SLEEP DISORDERS IN PREGNANT AND NURSING WOMEN

Sleep problems are very common during pregnancy. For many women, insomnia begins already in the first trimester of pregnancy. There are a lot of thoughts in the head of the expectant mother that do not allow her to sleep, she cannot find a comfortable position, she tosses and turns, in the third trimester the growing belly begins to interfere, and in the third trimester thoughts about the upcoming birth prevent her from falling asleep. How can I sleep here? To overcome insomnia during pregnancy, you need to establish its causes and eliminate them yourself and with the help of specialists.

Causes

Hormonal changes in a woman’s body can lead to insomnia in the very early stages

for example, during pregnancy the level of progesterone and a number of other hormones increases. By mobilizing strength to carry a pregnancy to term, they at the same time put the body in a state of “combat readiness” and sometimes simply do not allow one to relax. As pregnancy progresses, there are more and more reasons for insomnia.

The causes of sleep disturbances in pregnant women can be physiological:

• difficulties in finding a comfortable position (increased weight and a larger belly make this process very difficult);
• back and lower back pain;
• fetal movement;
• frequent urge to urinate at night (the enlarged uterus puts pressure on the bladder, now it needs to be emptied much more often);
• heartburn (disorders of the gastrointestinal tract are generally characteristic of pregnancy);
• cramps (pregnant women especially often complain of leg cramps);
• itching in the abdominal area due to stretching of the skin;
• shortness of breath (increased body weight makes breathing difficult, in addition, the uterus puts pressure on the lungs);

and psychological:

• chronic fatigue;
• nervous tension, stress (fear of upcoming changes, anxiety for the child, fear of childbirth);
• nightmares.

Any of these reasons is quite enough to deprive a woman of sleep, and most often they are also combined!

Finding a comfortable sleeping position

At the beginning of pregnancy, you need to get used to sleeping on your side. The most comfortable position during pregnancy is to sleep on your side with your knees bent. This position is easier on the heart because it keeps the baby's weight from putting pressure on the large vein (called the inferior vena cava), which carries blood back to the heart from the feet. Some doctors recommend that pregnant women sleep on their left side. Since the liver is on the right side of the abdomen, this helps protect it from the pressure of the uterus. Sleeping on your left side also improves blood circulation to the heart and ensures better blood flow to the fetus, uterus and kidneys.

No need to worry about rolling over on your back at night. Changing positions is a natural part of sleep that cannot be controlled. Most likely, in the third trimester of pregnancy, a woman will automatically choose a comfortable position for herself. You can try experimenting with sleeping pillows to find the most comfortable position. Some women say that placing a pillow under their stomach or between their legs helps them sleep. Additionally, using a folded pillow or rolled blanket under your lower back can help relieve pressure on your spine.

How to deal with insomnia?

From the tips listed below, try to choose only what suits your case and what you personally like. If one recommendation doesn't help, try another one. Each situation is individual, each woman needs to choose her own method, her own combination of techniques.

During the day :

1. Avoid overexertion. Fatigue accumulated during the day does not always lead to sound sleep; sometimes it turns out that after a hard day you simply cannot relax.
2. If you are used to sleeping for some time during the day, try to give up this habit for a few days or at least reduce the time you sleep during the day - maybe night sleep will be restored.
3. If you are tormented by nightmares, which you then cannot forget about, talk about them in the morning or afternoon with a loved one (husband, mother, friend). Psychoanalysts consider discussing night dreams a very effective means of overcoming the fear of them: firstly, loved ones will try to calm you down, and most likely they will succeed, and secondly, by putting into words the vague visions that tormented you, you yourself will discover that there are no special reasons for no fear.
4. During the day, find time and opportunity to do simple exercises that you can do. Swimming, walking and even dancing are considered very useful (in the latter case, of course, it all depends on the stage of pregnancy and your well-being).
5. Your body should get used to the fact that the bed is a place only for sleeping: break the habit of lying in bed - you should not read, watch TV, etc. while lying down.

