to sleep on your side can help with multiple comfort issues: left-side sleeping offers some relief from reflux and both partial and complete obstructions of the airway (apnea); it also improves blood flow between your body and your womb and better assists your system in voiding wastes. 

When you lay down at night to sleep, fluids that have collected in your feet will redistribute across all of your tissues (gravity) and that could mean you may be experiencing apneas at night. 

If your bed partner tells you they have noticed you gasping for sleep or snoring when you weren't snoring before, speak with your doctor about getting a sleep study to rule out (or rule in) sleep apnea as the culprit behind your sleep problems. 

Nausea and vomiting, incorrectly dubbed "morning sickness," can happen at any time and doesn't wait until morning to present itself. You may find yourself feeling sick at 2pm or 2am as well as 7am.  

While there's no specific reason behind these side effects of pregnancy, they are usually the result of your swiftly changing body chemistry, matched with heightened sensitivity to odors and taste. Your digestive system is also making changes and the result may lead to feeling sick to one's stomach.

When nocturnal queasiness strikes, it can cut significantly into quality sleep time. If it is an ongoing problem and you are sick and vomiting around the clock, contact your doctor immediately.

Solution? Mild carbohydrate snacks like crackers, kept on your nightstand, can take the edge off nausea. 

So can avoiding high-fat acidic foods before bedtime, which can lead to reflux and gastrointestinal issues. 

Acupressure wrist devices (used for seasickness), when worn to bed, may help. 

Ginger tea at bedtime is helpful for some, but make sure it is only ginger (other herbs can be dangerous to take during pregnancy). 

Ultimately, don't let this common problem get you down; try to remember that it is usually temporary and goes away for most mothers by the end of the first trimester, if not sooner. 

For those who have extreme problems, consulting your healthcare professional about an anti-nausea drug may be the only way to conquer the problem of nausea and vomiting. 

Vivid dreams are a product of brain and body chemistry changes blended with your own anxieties about being pregnant and anticipating the new work of mothering. 

You will have both positive and negative emotions at this time: mood swings are normal as you begin to reinvent who you are with the prospect of becoming a mother. Dreams and nightmares are one way your consciousness allows you to work off some of that extreme anxiety or anticipation. 

You may also just notice your dreams are more vivid because you'll wake up more frequently due to a need to use the bathroom; that unexpected wake time might interfere with one of your REM (rapid eye movement) or "dream" cycles, meaning you are likely to remember your dreams than if you'd just slept right through them.

Solution? If you have extreme emotions about being pregnant, you may want to get some help to manage your anxiety. If it's not extreme, then try capturing your dreams in a journal. 

Vivid dreams, in and of themselves, are not a bad sign of anything. They just happen. If the content and tone of your dreams is more or less positive, especially, try to find ways to enjoy this experience. 

Appetites change dramatically during the first trimester. You are eating for two, after all! Your metabolism is racing! For some women, this means constant hunger and cravings for odd foods; for others, it means food aversions. 

Food cravings and insatiable hunger can keep up the most ardent sleeper. 

For food aversions, the mere thought of certain foods right before bed can launch a wave of nausea.

Solution? Manage your meals so that you have them evenly spaced throughout the day, and choose healthy snacks between them to cut down on hunger pangs. 

It's okay to indulge in cravings if they are healthy, but portions and frequency of cravings of high-fat, less-healthy foods should be held in check. 

Also, try to keep your nighttime foods limited to lower fat, lower acid foods to ward off reflux. 

If you have food aversions, go ahead an honor them as long as they don't get in the way of eating healthy, keeping in mind that, if you don't eat enough calories, by nighttime your hunger pangs may present as nausea. 

Some healthy snacks to have on hand for all hours of the day and night include fresh fruit, cut raw vegetables, avocado, whole grains, whole grain breads and crackers, peanut butter, cereal with milk, hard-boiled eggs, low-fat cottage cheese, cheese sticks, and lean organic cold cuts.

WOMEN & SLEEP || Introducing Adventures in Sleep for the Pregnant Woman

It may or may not surprise the new mother-to-be to learn that their sleeping habits may suffer even before they have their baby, even as soon as a few short weeks into pregnancy. In fact, the sleep deprivation that comes of starting a new family can begin well before the baby is even born!

The first part of a woman's pregnancy is a busy time for the body; major changes are taking place that may not be outwardly obvious. The bloodstream is racing with new levels of progesterone, which can lead to swelling, changes in the actual structure of certain tissues, extreme changes in energy levels, unusual cravings, nausea and, for many, a deep desire to sleep all day every day. 

Over the next few days, SHC will discuss the "adventures in sleep" by breaking down what to expect by way of trimesters before birth and into the days postpartum. Generally speaking, however, a woman who is newly pregnant can expect to experience changes with some or all of the following body functions over the course of their pregnancy. 

Anxiety: The uncertainties of pregnancy, when added to the day's list of other worries, can take its toll on sleep. 

Appetite: Some women have immense cravings and feel like they cannot eat enough. These feelings don't just happen during mealtimes, either; sometimes hunger pangs can wake up the soundest sleepers when they are pregnant. 

Congestion: Your body overall will swell as it holds more fluids, and that can lead to stuffy noses that can make it difficult to breathe comfortably at night.

Fitness impacts: Levels of fatigue may swing high or low depending upon the pregnancy. Also, one's ability to exercise can be interrupted by many of these other symptoms. Exercise can help tremendously with a good night's sleep, but if it's done too close to bedtime, it can leave stress hormones at too high a level to promote an easy transition to sleep. 

