Category Archives: Women

8 Tips To Improve Your Pregnancy Sleep

Pregnancy can be both a joyful and stressful time. There is happiness about the expectant arrival but there can be anxiety preparing for the new arrival. One detail that many mothers are not prepared for is the negative impact on their sleep. Here are eight common problems and potential solutions:

  1. Increased Urinary Frequency

This problem can occur in the first or third trimester. It is due to a combination of factors such as increased production of progesterone and compression of the bladder by the uterus.

Solution: Avoid fluids two hours before bedtime and try to empty your bladder completely. Of course, stay well hydrated the rest of the day.

  1. Nausea

This is very common during the first trimester, and even though called morning sickness, it can occur at any time, including bedtime.

Solution: Keeping crackers at the bedside and eating small amounts seems to avoid the empty stomach that contributes to this problem. In addition, ginger has also been found to be effective.

  1. Back Pain

This is quite common at the end of the second and throughout the third trimester. Your growing baby and a hormone called relaxin tends to weaken ligaments.

Solution: Use a pregnancy pillow and sleep on your left side. Pregnancy pillows support your abdomen and can be placed between your legs at the same time. Sleeping on your left side increases blood flow and oxygen delivery to your uterus and baby. In addition, exercises that increase back strength such as straight leg raises and pelvic tilts are safe and beneficial.

  1. Restless Legs Syndrome

Twenty percent of women experience Restless Legs Syndrome, usually during the third trimester. It is a major cause of sleep deprivation during pregnancy.

Solution: Make sure you are taking folate and iron. Daily exercise such as walking and stretching can help. Caffeine, nicotine, and alcohol can all worsen the problem. In some cases, especially when there is associated swelling, support hose can help. Finally, talk to your obstetrician. You may be on medications that are making it worse.

  1. Insomnia

The National Sleep Foundation, in their Sleep in America survey, reported that 79% of women describe difficulty falling or staying asleep during pregnancy.

Solution: Develop a calming bedtime routine and try to keep a stable sleep-wake schedule. Learn relaxation techniques such as progressive muscle relaxation, abdominal breathing, and guided imagery. Above all, practice good sleep hygiene, which means no caffeine after noon, and no computers, cell phones, or televisions at least one hour before bedtime. If sleep trouble continues, talk to your health care provider. Untreated insomnia, especially during the third trimester, has been associated with PPD (postpartum depression).

  1. Elevated Blood Pressure

Sleep apnea is a major cause of PIH (Pregnancy Induced Hypertension) as well as gestational diabetes. If you are among the 40% of women who snore during pregnancy, discuss this with your physician. You may be doing more than snoring. Your airway may be collapsing during sleep. Treating sleep apnea can bring down blood pressure and improve blood sugar levels.

  1. Leg Cramps

It is estimated that over one third of pregnant women suffer from severe leg cramps that awaken them from sleep. This can be due to low calcium and magnesium levels during pregnancy. Remember, your growing baby requires a lot of calcium.

Solution: Discuss this with your health care provider. Taking calcium supplements, or in some cases vitamin D3, may be necessary. Foods high in magnesium such as almonds, cashews, legumes, and dairy products, as well as stretching exercises, may be helpful.

  1. Nasal Congestion (Pregnancy Rhinitis)

This common pregnancy problem can be a major cause of discomfort and inability to fall or stay asleep. The congestion is due to a combination of high estrogen causing increased mucous, as well as a higher blood volume associated with pregnancy.

Solution: Elevate the head of your bed or use a pillow that does this. Avoid caffeine, which can exacerbate the problem. Steam, in the form of a hot shower before bed as well as saline nasal sprays can be helpful. Avoid spicy foods, which can intensify the problem.

Pregnant? Here’s What You Need to Know About Sleep Apnea

We have known for some time that sleep apnea can cause problems during pregnancy. Several studies have shown an increased risk of hypertension and diabetes in pregnant women with sleep apnea. However, a study in this month’s issue of the journal Sleep, bring to light some truly startling revelations about how sleep apnea affects a woman’s health during pregnancy.

