Many pregnant women find themselves waking up in the middle of the night to go to the bathroom (for the third time) or struggling to find a comfortable sleep position.
Mildly disrupted sleep is common and bothersome but should not be confused with the much more serious problem of insomnia — which impacts more than 20 per cent of women during their pregnancy.
Likely because mild sleep problems are so common during pregnancy, many health-care providers dismiss reports of insomnia, leaving women to manage the condition on their own and without resources they desperately need.
As clinical health psychologists, we often hear about women resorting to expensive sleep products (think body pillows) or taking herbal remedies which they hope will lull them to sleep. Unfortunately, the benefits of these interventions are often fleeting.
Use of pharmacological treatments is increasingly discouraged, and pregnant women in particular report that they are reluctant to take sleeping medication due to concerns about the potential impact on their developing baby.
The good news is that there is a highly effective behavioural treatment available.
Cognitive behavioural therapy
Exciting new research has demonstrated that cognitive behavioural therapy for insomnia (CBT-I) can improve sleep during pregnancy.
This is a structured program that helps to replace unhelpful thoughts and behaviours that cause insomnia or worsen sleep problems. CBT-I helps to address the underlying causes of sleep problems with habits and thoughts that lead to deeper sleep.
CBT-I is delivered either in person, in a group or over the internet. Within four to five weeks of participating in therapy, most people experience the benefits of treatment. Unlike with medications, sleep problems typically don’t return when the therapy is complete.
There are comprehensive books and resources available about using CBT-I, for those who would like to learn more.
Many of the sleep practises involved in this therapy are quite simple and you can implement them at home by yourself today. The impacts will last beyond pregnancy. And many of them have the added benefit of equipping you with tools that will also help your children sleep well as they grow older.
Keep track of your sleep
One of the most common, and effective, sleep hygiene strategies is to set a regular sleep schedule. This suggestion is particularly true for setting a regular wake-up time, as there is no reason to crawl into bed if you don’t feel sleepy.
Maintaining your standard wake time can serve as a hard reset of your biological rhythms. Your body will get used to waking up and falling asleep at a certain time — making mornings much easier. Your sleep and wake cycles are controlled by hormones and those particular hormones love a good routine.
By setting your wake-up time to be around the same every morning you are helping to your body re-establish better sleep.
Another method of improving sleep is tracking it. We know from weight-loss and smoking-cessation research that simply keeping track of a behaviour leads humans to adjust it.
Start by keeping a record of your sleep using a paper sleep-journal or an app. The point of tracking is to notice patterns so that you can begin to use what you learn to adjust your behaviours to improve sleep.
Use your bed only for sleep
And then brace yourself — one of the key reasons sleep therapy works can be one of the hardest to do. Use your bed only for sleep!
Our brains are learning machines. We can teach them to sleep when we get into bed, or we can teach them to do other things — like worry. It all depends on what we actually do when we get into bed.
Unfortunately, the bed can become ground zero for a thousand other activities ranging from reading your iPhone, replaying yesterday’s arguments or worrying about tomorrow’s meetings.
So, things not associated with sleep (worrying, phones, tablets) should be scrubbed from your bedroom. Remember, you can just as easily scroll Instagram from your couch. If you’re in your bed and not sleeping for more than 15 minutes at any point in the night, get up and do something boring until you feel sleepy.
Insomnia during pregnancy is treatable
Changing sleep habits can be hard, so draw on your social support. Pregnant women often share their beds with partners, other children and even pets. It’s important to get clear on the strategies you are going to try.
Having a plan about who will get your toddler a drink of water in the middle of the night or when the electronics need to be turned off is essential.
The time to have these conversations is not at 3 a.m. — plan ahead!
In the end, insomnia in pregnancy is a treatable condition. Women with more serious insomnia also need access to online or in-person sleep resources as they transition to parenthood — something that our research group is currently trying to solve.