Pregnancy and sleep

Last updated

Sleep during pregnancy can be influenced by various physiological, hormonal, and psychological factors, leading to changes in sleep duration and quality. [1] [2] [3] [4] Furthermore, pregnant persons are more prone to experiencing sleep disorders like insomnia, [5] sleep-disordered breathing, [6] and restless legs syndrome. [7] [8] [9] Most women experience sleep disturbances during pregnancy. [10] Interrupted sleep is recognized for its substantial impact on health and its association with a heightened risk of unfavorable pregnancy outcomes. [1]

Contents

Aetiology

Anatomic and metabolic changes

Pregnancy brings about significant and dynamic physiological changes that can impact sleep and contribute to sleep disorders. These changes encompass structural alterations that may affect the length and quality of sleep, disrupt breathing during sleep, and metabolic shifts that raise the risk of restless legs syndrome. For example, conditions like gastroesophageal reflux tend to worsen as pregnancy advances, affecting a substantial portion of pregnant individuals and potentially causing sleep disruptions. [11] Frequent nighttime urination due to increased sodium excretion can also fragment sleep. [12] Additionally, the musculoskeletal system undergoes stress as it readies itself for the expanding uterus and eventual delivery, which can lead to sleep disturbances. [13] Alterations in iron and folate metabolism during pregnancy have been proposed as factors contributing to the higher prevalence of restless legs syndrome among expectant mothers. [1] [14] [15]

Hormones

The secretion of sex hormones like estrogen and progesterone increases significantly during pregnancy, influencing the regulation of sleep in terms of both circadian rhythms and sleep need. [1] [16] Sleep disruption can also occur due to nighttime uterine contractions, which are a result of the nighttime surge in oxytocin levels. [1] [17]

Sleep disorders

Sleep disorders are frequently experienced during pregnancy, impacting over 50% of all pregnancies. [18] These issues tend to become more prevalent as pregnancy advances. The most commonly observed sleep disorders in pregnant women include insomnia, obstructive sleep apnea, and restless legs syndrome. [18] The American Academy of Sleep Medicine has officially recognized 'pregnancy-associated sleep disorder' as a distinct condition, encompassing both insomnia and increased daytime sleepiness occurring during pregnancy. [19] [20]

Parasomnias

Parasomnias represent a notable concern in pregnancy, with somnambulism, nightmares, night terrors, and vivid dreams being frequent occurrences. [9] [21] The disrupted sleep experienced during pregnancy, along with sleep disorders like sleep-disordered breathing and movement disorders, can act as substantial triggers for parasomnias, leading to an elevated likelihood of experiencing such episodes during pregnancy. [9]

Insomnia

Pregnancy-related insomnia is quite common. [22] As pregnancy advances, both subjective and objective assessments reveal a notable increase in sleep disruptions. [5] [23] [24] [25] Researchers who have used polysomnography to study sleep in pregnant women have observed distinct patterns. These patterns include more wakefulness after initially falling asleep, reduced rapid eye movement sleep, and a greater amount of time spent in lighter sleep stages compared to non-pregnant women. [5] [26] [27] Furthermore, as pregnancy progresses, women tend to experience less total sleep time, increased wakefulness after falling asleep, more time in lighter sleep stages, decreased periods of deep and rapid eye movement sleep, and more frequent awakenings compared to earlier stages of pregnancy. [23] [28] Additionally, it's common for pregnant persons to express dissatisfaction with the quality of their sleep, with almost half reporting poor subjective sleep experiences. [4]

Restless legs syndrome

Restless legs syndrome is a condition characterized by uncomfortable sensations in the legs and an irresistible urge to move them, particularly during periods of rest or inactivity.

