Sleep Disorders During Pregnancy

Tired and Sleepy During Pregnancy? Sleep disorders during pregnancy are more common than first thought.

Pregnancy is an episode in a woman’s life that is unique. Never before or after pregnancy, did you or will ever feel the same. The norm is happiness, elation, high expectations, blissfulness, wonder to the miracle of life entrusted to your body, and a sense of invincibility as you expect the arrival of your baby. You will overcome the nuisance of the early pregnancy nausea, should that be the case, or the aches and pains associated with your growing girth and increasing weight. All in good time will be compensated by the newcomer’s birth.

Among the many events occurring as pregnancy progresses are tiredness and sleepiness during the day, perhaps snoring at night, which you never did, and restless sleep. Chances are that, should you ask your doctor or midwife about it, you will be told to rest and take a snooze in the afternoon. Future grandma could have told you that much!

Well, things have changed since you were born. Tiredness, restless sleep and sleepiness during the day, in some cases, are not as simple as they appear to be at first sight. Certainly a snooze during the afternoon will not solve the problem. Sleep disorders during pregnancy are more common than first thought. What’s more, such events may adversely affect the developing baby and make you more prone to certain complications of pregnancy.

What I am referring to is “Sleep Apnea” (apnea means “without breathing”). I am sure you may have heard the term. Sleep apnea did not make it to the medical literature until 1965. Historically, Sir William Osler (1849-1919), a distinguished Canadian physician who, among other achievements, is known for being one of the founders of the Johns Hopkins Medical School, was a physician with an acute clinical observation capacity. He coined the term “Pickwickian syndrome”, inspired by one of Charles Dickens characters in “The Pickwick Papers”, the description of which is typical of what today we call “sleep apnea”. Today, with a better understanding of what the disease really entails, it was named “obstructive sleep apnea” (OSA). People affected by it have repeated episodes of shallow breathing during sleep, and sometimes stop breathing for short periods of time. Snoring is common. Those affected by OSA, sleep poorly, are tired, fatigued and have daytime sleepiness. Usually they are not aware of the problem. It is someone else that observes them sleeping while the breathing stops, who makes the individual aware of the problem.

During sleep, because of relaxation, the soft tissues around the airway can collapse and obstruct it. That is of short duration and is normal. When it becomes chronic, the result is OSA. During episodes of OSA, the oxygen in the blood decreases, sometime to dangerously low levels. Heart problems, high blood pressure and other abnormalities may result from untreated chronic OSA. This is true whether you are pregnant or not.

Modern treatment is very effective for OSA, due to the advent of Continuous Positive Airway Pressure (CPAP) equipment. The individual wears a mask during the night, which is connected to the CPAP machine. An oxygen generator may also be attached to the CPAP. Air is continuously pushed by the CPAP into the airway and should breathing stop the CPAP senses it and forces the air into the airway. Thus sleep apnea is avoided.

Very recently, investigators from United States and Israel have called attention to the fact that some pregnant women may suffer from sleep apnea. This new pregnancy complication has been labeled Gestational Sleep Apnea (GSA), thus adding to the list of other gestational abnormalities, like gestational diabetes and gestational hypertension.

Except for someone who may have come to pregnancy with a known diagnosis of sleep apnea prior to becoming pregnant, the condition is not routinely considered of concern during prenatal care. Being tired is a common complaint during pregnancy. Usually one counsels the patient to rest and perhaps take a nap during the afternoon. Tiredness is not investigated further as would, for example, sugar in the urine. Many physicians and midwives seldom think of sleep apnea in pregnancy and therefore do not make the diagnosis of gestational OSA. That may put you at risk by allowing your oxygen to get lower than normal, which may also affect the fetus. Unborn babies get their oxygen from their mother. If the mother’s oxygen level decreases so does that of the baby. In early pregnancy lack or low levels of oxygen may affect the baby’s normal early development. As pregnancy progresses it may have other consequences, some of which may potentially be serious.

Now that GSA has been recognized as a potential problem for pregnant women and has surfaced in the medical literature, it won’t be long before studies will be performed and the information will be perused to the benefit of maternal care. The earlier it becomes a reality, the better for both mother and baby. In the meantime, should you be pregnant and feel tired and sleepy during the day, ask your health care provider if you could have GSA.

SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so at: dr.aladjem@gmail.com

You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a recurring post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.