8.77 MB | 21:52 Min
Kathryn Lee is a U.C. San Francisco Professor of Nursing who specializes in sleep, and is an expert on sleep during pregnancy.
Leslie Ludka is a Certified Nurse-Midwife who graduated from the midwifery program at the Yale University School of Nursing. After a year of providing full scope midwifery care to native Hawaiian and rural community women on the island of Molokai, Leslie returned to Boston, where she spent nine years at Brigham and Women’s Hospital, the primary teaching facility for Harvard Medical School. Since leaving that position, Leslie has been self employed with LML Consulting, providing full-scope clinical midwifery both nationally and internationally.
Welcome to your Pea in the Podcast, I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey to becoming a mommy.
This week we’re going to help you get a good night sleep. From a problem you might not expect to be keeping you up during the first trimester…
“Urinary frequency is very common.”
To discomforts that might plague you for your entire pregnancy…
“Well heartburn is certainly pretty common because your whole digestive system is moving around to make space.”
Yeah heartburn, congestion, restless legs, leg cramps and a kicking baby…we’ll talk about all of that and much more, and we’ll help you figure out how to get a better night sleep. A sleep expert and so much more coming up in this Pea in the Podcast.
Ah sleep! It’s the holy grail of pregnancy! If you’re not doing it you’re trying to figure out how to carve out some time to do it.
“Over the course of those 9 months they’re actually losing about an hour of sleep every night. And you know there’s just not much you can do about losing that sleep, but you can get to bed earlier and start making up for it sooner instead of realizing at the end of the pregnancy that you’ve been missing an extra hour of sleep that you weren’t before. Because it’s very gradual, you know I guess if you factored it out it would be in 2 minutes a night that you’re losing every night. Then 4 minutes and 6 minutes so when things are gradual like that we tend not to pay attention until it is over.”
And when it’s over you have a baby and you’ll have needed all of that sleep. And by the way that’s Kathryn Lee, UC San Francisco Professor of Nursing. She specializes in sleep and she is going to help us figure out how to get a better night sleep before that baby comes, because the fight for enough sleep starts not too long after your pregnancy begins.
Mainly, as mom-to-be Alissia says, you need so much of it.
“Well I can tell you today it is about 3 o’clock here and I’ve already taken 2 naps. On the weekends is when I catch up with my nap time. As a family physician I have set hours so I usually getting up about 6:30 and working until about 5 or 6PM in the evening. And probably about 11 o’clock in the morning I’m already counting down the hours until I can go take a nap or get some sleep. It actually consumes a lot of my mind you know just thinking and planning when my next nap or sleep can be. Unfortunately I’m not able to take a nap at work but I have heard definitely some of my friends making time and finding ways to sneak in a little nap in the middle of the day. But usually my routine is I get home, have something to eat and as soon as I can just get into bed.”
Yeah, it’s that early surge of progesterone. It exhausts you and Kathryn Lee says many women are not ready for that.
“Most women who get pregnant the first time are at least are prepared for morning sickness but what a lot of them weren’t prepared for was the fatigue that they felt and that was often when you talk to experienced moms that’s then in hindsight the first symptom that they experienced. So just this overwhelming fatigue.”
This was definitely true for me; before I knew I was pregnant I thought I must be dying. I had never gone to bed before 11 for any reason and here I was ready to conk out at 8 o’clock every night. Mom-to-be Alissia says that can be hard on more than just you.
“It is a little bit frustrating for my husband because I get home, I make dinner and then it is goodnight. Hardly to talk at all. So I think that has been a little bit difficult for him too to adjust to this new person that he is living with who doesn’t have the same endless energy as I used to have.”
Lee says often, in addition to progesterone making you tired, you won’t necessarily be getting the best sleep of your life during the first trimester, and you can blame a problem you probably didn’t expect to have to deal with until your baby was much bigger.
“Most of it is related to bladder function, even early, even before the fetus gets big and starts pressing on the bladder the pelvis is changing and the hormones are increasing. Some of those hormones make the muscles around the bladder kind of boggy and dilated so urinary frequency is very common.”
So you’re trying to sleep but you have to pee all of the time, great. Thankfully this need to pee all of the time will ease up in the second trimester only to return when you expect it to when your baby is sitting on and kicking your bladder.
In the meantime you can deal with this early need to pee and prepare for the third trimester trips to the bathroom by considering rearranging your house.
“I think women who are closer to their bathroom at night don’t wake up as much. If you have to wake up and walk and turn on the light and go down the hallway to go down to the bathroom you are going to be awake, more and more aroused and then have trouble falling back asleep.”
We did this. We moved into the guestroom which is right next to the bathroom so I was close to the bathroom, even then though I considered sleeping in the tub. I wanted to be even closer. Also get some nightlights so your nocturnal trips to the loo are dimly lit so you don’t wake all of the way up. And Nurse Lee suggests rearranging your bedtime habits.
“If she can just start planning to go to bed earlier because you I think still have to get up in the morning to get to work at a certain time and that drives all of us but we have some control over bedtime.”