The condition is more common among pregnant women than in the general population. [7] Research studies have reported varying prevalence rates, with estimates ranging from 10% to 34% of pregnant individuals experiencing RLS symptoms at some point during their pregnancy. [29]

Sleep-disordered breathing

Snoring and sleep-disordered breathing are significantly more common in pregnant women, being 2–3 times more prevalent than in nonpregnant females. [30] These changes are associated with alterations in upper airway anatomy and tend to return to nonpregnant levels after childbirth. [30]

Obstructive sleep apnea is a condition where breathing repeatedly stops during sleep due to the collapse of the upper airway, often leading to a decrease in oxygen levels. It is a prevalent health concern among pregnant women and is linked to various pregnancy-related health consequences. [6] [31] The condition is more prevalent in pregnant women who are obese. [32] [33] Pregnancies where obstructive sleep apnea is a complicating factor face a higher risk of developing conditions like intrauterine growth restriction, pre-eclampsia, and stillbirth. [32]

Management

The management of sleep disorders during pregnancy may require the use of psychopharmacological drugs. [34] Primary insomnia can be managed with cognitive behavioral therapy and medication, while secondary insomnia should primarily target the underlying medical issue. [35] When dealing with restless legs syndrome, treatment includes medication use and minimizing exposure to triggers like smoking, caffeine, and specific medications. [35]

Sleeping positions

The National Health Service (NHS) advises pregnant individuals to sleep on their side, either the left or right, for optimal safety during pregnancy. [36] Research indicates that beyond the 28th week, assuming a supine (back) sleeping position can result in a twofold increase in the risk of stillbirth. [36] This increased risk may be attributed to potential disruptions in fetal blood circulation and oxygen supply. [36] Sleeping on the back can also give rise to various complications, including back pain, respiratory issues, hemorrhoidal problems, low blood pressure, gastrointestinal discomfort, and reduced blood flow to both the maternal heart and the developing fetus. [37] Furthermore, the weight gain associated with pregnancy may heighten the likelihood of developing sleep apnea when sleeping on the back. [37]

Dreams

During pregnancy, a significant period of emotional adjustment occurs, involving thoughts, feelings, and relationships regarding oneself and the unborn child, which often find expression in dreams. Pregnant women often describe their dreams as exceptionally vivid and realistic. [38] Some systematic studies suggest that the majority of pregnant women (67–88%) report experiencing at least one dream related to topics like pregnancy, childbirth, or babies. [39] [40] [41] [42] Additionally, some other studies indicate that 30–62% of these dreams include maternal elements, and their frequency tends to increase as pregnancy progresses. [39] [43] [44] [45] [41] These dreams typically touch upon the mother's physical well-being and the baby's sex, but may also feature elements of danger or harm to the baby, mother, father, as well as issues within the family and marriage. [39] Pregnant individuals tend to have better dream recall, and notably, the content of their dreams tends to be more disturbing compared to other life stages. [10] [38] [46] Comparative research suggests that pregnant persons recall more dreams centered around pregnancy-related themes (e.g., childbirth, pregnancy, the fetus, their own body, the baby's body) and more elements involving potential risks to the fetus and themselves. [39] [47] [42] Pregnancy can influence dream patterns, leading to an increased likelihood of experiencing bad dreams and nightmares. [10] Pregnant women's dreams tend to be more masochistic and include more elements where they experience misfortune, harm, or face environmental threats, although they do not necessarily involve more aggressive actions. [39]

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring. A choking or snorting sound may occur as breathing resumes. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children, it may cause hyperactivity or problems in school.

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

<span class="mw-page-title-main">Restless legs syndrome</span> Long-term disorder that causes a strong urge to move ones legs

Restless legs syndrome (RLS), also known as Willis–Ekbom disease (WED), is generally a long-term disorder that causes a strong urge to move one's legs. There is often an unpleasant feeling in the legs that improves somewhat by moving them. This is often described as aching, tingling, or crawling in nature. Occasionally, arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may be sleepy during the day, have low energy, and feel irritable or depressed. Additionally, many have limb twitching during sleep, a condition known as periodic limb movement disorder. RLS is not the same as habitual foot-tapping or leg-rocking.

