Sleepless in Pregnancy

Sleeplessness or poor sleep is one of the many problems that expecting mothers have to deal with. That leads to increase in the fatigue that a woman already faces during these trying times.

Why is good sleep important during pregnancy?

The possibility of the woman having a low birth weight baby and pre-term labor increases because of the poor sleep during this period.  There is a link between birth complications and expectant mothers’ sleep that appears to be in disruptions to normal immune system function, caused by insufficient and low-quality sleep.

Why do pregnancy lead to sleep problems?

Several factors that contribute to the sleep difficulty during pregnancy are:

Hormonal changes. 

Pregnancy is a time of major hormonal shifts, which change sleep cycles and can disrupt sleep. Rising levels of progesterone may cause increase in BMR and may cause fatigue, as well as more sleepiness during the day, leaving women unusually wakeful at night. Fluctuating levels of estrogen also interfere with sleep. Levels of the hormone progesterone soar and your metabolism is running high. This can make you feel exhausted. At the same time, lower blood pressure and increased blood production might team up to sap your energy. If you have another child or children to care for, you might experience even more fatigue.

Leg cramps: 

Dehydration, increase in weight and hormonal shifts all might cause the leg cramps and might hamper your sleep.

Shortness of breath: 

Because of the increase in the uterus size that might put pressure on the diaphragm, which is one of the breathing muscle. This pressure increase in supine position while sleeping and worsens the ability to sleep.

Nocturnal heartburn or gastro-esophageal reflux disease (GERD) : 

Pressure on the stomach by uterus and loosening of the lower esophageal sphincter leads to increased heartburn that again increases in lying down position.

Pain Syndromes:

Many types of pain that occur during this period like Back pain, Joint pain, Carpal tunnel syndrome (numbness in the hands that occurs due to fluid retention during this period) and Breast tenderness might hamper your sleep during this period.

Itching: 

Pruritus during pregnancy might get exaggerated and lead to persistent itching that might increase your sleeplessness.

Nightmares:

Vivid dreams or nightmares increase during pregnancy because of the hormonal shifts that increase the REM Sleep during this period and it is responsible for increased dreaming, which might cause increased anxiety in the pregnant women.

Anxiety.   

Anxiety about the pregnancy itself as well as about managing all the aspects of their lives alongside the impending arrival of a new baby might scare away the women to make them sleepless.

It is also during this phase of pregnancy that preeclampsia may occur, which has an impact on the timing of sleep or circadian rhythm.

What can a woman do to improve her sleep during this pregnancy?

Few simple things may improve your sleep and better the fatigue and the quality of life during pregnancy.

Sleep on the left lying position.                           

Lying on your left side can help improve blood flow to your baby and to your body. Also, try to keep one or both knees bent. And it's OK though, if you wake up in a different position.

Use pillows.                    

To prevent discomfort, consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.

Elevate your headend while sleeping.               

Elevating the head of your bed can prevent or decrease heartburn or snoring.

Maintain a sleep schedule and follow good sleep hygiene.                    

Regularly go to bed and wake up at the same time. If you need more sleep, try napping early in the day.

Drink lots of fluids. 

Drink plenty of fluids during the day. To prevent frequent urination at night, cut down on how much you drink late in the day.

Plan your Nutrtion. 

Strive for a balanced diet rich in vitamins. A healthy diet can help you improve your energy levels and keep your pregnancy weight gain on target. To prevent heartburn, eat small, frequent meals and avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods.

Keep active. 

Regular physical activity during pregnancy might help prevent excess weight gain and leg cramps, as well as boost energy.

Stretch. 

Stretching your calf muscles before bed may help prevent leg cramps during pregnancy.

Relaxation.

Breathing techniques, in particular, can help reduce tension.

Use nasal saline sprays or mechanical nasal dilators. 

These can relieve the nasal congestion that often occurs during pregnancy. Also, avoid smoking and exposure to secondhand smoke.

Creating an atmosphere to sleep.

A dark, quiet and comfortably cool environment can help encourage sleep.

Relieve pain safely. 

If minor pain caused by muscle stretching or your increased weight during the late stages of pregnancy is keeping you up, occasional use of acetaminophen (Paracetamol, others) might help.