Now around 12 weeks and heading into the second trimester, the sleep situation does improve.
“The second trimester is a real nice break. You feel better, you have a lot more energy, your hormones are leveling off a little bit and you’re getting better sleep, some of your deep sleep gets a little higher so you actually feel more energy and more vigor.”
This is why so many people plan their babymoons for the second trimester, because they feel good enough to enjoy it. But as you move through the second trimester and into the third, typical sleep interrupting pregnancy discomforts are bound to pop up like heartburn.
“Heartburn is certainly pretty common because your whole digestive system is moving around to make space. So usually it’s avoid a lot of spicy foods of course. But if you’re really having trouble sleeping then you really should be sleeping sitting up slightly so elevating your head with more pillows works quite well. Some people put cement blocks at the head of the bed to elevate the whole bed and mattress but the sleeping partners don’t like that very much. So if you can do it with pillows that’s great. And some women end up sleeping in a chair so that they’re much more sitting up and that helps with the heartburn.”
Elevated sleeping can also help you with pregnancy related stuffy nose which definitely interferes with sleep.
“You know I think there’s a couple of things positioning so that you’re not on your back but you can’t avoid all of that congestion that is in your nose, that is hormonal, estrogen based. You have vision changes because your eyes change. Your feet and all of the connective tissue are changing the size of your feet so you have smaller spaces in your body when you are pregnant making room for the baby getting all kinds of hormonal changes so one of things that women have tried that I think has worked successfully for about half of the women are those nasal dilator strips, they are called Breathe Right, things that you see football players wearing across their nose, it opens the nasal passages and a lot of women who have nasal congestion especially are more likely to have snoring because of that.”
And snoring is something healthcare professionals pay very close attention to during pregnancy.
“Snoring is just that noise that you make when your airway is partially obstructed and if you get obstructed all of the way you stop breathing and obviously you’re not snoring. There is no air movement or sound at all then it does have a reaction in your brain and your heart to cause high blood pressure. And the high blood pressure is probably related to that, but it’s over time. Though we do worry about that with women who are overweight or obese who snore and who have high blood pressure. We do worry about things like preeclampsia and hypertension of pregnancy.”
Very serious concerns, so as Nurse Kathryn Lee suggests, positioning is key. You may need to get your upper body elevated to fight heart burn and congestion and snoring. And to do that you’ll need pillows, maybe lots of them. Brandy is late in her pregnancy and she is all about the pillows.
“I do sleep best with a ton of pillows especially the one that goes right between my legs and then of course there is no room for my husband but he’s been pretty good about it.”
A lot of pregnant women who are most comfortable on their side will sleep with a pillow between their knees. You can use a regular pillow, or a body pillow that you can also hug, or there are those special curving sort of hooking pregnancy pillows that wrap around you. Lot’s of moms just make a nest out of regular pillows. But Kathryn Lee UC San Francisco Professor of Nursing agrees, pillows will help you get a better night sleep.
But there are some problems pillows will not help you with, like excruciating leg cramps.
“Leg cramps are something that you wake up out of a deep sleep feeling intense pain in a really contracted muscle in your leg and you have to get up and walk and move and try to get it released but it leaves a really painful, tender spot on your leg. But it wakes you up out of a sound sleep and that’s about 75% of women have that particularly more often is the pregnancy goes on and third trimester may be once every other night or so.”
How do you fight these cramps? Well first even if you’re afraid you’ll be up all night going to the bathroom…
“Drink plenty of fluids because it is not good to just get dehydrated at all but then just stop drinking a couple of hours before bedtime or try to drink enough that you’re emptying your bladder all at one time.”
So stay hydrated. Also keep your calf muscles stretched out, bend your foot at the ankle several times a day to keep them loose. Rotate those ankles, wiggle your toes, stay limber, don’t sit with your legs crossed all day and don’t stand still for extended periods of time. Go for walks when you can. Draw a warm bath before bed and some suggest increasing your folate intake with the green leafy vegetables or potassium by adding a banana a day or increasing your calcium with milk or yogurt or even Ovaltine.
Another problem pregnant women have with their legs is called Restless Leg Syndrome.
“Restless Leg comes on in the evening when you’re sitting. You just have this tremendous urge to move your legs and about 20% of women experience this by the third trimester so what you experience is this discomfort, it’s not a sudden pain, it’s a discomfort some women describe as feeling like ants crawling up their veins or Coca Cola in their veins. It feels really weird and the only way to release it is to move, to stand up and walk around. And then it goes away and as soon as you lay down again it starts and so they never, they have trouble falling asleep because every time they start to fall asleep their legs feel like they have to move, they are restless and they have to get up and move.”
Now as Lee said 20% of you will experience this by the third trimester but we can’t even predict who is going to experience them and who isn’t.
“If there is a family history of restless legs, but it can be totally related to just the iron and folate metabolism during pregnancy.”
So what do you do about it?