<span class="mw-page-title-main">Obesity hypoventilation syndrome</span> Condition in which severely overweight people fail to breathe rapidly or deeply enough

Obesity hypoventilation syndrome (OHS) is a condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels. The syndrome is often associated with obstructive sleep apnea (OSA), which causes periods of absent or reduced breathing in sleep, resulting in many partial awakenings during the night and sleepiness during the day. The disease puts strain on the heart, which may lead to heart failure and leg swelling.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, orthodontics, surgery, or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

Periodic limb movement disorder (PLMD) is a sleep disorder where the patient moves limbs involuntarily and periodically during sleep, and has symptoms or problems related to the movement. PLMD should not be confused with restless legs syndrome (RLS), which is characterized by a voluntary response to an urge to move legs due to discomfort. PLMD on the other hand is involuntary, and the patient is often unaware of these movements altogether. Periodic limb movements (PLMs) occurring during daytime period can be found but are considered as a symptom of RLS; only PLMs during sleep can suggest a diagnosis of PLMD.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

Mouth breathing, medically known as chronic oral ventilation, is long-term breathing through the mouth. It often is caused by an obstruction to breathing through the nose, the innate breathing organ in the human body. Chronic mouth breathing may be associated with illness. The term "mouth-breather" has developed a pejorative slang meaning.

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.

The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published by the AASM in 2005. The third edition, ICSD-3, was released by the AASM in 2014. A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM.

<span class="mw-page-title-main">Sleep medicine</span> Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders

Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.

<span class="mw-page-title-main">Catathrenia</span> Sleep-related breathing disorder

Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea and expiratory groaning during sleep. and it describes a rare condition characterized by monotonous, irregular groans while sleeping. Catathrenia begins with a deep inspiration. The person with catathrenia holds her or his breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. It appears more often during expiration REM sleep than in NREM sleep.

Christian Guilleminault was a French physician and researcher in the field of sleep medicine who played a central role in the early discovery of obstructive sleep apnea and made seminal discoveries in many other areas of sleep medicine.

Central sleep apnea (CSA) or central sleep apnea syndrome (CSAS) is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds either intermittently or in cycles, and is usually associated with a reduction in blood oxygen saturation. CSA is usually due to an instability in the body's feedback mechanisms that control respiration. Central sleep apnea can also be an indicator of Arnold–Chiari malformation.

Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.

Sleep and weight is the association between the amount of sleep an individual obtains and the weight of that individual.

Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

Sleep problems in women can manifest at various stages of their life cycle. Both subjective and objective data indicate that women are at an increased risk of experiencing different types of sleeping problems during different life stages. Factors such as hormonal changes, aging, psycho-social aspects, physical and psychological conditions, and the presence of sleeping disorders can disrupt women's sleep. Research supports the presence of disturbed sleep during the menstrual cycle, pregnancy, postpartum period, and menopausal transition. The relationship between sleep and women's psychological well-being suggests that the underlying causes of sleep disturbances are often multi-factorial throughout a woman's lifespan.

