The main sleep disorders in pregnant women

Why does sleep quality tend to decline during pregnancy?

During pregnancy, several general factors can contribute to the onset or worsening of sleep disorders, including:

• Weight gain and edema can increase the risk of airway obstruction.
• Increased levels of progesterone and estrogen during pregnancy can affect the relaxation of the upper airway muscles and facilitate the onset of apnea.
• The growth of the uterus puts pressure on the diaphragm and lungs, reducing the mother's breathing capacity.

There are also specific disorders that occur during pregnancy.

Restless Leg Syndrome

Restless leg syndrome affects between 20% and 30% of pregnant women, particularly in the third trimester. It manifests as unpleasant sensations in the legs and an irresistible urge to move them, especially in the evening or at night. Possible causes include:

• Hormonal fluctuations (increased progesterone and estradiol)
• Iron deficiency (common during pregnancy)
• Circulatory changes (increased blood volume)
• Fatigue and lack of sleep

These symptoms usually disappear after childbirth. However, nearly half of women who have experienced RLS during their first pregnancy will experience it again in subsequent pregnancies.

The management of RLS during pregnancy is the same as outside of pregnancy, namely:

• Avoid coffee, tea, alcohol, and tobacco—which should be avoided during pregnancy anyway
• Engage in moderate, regular exercise, massage, and stretching exercises, and wear compression stockings
• Practice relaxation techniques.

If these measures are not sufficient, you should check for possible iron, folic acid, or vitamin B12 deficiency, and possibly ask your doctor for other supplements such as magnesium.

Pregnancy and Gastroesophageal Reflux Disease (GERD)

Two-thirds of pregnant women suffer from acid reflux, and one in four experience its effects on a daily basis. GERD is caused by stomach acid rising into the esophagus, causing heartburn, chest pain, and nighttime discomfort that can affect sleep quality.
GERD is more common in the second and third trimesters, when the uterus increases significantly in size. It particularly affects women who already have a history of reflux or digestive disorders, but it can occur in any pregnant woman.
Several factors may explain the increased frequency of GERD in pregnant women:

The increase in progesterone has a relaxing effect on the lower esophageal sphincter, a valve that separates the stomach from the esophagus. This results in easier reflux of stomach contents into the esophagus.
The growing uterus puts pressure on the stomach, which increases acid reflux, especially after meals or when lying down.
Tips for managing GERD during pregnancy

As a first step, and as with many other disorders during pregnancy, a lifestyle-focused approach is recommended:

• Wait 2 to 3 hours after a meal before going to bed
• Eat light, frequent meals
• Avoid trigger foods (acidic, spicy, fatty foods, carbonated drinks, coffee, chocolate)
• Raise the head of the bed and sleep on your left side
• Avoid tight clothing around the waist
• Drinking chamomile or ginger tea can help soothe the stomach, although effectiveness varies.

Medical treatments

If lifestyle and dietary measures are not sufficient, calcium-based antacids can be used. In cases of persistent symptoms, doctors may prescribe proton pump inhibitors or H2 receptor antagonists, ensuring that they are safe for pregnancy. In rare cases, a consultation with a gastroenterologist or an endoscopy may be considered.

Frequent urge to urinate

From the first weeks of pregnancy, many women notice an increase in the frequency of urination, including during the night. This bladder hyperactivity is explained by hormonal factors, in particular the vasodilatory effect of progesterone, which stimulates blood flow to the kidneys and therefore urine production. Later in pregnancy, the enlarging uterus puts direct pressure on the bladder, reducing its capacity. This phenomenon becomes more pronounced in the second and third trimesters. Finally, during pregnancy, blood volume increases to support the baby's growth. This extra volume is filtered by the kidneys, which increases urine production.

Tips for managing frequent urination during pregnancy

To reduce nighttime awakenings, it is recommended to limit fluid intake, especially beverages containing caffeine or diuretics, before bedtime. Certain foods that irritate the bladder, such as citrus fruits or tomatoes, can also be avoided if necessary.

Physical and postural pain

Physical pain is one of the main causes of fragmented sleep during pregnancy. It is usually mild, but can be particularly uncomfortable, affecting the quality of sleep and the overall well-being of the expectant mother.