“You can certainly before you get pregnant you can make sure that your nutrition is good. That you are eating a lot of protein and getting a lot of iron and folate. A lot of women do get this in their prenatal vitamins but if they are already low to begin with it is hard to make up the iron deficiency when they are pregnant. It just keeps getting worse. The good news is as soon as the baby is born it goes away, the restless legs and the leg cramps go away. But that can be women describe it as a real torture during that third trimester. So there is nutritional iron and folate supplements. There is also, if you do have restless legs and warm bath and massage really help a lot. It’s not a cure of course but it does help relieve the symptoms.”
Now if you’re increasing iron and folate in your diet for restless legs or cramps, remember cut out the caffeine.
“Caffeine makes it harder to get the iron and folate digested and into your system to use. So you might be, if you’re taking folate and iron and prenatal vitamins with coffee they’re not having as much an effect.”
And you don’t want caffeine anyway during early pregnancy because at least one recent study links it with higher miscarriage rates, plus it can interfere with the subject of this podcast, sleep. And it can increase anxiety and you’re anxious enough right?
In fact, that might explain those vivid dreams you might be having. That’s what Kathryn Lee thinks anyway…
“A lot of women’s anxiety comes out a little bit in some dreams. They dream that they forgot to give birth or that they left the baby somewhere and they haven’t had the baby yet. They have a little bit more anxious dreams.”
Some moms-to-be dream that they are going to hurt their babies…
“They do, and it might be recurring types of dreams and it’s more an issue of the anxiety that they’re feeling about being pregnant.”
You might find yourself having really, very sexy dreams which may be linked to hormones, enjoy those. But Lee thinks the reason our dreams more vivid when we’re pregnant is that we’re remembering them more because we’re more likely to wake up after we dream, and people who wake up after they dream generally are more likely to remember them.
Another thing that can disturb your sleep during the second half of your pregnancy is that active baby. Now there is nothing more amazing and thrilling of the feeling of your baby moving inside of you, except when you are trying to sleep and they want to dance on your bladder or your cervix or give you a kick in the ribs every now and then.
Some say babies are more active at night because, well, you’re not. When you’re busy moving during the day you’re rocking them to sleep but when you’re trying to sleep it’s happy hour at your baby’s house. Lee says one thing you can do to reduce your risk of that happening is watch what you eat before bed. She said she once had a pregnant woman in the sleep lab who ate a piece of cheesecake before bed and when she woke up she said her baby had been busy.
“She said well the baby was just kicking all night and I realized at that point it was probably the baby having a sugar high and what you eat before you go to bed affects the baby and the kicking motion a lot more than you may think.”
So try not to sugar up before bed. I was battling borderline gestational diabetes so before bed I had a glass of milk and a graham cracker, that didn’t send my baby off on a dance marathon and my morning blood sugars were always good.
Okay what else could we do to improve your sleep?
“One of the major lifestyle things they you should do if she’s not doing already is some sort of form of physical activity. So we know that exercise during the day helps people get deeper, better sleep at night and so if they are not exercising it would be really nice to take a walk in the evening after dinner would help digestion and it would also help give them some physical activity and they should sleep deeper that night. Yoga is also very popular these days and they have pregnancy yoga classes but it’s not only that physical activity and the position but the deep breathing is also very relaxing and would help with sleep if they start early enough. It also helps with the pain and aches or pregnancy.”
Swimming is also good for pregnant women; it is good to feel buoyant when you think you’re as big as a house, too. What else can you do to improve your sleep?
“Lavender scent is very good. It has been studied and it is very soporific, it can induce sleep and relaxation. There have been cases where you can overdose on lavender so I do worry about it with small babies when there is lavender that babies are getting too much exposure to lavender. But lavender in the bubble bath is very soothing.”
Ahhh soothing music, waves and lavender. What else?
“Going to bed earlier so that you know you’re going to get a lot more awakenings but if you can make up that sleep by starting sooner that will help. We do know that the less sleep you get the more pain and anxiety you feel. So when we actually put people in labs and sleep deprive them they have lower pain threshold, they feel pain at lower levels and they start to get anxious and depressed feelings. So you want to just try to get as much sleep as you can.”
Because you’re uncomfortable enough already right?
Certified Nurse-Midwife Leslie Ludka shared her knowledge with us in a few Pea in the Podcasts (The First Trimester, The Second Trimester and The Third Trimester specials), and she has some final thoughts about getting a better night’s sleep…
“A nice back massage and real quiet and have a very comfortable bed. And just make sure they haven’t eaten a heavy meal before they go to bed. And just try as best they can to make themselves comfortable in whatever way she can.”
Oh, and if you’re as lucky as I was your partner will rub your belly and your back with cocoa butter every night before your go to sleep. Even after the stretch marks showed up anyway, we kept it up. All in the name of a goodnight’s sleep.
Sleep well, mommy.
We hope you’ve enjoyed this Pea in the Podcast: Getting a Goodnight’s Sleep. Please visit our website PeaInThePodcast.com for more information about our experts, to find links and transcripts and to register to get tailored week by week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie. Thanks for listening.
The National Sleep Foundation Has a wealth of information for you on getting better sleep during your Pregnancy, and — in fact — our expert, Kathryn Lee, contributed quite a bit to there storehouse of information. You can start your reading here.