WOMEN & SLEEP || Adventures in Sleep for the Pregnant Woman, Part Two: The Second Trimester

See Also:
Adventures in Sleep
for the Pregnant Woman, Part One:
The First Trimester

Adventures in Sleep
for the Pregnant Woman, Part Three:
The ThirdTrimester

Adventures in Sleep
for the Pregnant Woman, 
Postpartum Edition

So you’ve made it through the first 13-14 weeks, congratulations! You may find the second trimester much easier to cope with in regard to sleep issues. Less nausea and more energy are common improvements women enjoy as they move into the middle of their pregnancy. But sleep may still be disrupted, at least compared with how you slept before pregnancy. 

Potential sleep disruptions during the second trimester include: 

1. Sleep breathing problems
2. Charleyhorses and restless legs
3. Vivid dreams 

Let’s take a closer look.

Sleep breathing issues can become more apparent during the second trimester. At this point, the pregnant woman has gained some necessary weight, and swelling and fluid retention have likely become the new “norm.” 

Sleep breathing issues that can emerge include snoring, nasal congestion, upper airway resistance and obstructive sleep apnea. 

Body tissues during pregnancy soften due to hormone changes and retain more fluid, making the airway a target for airflow resistance. Mucus membranes may in fact be generating even more mucus than normal, which contributes to that resistance. Snoring reflects the vibrations and sounds that come from the friction inside the airway as the person breathes in and out. Nasal and sinus congestion can also be blamed on these hormonal shifts. Blood vessels will also expand, crowding your airway passages as well. 

Upper airway resistance syndrome is a sleep disorder in which the pattern of snoring and friction through the nasal passages and upper airway in general leads to micro-arousals, mini waking sessions which disrupt the architecture of sleep and can lead to sleep fragmentation, a cause of excessive daytime sleepiness. 

Finally, if the airway becomes blocked, either partially or completely, by enlarged or swollen tissues or due to fluid retention in the neck, obstructive sleep apnea can occur. OSA is especially concerning for pregnant women because it leads to lower blood oxygen saturation during the night which can have negative impacts on both mother and baby.

Solutions? Speak to your doctor about nighttime congestion, excessive daytime sleepiness or any reports from your sleep partner about gasping, loud snoring or choking sounds you might be experiencing during sleep. Other signs you might have a sleep breathing issue include waking up with dry mouth in the morning, headaches upon waking, and elevated blood pressure that can’t be explained by anything else. 

Snoring and congestion can usually be corrected by simple treatments or behaviors like positional therapy or saline nasal spray. Try elevating the head of your bed by three inches to help with postnasal drainage, and learn how to sleep on your side, if you haven’t already.

If your doctor suspects UARS and/or OSA, they may have you participate in a home sleep study and/or an overnight sleep study to identify what’s going on so they can give you appropriate treatment.  This can include a trial on PAP (positive airway pressure) therapy or an oral device to reposition your jaw so that your airway remains clear throughout the night.
Nighttime leg cramps, sometimes called “charleyhorses,” are a common complaint among women who are pregnant. You’re sleeping just fine, then WHAM! your toe or calf muscle seizes up, sending you out of your bed to massage the rock-hard spasm or walk it off. The experience is painful and highly disruptive to sleep.
Similar to these leg cramps are restless legs. They occur just as you are going to bed; your legs begin to feel restless and you are compelled to walk to calm them down. Some people describe the feeling as crawling, tingling or burning sensations or an undeniable need to move the legs. As many as 16 percent of all pregnant women experience restless legs. Restless legs can happen during the day as well, especially after long periods of sitting. At night, however, they become a nuisance because they can force a delay in sleep onset and pregnant women need to get as much sleep as possible.

In either case, leg cramping may indicate a dietary imbalance in minerals like potassium, calcium, magnesium or iron. It could be that your enlarged blood vessels in your legs experience more pressure than usual, leading to these kinds of discomfort. Surges in estrogen and progesterone can lead to the experience of restless legs. Finally, restless or cramping legs may present in a way that is similar to “growing pains” in children. Many pregnant women literally feel their body growing while pregnant and these sensations in the legs might reflect that phenomenon. 

Solutions? Some simple habit changes can go a long way to help you prevent leg cramps at night, such as standing for long periods or sitting in a way that prevents good blood flow. You would be better off moving your body from sitting to standing to walking to elevating your feet throughout the day to improve circulation in your legs. Stretching your calves and moving your feet in circles in both directions also offers some relief; so does massage. Left side sleeping improves blood circulation while you sleep. 

Don’t forget to drink you water as dehydration can be a direct cause of leg cramps. If you drink a lot of tea or coffee during the day, you may rethink this habit; both have a diuretic effect on the body and can lead to unintentional dehydration. If you don’t want to exclude these beverages from you diet, at least consider chasing each glass or cup of tea or coffee with an equal amount of water to replace your fluids. Remember, dehydration can also lead to ongoing fatigue.

How to fix a charleyhorse: Stand upright and straighten your affected leg, flexing your heel so that your toes are pointed back toward your shins. Breathe through the pain this might cause at first; it will subside as the spasm lets go of the affected calf muscle. Walking a few minutes to improve mobility of the muscle, or using a hot pad or heating ointment on the muscle can also help.

Be wary of any swelling or tenderness in your leg that may accompany the cramping. With the larger volume of blood circulating in your blood vessels, the odds naturally increase for blood clots. Though these are rare, they still require immediate identification and treatment. 

For people with restless legs, a massage or warm shower at bedtime can be extremely helpful for calming those uncomfortable sensations. Taking a short, slow walk can also help. It may be that an increase in light exercise during the day can counteract some of the restlessness that some feel in their legs at night.

Finally, many women will swear on supplements for minerals like magnesium, calcium, potassium or iron; you are best advised to discuss these possibilities with your doctor. For most pregnant women taking an iron-fortified prenatal vitamin, the amounts dosed in this daily supplement should be enough to supplement their needs. However, eating foods high in these minerals is still a better way to improve their levels in your bloodstream, since eating mineral-rich foods makes many minerals and vitamins more bio-available, which is better for both mother and baby. 

A vivid dream life may continue into your second trimester (see our comments on what this means in Part One). Again, go with the flow and try not to let this bother you. Dreams are a great release for anxiety and you shouldn’t worry about them too much.

About Tamara Kaye Sellman (621 Articles)

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