In the evening, about two hours before bed, begin preparing for the coming night to be calm and peaceful. Experts talk about sleep hygiene, which includes a number of activities:

1. Do not eat heavy food shortly before bed: on a full stomach you will toss and turn until the morning.
2. Do not schedule tasks that require physical or mental effort for the evening.
3. Avoid emotional tension and stressful situations during this period of the day (do not schedule unpleasant conversations and heated explanations for the evening, ask your family and friends not to call you in the evening and, of course, do not watch action films and thrillers at night).
4. Take a warm bath or shower before bed. You can add a decoction of chamomile or a few drops of some aromatic oil (for example, lavender) to your bath - this will help you relax.
5. Try to drink less in the evening (keeping your total daily fluid intake at 6-8 glasses), this will help you cope with the cause of insomnia, such as the need to empty your bladder frequently.
6. Before going to bed, drink a cup of warm milk (if you don't like the taste of milk, you can add cinnamon, a little honey or sugar) or herbal tea (chamomile is often recommended for its relaxing effect). But you need to give up regular tonic tea (not to mention coffee!). By the way, milk contains tryptophan, which can be called a mild natural sleeping pill - this substance has a calming, sedative effect.
7. You can eat a small sandwich with boiled turkey before bed (the meat of this bird is also rich in tryptophan).
8. If you feel weak, lightheaded, or have an increased heart rate in the evening, your insomnia may be due to hypoglycemia (low blood sugar). In this case, sweet tea, juice, or just a piece of sugar can help you (and be sure to tell your doctor about these symptoms so that he can confirm or deny this diagnosis and take appropriate measures).
9. Before going to bed, apply lotion to the skin of your abdomen, this can prevent itching.
10. Ask your husband or someone close to you to give you a massage before going to bed: it will give you the opportunity to relax, relieve back and lower back pain, and massage your feet and ankle joints will help avoid cramps. Shiatsu acupressure massage can also be effective, if someone in your family knows its technique, why not try it.
11. It is possible that homeopathic remedies correctly selected by a specialist will help in the fight against insomnia.
12. For some people, sex will help them fall asleep. If you have no medical contraindications to having sex, you feel desire and know that you usually feel sleepy after sex - why not?

But now the nightly ritual of getting ready for bed is completed, and you are already in bed. What to do at night so that the desired dream comes to you?

At night :

1. First of all, try not to get nervous, don’t think about not being able to sleep, this will only make the situation worse.
2. The bedroom should be cool (however, you must avoid overcooling your feet - you can sleep in socks). If it is not possible to sleep with the window open, you need to ventilate the room well before going to bed.
3. Nightwear (shirt, pajamas) should be comfortable, made from natural materials, and not restrict movement and breathing.
4. It is best to sleep on a comfortable mattress . Find out what is right for you - maybe a feather bed, maybe a textured mattress with a surface reminiscent of cartons for transporting eggs, or maybe, on the contrary, it will be easier for you to sleep on a hard surface, and you just need to put boards under the mattress.
5. A pregnant woman will need many pillows (at least 3) of various shapes and sizes to sleep. It’s good if you manage to purchase a special pillow for pregnant women - it has a wedge shape and is specially designed to be placed under the stomach. After giving birth, you can use it while breastfeeding. Pillows can be placed under the side, under the neck, pressed between the legs; You can cover the entire mattress with pillows - this improved bed will better conform to the shape of your body. You can place an extra pillow under your head - in some cases, this not only makes breathing easier, but also proves to be an effective remedy against heartburn.
6. Look for a comfortable position in which you can fall asleep. If you can’t sleep on your stomach and back, that means you’ll have to lie on your side (some doctors believe that it’s better to lie on the left, as this increases blood flow to the uterus). Place one pillow under your stomach, squeeze the other between your knees, if your back and lower back hurt, you can tuck another pillow under your side. Sometimes women are advised to sleep in the fetal position (it is unnecessary to remind you how physiological it is, I will only say that by stimulating blood circulation, it promotes maximum relaxation of all muscles).
7. However, it should be remembered that in the last months of pregnancy it is not recommended to sleep on your back, since the weight of the uterus can compress the inferior vena cava, which runs along the spine. This causes loss of consciousness in a pregnant woman and oxygen starvation in a child.
8. When you feel sleep approaching, try to breathe slowly and deeply.
9. It is possible that aromatherapy . A drop of lavender oil can be useful not only in the bath, but also in bed.
10. If you are unable to fall asleep within half an hour, get up, go into another room, leaf through a magazine or read a book that can induce sleep, start knitting, listen to soothing music and go to bed only when you feel sleep approaching.

