Sleep Disorders in Pregnancy

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You think getting some is hard with a newborn?! Try doing it whilst you’re still preggers!

(We’re talking SLEEP, not sex – you filthy lot!)

Picture this… it’s 3am.  I’m 40 weeks pregnant and awake.  Again.  I’ve peed a gazillion times already tonight but now I’m running to the loo to vom.  Gross. Shortly after, and although I can’t believe it, I’m now ready for my regular nightly feed of a pre-breakfast breakfast (usually a bowl of cereal and a banana) before going back to bed and to (try to) sleep until the real wakey-up time (try telling my body that) of 7am… Waddling back up the stairs on swollen, incinerator-hot feet – It’s a blistering nocturnal 24 degrees Celsius in central London in August during a ridiculous heat wave and like most Brits we’re without Aircon or even a fan (WTF?!  What dickhead DOESN’T have a fan in Summer?! Me, obvs!) – I haul my heavy ass back into bed and then it starts…the leg twitching, FFS!

Pregnancy screws with your sleep like a MO-FO!  Nothing about that is nice – I know!  But the physiology behind is – IMO – kinda cool (I am an anatomy/physiology-obsessed freak though!) and often, when we understand why something is happening, it can be a bit easier to accept it and move on or, in some cases, treat it and (fingers-crossed) go back to sleep!

Some of the common disturbances to sleep in pregnancy can either be associated with anatomical, mechanical or hormonal changes brought about by pregnancy.

Let’s have a closer look…


Sleep Disordered Breathing (SDB) in Pregnancy

SDB is a spectrum of disorders that can be exacerbated or initiated by pregnancy including snoring, upper airway resistance and Sleep Apnoea, although these are rare (and yet I distinctly recall snoring myself awake on the tube one stuffy afternoon whilst heavy with child – not something I’d done before or since! #embarrassing) all can cause recurrent sleep disturbance and potentially impact upon the wellbeing of mum and baby.   Whilst there are a number of theories as to exactly why this happens, there is no conclusive answers, only that changes to the anatomy brought about by pregnancy, including the hyperactivity and oedema (swelling) of the upper airway and nasal mucosa could be responsible.  Also the effect of oestrogen on blood volume and progesterone on the upper airway and cardiac output.


Supine Hypotention Syndrome

I’m sure you’ve either been told this or you’ve figured it out for yourself (the hard way), from the 5th month of pregnancy many mamas can have a hard time sleeping on their backs.  As baby grows additional weight can press down on the Inferior Vena Cava and the Aorta causing Supine Hypotension Syndrome (pallor, racing pulse, drop in blood pressure, dizziness, nausea an vomiting).  This presents a considerable disruption to sleep if you’re naturally a back sleeper and you now have to sleep in an unfamiliar (or less comfortable) position or, if you accidently role onto your back during your sleep – as I used to do – you could find yourself vomming in bed!   On a serious note, a recent study linked back sleeping to a possible increase in the chance of still birth and you can read more about that here.

Gastroestophageal reflux

This often starts early in pregnancy.  Relaxin (another hormone!) responsible for loosening up the ligaments and joints to accommodate your growing belly, also loosens up the sphincter (no giggling now!) muscle in the oesophagus and delaying gastric emptying.  That, combined with a growing baby pressing on the stomach and you have the complete recipe for reflux right there!  This can worsen at night due to lying down. What joy!


Nocturia (that’s needing a god-damn pee every 30 minutes throughout the night, for you and me) has two causes: 1, Hormones (always the hormones!) and 2, baby pressing on/or bladder and restricting bladder capacity.  Hmmmm not much we can do about that. Soz.

Restless Leg Syndrome (RLS)

Characterised by the (unpleasant) sensation that causes an irresistible urge to move the legs.  The sensation usually takes hold just as a person is about to sleep.  RLS is usually worse at night, when a person is lying/sitting still and resolves if the legs are moved around.  More than 27% of pregnant women report RLS.  Pregnancy is considered a ‘secondary’ cause of RLS.  ‘Primary’ causes can be associated with deficiency in iron, folate deficiency, advanced renal disease and peripheral neuropathy.  If RLS is bothering you, you may want to discuss being tested for these deficiencies with your GP.  See the full medical journal here.

Leg cramps

Relaxin causes the pelvis to widen by relaxing the ligaments and – thankfully – makes space for a tiny human to pass through.  However, this widening can cause a displacement of the hips which in turn leads to cramping of the legs, often also occurring at night.


The production of many hormones in the body follow a circadian rhythm (more about how hormones can impact sleep here).  Oxytocin output peaks at night which can coincide with the onset of uterine (womb) contractions.  Obvs, this is likely to wake you up! Whilst elevated Progesterone levels are likely making you sleepy and increasing amount of REM sleep, increased Oestrogen levels are probably shortening our REM time.  What a trip!      Hormonal changes might also contribute to RLS and cramping of the legs whilst changes to insulin resistance and blood sugar levels may cause pregnant women to wake at night to eat (No shit! I knew that one already!)

If your pregnancy is playing havoc with your sleep, you may find it helpful to:

  • Sleep on your left side
  • Sleep propped up in a seated position
  • Have blood iron and folate levels checked
  • Do some gentle lower-leg stretching before bed
  • Have a light snack of some complex, slow-release carbohydrates before bed (Oat cakes and peanut butter, for example)

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