The researchers drew upon a nationally representative sample of 55 million maternal-related hospital discharges. They reviewed the records of women who were pregnant or gave birth from 1998 to 2009. The findings were stunning.

They found that the incidence of sleep apnea increased by an average of 24 percent per year. In 1998, the rate of sleep apnea was .7 per 10,000. By 2009, it had climbed to 7.3. Even more shocking was how much having sleep apnea increased the pregnant women’s chances of developing associated medical problems. The researchers found that the chances of developing preeclampsia and eclampsia, two conditions involving hypertension associated with pregnancy, increased by a factor of 2.5 and 5.4 respectively. The chance of developing cardiomyopathy, a significant and dangerous weakness of the heart muscle, was nine times more likely in pregnant women with sleep apnea. Finally, pregnant women with sleep apnea were five times as likely to die while hospitalized for their pregnancy. In all cases, obesity made matters worse, and may have contributed to the rise in sleep apnea.

We know that untreated sleep apnea is associated with many undesirable metabolic and mechanical changes. There is an increased production of inflammatory mediators that damage organs and the lining of blood vessels. At the same time, sleep apnea results in insulin resistance, arterial vasoconstriction, and cardiac dysfunction. Is it any wonder that when coupled with the increased demands of pregnancy, bad things are more likely to happen?

I believe that this study is a wake-up call for all of us in the medical profession, especially for those physicians and healthcare professionals involved in maternal care. We all need to be more mindful of the increased risk of sleep apnea in our pregnant patients. We need to be more proactive about inquiring as to snoring and be suspicious of sleep apnea in any of our pregnant patients who are excessively overweight during their pregnancy.

The good news is that sleep apnea is treatable. I myself have had numerous patients who were successfully treated for sleep apnea during their pregnancies. I believe that now there is no reason for pregnant women to suffer these dreadful complications.

Sleep Apnea and Sexual Dysfunction in Women

Until recently, when it came to sexual problems and sleep apnea, all we ever heard about were men.  The relationship between erectile dysfunction, loss of libido, and sleep apnea has been well established.  In fact, several studies have documented definite improvement in male sexual function following effective treatment of the sleep disorder.

Finally, we have some studies involving Female Sexual Dysfunction (FSD) and sleep apnea.  FSD is defined in standard questionnaires as problems involving desire, arousal, orgasm, pain, vaginal lubrication, and sexual satisfaction.

In one study, the incidence of FSD in women with sleep apnea was 34% and in another 54%.  These are truly impressive numbers.  The logical question is why would sleep apnea affect women’s sexual function?

In both of these studies, FSD was directly related to the severity of the sleep apnea.  In particular, it correlated directly with how frequent and severe were the drops in oxygen resulting from the apnea.  In sleep apnea, the airway closes intermittently while we are asleep.  This results in an obstruction to breathing that causes oxygen levels to plummet until it gets so low that we finally take a breath.

These episodic drops in oxygen followed by normalization generate harmful free oxygen radicals.  This process is referred to as oxidative stress.  These free radicals can injure nerve tissue and the lining of blood vessels.  In fact, this may be one of the major reasons that strokes and heart attacks are so frequent in both men and women with sleep apnea.

It would appear that in women this results in damage to nerve tissue and blood vessels that are integrally involved in sexual function.  Interestingly, in these studies, hormonal levels such as estrogen, progesterone, and testosterone did not differ between those with and without FSD due to sleep apnea.  This is interesting because in men sleep apnea has been shown to cause low testosterone.

To sum up, FSD is common in sleep apnea.  In fact, the authors of both studies urge that health care workers carefully screen their female patients with sexual difficulties for sleep apnea.  So if you have FSD and snore or are excessively sleepy, fatigued, have trouble concentrating, or have difficult to control hypertension, these are some of the symptoms of sleep apnea and you should probably discuss this with your health care provider.  In many, effective treatment of sleep apnea can result in a return of normal sexual function.