Types of pain that are common during pregnancy

Lower back and back pain. The increase in weight of the belly, changes in posture, and the loosening of ligaments under the effect of progesterone can cause pain in the lower back, lumbar region, and spine.
Pelvic pain: The widening of the pelvis that accompanies pregnancy, as well as the loosening of the pelvic ligaments and joints under the influence of hormones, can cause pain in the lower abdomen, pelvis, and hips. This phenomenon is sometimes referred to as pubic symphysis.
Leg and foot pain: Increased body weight, water retention, and changes in blood circulation during pregnancy can cause pain in the legs, ankles, and feet.
Sciatica and nerve pain: The growing uterus can press on the nerves in the lower back, particularly the sciatic nerve, causing radiating pain in the buttocks, thighs, and legs. This phenomenon is more common from the second trimester onwards.
Abdominal pain and uterine growth: The development of the uterus can cause pain in the lower abdomen, often felt as pulling or spasms. These are usually related to the stretching of the round ligaments that support the uterus, or to the growth of the uterus putting pressure on surrounding organs.
This pain can be confused with uterine contractions. Preparatory uterine contractions, known as Braxton Hicks contractions, often occur from the 28th week of pregnancy onwards, causing a feeling of tension in the abdomen, which is usually painless and irregular. Labor contractions, on the other hand, are more intense, regular, and become increasingly frequent. They may start in the lower back before spreading to the front of the abdomen, signaling the onset of labor. If you have any doubts, call your midwife, doctor, or our maternity ward.

Tips for improving sleep despite pain

To alleviate these discomforts, it is recommended that you sleep on your left side, a position that promotes venous return and relieves pressure on certain organs. Using maternity pillows to support your belly, hips, and lower back can provide significant comfort. Relaxation exercises, gentle stretching, or prenatal yoga can also help reduce tension. The use of hot water bottles or warm compresses applied to painful areas can provide temporary relief. Adopting good posture during the day can prevent pain from worsening. Finally, in cases of persistent pain, complementary approaches such as physical therapy, osteopathy, or acupuncture may be helpful.

Pregnancy and nasal congestion

Nasal congestion frequently affects pregnant women, sometimes as early as the first trimester. This is partly due to hormonal rhinitis, caused by the dilation of blood vessels in the nasal mucosa under the effect of estrogen and progesterone. Although harmless in most cases, this breathing discomfort disrupts sleep quality and can increase feelings of fatigue. In some cases, nasal obstruction may have other causes, such as allergic rhinitis or respiratory infections. In cases of allergic rhinitis, certain medications such as antihistamines and nasal drops can be used to relieve symptoms, after consulting a doctor.

If the cause is allergic, appropriate treatment may be considered, provided it is approved by a professional. Certain local solutions or specific antihistamines are considered safe during pregnancy. In cases of persistent or severe discomfort, a consultation with an ENT specialist will allow for a more accurate diagnosis and appropriate treatment.

Pregnancy and anxiety

Pregnancy is often synonymous with emotional upheaval. Psychologically, it marks the beginning of a period during which women are more receptive and therefore vulnerable. This phenomenon is known as “psychic transparency.” During this phase, concerns about childbirth, the baby's health, or emerging parenthood become more pronounced. These concerns, although natural, can lead to chronic stress, interfering with relaxation and the ability to fall asleep.

It is essential to recognize these emotions and talk about them. If you feel anxiety, worry, or obsessive thoughts, don't hesitate to talk about it. Healthcare professionals, whether midwives, doctors, or psychologists, are there to listen, support, and refer women to appropriate resources: support groups, relaxation sessions, or cognitive behavioral therapy. Psychological support can make a real difference in calming the mind and improving sleep.

Conclusion

Although sleep disorders are common during pregnancy, they should not be considered inevitable. Understanding the physiological, hormonal, and emotional causes that trigger them not only helps you cope better, but above all provides concrete solutions. Adapting your lifestyle, recognizing warning signs, and seeking professional help when needed are all steps that can promote better sleep.

Every woman experiences pregnancy differently. It is therefore essential to adopt a personalized approach that respects the body and emotions. Quality sleep is not a luxury during this special time, but an essential component of maternal and fetal well-being.