Frequent urination: The uterus and the bladder will have many battles over real estate across the entirety of pregnancy as pressure from the uterus will place more voiding demands on the bladder. This can mean lots of nocturnal awakenings to use the bathroom.

General discomfort: The processes that define pregnancy are complex; so many different organs and tissues are undergoing transformation more or less at the same time. Your body, no doubt, will feel different and, sometimes, downright uncomfortable. Sleeping may be an uncomfortable experience as the body shape changes, weight distribution falls out of normal balance and joints and connective tissues try to keep everything in place. 

Heartburn and indigestion: This is a common side effect of pregnancy and can lead to reflux disease at night, which can keep many pregnant women up late (especially if they are having nighttime food cravings). 

Insomnia: There are multiple reasons why pregnant women, who are tired all the day, end up suffering with insomnia as well. Blame it on body chemistry and changes in mood, but don't rule out other possibilities, like sleep apnea or restless legs.

Leg cramps: Again, this is a chemistry imbalance; the body needs its electrolytes and when it doesn't get them in full balance, the legs are often the first place to reveal this problem. Nighttime charleyhorses can result; they are no fun during the day, and at night, they can be tenfold worse because they disrupt your sleep. 

Medications: If you are taking any medications while pregnant, make sure it is safe to do so. And keep in mind that medications are essentially chemistry. You add chemistry to your body chemistry every time you take a drug; at nighttime, this can lead to problems with insomnia when chemistry collides. 

Nausea: Some women experiences runs of nausea that blunt their appetite; unfortunately, morning sickness doesn't always wait until morning.

Restless legs: This could have been a "thing" before pregnancy, or it could happen while being pregnant. There are multiple causes for these and they should be identified and treated whenever possible. One cause among pregnant women is anemia; the twitching and discomfort can make it very difficult to fall asleep.

Sleep apnea: More general edema in the body means plumper tissues and more opportunities to interfere with the upper airway. Swollen areas around the feet during the day can become swollen areas around the neck at the end of the day when the pregnant woman lies down to sleep, as fluids are redistributed. This can lead to sleep breathing disorders like Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA). 

Snoring: Just as with sleep apnea, the added fluids that build up in the body can create resistance in the upper airway; add to that any congestion issues in the nasal passages and the odds of becoming a first-time-ever snorer are pretty good.

Vivid dreams: Dreams are a product of REM activity. With all the other changes in the body, it's not surprising to learn that the brain is also adjusting, redirecting focus, learning, processing anxiety, consolidating new information as memories. Pregnancy is a heightened state; it makes sense that crazy dreams would follow.

________
Stay tuned: next week SHC will discuss sleep challenges based specifically on what's going on during the trimesters.

Sleep in the Media || Movie Review || Sleepwalk With Me

Sleepwalk with Me
-----
Directors: Mike Birbiglia and Seth Parrish
Writers: Mike Birbiglia, Ira Glass, Joe Birbiglia, Seth Parrish
Starring: Mike Birbiglia and Lauren Ambrose
Cameo performances: Ira Glass and Dr. William Dement
Year: 2012
Rating: PG-13

-----

This independent film by comedian Mike Birbiglia is the intimate true story of his struggles with the progressive development of REM Behavior Disorder (RBD). Birbiglia's comedy career parallels, in many ways, the strange journey he has embarked on as a sufferer of this rare sleep disorder, in which he physically acts out his dreams while in REM sleep.

Sleepwalkers are not usually aware of their dreams, which happen during nonREM sleep, because their brains during these sleep stages are engaged in deep slow wave sleep which does not typically promote active mentation (mental activity like cognition or memory). In REM sleep, the brain switches into levels of high electroencephalographic activity; to prevent the body from acting out these active dream engagements, the brain literally paralyzes the body from the neck down until the REM sleep stage is complete (the exception: the brain continues to activate the phrenic nerve and diaphragm so that the respiratory system can function in default mode as we sleep). However, when RBD occurs, this critical paralysis doesn't occur, and the sleepwalking that results becomes a kind of entrance into two worlds at once: the world of reality blended with the world of dreams. It's like the dreamer is actively engaged in two worlds at once and can physically interact with both. The hallucinations are compelling and irresistible to the dreamer because they seem so utterly real to them.

This filmic experience of RBD definitely contributes a leaf to the comedic history of the brain, but Birbiglia's first-hand experience also shows a very dark side to the condition, which can lead to a dangerous outcome for both the sleeper and anyone the sleeper might encounter while acting out their dreams.

I highly recommend this movie because it's not only an entertaining and curious memoir, like nothing you've ever seen, but it's also a pretty accurate depiction of RBD. RBD is a rare condition, but some people can experience a handful of these strange nocturnal events without developing the condition (I should know, I can recall 3-4 incidents of RBD in my own personal history, which may actually be related to my mild narcolepsy). Also, if you want to glimpse a living legend in sleep medicine, you'll get a kick out of Dr. William Dement's cameo role as himself in one of Birbiglia's hallucinations.

Look for "Sleepwalk With Me" in movies on demand (we watched it free on Roku). It's available for rent and on satellite as well.

National Sleep Foundation: "What To Do When Your Child Is Too Scared To Sleep"

"Nap time" by Vladimir Rodionov. CC BY-SA 3.0

Here are some great tips from the experts at the National Sleep Foundation for those parents who are struggling with children who are experiencing nightmares. I would add that children refrain from playing stimulating video games right before bed, as these, too, present intense, scary characters and narratives that could disturb them as well.