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Sleep Changes: Pregnancy Sleep by Trimester



Pregnancy SleepOne of the best things you can do for yourself when you’re pregnant is to get adequate sleep. It’s recharging and restorative for a body – yours! – that’s working harder than it ever has before on the complex and important task of creating a life. But ironically, pregnancy can also make it tough to get the sleep you need. Here are some sleep changes you can expect in each trimester of pregnancy:

First Trimester

The first trimester can be a time of heightened nerves and trepidation. So much is going on in your body, and you’re looking down the long road of the weeks and months ahead. Just that alone can interfere with your sleep time and quality. But there’s more than can disrupt sleep the first 12 weeks:

  • Morning sickness. The queasiness that frequently accompanies the early stages of pregnancy can be triggered by an empty stomach – so if you suffer from morning sickness, you may wake up earlier than you need to thanks to that combination of hunger and nausea.
  • Early in pregnancy, your progesterone levels skyrocket. But one side effect of the progesterone surge is that it can make you drowsy and draggy, as well as interfere with the quality of nighttime sleep (that is, you don’t spend enough time in the restorative, restful phases of sleep).
  • Tender breasts. Even before your belly swells, the first trimester brings changes to your body – sore, full, tender breasts – that can make your usual coziest sleeping positions harder to achieve.
  • Urinary frequency. Time to blame progesterone again! Another effect this hormone has is to relax smooth muscle throughout your body – and that includes the muscle that helps hold urine in your bladder.

Second Trimester

These second 12 weeks bring pretty dramatic changes to your body, and it stands to reason that second trimester sleep is affected. The good news here is that your hormones have settled down and you will probably be less bothered by nighttime trips to the bathroom, as your uterus is still too small and high up in your pelvis to press on your bladder much. Here’s what you might encounter:

  • Size matters. No denying it now – you’re getting big enough that the positions in which you may usually settle for sleep are either uncomfortable (such as stomach sleeping) or unadvisable (back sleeping). To increase your chances for a good night’s rest, experiment with pillows – sleep on your side with a pillow against your back and another between your knees.
  • This is the reflux or backup of stomach acid into the esophagus. What happens is that your growing uterus restricts the diaphragm, which interferes with normal digestion. This is made worse when you lie down and try to sleep.
  • Leg cramps or restless leg syndrome. Some pregnant women are susceptible to muscle cramps, which may be caused by low iron levels. Restless leg syndrome, a condition in which you feel tingling pain up and down your legs that only ceases if you move around, may also crop up at this time.

Third Trimester

In the third trimester of pregnancy, sleep can be disrupted by a number of issues, from your burgeoning belly making it tough to get comfortable, to good old-fashioned anxiety about what’s on the horizon. Here’s what else might be keeping you awake at night:

  • Urinary frequency. It’s baaack! In your final 12 weeks, the size and weight of your baby presses on your bladder, increasing the urge to go.
  • Joint and back pain. Carrying around your heavy belly puts stress on your lower back and your joints, the latter of which may also be more vulnerable to injury because pregnancy hormones soften the ligaments that connect joints. All this means greater frequency of aches and pains that can make comfortable sleep even more elusive now.
  • Both your increased girth and a higher incidence of nasal congestion during pregnancy can make you snore at night. This may bother your bed partner more than you, but it can also cause you to wake more often during the night, disrupting sleep.

If any of the above sleep-disturbing issues become problematic or worrisome—and can’t be alleviated with some commonsense measures—talk to your healthcare provider right away; he or she may have some solutions you haven’t thought of. A final bit of advice: Take naps!

5 Questions About Pregnancy and Sleep

Pregnancy is a time of increased sleep needs and—ironically—increased sleep problems. You might have heard the quip that sleep difficulties now are nature’s way of helping inoculate you against the sleep deprivation you’re likely to encounter once your little one arrives, but we reject the notion that you’re doomed to poor sleep for 40 weeks. Maximizing your rest is highly important right now, and if you have questions about how best to accomplish that, we have answers. Well, we have answers to these top 5 “sleeping for two” questions:

1. I’m in my first trimester, and the other day, I fell asleep at my desk! It was only for a few minutes and no one noticed, but I’m so embarrassed. I’ve never been a napper. How can I remedy this problem?