References

  1. 1 2 3 4 5 Pengo, Martino F.; Won, Christine H.; Bourjeily, Ghada (2018). "Sleep in Women Across the Life Span". Chest. Elsevier BV. 154 (1): 196–206. doi:10.1016/j.chest.2018.04.005. ISSN   0012-3692. PMC   6045782 . PMID   29679598.
  2. ↑ Cai, Shirong; Tan, Sara; Gluckman, Peter D.; Godfrey, Keith M.; Saw, Seang-Mei; Teoh, Oon Hoe; Chong, Yap-Seng; Meaney, Michael J.; Kramer, Michael S.; Gooley, Joshua J. (2016-12-09). "Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus". Sleep. Oxford University Press (OUP). 40 (2). doi: 10.1093/sleep/zsw058 . ISSN   0161-8105. PMID   28364489.
  3. ↑ Meers, Jessica M.; Nowakowski, Sara (2022-06-11). "Sleep During Pregnancy". Current Psychiatry Reports. Springer Science and Business Media LLC. 24 (8): 353–357. doi:10.1007/s11920-022-01343-2. ISSN   1523-3812. PMID   35689720. S2CID   249551102.
  4. 1 2 Sedov, Ivan D.; Cameron, Emily E.; Madigan, Sheri; Tomfohr-Madsen, Lianne M. (2018). "Sleep quality during pregnancy: A meta-analysis". Sleep Medicine Reviews. Elsevier BV. 38: 168–176. doi:10.1016/j.smrv.2017.06.005. ISSN   1087-0792. PMID   28866020.
  5. 1 2 3 Sedov, Ivan D.; Anderson, Nina J.; Dhillon, Ashley K.; Tomfohr-Madsen, Lianne M. (2020-11-02). "Insomnia symptoms during pregnancy: A meta-analysis". Journal of Sleep Research. Wiley. 30 (1): e13207. doi:10.1111/jsr.13207. ISSN   0962-1105. PMID   33140514. S2CID   226242525.
  6. 1 2 Liu, Lina; Su, Guang; Wang, Shuling; Zhu, Bingqian (2018-09-25). "The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: a systematic review and meta-analysis". Sleep and Breathing. Springer Science and Business Media LLC. 23 (2): 399–412. doi:10.1007/s11325-018-1714-7. ISSN   1520-9512. PMID   30255484. S2CID   52821295.
  7. 1 2 Chen, Si-Jing; Shi, Le; Bao, Yan-Ping; Sun, Ye-Kun; Lin, Xiao; Que, Jian-Yu; Vitiello, Michael V.; Zhou, Yu-Xin; Wang, Yong-Qing; Lu, Lin (2018). "Prevalence of restless legs syndrome during pregnancy: A systematic review and meta-analysis". Sleep Medicine Reviews. Elsevier BV. 40: 43–54. doi:10.1016/j.smrv.2017.10.003. ISSN   1087-0792. PMID   29169861. S2CID   5208761.
  8. ↑ Gupta, Ravi; Rawat, Vikram Singh (2020). "Sleep and sleep disorders in pregnancy". Handbook of Clinical Neurology. Vol. 172. Elsevier. pp. 169–186. doi:10.1016/b978-0-444-64240-0.00010-6. ISBN   9780444642400. ISSN   0072-9752. PMID   32768087. S2CID   226740697.
  9. 1 2 3 Bušková, Jitka; Miletínová, Eva; Králová, Radana; Dvořáková, Tereza; Tefr Faridová, Adéla; Heřman, Hynek; Hrdličková, Kristýna; Šebela, Antonín (2023-02-18). "Parasomnias in Pregnancy". Brain Sciences. MDPI AG. 13 (2): 357. doi: 10.3390/brainsci13020357 . ISSN   2076-3425. PMC   9954207 . PMID   36831900.
  10. 1 2 3 Lara-Carrasco, Jessica; Simard, Valérie; Saint-Onge, Kadia; Lamoureux-Tremblay, Vickie; Nielsen, Tore (2014). "Disturbed dreaming during the third trimester of pregnancy". Sleep Medicine. Elsevier BV. 15 (6): 694–700. doi:10.1016/j.sleep.2014.01.026. ISSN   1389-9457. PMID   24780135.
  11. ↑ Habr, Fadlallah; Raker, Christina; Lin, Cui Li; Zouein, Elie; Bourjeily, Ghada (2013). "Predictors of gastroesophageal reflux symptoms in pregnant women screened for sleep disordered breathing: A secondary analysis". Clinics and Research in Hepatology and Gastroenterology. Elsevier BV. 37 (1): 93–99. doi:10.1016/j.clinre.2012.03.036. ISSN   2210-7401. PMID   22572522.
