Presentation on theme: "Sleep in the perinatal period Dr Andy Mayers Lauren Kita."— Presentation transcript:
Sleep in the perinatal period Dr Andy Mayers Lauren Kita
2 An overview of normal sleep 1/3 of our lives are spent asleep! What is normal sleep? Average sleep 6½ - 8 hours each night Regulated by 25-hour circadian rhythm Borbely - 2 process model Adjusted to coincide with normal wake-sleep routines Use cues from environment Clocks and sunlight/darkness
3 Sleep cycles Sleep EEG stages Stage 1 – light sleep Stage 2 – getting deeper… Stage 3 – deeper sleep Stage 4 – deepest sleep Stages 3 and 4 represent slow-wave sleep (SWS) Rapid-eye-movement (REM) sleep Appears after 1 st cycle Periods of intense brain activity Frequent and intense bursts of eye movement Referred to as ‘active sleep’ in younger children
4 Functions of sleep Sleep is crucial for our survival! SWS is the most restorative stage – growth hormone is released REM sleep is important for memory consolidation and possibly emotional regulation Sleep deprivation is associated with: Depression Decreased cognitive functioning Obesity Reduced immune system functioning - reduced t-cells, increased cytokines – more likely to become ill
5 How we can measure sleep Polysomnography (PSG)
6 Sleep cycles Sleep for ALL humans presents in cycles throughout night This is an example of healthy adult sleep
7 Sleep in the perinatal period Sleep disturbances are common in pregnancy Physical changes Backache Uncomforatable sleeping position Needing to urinate Snoring (Baratte-Beebe & Lee, 1999; Facco et al. 2010) Sleep disturbances are common in postpartum period Hormonal changes The baby!
8 Perinatal sleep Non-first time mothers First time mothers Lee, Zaffke & McEnany (2000)- Obstectrics & Gynecology, 95 (1)
9 Perinatal sleep Sleep becomes worse throughout 3 rd trimester Amongst women in 3rd trimester (n=23) weeks pregnant associated with: Poorer subjective sleep quality (r=.66) Poorer subjective sleep satisfaction (r=.47) Poorer subjective sleep depth (r=.71) Less TST (r=.60)
10 Perinatal sleep - quality Pregnancy is associated with decreased REM & SWS (deep sleep) Early postpartum period associated with a SWS rebound (Lee, Zaffke & McEnany, 2000; Hertz et al., 1992; Karacan et al., 1968) Non-first time mothers First time mothers
11 Sleep in women with a history of depression Women with a history of depression have increased risk of PND Differences in sleep throughout pregnancy Greater changes in TST over course of childbearing 2-3 x greater decrease in TST between 36 wks and 1 month PP compared to no-history group More subjective sleep disturbances Reduced REM latency Coble et al. (1994) History of depression No history of depression
12 Sleep disorders in pregnancy Obstructive Sleep Apnea (OSA) Snoring increases during pregnancy Incidence of OSA remains unknown Weight gain increases risk Reduced REM sleep may reduce risk OSA and the risk of adverse pregnancy outcomes (Chen et al., 2012) Pregnant women with OSA are at increased risk for having LBW, preterm, and SGA infants, C-Section, and preeclampsia, compared with pregnant women without OSA. Restless legs syndrome (Mancoli et al. 2005) 2-3 x higher risk in pregnancy (mainly 3 rd trimester) 11-27% pregnant women Related to iron / folate deficiency Majority of cases disappear after birth Tiring days, caffeine, iron deficiency and anxiety can make the restlessness worse
13 Sleep and Postnatal Depression Cross-sectional studies Women with PND report poorer subjective sleep quality (e.g. Da Costa et al., 2006; Dorheim et al., 2009) Unclear whether actual (objective) sleep is poorer (Posmontier, 2008; Dorheim et al., 2009) Longitudinal studies Sleep in 3 rd trimester is related to PND Specific relationship remains unclear PND related to longer sleep & more naps in 3 rd T (Wolfson et al. 2004) PND related to poor subjective sleep quality & sleep disturbances in 3 rd T but not objective sleep (Bei et al., 2010) Subjective sleep more important? Lack of research using PSG
14 Why is it important? What factors affect how women perceive their sleep? Help to identify those at greater risk of PND Easy to talk about sleep issues Harder to talk about signs of PND May help to provide a talking point
15 Possible interventions – Mind-Body Growing evidence for mind-body interventions Reducing stress & anxiety during pregnancy Beddoe & Lee (2008) - review of mind-body interventions during pregnancy (e.g. relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong) Associated with increased BW, shorter labor, fewer instrument-assisted births, reduced stress / anxiety Preliminary research evidence that yoga during pregnancy can improve sleep (Beddoe et al. 2010)
16 Possible interventions – Infant Sleep Hiscock & Wake (2001) 3-part intervention on infant sleep @ 6-12 months- controlled crying & sleep management plan vs. control group with infant sleep information (no advice) Decreased infant sleep problems and maternal depressive symptoms Stremler et al. (2006) 45 min meeting with nurse @ 6 weeks to discuss infant sleep strategies, 11-page booklet & weekly calls vs. control group with basic sleep hygiene and calls (no advice) Improved maternal and infant sleep & mothers rated infant sleep as less problematic (using actigraphy & diaries)
17 Practical implications Talk about sleep problems – ask questions & encourage discussion Women’s expectations of sleep throughout this period Looking out for sleep problems restless legs / sleep apnea very poor self-reported sleep affecting well-being The importance of sleep for the mother and baby Discussing possible strategies (e.g. infant sleep) Discussing individual situations Setting realistic goals & reviewing them Encouraging rest & relaxation Yoga / breathing exercises to reduce stress & anxiety & improve sleep
18 Over to you! How might you use this information in your role as a health visitor? What can be done to make sure mother is sleeping OK? What is best method for baby sleep? Controlled crying? Gentle intervention? Anything goes?
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