Contributed By:

Dr Sweta Singla

Consultant Neurology & Sleep Disorder
At KVSC, we believe in providing you updated, ethical and evidence based care to you. We invite your valued feedback.    

Effect of Thyroid Dysfunction on Pregnancy

Pregnancy is a time when the woman needs to maintain perfect health condition, as staying disease free will help in the proper foetal growth and development. 

Hence, the need to screen for various diseases so that we can manage the health issues timely before any complications arise because of them. 

One of such problems is thyroid dysfunction during pregnancy. 

Dealing with thyroid dysfunction timely and adequately will prevent premature labour and lead to better neurological development of a foetus leading to healthy and intelligent babies.

What is thyroid hormone?

Thyroid hormone is secreted by a gland located in center of neck just below your Adam’s apple. This hormone is required for optimum functioning of all body parts including your muscles, stomach, bone, heart and brain.

What are common thyroid diseases and what are the common symptoms for same?

When thyroid gland produces less than desired levels of thyroid hormones, it is considered to be underactive or “hypothyroidism” and when it is over-producing then we call it “Hyperthyroidism”. Both of these states are harmful for baby as well as mother. Both of these states have distinct symptoms:

Hypothyroidism	Hyperthyroidism
Tiredness  Depression  Weight gain  Feeling cold  Dry skin and hair	Feeling too hot when others are comfortable Rapid heartbeat Trembling hands Weight loss even though you eat enough Tiredness and/or trouble sleeping  Feeling irritable and anxious

What are the risk factors for developing thyroid disease?

In large number of patients, there is no identifiable risk factor for thyroid disease. But certain risk factors do predispose for development of thyroid disease, especially for hypothyroidism.

1.     A family history of thyroid or autoimmune disease

2.     Type 1 diabetes or other autoimmune disease

3.     Prior radiation treatment of the head or neck

4.     Past thyroid surgery

5.     Thyroid antibodies, mainly thyroid peroxidase (TPO) antibodies, which are often present in Hashimoto’s disease

6.     Past infertility or preterm delivery

7.     A goiter (swelling of the thyroid gland)

When should I get myself tested for thyroid disease?

Every woman who is planning pregnancy should get herself tested for thyroid disease beforehand and in case of unplanned pregnancy, thyroid testing should be recommended at first visit to gynecologist.

The reason for such liberal recommendation is two- fold. Firstly, it is an easily treatable disease and secondly, treatment is cheap and generally has no associated side-effects.

How are thyroid disorders detected?

To detect thyroid disorders, your doctor does a physical exam and orders blood tests to 

measure your thyroid hormone levels.

In the blood tests, main conclusion is drawn from a test called serum TSH. Interpretation of TSH values requires understanding of normal physiology of thyroid gland.

How do I treat my thyroid problems in pregnancy?

In pregnancy, you need to start some medications for both types of thyroid diseases, in consultation with your endocrinologist.

Treatment of hypothyroidism involves replacement with tyroid hormone i.e. T4. This hormone has been prepared with recombinant technology and is exactly same as is being produced inside your own thyroid gland.

For hyperthyroidism, drugs are given to suppress your thyroid gland from producing more thyroid hormone.

Why is it so necessary to take treatment for thyroid problems in pregnancy?

Maternal hypothyroidism poses a risk for both mother and baby, if left untreated. A pregnant woman’s thyroid hormones are vital not only for her but also for the development of her baby. Pregnant women with uncontrolled hypothyroidism can get high blood pressure, anemia (low red blood cell count), and muscle pain and weakness. There is also an increased risk of miscarriage, premature birth (before 37 weeks of pregnancy), or even stillbirth.

Pregnant women with uncontrolled hyperthyroidism may develop high blood pressure. 

There is also an increased risk of miscarriage, premature birth, and having a baby with a low birth weight.

Is there anything to worry?

No, there is nothing to worry. If treated well, thyroid diseases pose no risk to mother or child. So, importance of screening for thyroid disease in pregnancy cannot be over-emphasized.
 

Contributed By:

Dr Rajiv Singla

Consultant Endocrinology

MD, DM - Endocrinology & Metabolism.

At KVSC, we believe in providing you updated, ethical and evidence based care to you. We invite your valued feedback.