Sleep during pregnancy- Insights and tips from Dr. Jade Wu

Getting good sleep during pregnancy and postpartum is complicated, and often elusive. According to one study, 39% of women reported poor-quality sleep during their first trimester and 53.5% experienced sleep disturbances later in their pregnancy.

Sleep issues during the first trimester are commonly due to hormonal changes, whereas physical discomfort makes a restful night more challenging in the later pregnancy stages.

Because problematic sleep is so normalized during pregnancy, it can be difficult for women to know how much disrupted sleep to put up with and when to call their doctor.  For example, many women may not realize that insomnia, restless leg syndrome, and sleep apnea, which can develop at any time during pregnancy, are conditions that require medical intervention.

We wanted to better understand practical solutions for sleep during pregnancy, and we found the perfect source. Dr. Jade Wu is a behavioral sleep medicine specialist, clinical psychologist, researcher – and currently expecting her 2nd child. We asked her about what’s been working for her and what advice she wanted to pass along to other moms.

New moms often get messages about needing to "deal with it" when it comes to sleep problems during pregnancy and postpartum. What’s your response to this?

It is undeniable that sleep is disrupted during pregnancy and postpartum, but I'd also add one warning and one piece of reassurance.

The warning is that some sleep changes during pregnancy are not normal and should be red flags. These include increased snoring and breathing problems (e.g., gasping, breathing pauses) during sleep. Obstructive sleep apnea is much more common during pregnancy, and it is a big risk to both maternal and fetal health.

If you had sleep apnea before pregnancy, it is more important than ever to treat it. If you never snored or had apnea but began snoring during pregnancy, this actually bodes an even higher risk for gestational hypertension and postpartum depression.

Many people have sleep apnea and don't know it. It’s underdiagnosed in women in general, not just pregnant women, so I highly recommend erring on the side of caution, and checking in with your doctor if you snore at all.

My piece of reassurance is that postpartum sleep does not have to be as bad as we collectively fear, and more of it is under our control than you might think. Take good care of your circadian rhythm during pregnancy and postpartum by getting lots of bright light exposure during the day, dimming lights at night, and keeping as consistent a sleep-wake schedule as possible. Your baby will establish their circadian rhythm more readily after birth (this happens between about 6 and 12 weeks of age). This leads to quicker differentiation between day and night, allowing everyone to sleep more and protecting your sleep quality.

What strategies have you found to be most helpful for managing your sleep during your pregnancy?

Going with the flow has been crucial. At every stage of pregnancy, my sleep needs have changed. For example, I was so sleepy during the first trimester that I needed about 9 to10 hours per night – plus a 1 to 2 hour nap every day! I listened to my body and gave it what it needed.

In the second trimester, I needed less sleep than that, so I followed my body's cues and went back to my baseline sleep pattern. Now, in my third trimester, insomnia symptoms are cropping up because of rising progesterone levels and pain and discomfort. So I've tried different positions, working with a physical therapist to manage the discomfort or pain. When I still have trouble falling asleep, I get up and read rather than trying to force it.

Not being too rigid with my sleep expectations during pregnancy has been key. That being said, I do get up at the same time every day, which keeps my circadian rhythm robust and sets me up for the best sleep health possible, now and after the baby arrives.

What are your favorite and trusted resources for peripartum sleep?

Dr. Bei Bei's research is the best out there. She has done a lot of work on adapting behavioral sleep interventions specifically for pregnant and postpartum women.

I also highly recommend the Pediatric Sleep Council's website, which provides evidence-based and practical mini-videos and articles on baby sleep, which can be helpful for not only the babies' but parents' sleep.

Sadly, there’s not a lot of widely circulated information for maternal sleep, but hopefully, that will change as we pay more and more attention to this important topic!

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