Maybe you were never a napper before, but pregnancy changes just about everything, so why not that, too? Early in pregnancy, in particular, the struggle (to stay awake) is real. And for good reason; the work your body is doing to nurture the new life inside it has been likened to running a marathon everyday. Meanwhile, hormonal changes and a more-frequent need to pee may be disturbing your nighttime sleep, so you may benefit from catching up in the daytime. If you have the space, the privacy, and the type of job that allows for a short snooze every now and then, by all means, take advantage. Just keep naps short—20 minutes seem to be ideal—so you don’t hinder your ability to fall asleep at night. If you don’t have a desk to lay your head on or a door to close, consider a brief shut-eye in your car instead of a coffee break. Or, lay down for 20 minutes when you get home to recharge for the rest of the evening. You deserve it. 











2. I never in my life got heartburn, but now I can't even think about lying down in bed without feeling that burning pain in my chest. What's wrong?

One thing we know for sure is that your heartburn is not a sign that you’ll have a baby with a full head of hair, as the charming but false old wives’ tale tells us. Heartburn is caused by a weakening of the ring of muscle called the esophageal sphincter that normally keeps your stomach contents where they should be. When that occurs, food and stomach acid can back up and you’ll feel the burn. Why now if you’ve never had it before? Pregnancy-related heartburn (also called gastroesophageal reflux disease or GERD) is likely caused by increased levels of pregnancy hormones that relax muscles including the esophageal sphincter. Increasing weight can also exacerbate the problem. GERD is surprisingly common in pregnancy—up to 50% of pregnant women experience it.

If heartburn is interfering with your sleep, consider lifestyle modifications as a first line of defense: Don’t eat heavy, greasy, fried or acidic or spicy foods, which tend worsen heartburn, and don’t eat too close to bedtime. Speaking of your bed, elevating the head of it can help you rest easier. If it’s truly bothersome, or isn’t helped by changes in diet or other habits, talk to your doctor about over-the-counter meds that are considered safe throughout pregnancy.

3. Before I got pregnant, if I had a headache or was sore from working out, I’d take some Tylenol and it would also help me relax and sleep. Is that no longer safe for me?

If you’re asking, it’s likely you’ve seen or read news fairly recently about a study linking pregnant women’s acetaminophen (Tylenol) use with evidence of language delays in toddlers. The study getting all the ink, published in the journal European Psychiatry, concerned an observed delay in spoken language among a cohort of Swedish women’s children at about 30 months of age. It’s worth pointing out that the study showed a correlation between acetaminophen use and language delay; they did not prove a causal link between the two. And it should be stated that the researchers themselves aren’t calling for pregnant women to swear off the pain reliever. They note that these results should be replicated in further studies—and that the children studied should be followed up on—before any recommendations are made. On the other hand, there have been other studies in recent years linking Tylenol use to problems such as ADHD and autism in children. But on the other other hand, in all studies of this kind, the moms took a fair amount of the pain reliever; this is not a case of popping a tablet for the occasional headache so you can sleep, but more consistent, regular use.

The bottom line is that you should speak to your doctor or healthcare provider and ask his or her advice about any drug or remedy—prescription or OTC—that you take while pregnant. Consider how often you need Tylenol. If you are achy from a workout, a warm bath or shower may help. If you can’t sleep, consider other forms of sleep hygiene, like drinking warm milk or eating a small, carbohydrate-rich snack, which may help you drop off. But if you have a fever—which has the potential to be harmful to your baby—definitely talk to your doctor about taking acetaminophen, because in some cases a fever may be far more provably harmful to your baby than a couple of Tylenol.

4. I'm having the craziest dreams lately. I wake up to pee (of course) and I can’t even believe the things I dreamed. Is it pregnancy related?

Maybe. Wild, right? Many pregnant women report far more active, crazy, vivid dreams than they recall having beforehand. The subjects can sound like the headlines on supermarket tabloids: “I Gave Birth to an Alien Baby!” “Recall” may be the operative word here. Some experts speculate that the explanation for vivid pregnancy dreams (or nightmares) may be as simple as this: Pregnant women wake up more often during the night for various reasons, and if woken during the phase of sleep associated with dreaming, you may just remember the dream more clearly in the moment than if you’d stayed asleep till morning.

