Sleep, pregnancy and depression

SLEEP, PREGNANCY AND DEPRESSION – IS THERE AN ASSOCIATION?

According to the National Sleep Foundation’s 1998 Women and Sleep poll, 78% of women report more disturbed sleep during pregnancy than at other times.

Pregnancy can be a special time, alas it may also be a time when snoring and obstructive sleep apnea (OSA) can commence or worsen. Water retention, hormonal changes and weight gain can all be factors. For both the women and the bedpartner, just the disruption from snoring can seem to be enough, but there seems little doubt that the problem is real.

Pregnancy and sleep

It should be a time of excitement and joy but, for many it can also be a time of serious sleep disturbance, even for women who have never had problems sleeping before. Weight change, sleeping position and hormonal changes can all affect sleep.

It is therefore, well known that sleep affects pregnancy and its healthy outcome, for instance OSA during pregnancy may lead to premature birth. Low birth weight babies, gestational diabetes and pulmonary hypertension and pre-eclampsia.

Pregnancy and fatigue

Many women also report feeling extremely fatigued during pregnancy, especially during the first and third trimesters. There are increased physical and emotional demands during pregnancy and the prevalence of sleep disorders among pregnant women increase, which may explain why some expectant mothers become so tired.

One reasons for fatigue and sleep problems during pregnancy are changing hormone levels. Rising progesterone levels may partly explain excessive daytime sleepiness, especially in the first trimester. Hormonal changes may also have a relaxing effect on muscles, as it prepares to house the growing baby, which may result in snoring and increase the risk of developing sleep apnea and also be partly responsible for the frequent trips to the bathroom during the night.  This loss of muscle tone can result in snoring as the upper airway partially closes. More than a quarter of women become first-time snorers while pregnant and for some, this may lead to OSA.

Fluid retention, sleep and pregnancy

Increases in both progesterone and oestrogen may lead to fluid retention, the fluids cause swollen ankles by day redistribute to the neck upon lying down. Bedtime nasal congestion is often the result of swollen mucus membranes within the nasal passages. The pregnant body also generates up to 50% more blood by volume, and this alone can cause tissue congestion.

 OSA in pregnancy is a dynamic process made apparent by different markers with each passing trimester. Ideally screening patients at trimester intervals to identify any breathing problems in an effective approach.

These interruptions as well as those caused by nausea and other pregnancy-related discomforts can result in significant loss of sleep. Many women experience insomnia due to emotions and anxiety about labor and delivery too, balancing motherhood and work, or their changing relationship with their partner.

This is especially true of first-time mothers. For most women, getting a full night’s sleep becomes even harder once the baby is born. It is very important for pregnant women to prioritize sleep and to find effective strategies for managing their sleep problems as early as possible in their pregnancy.

Pregnancy and depressive symptoms – affective disorder.

In pregnancy, the prevalence of both OSA and depression increase. Research (1) reveals an association in the general population with up to 45% of patients diagnosed with OSA having depressive symptoms. Therefore, the relationship between OSA and depression in pregnant women is clearly real and important.

A recent study (1) indicates that during late pregnancy, women with OSA had eight times the odds of having depressive symptoms. Furthermore, an interaction was found between OSA and history of depression.

Specifically, in women with no history of depression, OSA increases depressive symptoms. In women with a history of depression, OSA has an even stronger effect on depressive symptomatology.

This and other studies suggest that screening for OSA in pregnancy may identify women prone to future depressive episodes and allow ‘targeted intervention’

Here are some general tips that might help during pregnancy.

Napping whenever practical to avoid becoming over tired.

Screening for Sleep Disordered Breathing. (Snoring and OSA)

Left side sleeping, which improves blood circulation and helps maintain the airway.

Using saline (not steroid) nasal spray for congestion.

Getting 30 minutes of exercise daily (with physician approval).

Eating a balanced diet for healthy metabolism.

Considering a bedside humidifier and filter to keep sinuses clear

Obstructive sleep apnea is associated with depressive symptoms in pregnancy,

Conclusions: During late pregnancy women with OSA had eight times the odds of having depressive symptoms. Furthermore, an interaction was found between OSA and history of depression. Specifically, in women with no history of depression, OSA increases depressive symptoms. In women with a history of depression, OSA has an even stronger effect on depressive symptomology. This suggests screening for OSA in pregnancy may identify women prone to future depressive episodes and allow for targeted interventions.

Dr Stephen Bray 2019

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