  12. ↑ Parboosingh, J.; Doig, A. (1973). "Studies of Nocturia in Normal Pregnancy". BJOG: An International Journal of Obstetrics and Gynaecology. Wiley. 80 (10): 888–895. doi:10.1111/j.1471-0528.1973.tb02147.x. ISSN   1470-0328. PMID   4271274. S2CID   42747495.
  13. ↑ LT, Goldsmith; G, Weiss; BG, Steinetz (1995). "Relaxin and its role in pregnancy". Endocrinology and Metabolism Clinics of North America. 24 (1): 171–186. doi:10.1016/S0889-8529(18)30058-6. ISSN   0889-8529. PMID   7781625.
  14. ↑ Lee, Kathryn A.; Zaffke, Mary Ellen; Baratte-Beebe, Kathleen (2001). "Restless Legs Syndrome and Sleep Disturbance during Pregnancy: The Role of Folate and Iron". Journal of Women's Health & Gender-Based Medicine. Mary Ann Liebert Inc. 10 (4): 335–341. doi:10.1089/152460901750269652. ISSN   1524-6094. PMID   11445024.
  15. ↑ M I Botez; B Lambert (1977-09-22). "Folate deficiency and restless-legs syndrome in pregnancy". New England Journal of Medicine. Hysterectomies. Massachusetts Medical Society. 297 (12): 670–671. doi:10.1056/nejm197709222971220. ISSN   0028-4793. PMID   895774.
  16. ↑ Deurveilher, Samüel; Rusak, Benjamin; Semba, Kazue (2011). "Female Reproductive Hormones Alter Sleep Architecture in Ovariectomized Rats". Sleep. Oxford University Press (OUP). 34 (4): 519–530. doi:10.1093/sleep/34.4.519. ISSN   1550-9109. PMC   3065263 . PMID   21461331.
  17. ↑ Hirst, Jonathan J.; Haluska, George J.; Cook, Michael J.; Hess, David L.; Novy, Miles J. (1991). "Comparison of Plasma Oxytocin and Catecholamine Concentrations with Uterine Activity in Pregnant Rhesus Monkeys". The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society. 73 (4): 804–810. doi:10.1210/jcem-73-4-804. ISSN   0021-972X. PMID   1890153.
  18. 1 2 Facco, Francesca L.; Chan, Megan; Patel, Sanjay R. (2022-07-06). "Common Sleep Disorders in Pregnancy". Obstetrics & Gynecology. Ovid Technologies (Wolters Kluwer Health). 140 (2): 321–339. doi:10.1097/aog.0000000000004866. ISSN   0029-7844. PMID   35852285. S2CID   250393764.
  19. ↑ Bourjeily, Ghada (2009). "Sleep disorders in pregnancy". Obstetric Medicine. SAGE Publications. 2 (3): 100–106. doi:10.1258/om.2009.090015. ISSN   1753-495X. PMC   4989752 . PMID   27582822.
  20. ↑ American Academy of Sleep Medicine. International Classification of Sleep Disorders, revised: Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine, 2000:114–5.
  21. ↑ Schredl, Michael; Gilles, Maria; Wolf, Isabell; Peus, Verena; Scharnholz, Barbara; Sütterlin, Marc; Deuschle, Michael (2016-11-09). "Nightmare frequency in last trimester of pregnancy". BMC Pregnancy and Childbirth. Springer Science and Business Media LLC. 16 (1): 346. doi: 10.1186/s12884-016-1147-x . ISSN   1471-2393. PMC   5103377 . PMID   27829406.
  22. ↑ Chaudhry, Simriti K.; Susser, Leah C. (2018). "Considerations in Treating Insomnia During Pregnancy: A Literature Review". Psychosomatics. Elsevier BV. 59 (4): 341–348. doi:10.1016/j.psym.2018.03.009. ISSN   0033-3182. PMID   29706359. S2CID   14004769.
  23. 1 2 Brunner, Daniel P.; Münch, Magdalena; Biedermann, Kurt; Huch, Renate; Huch, Albert; Borbély, Alexander A. (1994). "Changes in Sleep and Sleep Electroencephalogram During Pregnancy". Sleep. Oxford University Press (OUP). 17 (7): 576–582. doi:10.1093/sleep/17.7.576. ISSN   1550-9109. PMID   7846455.