Anxiety and worry over the impending event can also make some women have more turbulent and memorable dreams. As for the content of your dreams, who knows? If you believe that dreams reflect your subconscious or are a way to work through problems or events in your waking life, then dreams about labor and delivery or visions of your baby to be seem like a natural fit. If you’re curious and if your dreams are particularly entertaining or confounding, consider keeping a dream journal. Hey, your child may someday find it interesting reading!

5. I keep going to sleep on my left side, but wake up on my back. Help!

It's no doubt that you’ve internalized the advice that it’s best, after the first trimester, to snooze on your left side, which allows for unimpeded blood flow to your uterus. (If not the left side, then at least a side is better than flat on your back, and of course stomach sleeping simply becomes impossible after a certain point.) If you want to increase your chances of staying put and remaining comfy on your side, consider a body pillow or two to prop yourself in the best position. But if you wake up on your back, don’t worry—you’re not putting your baby in danger. Just make an effort (as best you can as you get bigger!) to resettle yourself on your side.

Sleeping for Two: What Is Nesting?

If you’re pregnant and have some notion of what “nesting” is, you may be thinking, “not me!” You’re a modern woman—not a mother hen! But if you’ve recently been seized by the need to clean, organize, unpack, decorate, stock up, and settle in, then, yes, that's nesting.

Nesting, which typically happens in the third trimester, is perfectly normal and even practical. It may include such obvious baby-prep activities as buying a crib, stocking a changing table, or decorating a nursery. But nesting can also encompass other “getting ready” bursts of activity around your home (or workplace), such as cleaning, cooking, purging unnecessary items, or getting finances and paperwork in order.

Got nesting questions? We’ve got answers:

Why is it called “nesting”?

You’re not a bird, of course—but your home is your nest. The term may derive from birds building nests to cradle their eggs and hatchlings, but much of the rest of the animal kingdom exhibits forms of nesting, too. In the wild, it’s about finding a safe space—warm, near food, and reasonably protected from predators. Isn’t that kind of how you feel about your home too?

Is nesting hard wired?

It may well be. There haven’t been tons of scientific studies about nesting, but at least one, conducted in 2013 at McMaster University in Toronto, Canada, and published in Evolution & Human Behavior, found that many pregnant women experience a surge of energy and the compulsion to do at least some sort of cleaning, organizing, and preparing in the later stages of pregnancy. The researchers’ conclusion should help you feel less like you’re a crazy person as you fold your zillionth onesie or clean the corners of the nursery again: The behavior serves as a way to make sure the environment we’re bringing our baby into is safe and cozy. It also helps you emotionally prepare for the sea of change that’s about to happen. The work you’re doing is a way to feel closer to this person you’ve yet to meet. Think of nesting as an early form of bonding.

What if I don’t feel like cleaning or painting the nursery?

It’s normal to nest. It’s also normal not to exhibit those signs. With that said, you may be doing your version of nesting and just not realize that’s what it is. For example, you may find yourself settling in to read books you haven’t gotten to, or sorting through your finances, or calling old friends. The point is we may all have the instinct in terms of evolution, but it’s not as evident in every person. Whether or not you can point to anything in particular you’re doing that qualifies as “nesting,” it doesn’t reflect on the health of your pregnancy, or on how good a parent you’re likely to be. Remember, too, that not all moms-to-be can nest—for example, if you’re on bedrest, go into labor early, or are adopting a baby and have little time to prepare.

I’ve found I don’t want to do much outside the house right now. Is that part of nesting?

It very well could be. Many soon-to-be moms experience nesting not as a flurry of cleaning or organizing activity, but as an instinct to burrow in at home, and/or to surround themselves with only their partner, close friends, and family.

Does nesting ever indicate something’s wrong?

Not in itself, even if it does feel like Martha Stewart has taken over your brain! But on a serious note, if you find yourself feeling unduly anxious—say, you’re losing sleep over things like car seats and cleanlinessspeak to your healthcare provider.

Does nesting mean I’m about to pop?

No. If you finish assembling the crib and then your water breaks, it’s purely coincidental! Nesting urges may start earlier in pregnancy, but they peak in the third trimester, and it’s not anything physical or indicative of impending labor.

A final thought: What may feel and look frivolous on the outside (who really cares if the nursery walls are seafoam green or cornflower blue?) can actually have a powerful meaning. Nesting is your instinctive way to throw a switch in your mind from your old self to your new. What’s about to change, after all, isn’t the decor in your former guest room, but your identity. Nesting isn’t only about making room in your home for baby, but in your heart.

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