First trimester: what does excess and lack of sleep indicate?

Insomnia in women is rare in the first trimester. Quite the contrary. The expectant mother feels constant drowsiness, apathy, and lethargy.

Coming home from work (and most women also work during this period), they hardly do household chores and dream of only one thing: to lie down on the bed.

This drowsiness is completely normal and is associated with changes in hormonal balance.

In addition to drowsiness, increased irritability and sometimes even aggressiveness may appear.

Dear men, if you have suddenly read the article to this point, please surround the pregnant woman with care and do not demand too much from her!

Pregnancy is not yet visible, but a global restructuring has already begun in the body, accompanied by a heavy load on all organs and systems of the body. Give the future mother of your baby the opportunity to rest at any time, free her from being overly involved in household chores.

And also - fulfill all her whims, even the most incredible ones.

Meet her unusual nutritional needs as well, even if that means running to the store 1, 2, or 3 times a day. Remember, the health of your unborn child largely depends on her mental well-being and peace of mind!

You can learn about the fears, concerns, and thoughts of the expectant mother by analyzing her dreams. Dreams during this period are very vivid and unusual.

By analyzing them, it is possible to work out even the deep layers that underlie the formation of adult stereotypes, templates, and some patterns of behavior.

The first trimester of pregnancy is a time of creation, a time when peace and comfort are needed.

What is needed to achieve a state of maximum comfort during this period?

• Get used to the new state, accept the changes occurring in the body calmly;
• Do not neglect gentle physical activity (gymnastics in the morning, walking, swimming);
• Do not limit yourself in nutrition and follow the drinking regime.
• Avoid taking on urgent projects at work, avoid multitasking, and delegate home and work responsibilities.
• If you have the opportunity to organize a nap, be sure to take advantage of it.

As you already understand, dear readers, drowsiness in the first trimester indicates the normal course of pregnancy. Therefore, insomnia is an alarm signal.

If you have trouble sleeping due to unpleasant dreams, then your task is to analyze (on your own or with your psychologist) these dreams.

Perhaps the reason is a high level of anxiety, problems in interpersonal relationships, and an unfavorable environmental and emotional climate in the workplace.

How does hormonal imbalance manifest itself?

If, at the beginning of pregnancy, you have difficulty falling asleep, frequent awakenings, interrupted or short slow-wave sleep, then this indicates a hormonal imbalance.

It is likely that the level of progesterone is insufficient, which indicates a high risk of spontaneous abortion. Why is this so?

This hormone is responsible for many processes occurring in the body of a pregnant woman:

• Stimulates uterine growth;
• Prepares the mammary glands for lactation;
• Stimulates metabolism in the body (so that decay products are quickly eliminated and do not create intoxication);
• Strengthens the muscles of the uterus;
• Prevents fetal rejection;
• Reduces the tone of the uterus.

As you can see, insomnia in the first trimester is not such a “safe” sign. Therefore, when it appears, immediately check your progesterone level.

It is changes in hormonal levels that are responsible for many processes occurring in the female body.

The book “Woman Code: How Hormones Affect Your Life” by Susan S. Weed contains a lot of information, including how to make pregnancy easier. In addition, this book is recommended for those who cannot get pregnant or who have been treating polycystic ovary syndrome for a long time.

The author, using personal example, proved the effectiveness of the technique she describes.

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• Kalmbach DA., Cheng P., Roth T., Swanson LM., Cuamatzi-Castelan A., Roth A., Drake CL. Examining Patient Feedback and the Role of Cognitive Arousal in Treatment Non-response to Digital Cognitive-behavioral Therapy for Insomnia during Pregnancy. // Behav Sleep Med - 2021 - Vol - NNULL - p.1-20; PMID:33719795
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How to sleep in the first trimester of pregnancy

The first trimester is the most important period of gestation. In the early stages, a woman may suffer from vomiting and frequent urination, accompanied by internal anxiety. Also, the first months may be characterized by the expectant mother’s anxiety about pregnancy, the upcoming birth, and even raising a child. Intrusive thoughts can persist throughout the day and affect sleep, which is very important for a pregnant woman. Choosing the right sleeping position will help you get a good night's sleep.