  24. ↑ Maasilta, Paula; Bachour, Adel; Teramo, Kari; Polo, Olli; Laitinen, Lauri A. (2001). "Sleep-Related Disordered Breathing During Pregnancy in Obese Women". Chest. Elsevier BV. 120 (5): 1448–1454. doi:10.1378/chest.120.5.1448. ISSN   0012-3692. PMID   11713118.
  25. ↑ Tomfohr, Lianne M.; Buliga, Elena; Letourneau, Nicole L.; Campbell, Tavis S.; Giesbrecht, Gerald F. (2015). "Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period". Sleep. Oxford University Press (OUP). 38 (8): 1237–1245. doi:10.5665/sleep.4900. ISSN   1550-9109. PMC   4507729 . PMID   25845691. S2CID   207533017.
  26. ↑ Hertz, Gila; Fast, Avital; Feinsilver, Steven H.; Albertario, Claude L.; Schulman, Harold; Fein, Alan M. (1992). "Sleep in Normal Late Pregnancy". Sleep. Oxford University Press (OUP). 15 (3): 246–251. doi: 10.1093/sleep/15.3.246 . ISSN   1550-9109. PMID   1621025.
  27. ↑ Wilson, Danielle L.; Barnes, Maree; Ellet, Lenore; Permezel, Michael; Jackson, Martin; Crowe, Simon F. (2010-12-07). "Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy". Australian and New Zealand Journal of Obstetrics and Gynaecology. Wiley. 51 (1): 38–46. doi:10.1111/j.1479-828x.2010.01252.x. ISSN   0004-8666. PMID   21299507. S2CID   1125445.
  28. ↑ Izci-Balserak, Bilgay; Keenan, Brendan T.; Corbitt, Charles; Staley, Beth; Perlis, Michael; Pien, Grace W. (2018-07-15). "Changes in Sleep Characteristics and Breathing Parameters During Sleep in Early and Late Pregnancy". Journal of Clinical Sleep Medicine. American Academy of Sleep Medicine (AASM). 14 (7): 1161–1168. doi:10.5664/jcsm.7216. ISSN   1550-9389. PMC   6040782 . PMID   29991418.
  29. ↑ Gupta, R.; Dhyani, M.; Kendzerska, T.; Pandi-Perumal, S. R.; BaHammam, A. S.; Srivanitchapoom, P.; Pandey, S.; Hallett, M. (2015-10-19). "Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment". Acta Neurologica Scandinavica. Hindawi Limited. 133 (5): 320–329. doi:10.1111/ane.12520. ISSN   0001-6314. PMC   5562408 . PMID   26482928.
  30. 1 2 Izci, B. (2006-02-01). "Sleep-disordered breathing and upper airway size in pregnancy and post-partum". European Respiratory Journal. European Respiratory Society (ERS). 27 (2): 321–327. doi: 10.1183/09031936.06.00148204 . ISSN   0903-1936. PMID   16452587. S2CID   16474791.
  31. ↑ Sahin, Figen Kir; Koken, Gulengul; Cosar, Emine; Saylan, Filiz; Fidan, Fatma; Yilmazer, Mehmet; Unlu, Mehmet (2007-10-31). "Obstructive sleep apnea in pregnancy and fetal outcome". International Journal of Gynecology & Obstetrics. Wiley. 100 (2): 141–146. doi: 10.1016/j.ijgo.2007.08.012 . ISSN   0020-7292. PMID   17976624. S2CID   23426474.
  32. 1 2 Louis, Judette M.; Auckley, Dennis; Sokol, Robert J.; Mercer, Brian M. (2010). "Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy". American Journal of Obstetrics and Gynecology. Elsevier BV. 202 (3): 261.e1–261.e5. doi:10.1016/j.ajog.2009.10.867. ISSN   0002-9378. PMID   20005507.
  33. ↑ Olivarez, Sofia; Ferres, Millie; Antony, Katherine; Mattewal, Amarbir; Maheshwari, Bani; Sangi-Haghpeykar, Haleh; Aagaard-Tillery, Kjersti (2011-04-08). "Obstructive Sleep Apnea Screening in Pregnancy, Perinatal Outcomes, and Impact of Maternal Obesity". American Journal of Perinatology. Georg Thieme Verlag KG. 28 (8): 651–658. doi:10.1055/s-0031-1276740. ISSN   0735-1631. PMC   3966067 . PMID   21480159.
