A new pregnancy is exciting and brings with it the classic discussions about morning sickness, food cravings, and having that "special glow."
However, few consider how the quality of their sleep may worsen as a result of pregnancy. The National Sleep Foundation's Women and Sleep poll showed that 78 percent of women had more sleep complaints during pregnancy than at any other time.
Yet, thoughts of sleep deprivation are still mostly assigned to the distant future of parenthood. However, these same women might actually face those legendary sleepless nights in the months well before junior’s birth.
Sleep breathing disorders arise as the result of changing hormones and physiology in pregnancy. If left untreated, they lead to health issues for both mother and baby, before and after birth.
How Pregnancy Can Lead to Sleep Breathing Disorders
Many women enter pregnancy perfectly healthy, but this doesn’t guarantee they will escape congestion, snoring, and sleep apnea. All three can happen with pregnancy. Why?
Higher estrogen and progesterone levels lead to fluid retention in the pregnant body. Those swollen ankles by day become swollen areas around the neck as soon as your head hits the pillow and fluids are redistributed. Even stuffy noses at bedtime are the result of swollen mucus membranes and nasal passages.
These fluid increases are not just "water retention." The pregnant body generates 50 percent more blood by volume; this, alone, can cause congestion.
These changing hormones alter the body’s muscle tone as it prepares to house the growing baby. This "inhibitory" effect can result in snoring: the upper airway relaxes and partially closes, creating less space to inhale and exhale. More than a quarter of women become first-time snorers while pregnant.
However, for some, problems with snoring and general upper airway resistance can quickly lead to obstructive sleep apnea (OSA).
OSA occurs when the upper airway becomes completely obstructed by soft, swollen tissues. The result is heavy snoring accompanied by long pauses and gasping or choking that leads to reduced blood oxygen. Dr. Robert Atlas of Baltimore’s Mercy Medical Center asserts that untreated sleep apnea deprives not only the mother but also the unborn child, of oxygen critical to the health of the pregnancy.
Sleep Apnea and Pregnancy, By the Trimester
OSA’s symptoms can increase significantly from the first trimester to the final delivery. A recent longitudinal study showed that risk for OSA increases by more than 15 percent between the first and third trimesters.
First trimester: OSA occurs as a direct result of edema (swelling). Fatigue is also common. If you have been told you snore loudly or gasp and choke in your sleep, you may be developing OSA.
Second trimester: Any minor problems with OSA become apparent. Normal weight gain plus continued swelling contribute to OSA. Mucous membranes may also be secreting even more fluid.
Third trimester: Excessive daytime sleepiness may return with a vengeance, signaling the onset of OSA. This is when pregnant women also run the highest risk of becoming overweight. But even a pregnant woman with appropriate weight gain may still sleep without breathing problems at this time.
Pregnancy and OSA: Other Risks
Obesity. Obesity is a major risk factor for OSA. The CDC estimates that more than 50 percent of pregnant women are either overweight or obese. These mothers have a higher risk for miscarriage, premature birth, stillbirth, and babies with birth defects. Obesity puts both mother and baby at risk for hypertension and insulin resistance. These mothers also have more incidence of heart problems, diabetes, preeclampsia, pulmonary hypertension, and blood clots. They more often require a Cesarean section delivery and are at higher risk for postpartum infection.
Diabetes. Pregnant women who struggle with high blood sugar and insulin resistance (often termed "gestational diabetes") are more likely to give birth to babies with congenital heart defects. This includes those who were not diabetic before pregnancy. Learn how diabetes and OSA are related here.
Pulmonary Hypertension and Preeclampsia. A shortage in blood oxygen during sleep can set off a chain of events that leads to dangerously high blood pressure, sometimes resulting in a rare but dangerous pregnancy-related condition known as preeclampsia. Studies show that 42 percent of pregnant women with OSA develop preeclampsia, versus 17 percent of mothers who don’t have OSA.
Risks to the unborn child. Dr. Atlas says that babies carried by women with untreated OSA may “grow up to have different types of complications like diabetes, obesity and weight issues themselves," a condition referred to as Metabolic Syndrome. Recurring oxygen deprivation caused by can impact liver function in the baby in utero, causing long-term changes in their ability to maintain balanced blood sugar after they are born.
Labor and delivery complications. Researchers recently found that women who slept fewer than 6 hours per night had longer labors and were nearly 5 times more likely to deliver by Cesarean. Having OSA doubles the C-section rate as well.
Depression. A relationship exists between OSA and depression; for pregnant women, the risk for developing depression during pregnancy through the postpartum period is elevated in those with untreated OSA.
The Importance of Sleeping for Two
For many new mothers, getting adequate sleep is even less likely after labor and delivery. It's critical that all pregnant women prioritize sleep before then. Identifying and treating any sleep breathing disorders benefit both mother and baby.
A few ways to ensure adequate sleep and defend against sleep breathing problems during pregnancy include:
- Napping whenever practical.
- Left-side sleeping, which improves blood circulation and helps keep the airway open.
- Using saline nasal spray for congestion.
- Getting 30 minutes of exercise daily (per physician approval).
- Eating a balanced diet for healthy metabolism.
- Opting for a bedside humidifier to keep sinuses clear.
- Treatment for OSA during pregnancy
OSA in pregnancy is a dynamic process made apparent by different markers with each passing trimester. A thorough healthcare provider should screen patients at trimester intervals to identify any breathing problems.
Screening especially during the second trimester has been shown to be effective in pinpointing sleep breathing problems, and comparisons of BMI in the third trimester can reliably predict the new onset of OSA.
Continuous positive airway pressure (CPAP) therapy is considered the safest and most effective treatment for OSA, but it does require diagnosis and a prescription.
Don’t hesitate to tell your caregiver about bedtime stuffiness, loud snoring, nighttime choking or gasping, morning headaches, dry mouth or sore throat upon awakening, or excessive daytime sleepiness.
Don't put your and your unborn baby's health at risk. If you have any signs of sleep apnea, call Alaska Sleep Clinic for a FREE sleep assessment.