Many women are interested in whether pregnant women can sleep on their stomachs in the first trimester. At 11-12 weeks, the stomach already begins to bulge, so from this period it is not recommended to sleep on it. The beginning of the first trimester is the only period during the entire pregnancy when a woman can sleep on her back. Further, the uterus will grow and compress the vena cava, which will negatively affect the condition of the mother and fetus. To avoid this, from 15-16 weeks you should abandon this position.

Clinical significance of sleep disorders in pregnant women

Polysomnography Laboratory of City Clinical Hospital No. 81, Moscow
With
the onset of pregnancy, sleep changes in most women; complaints arise of a lack of feeling of rest after sleep, back pain and cramps of the calf muscles [13,14].
More than 50% of pregnant women complain of back pain and cramps, about a third of whom experience these inconveniences at night, which negatively affects the quality of sleep [2,12]. Sleep efficiency decreases even though total time in bed increases. This is associated with an increase in the number of night awakenings (the time of falling asleep may not change) [4]. In addition, there is an increase in the percentage of stage 1 sleep (the drowsiness stage) and a decrease in the stage of sleep with dreams [5]. Preliminary studies of pregnant women with preeclampsia have shown that most patients experience a decrease in sleep quality
due to changes in the usual body position, an increase in the number of night awakenings and the appearance of periodic limb movement syndrome during sleep [10]. Sleep-related diseases (narcolepsy, sleepwalking), which began before pregnancy, continue during pregnancy [8]. As the duration of pregnancy increases, the total sleep time changes; it increases slightly in the first trimester, after which it progressively decreases by the third trimester of pregnancy [5,15].

During pregnancy, pulmonary mechanics change significantly, which is associated with a reduction in functional residual capacity of the lungs by 20% ( functional residual capacity

– FRC) [16–18], as a consequence of raising the diaphragm with an enlarged uterus. This effect becomes especially important during sleep. As FRC decreases, maternal oxygenation also decreases, accounting for the increased arterial/oxygen gradient detected during pregnancy [19]. During a normal pregnancy, there is some compensation for these changes as a result of a shift in the hemoglobin saturation curve of circulating blood to the right, which increases the delivery of oxygen to the placenta and tissues of the maternal body [20].

Hormonal changes that occur during pregnancy also significantly affect changes in respiratory function. Levels of estrogen and progesterone almost level out during pregnancy. Both hormones serve primarily to maintain pregnancy, but there are other physiological changes caused by these hormones. Progesterone significantly increases pulmonary ventilation, influencing at the level of central chemoreceptors [7,21]. On the other hand, the partial pressure of arterial carbon dioxide and associated respiratory alkalosis are reduced with a mean arterial pH of 7.44 (compared to 7.40 in the non-pregnant state). It is known that in non-pregnant women, the observed hypocapnia and respiratory alkalosis can lead to the appearance of obstructive sleep apnea syndrome (OSA) [22]. Changes in the central regulation of breathing during sleep lead to an increase in diaphragmatic force, leading to an increase in negative inspiratory pressure at the level of the upper respiratory tract. In a normal pregnancy, there are factors that contribute to the development of OSA - increased weight, supine sleeping position, and decreased functional residual volume of the lungs [6]. However, a polysomnographic study of pregnant women revealed that during a normal pregnancy, sleep apnea syndrome is practically not recorded [10]. Apparently, this is due to the fact that during pregnancy, progesterone production increases significantly. Progesterone is known to improve alveolar ventilation without increasing respiratory rate. Its level at 36 weeks of pregnancy is 10 times higher than the level at the peak of the menstrual cycle [7].

The patency of the upper respiratory tract is an important criterion for the presence of breathing disorders during sleep and determines the degree of their severity. Reduced pharyngeal dimensions during pregnancy were demonstrated using the Mallampati scale [23]. The passage of the nasal passages can also be difficult during pregnancy. 42% of women at 36 weeks of pregnancy reported difficulty breathing or rhinitis [24]. These symptoms may be due to a combination of increased progesterone and estrogen levels as pregnancy progresses. An increase in the content of circulating estrogens, accompanied by rhinitis, is observed both during the luteal phase of the menstrual cycle [25] and during pregnancy [26]. In addition, the increase in circulating blood volume associated with pregnancy may contribute to the accumulation of nasal secretions. In summary, there are many physiological changes that occur during pregnancy that may predispose women to worsen pre-existing or develop sleep-disordered breathing.

