Should Pregnant Women Expect to Have Sleep Apnea?

Pregnancy brings many common challenges made familiar in popular culture: images of morning sickness, fatigue, increased appetite, swollen ankles, discomfort, and an active bladder.

What’s something expectant mothers may not expect?

Sleep-disordered breathing? Yes. It could be as simple as the beginning of a new snoring routine, could lead to frequent nighttime arousals caused by upper airway resistance, or could develop into obstructive sleep apnea (OSA).

Sleep and pregnancy: what you can expect

Pregnancy can bring with it a long list of sleep-busting situations. Especially disruptive to sleep are problems with:

  • Anxiety
  • Midnight hunger pangs
  • Stuffy noses that make it hard to breathe at bedtime
  • Frequent trips to the toilet
  • Tenderness in the body that can bring discomfort
  • Busy baby movement that can awaken a sleeping mom
  • Reflux disease
  • Sleeplessness
  • Cramping legs and feet
  • Nausea at all hours of the night
  • Restless legs
  • Vivid dreams

Medications taken during pregnancy may cause insomnia or daytime sleepiness, as well. And then there are the inevitable lifestyle shifts—a result of body changes that bring discomfort and fatigue, leading to less or different kinds of physical activity. This can alter the quality of sleep for a pregnant woman.

Along with all of these challenges, there are concerning problems with breathing while asleep.

Snoring, UARS, and OSA

Snoring, upper airway resistance syndrome (UARS), and OSA are three specific sleep-breathing disorders that a pregnant woman may experience across the entirety of her pregnancy and quite possibly into the postpartum period.

Snoring

This describes the friction that occurs along the upper airway and nasal passages as we sleep. When the tissues there become flabby or swollen (as in the case of pregnancy), they create a vibration that generates the sound we all recognize as snoring. Some snoring is soft and infrequent, while other snoring may be heard through apartment walls and even outside the home!

To alleviate snoring and congestion, a simple nasal solution spritzed into the nostrils at bedtime can bring safe relief. Raising the head of the bed by three inches can also lessen postnasal drainage, which might contribute to snoring. But don’t presume that snoring is nothing to worry about. It could signal another problem with far bigger problems.

Upper airway resistance syndrome (UARS)

This condition generally refers to frequent awakenings due to breathing issues that aren’t classified as apneas (or, in the case of partial obstructions, hypopneas).1 UARS disrupts sleep frequently throughout the night, though the person experiencing these disruptions may be unaware of it. Snoring and gasping are common companion behaviors, and UARS can lead to extreme daytime sleepiness.

Interestingly, UARS is called the “young, thin beautiful women’s sleep disorder,” as it happens frequently, not in older obese men, but in people who are not expected to have a sleep-breathing disorder: young, average-sized women.2

This makes it a difficult problem to catch. Pregnant women are, by the very nature of being pregnant, tired during the day! New-onset snoring can be a telltale sign of UARS worth pursuing with the OB-GYN.

Obstructive sleep apnea (OSA)

OSA is, by far, the most concerning of the conditions of sleep-disordered breathing. When someone has OSA, the upper airway becomes partially or completely blocked by swollen upper airway tissues (such as the tongue, the uvula, or the tonsils). This creates an obstruction marked by long pauses in breathing that can prevent adequate oxygen intake.

In response to this shortage of oxygen (and a buildup of carbon dioxide in the bloodstream), the respiratory system makes an effort to breathe. The diaphragm and muscles in the chest will contract, yet no air is inhaled (and no carbon dioxide is exhaled). When several of these pauses last for 10 or more seconds, blood oxygen levels begin to drop in a condition called hypoxia. This signals an urgent imbalance in the body. The brain then forces the body awake to consciously breathe in order to correct the hypoxia. As with UARS, people with OSA do not know they have it until a loved one describes their breathing pauses and gasping for air.

What to do if you think you have UARS or OSA

If a pregnant woman suspects she has UARS or OSA, she may be screened for OSA in pregnancy or asked to participate in a sleep study.3 The goal would be to identify and diagnose any hidden sleep breathing disorder and then actively treat it.

It’s not uncommon for a pregnant woman to need positive airway pressure (PAP) therapy during pregnancy. It may only be needed temporarily during pregnancy, or up until the majority of pregnancy weight gain has dropped in the postpartum period.

For more information, check out part 2: What Sleep Apnea Looks Like in Pregnancy, Trimester to Trimester.

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