Linked to hormonal, morphological and psychological changes induced by pregnancy, sleep disorders are common in pregnant women and generally intensify over the months. The mother-to-be, however, needs a restful sleep to carry out her pregnancy and gain strength for the aftermath.

Difficulty falling asleep, frequent nocturnal awakenings, waking up in the early morning with the inability to go back to sleep: during pregnancy, sleep disorders are frequent and can take different forms. Many factors favor them:

• the increase in uterine volume which makes it difficult to find a comfortable sleeping position;
• the hormonal climate: the strong secretion of estrogen and progesterone promote insomnia, and also have an impact on the cortisol / melatonia ratio, two hormones which directly participate in the waking / sleeping rhythm. The secretion of prolactin (which prepares the mother-to-be for breastfeeding, and therefore for nocturnal awakenings to feed the baby), for its part, leads to a fragmentation of sleep at the end of pregnancy;
• acid reflux or gastroesophageal reflux, which affects 22% of expectant mothers in the first trimester, 39% in the second and 72% in the last trimester (1), are favored when lying down;
• frequent urges to urinate due to the uterus pressing more and more on the bladder;
• night cramps;
• back pain, which usually appears between the 5th and 7th month of pregnancy with a predominance at night;
• the baby’s movements;
• restless legs syndrome, which affects 23% of pregnant women in the 3rd trimester. It manifests itself by cramps, impatience, possibly coupled with periodic movements of the legs which fragment sleep (2);
• the feeling of suffocation due to the compression of the diaphragm by the uterus;
• the worries and anxieties that the prospect of becoming a mother and that of childbirth can give rise to. An expression of the profound psychological reorganization that a pregnant woman experiences during her pregnancy, nightmares are also frequent;
• carpal tunnel syndrome, a pathology that affects 20% of pregnant women (3), and whose manifestations (tingling, feeling of paralysis, or even pain) are most often felt at night.

In general, sleep disorders worsen during pregnancy.

The first trimester

At the beginning of pregnancy, the body adapts to its new state and this requires a lot of energy, so much so that the expectant mother usually falls asleep in the early evening. Especially since progesterone, secreted in large quantities the first weeks, acts like a real sleeping pill. The duration of nocturnal sleep during this first trimester is thus estimated at 9 hours (4). But sometimes, the discovery of pregnancy gives rise to anxiety and worries which, once on the pillow, can prevent the mother-to-be from easily falling asleep.

The second trimester

Just as this second trimester is often experienced as the most pleasant of pregnancy, sleep is generally of better quality at this stage of pregnancy (5). Unless the baby, very active and who still has enough space to make great movements, prevents the mother-to-be from sleeping, especially since he generally takes advantage of his moments of rest to gesticulate at his easy. Pregnancy ailments can also appear and interfere with sleep: acid reflux, back pain, etc.

At the end of pregnancy, sleep disorders are accentuated. They affected 82% of women near term (6). The very large belly prevents you from finding a comfortable position and, by exerting pressure on all the organs of the abdomen and upsetting the balance of the body, amplifies the various ailments of pregnancy: frequent urges to urinate, acid reflux , feeling of having trouble breathing, back pain, cramps, restless legs syndrome, etc. Add to this the anxiety that increases with the approach of D-Day and nightmares: the nights of late pregnancy are clearly not easy. We also observe a change in the composition of sleep, with a greater proportion of phases of light slow sleep and awakenings and a decrease in the number of phases of slow deep sleep decreases. In the end, sleep is therefore less restorative (7).

Very quickly, it becomes difficult to sleep on your stomach. The position on the side is then the most comfortable. A breastfeeding pillow slipped under one leg and stomach can be a solution to relieve various areas of tension in the body. We recommend a breastfeeding pillow of at least 1,70 m (8).

But another parameter is added to that of comfort: the risk of vena cava syndrome, also called the poseiro effect. From the 24th WA, in the supine position, compression of the inferior vena cava by the uterus can reduce venous return and therefore the stroke volume leading to a drop in maternal blood pressure, a decrease in blood pressure. uteroplacental perfusion, which in turn can cause the fetal heart rate to slow (9).

To prevent this phenomenon, pregnant women are recommended to sleep on their left side from the 6th month of pregnancy.

The practice of a regular physical activity adapted to the pregnancy such as walking, prenatal yoga or swimming, have multiple benefits on the sleep of the mother-to-be. By calling on the body, it induces “good fatigue” and thereby promotes falling asleep. As a natural stress reliever, physical activity also has a relaxing effect. It also helps prevent various pregnancy ailments that can affect the quality of sleep: back pain, excessive weight gain, nighttime cramps, etc.

Relaxation methods such as sophrology, self-hypnosis, meditation, breathing exercises are also interesting resources to fight against sleep disorders during pregnancy.

First of all, it is advisable to adopt some hygiene rules for good sleep, valid for all people:

• have regular times of getting up and going to bed;
• go to bed as soon as you feel sleep signals;
• take a brief nap (less than 20 minutes) at the start of the afternoon, but avoid longer and / or late naps which can encroach on the night’s sleep time (or to reserve in the event of very important sleep debt) ;
• have a regular and reasonable weight gain, because a strong weight gain seems to promote sleep disorders during pregnancy (10);
• set up an environment conducive to sleep in the bedroom: have good bedding, do not overheat the room (18-19 ° C), limit sources of noise and light;
• avoid using screens in the evening (smartphone, tablet, computer). They emit a blue light which delays the secretion of melatonin, the sleep hormone. In general, avoid all awakening activities in the evening, and favor those that relax, such as a hot bath;
• avoid exciting drinks in the afternoon (caffeinated soda, tea, coffee);
• eat light in the evening, especially in the event of acid reflux;
• in the event of gastroesophageal reflux, sleep with the back raised by a few cushions.

Phythotherapy

Certain plants with sedative properties are authorized from the 2nd trimester of pregnancy: Roman chamomile, orange tree, lime blossom, verbena, lemongrass. They are consumed as an infusion, to drink 1 to 3 times a day (11). Certain special anti-stress and sleep herbal medicine preparations are also authorized during pregnancy. Seek advice from your gynecologist, midwife or pharmacist.

homeopathy

The commonly recommended remedies for insomnia can be used during pregnancy:

• Coffea 15 Ch et Ignatia 15 CH, 5 granules 2 to 3 times a day, are the first-line remedies during pregnancy to promote falling asleep. To be combined optionally with Passiflora compound;
• Gelsemium 15 CH, 5 granules 2 to 3 times a day, is particularly indicated at the end of pregnancy if the prospect of childbirth prevents you from falling asleep;
• Sepia 15 CH, in the event of nocturnal awakenings every 2 hours, with anxiety;
• Arsenicum Album 15 CH if you wake up between 1 and 3 a.m., with anxiety;
• Nux vomica 15 CH in the event of early morning awakenings, with concerns (12).

Nutritherapy

Taking magnesium can help reduce stress and restore better sleep. With calcium, it would also have a preventive action against night cramps. Seek advice from your practitioner.

acupuncture

The preliminary results of the AP-HP GAS (Pregnancy, Acupuncture and Sleep) project showed some benefits of acupuncture during pregnancy, against stress and sleep disorders. Consult a gynecologist or midwife with an obstetric acupuncture IUD.