  34. ↑ Miller, Margaret A.; Mehta, Niharika; Clark-Bilodeau, Courtney; Bourjeily, Ghada (2020). "Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation". Chest. Elsevier BV. 157 (1): 184–197. doi:10.1016/j.chest.2019.09.026. ISSN   0012-3692. PMC   6965691 . PMID   31622589.
  35. 1 2 McLafferty, Laura P.; Spada, Meredith; Gopalan, Priya (2022). "Pharmacologic Treatment of Sleep Disorders in Pregnancy". Sleep Medicine Clinics. Elsevier BV. 17 (3): 445–452. doi:10.1016/j.jsmc.2022.06.009. ISSN   1556-407X. PMID   36150806. S2CID   252497486.
  36. 1 2 3 "Tiredness and sleep problems". nhs.uk . 2023-05-17. Retrieved 2023-09-13.
  37. 1 2 "Best Sleeping Positions During Pregnancy". American Pregnancy Association . 2021-09-01. Retrieved 2023-09-13.
  38. 1 2 Raphael-Leff, Joan; Trevarthen, Colwyn; Klaus, Marshall (2018-05-03). Psychological Processes of Childbearing. Routledge. doi:10.4324/9780429482922. ISBN   978-0-429-48292-2.
  39. 1 2 3 4 5 Lara-Carrasco, Jessica; Simard, Valérie; Saint-Onge, Kadia; Lamoureux-Tremblay, Vickie; Nielsen, Tore (2013). "Maternal representations in the dreams of pregnant women: a prospective comparative study". Frontiers in Psychology. Frontiers Media SA. 4: 551. doi: 10.3389/fpsyg.2013.00551 . ISSN   1664-1078. PMC   3753535 . PMID   23986734.
  40. ↑ Van, Paulina; Cage, Tene; Shannon, Maureen (2004). "Big Dreams, Little Sleep". Holistic Nursing Practice. Ovid Technologies (Wolters Kluwer Health). 18 (6): 284–292. doi:10.1097/00004650-200411000-00004. ISSN   0887-9311. PMID   15624275. S2CID   7575041.
  41. 1 2 RL, Blake; J, Reimann (1993). "The pregnancy-related dreams of pregnant women". The Journal of the American Board of Family Practice. J Am Board Fam Pract. 6 (2): 117–122. ISSN   0893-8652. PMID   8452063.
  42. 1 2 Nielsen, Tore; Paquette, Tyna (2007). "Dream-associated Behaviors Affecting Pregnant and Postpartum Women". Sleep. Oxford University Press (OUP). 30 (9): 1162–1169. doi:10.1093/sleep/30.9.1162. ISSN   0161-8105. PMC   1978400 . PMID   17910388.
  43. ↑ Ser̀ed, Susan; Abramovitch, Henry (1992). "Pregnant dreaming: Search for a typology of a proposed dream genre". Social Science & Medicine. Elsevier BV. 34 (12): 1405–1411. doi:10.1016/0277-9536(92)90149-k. ISSN   0277-9536. PMID   1529378.
  44. ↑ Gillman, Robert D. (1968). "The dreams of pregnant women and maternal adaptation". American Journal of Orthopsychiatry. American Psychological Association (APA). 38 (4): 688–692. doi:10.1111/j.1939-0025.1968.tb02438.x. ISSN   1939-0025. PMID   5661552.
  45. ↑ Winget, Carolyn; Kapp, Frederic T. (1972). "The Relationship of the Manifest Content of Dreams to Duration of Childbirth in Primiparae". Psychosomatic Medicine. Ovid Technologies (Wolters Kluwer Health). 34 (4): 313–320. doi:10.1097/00006842-197207000-00005. ISSN   0033-3174. PMID   5074957.
  46. ↑ SL, Ablon (1994). "The usefulness of dreams during pregnancy". The International Journal of Psycho-analysis. 75 ( Pt 2): 291–299. ISSN   0020-7578. PMID   8063485.
  47. ↑ Dagan, Yaron; Lapidot, Anat; Eisenstein, Michal (2001). "Women's dreams reported during first pregnancy". Psychiatry and Clinical Neurosciences. Wiley. 55 (1): 13–20. doi:10.1046/j.1440-1819.2001.00778.x. ISSN   1323-1316. PMID   11235851. S2CID   38486273.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.