November 19th, 2018
Sleep and Pregnancy
Let us look at sleep, an aspect of daily life that is critical to maternal memory formation, growth and repair of cells throughout the body including her baby.
Women are often challenged to get adequate sleep despite the rigorous demands of daily life including caring for children while they are actively pregnant. These demands often sap the energy that a women brings to each and every day making rejuvenating sleep critical to recharging her batteries.
The average American woman is juggling more balls in the air than any prior generation as women are often tasked with the day to day home related activities while also going to work outside of the home. This split duality of work is taxing to say the least. If the effect disrupts mom's sleep, is there a downstream effect that is problematic for mom and baby?
Therefore, we must ask the question, what are the effects of sleep deprivation on mom and then baby?
Chronic sleep deprivation in humans in general has known negative effects on macronutrient metabolism, inflammatory processes, learning and cognition, and mental health. At the cellular level, even a single brief episode of acute sleep restriction (4-8 hours) is associated with robust declines in immune cell activity. (Chang et. al. 2010)
There data is very limited on the effects of sleep deprivation during pregnancy. Two studies with reasonable data looked at pregnant medical residents that were sleep deprived frequently and highly stressed. They found that there was a small but significant increase in preterm labor and pre-eclampsia. (Osborne et. al. 1990)(Klebanoff et. al. 1990) All in all, very little in the way of bad outcomes despite the volume of negative stress. These findings could have easily been attributed to other confounders in stressed and sleep deprived individuals.
There data is also very limited on the effects of sleep on glucose metabolism during pregnancy. The preliminary evidence suggests that chronic sleep deprivation can affect glucose metabolism and put a mother at risk for gestational diabetes with all of its downstream effects on her newborn.(O'Keefe et. al. 2012) Here again, I suspect that diet and mental stress are far more dangerous to glucose metabolism then sleep. There is one review paper that looks at the total allostatic load or compounded chronic differing stresses on pregnant women. They found that women with increasing stress levels including sleep deprivation were at risk for prenatal depression, gestational diabetes, pre-eclampsia, prolonged labor/c-section, poor fetal growth and premature births. (Palagini et. al. 2014)
Let me summarize from the limited pregnancy related studies to date what I think. There is clearly a possible risk to chronic sleep deprivation with respect to mental health, metabolism and inflammation. My hypothesis is that women have special abilities genetically to handle and process normal sleep abnormalities during pregnancy and breastfeeding as these are natural disturbances that occur universally in humans. Science has shown us over and over again that the female matabonome, microbiome and nutrigenome are unique and protective when treated well. I suspect the same is true for sleep pathways.
If we shift to the general population data with regard to sleep deprivation or disturbance, some data exists. Humans that suffer sleep disturbance which is insomnia or poor sleep quality had elevations in inflammatory markers related to disease risk. Reduced sleep that is of quality type was not related to inflammation. (Irwin et. al. 2016)
The bottom line as I see it is that normal sleep disturbances of pregnancy are unlikely to be detrimental. Coupling chronic sleep deprivation or insomnia with other stressors on the mind and body can dramatically change the physiology of a human and this is not good.
What to do:
1) Protect your sleep time as much as possible while pregnant. If you have more than one child, schedule a nap for yourself when they go down for their naps. Buy yourself 20 minutes here and there where possible when dad or grandparents are around to help. It takes a village, so summon the village.
2) Let things that are not necessarily important for the families survival slip from your mind to reduce the overall stress levels. Focus on that which truly needs to get done. An uncluttered mind sleeps better.
3) Consider packing more food in the earlier part of the day to avoid food stuffing your stomach close to when you lay down to sleep as this can increase the uneasiness of heartburn.
4) Stack your drinking in the first 2/3 rds of the day to avoid nighttime awakenings for urination, a problem in later months of pregnancy.
5) Meditate, pray or perform whatever relaxing technique that you know. I recommend the Calm or Headspace app for guided meditations to sleep.
6) Move often during the day to fatigue yourself to sleep.
7) Try Chamomile herbal infusions 1 hour before bed.
Sleep while pregnant,
Dr. M
Chang Sleep Medicine Reviews Article
Osborne Journal of Family Practice Article
Klebanoff New England Journal of Medicine Article
O'Keefe International Journal of Obesity Article
Palagini Sleep Medicine Article
Irwin Biological Psychiatry Article