Physiological mechanisms during a normal pregnancy protect the fetus from potential hypoxemia. However, in pregnant women with underlying pulmonary disease (especially asthma) or obesity, where progesterone levels are not protective, hypoxemia is not uncommon [9]. In this case, even a slight decrease in oxygenation in the mother can lead to fetal hypoxia

.
Several studies have examined maternal oxygenation during sleep. Brownell [27] found no changes in oxygenation during sleep in six pregnant women without concomitant pathology at 36 weeks. Herz [4] showed a slight but significant decrease in nocturnal blood saturation in 12 women in the third trimester of pregnancy compared to studies after pregnancy in the same subjects. In addition, this nocturnal hypoxemia was noted in a study of 13 normotensive and 15 hypertensive pregnant patients with a gestational age of more than 35 weeks [28]. In the normotensive group, five of the 13 observed had an average blood saturation <95%, of which three had saturation <90% during at least 20% of the night observation time; in the hypertensive group, six of 15 had a mean blood saturation <95%, of which four had saturation <90% for at least 20% of the overnight observation time. According to Franclin KA [3], 502 pregnant women were examined: snoring and sleep apnea syndrome were found in 23% of them with a history of chronic obstructive pulmonary diseases. Also, according to this study, pregnant women with snoring and sleep apnea syndrome have a 2.5 times higher risk of arterial hypertension, preeclampsia, and fetal growth retardation. The child of such pregnant women is 5 times more likely to receive an APGAR score of 7 or lower. There is only one effective way to combat this situation - using
a special CPAP device (short for
continuous positive airway pressure
),
constant positive air pressure in the upper respiratory tract
, preventing their collapse and obstruction and eliminating hypoxia in the pregnant woman and the fetus [11].

The purpose of our study was to identify sleep disorders in pregnant women with pathology in the form of gestosis, threat of miscarriage, fetoplacental insufficiency and concomitant diseases - ovarian dysfunction (15 patients), somatoform autonomic dysfunction (19 patients), chronic obstructive pulmonary diseases (COPD) (12 patients ), chronic adnexitis (4 patients), chronic pyelonephritis (2 patients).

The study was carried out using a computer diagnostic system for polygraphic sleep research - sleep laboratory SAGURA - SCHLAFLABOR-II, manufactured in Germany. A survey of 53 pregnant women was conducted, the average age of which was 29.4±5.7 years, with gestational ages ranging from 12 to 39 weeks. All patients were divided into two groups depending on age: under 30 years (24 people) - group 1 and after 30 years (9 people) - group 2. The main complaints related to sleep were frequent awakenings at night, a feeling of tension, frequent urge to urinate, daytime sleepiness, and difficulty falling asleep.

According to the polysomnographic study, the following sleep structure disorders were identified: in the first group (up to 30 years old), a pronounced increase in the periods of falling asleep was determined to 39.3 ± 5.7 minutes. (with a norm of 20 minutes) and the number of EEG activation reactions up to 47.6±8.1 events per hour (with a norm of up to 21). In the second group, compared to the first, the stage of sleep with dreams decreased more markedly (on average to 9.6% with a norm of 20%) and the representation of stages 1 and 2 (superficial) sleep increased to 69.7% (the norm is 50%). In both groups, there was an increase in the percentage of wakefulness during sleep to an average of 10.2% (the norm is 5%) and a decrease in sleep efficiency to 75.5% (the norm is 90–95%). Two patients with COPD had a decrease in mean overnight blood saturation below 90%. However, in another four patients without a history of obstructive pulmonary disease, a decrease in blood saturation below 90% was observed for at least 20% of the overnight observation time, indicating the possible development of hypoxia in the mother and fetus.

As can be seen from the results, a decrease in sleep efficiency occurs due to the fact that the time in bed does not change, but the number of night awakenings increases.

