Online Health Chat with Megan Lutz, MD, MPH

January 13, 2015

Description

While a good portion of “pregnancy stories” might discuss food cravings, weight changes or relationship “learning opportunities,” sleep changes in pregnancy make up these stories as well. Whether it’s the notorious fatigue, nausea or daytime sleepiness of the first trimester that spells out pregnancy for your co-workers and family members (well before you planned to share your news), or the third trimester insomnia, it’s important to know that many pregnancy sleep changes are considered normal, expected changes during pregnancy.

Both the striking hormonal changes and physical discomforts of pregnancy can profoundly alter sleep. Just as much as your sleep profile may change, pregnancy also brings about an increase in sleep disorders. Everything from REM sleep, sleep apnea, leg cramps, to restless leg syndrome will be addressed.


About the Speakers

Megan Lutz, MD, MPH, is a physician in the Center for Specialized Women’s Health within the OB/GYN & Women’s Health Institute at Cleveland Clinic. She specializes in obstetrics and gynecology. Dr. Lutz completed medical school at The University of Toledo in 2009 and her residency in obstetrics and gynecology at The University of Toledo Medical Center. She was appointed to Cleveland Clinic in 2014.


Let’s Chat About Sleep Disturbances during Pregnancy

Moderator: Welcome to our chat Sleep Disturbances during Pregnancy with Cleveland Clinic OB/GYN Megan Lutz, MD, MPH. Dr. Lutz, thank you for taking the time to be with us to share your expertise and to answer our questions about pregnancy.


Common Question

Coral: What is causing my sleep disturbances?

Megan_Lutz,_MD,_MPH: Coral, sleep disturbances can vary, and so can the causes. Some sleep issues revolve around stress and anxiety: thoughts going through someone's mind when they are trying to fall asleep, feelings like they can't settle down, the mind racing causing someone to wake up at night. On the other hand, bladder issues cause sleep disturbance, if the need to urinate interrupts sleep too frequently. Hormonal changes at various times of life can affect sleep as well. For instance, hot flashes can wake perimenopausal women up at all hours of the night.


Am I Pregnant?

eka tyagi: I had sex on the October 28. After that, I had my period the November 25 or 26. But it’s been over a month that I didn’t have periods. I did a pregnancy test, which was negative, but still I don't understand. What’s the problem?

Megan_Lutz,_MD,_MPH: You need to speak with your obstetrics and gynecology physician. At this point, I would repeat a pregnancy test if you still have not gotten your period.

haylee9700: I have been cramping for two weeks, and it started right after my period ended. No bleeding, just cramps. It’s been going on for almost two weeks and only stopped for one day; but other than that, it's constant. I have had unprotected sex every time my partner and I have had sex. My next period isn't due for a week or two, but could I be pregnant? I've been trying for two years and nothing. Could this be it?

Megan_Lutz,_MD,_MPH: Take a home pregnancy test. You will find them to be the least expensive at The Dollar Store. For individuals who have tried to conceive for over a year and have been unsuccessful, we recommend they see a doctor. For those over the age of 35, you can see a doctor after trying for six months unsuccessfully. Problems conceiving can range from problems with the uterus, with the fallopian tubes, with the ovaries or with the sperm.


Nighttime Normal

stedman: I’m newly pregnant and having vivid dreams and nightmares. They are really interrupting my sleep. Is this normal?

Megan_Lutz,_MD,_MPH: Yes. This can be normal due to some profound hormonal changes and bodily adjustments at the beginning of pregnancy. I would discuss this with your doctor.

aliecat: I’m 16 weeks pregnant and continually wake up hungry during the night? Is this normal? What would a healthy snack be for me before bed or during the night?