For sleep disorders during pregnancy, pharmacological treatment is not recommended. Therefore, we proposed treating insomnia in pregnant women, especially in the pregnancy pathology department, with artificial white light, i.e. phototherapy

. This method has virtually no contraindications, except for some skin diseases, and its effects are multifaceted. It affects the chronobiological characteristics, mood, behavior, mental and endocrine functions of women [1].

We conducted 10 phototherapy sessions with a light intensity of 3300 lux using Biolamp (France) for phototherapy in the morning for 12 patients. A repeated polysomnographic study revealed that the number of night awakenings decreased by 2.9 times (p<0.05), correspondingly increasing sleep efficiency, and the percentage of the sleep stage with dreams increased on average by 1.6 times (p<0.05). 05). The patient tolerated the treatment well, and no side effects were recorded. In addition, the effect of phototherapy not only on sleep, but also on the course of labor and the condition of the fetus was noted. We conducted a comparative study using the method of pairs of pregnant women who received phototherapy and those from the control group.

Pregnant women who underwent phototherapy had a uneventful birth and a higher fetal APGAR score.

So, we can assume two ways of influencing phototherapy on the course of labor. Firstly, indirectly - through the normalization of the structure and quality of sleep, and secondly - through the direct influence of bright white light on various neurotransmitter systems of the body, including dopaminergic systems.

Thus, pregnant women, especially with a pathological course of pregnancy, need to study their sleep to prevent the risk of hypoxia of the mother and fetus, identify sleep disorders and their timely correction, one of the methods of which may be phototherapy, which affects not only sleep, but also the course of labor and the condition of the fetus.
Literature:
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2. Berlin RM. Sleepwalking disorder during pregnancy: a case report. Sleep. 1988; 11:298–300.

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4. Hertz G. Fast A. Feinsilver SH. et al. Sleep in normal late pregnancy. Sleep. 1992; 15:246–251.

5. Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol. 2000 Jan;95(1):14–8.

6. Lefcourt LA, Rodis JF. Obstructive sleep apnea in pregnancy. Obstet Gynecol Surv. 1996 Aug;51(8):503–6. Review.

7. Lyons HA. Centrally acting hormone and respiration. Pharmacol Ther. 1976; 2: 743–751.

8. Mindell JA, Jacobson BJ. Sleep disturbances during pregnancy. J Obstet Gynecol Neonatal Nurs. 2000 Nov–Dec;29(6):590–7.

9. Michelle DR. Davajan V. Reproductive Endocrinology, Infertility and Contraception. Philadelphia, Pa: Fa Davis; 1979:123–124.

10. Nikkola E, Ekblad U, Ekholm E, Mikola H, Polo O. Sleep in multiple pregnancy: breathing patterns, oxygenation, and periodic leg movements. Am J Obstet Gynecol. 1996 May;174(5):1622–5.

11. Oleszczuk J, Leszczynska–Gorzelak B, Mierzynski R, Kaminski K. Pregnancy in obstructive sleep apnoea syndrome under treatment with nCPAP. Zentralbl Gynakol. 1998;120(2):71–4. Review.

12. Richardson P. Sleep in pregnancy. Holist Nurs Pract. 1996 Jul;10(4):20–6. Review.

13. Santiago JR, Nolledo MS, Kizler W, Santiago TV. Sleep and sleep disorders in pregnancy. Ann Intern Med. 2001 Mar 6;134(5):396–408.

14. Suzuki S, Dennerstein L, Greenwood KM, et al. Sleeping patterns during pregnancy in Japanese women. J Psychosom Obstet Gynaecol. 1994;15:19–26.

15. Driver HS, Shapiro CM. A longitudinal study of sleep stages in young women during pregnancy and postpartum. Sleep 1992;15:449–53.

16. Weinberger SE, Weiss ST, Cohen WR, et al. State of the art: pregnancy and the lung. Am Rev Respir Dis 1980;121:559–81.

17. Knuttgen HG, Emerson K. Physiological response to pregnancy at rest and during exercise. Aust NZ J Obstet Gynaecol 1974;3:365–7.

18. Craig DB, Tool MA. Airway closure in pregnancy. Can Anaesth Soc J 1975;22:665–72.

19. Awe RJ, Nicorta MB, Newsom TD, et al. Arterial oxygen alveolar–arterial gradients during pregnancy. Obstet Gynecol 1979;53 182–6.

20. Kambam JR, Handte RE, Brown WU, et al. Effect of normal and preeclamptic pregnancies on the oxyhemoglobin dissociation curve. Anesthesia 1986;65:426–7.

21. White DP, Douglas NJ, Pickett CK, et al. Sexual influence on the control of breathing. J Appl Physiol 1983;54:874–9.

22. Skatrud JB, Dempsey JA. Interaction of sleep state and chemical stimuli in sustaining rhythmic ventilation. J Appl Physiol 1983;55:813–22.

23. Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth 1995;74:638–42.

24. Bende M, Gredmark T. Nasal stuffiness during pregnancy. Laryngoscope 1999;109:1108–10.

25. Stubner UP, Gruber D, Berger UE, et al. The influence of female sex hormones on nasal reactivity in seasonal allergic rhinitis. Allergy 1999;54:865–71.

26. Mabry RL. Rhinitis of pregnancy. South Med J 1986;79:965–71.

27. Brownell LG, West P, Kryger MH. Breathing during sleep in normal pregnant women. Am Rev Respir Dis 1986;133:38–41.

28. Bourne T, Ogilvy AJ, Vickers R, et al. Nocturnal hypoxemia in late pregnancy. Br J Anaesth 1995;75:678–82.

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From the editor: Interesting features of the brain

Tricks

As a child, I showed everyone the following trick: Take a handkerchief (only the handkerchief should have seams along the perimeter, as in my childhood), a match is first inserted into the seam. An empty handkerchief is shown to the public, then a match is placed in the middle...

morning insomnia

Every morning, from the very day I found out that I was pregnant, I wake up at 4 am and then can’t fall asleep for three hours... I keep thinking... all this is quite painful... the only thing that saves me is that I don’t go to work now... why is that? -)

How to sleep in the second trimester of pregnancy

The second trimester is the most favorable period, which is characterized by the absence of nausea and a small stomach. This promotes good sleep and good health for the expectant mother.

Discomfort can only be felt for the following reasons:

1. Heartburn. It is caused by high concentrations of progesterone. To improve your sleep, you need to eat small portions and chew your food thoroughly. The last meal should be 2-3 hours before bedtime. If necessary, you can use activated carbon.

2. Leg cramps. They are caused by excessive muscle tension. The intensity can be so high that the expectant mother can wake up from a strong spasm. To avoid this, it is necessary to reduce physical activity. It should consist of leisurely walks before bed. The spasm itself can be relieved with a light massage.

3. Feeling hungry. Although it is not recommended to overeat before bed, you should also not go to bed on an empty stomach. Instead of sweets, you can snack on a piece of cheese, an unsweetened cracker, or a glass of milk. If you wake up feeling hungry in the middle of the night, you can satisfy it with a light snack.

Even in the absence of discomfort and a large belly, many expectant mothers wonder whether pregnant women can sleep on their side in the second trimester. This position is the most preferable at this time. Even if your belly is not yet too big, sleeping on your back is not recommended. This will put pressure on the expanding uterus, digestive organs and spine. Due to muscle strain, the lower vein leading to the heart will be compressed. As a result, it can cause back pain, hemorrhoids, hypertension and digestive problems.

In the second trimester, it is best to sleep on your left side, which will improve blood supply to organs and metabolism.

Insomnia in a nursing mother

When the woman gave birth, her worries only increased. Now there is significantly less time for sleep (although not every day). Breastfeeding women are prevented from falling asleep by all the reasons that we listed above. But only one more thing is added - this is the need to get up at night because of the child’s various needs - for food, dry and clean clothes. If a child is sick, sleep problems are even more severe. But what to do when the child is sleeping, but you are not, you are tormented by insomnia? First, let's clarify why this happens. Why did insomnia occur after childbirth and what prevents you from falling asleep? Perhaps an uncomfortable position because the baby sleeps with you, nervous tension, pain of various types during lactation that then persists for a long time, or something else? After this, it is useful to contact your doctor with specific complaints. Perhaps he will advise what to do in such cases or suggest therapy methods so that insomnia during breastfeeding goes away without negative consequences for the baby and his mother.

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