Megan_Lutz,_MD,_MPH: To avoid gestational diabetes, always pick snacks, no matter what time of the day or night, that are high in protein and low in fats. Examples might include hummus, nuts, yogurt, chicken breast, quinoa and avocado. Avoid foods that are higher in carbohydrates every time you crave them. If you have late night cravings, try a high protein snack before bed to get you through the night. If you have a history of diabetes, gestational diabetes or a family history of diabetes, talk to your doctor about how your meals and appetite are going in pregnancy.

Viv79: I am getting up to go to the bathroom a lot at night. How much is normal, how long will it last – all of my pregnancy? I just want a full night of sleep.
 
Megan_Lutz,_MD,_MPH: Great question! Around weeks six to eight, pregnant women may find themselves urinating far more frequently than normal. This is a short-lasting issue. At the end of pregnancy, with the uterus resting on the bladder, one may experience urinary frequency. Consider limiting your evening fluids, but don't let yourself get dehydrated. Drink plenty during the day.
 
Additionally, urinary tract infection could be a possibility. Discuss this with your doctor. Signs of urinary tract infection include: pain with urination, difficulty starting or stopping your urine stream, urinary frequency, the sensation that you cannot completely empty your bladder and blood in the urine.


Suggestions for Sleeping

mn1975: Is it true that it is best to only sleep on your left side while pregnant?

Megan_Lutz,_MD,_MPH: Yes. Sleep on your left side from about 17 weeks until delivery. After about the first trimester, the uterus is large enough that it is out of the pelvis. At around 17 weeks, the uterus reaches up to the level around the belly button. At this point, the uterus is capable of pressing on the large blood vessel that delivers blood from the heart (aorta) and the softer vessel that returns blood from the body to the heart. This softer vessel is called the inferior vena cava (IVC). Compressing it by laying on your back or on your right side does not allow blood to return to the heart. Since the IVC is located just to the right of the aorta, if we sleep on our left, we decrease the pressure on the IVC. The heart is nicely set up for this as well. When blood gets the chance to return from the IVC, the heart first pumps it to the lungs to get nice, rich oxygen. Then, the left ventricle of the heart – which is the strongest muscle in the heart – pumps all that richly oxygenated blood to your body and your baby.

Susan: Are there any over-the-counter sleep aids that I can use while I am pregnant? And are there differences during the different trimesters?

Megan_Lutz,_MD,_MPH: Starting a medicine on your own during pregnancy is not a good idea. Talk to your doctor first before starting any medicine on a regular basis. Generally speaking, Benadryl® is safe in all trimesters of pregnancy, but make sure it's Benadryl without pseudoephedrine. Some sleep hygiene tips for good sleep include making the room very dark, choosing to relax before you lie down for bed, exercising during the day to help your body crave rest. It can be natural to have more interrupted sleep in the latter parts of pregnancy. Remember that in the latter parts of pregnancy, this is a natural and normal part of the process, and don't let it stress you out more than it should. If daily activities are being impaired by sleep deprivation, then talk to your doctor. But if you happen to wake up in the middle of the night, choose low stimulation, calming activities. Don't pick interesting books. If all else fails, I've got a great organic chemistry book!

babymakes3: I'm 35 weeks pregnant and can only sleep on my right side. Is that bad for my baby?

Megan_Lutz,_MD,_MPH: Generally, do everything possible to sleep on your left side, because it does help your baby. Decreased blood flow to the fetus can affect all parts of fetal growth. Sleeping on the right side can compress the large vessel that returns blood to mom's heart. If the mother's heart doesn't have as much blood to pump out, the fetus doesn't get as much blood and oxygen.

NanNJ: I am a person who really needs eight to 10 hour of sleep at night. How can I plan to get enough sleep when the baby arrives? I am freaking out!

Megan_Lutz,_MD,_MPH: If you are one who is sensitive to sleep deprivation, enlist support! Invite your family members to help out with the first month or so after the baby is born so that you have some safe opportunities to catch up on sleep. Consider pumping your milk to get ahead so that your spouse or support system can help with middle-of-the-night feedings. Having some frozen meals or easy-to-prepare meals on disposable dinnerware ready for those first two to three weeks can save some time in the evenings so that you might get to bed faster. With the first child, nap when your baby naps. If your other kids are in a daycare or babysitting situations, you will need to still use this to some degree when your newborn comes home. If your kids are at home during the day, arrange some playdates or have a friend or family member at the house during the day so that you can catch up on sleep.


Conditions and Treatments

judeeH: Help! I am 30 weeks pregnant and can’t sleep because I’m so congested. What is safe for me to take to help me get the sleep I need?

Megan_Lutz,_MD,_MPH: Benadryl by itself is safe to take during pregnancy. However, pseudoephedrine is not as safe in pregnancy, so make sure the Benadryl product you choose is free of pseudoephedrine. Also, consider some lifestyle adjustments: Take a warm shower before bed to let the steam clear up your congestion. Elevate the head of your bed with an additional pillow or a folded towel under your pillow. Talk to your doctor if your symptoms are persisting.

Bets: I just found out that I am pregnant. In the past, I have been dealing with restless leg syndrome. Is this going to be a bigger issue now that I am pregnant?

Megan_Lutz,_MD,_MPH: Some say that restless leg syndrome can be related to iron levels. These do change in pregnancy. It is possible that restless leg syndrome could change in pregnancy; however, with routine use of prenatal vitamins and healthy amounts of exercise, this would most likely remain at bay.

alice: What do I do if heartburn keeps me awake when I lie down?

Megan_Lutz,_MD,_MPH: Heartburn is common in pregnancy. Heartburn is essentially the sensation of food or drink coming back up into your throat. Tums® is a safe option to keep at home for the middle-of-the-night heartburn flare-ups. If Tums by itself does not improve heartburn, consider elevating the head of your bed to minimize the opportunity for food and drink to come back up. Various foods may trigger heartburn for individuals, so pay attention to what foods are associated with your symptoms. Timing your last meal before lying down could help. Save two to three hours at the end of the day without eating or drinking to deter heartburn. Finally, talk to your doctor about persisting symptoms. There are safe medicines to use in pregnancy.


Closing

Moderator: On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for Specialized Women's Health, visit us online at http://my.clevelandclinic.org/services/ob-gyn-womens-health.
                      
For Appointments
To make an appointment with Dr. Lutz or any of the other physicians within Cleveland Clinic’s Center for Specialized Women’s Health, please call 216.444.6001 or toll-free 800.223.2273, ext. 46001. Visit us online at http://my.clevelandclinic.org/services/ob-gyn-womens-health.


For More Information

On Cleveland Clinic

The Center for Specialized Women’s Health, within the OB/GYN & Women’s Health Institute at Cleveland Clinic uses an interdisciplinary approach in which physicians with different medical specialties, nurses and other allied health professionals collaborate on patient care. The center has become a model for women’s health care and education.

In addition to CustomFit Physicals and wellness exams, professionals within the Center for Specialized Women's Health offer a variety of services, including routine cancer screenings and information on cardiovascular disease prevention. Several Cleveland Clinic staff members have participated in the North American Menopause Society (NAMS) Certified Menopause Practitioner Program (NCMP), a competency examination program to set the standards for menopause practices and to assist women in locating clinicians who can provide optimal menopause-related health care. For more information on the Cleveland Clinic Center for Specialized Women’s Health. Cleveland Clinic's gynecology program is ranked third in the nation by U. S. News & World Report and top-ranked in Ohio.

On Sleep Disturbances - Health Information

Learn more about symptoms, causes, diagnostic tests and treatments for sleep disturbances during pregnancy:

Sleep During Pregnancy http://my.clevelandclinic.org/healthy_living/pregnancy/hic_sleep_during_pregnancy.aspx

For additional health information, visit clevelandclinic.org/health.

On Your Health

MyChart® is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org.
 
A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.


This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2015. The Cleveland Clinic Foundation. All rights reserved.