insomnia in late pregnancy sign of labor

Also noted by the authors, the ISQ does not necessarily differentiate insomnia due to a medical condition or a sleep disorder. Ideally, a good screening test for insomnia would have high sensitivity, since the consequences of missing the condition may be severe and the confirmatory test following a positive screen (i.e., clinical interview) is a low-risk process. As the authors acknowledge, their study was limited by the lack of a gold standard, such as a clinical interview, to validate the ISQ for pregnant women. This was primarily due to substantial variability in the comparison measures in their ability to identify insomnia. The ISQ scores were compared to the Pittsburgh Sleep Quality Index (PSQI), wrist actigraphy, and sleep diaries, and the ISQ was found to have high specificity but variable sensitivities. The ISQ identified insomnia in nearly 13% of pregnant women at 12 weeks gestation who had not previously been known to have insomnia. evaluated the usefulness of the Insomnia Sleep Questionnaire (ISQ), and concluded the simple 13-item self-report instrument was a useful tool to screen for insomnia in early pregnancy. The authors performed secondary analysis on data available from pregnant women who were part of a prospective observational study evaluating the impact of sleep disturbances on perinatal outcomes. 13 in this issue of Journal of Clinical Sleep Medicine (JCSM) address the need to scientifically unravel this sleeping in pregnancy paradox. 2 Recent data from a large pregnancy cohort showed that having OSA increases the risk of low birth weight, pre-term birth, Cesarean section and preeclampsia.

9 Snoring is reported in up to 35% of pregnant women, 10 and is associated with greater than two-fold increase in adjusted odds for preeclampsia, gestational diabetes, and unplanned Caesarean deliveries. 7, 8 Likewise, sleep deprivation during pregnancy has been associated with increased serum levels of inflammatory biomarkers such as interleukin-6. Sleeping less than 6 hours during the last month of pregnancy has been associated with longer labor and greater risk for Cesarean deliveries. Sleep disturbances during pregnancy have been associated with a multitude of negative maternal and fetal outcomes. In fact, the National Sleep Foundation's 1998 Women and Sleep poll found that 78% of women reported more disturbed sleep during pregnancy than at any other times of their lives.

5 Finally, pregnancy can be psychologically stressful, and the expectant mother may lie awake during the night worrying about labor, the baby's health, or any number of things. Preexisting conditions such as asthma may be exacerbated by pregnancy-related physiologic changes such as upper airway congestion, heartburn, and immunologic changes. Moreover, pregnancy increases the risk for sleep disorders such as restless leg syndrome, snoring and obstructive sleep apnea (OSA). Oxytocin, the hormone responsible for uterine contractions, peaks at night and may cause sleep fragmentation in late pregnancy. Progesterone, while promoting daytime sleepiness, also causes nocturnal sleep fragmentation. For example, it is very common for pregnant women to experience nausea, heartburn, nocturia, and back pain, all of which may interfere with sleep. Herein lies the great paradox of sleep in pregnancy-despite the seemingly imperative need for healthy sleep and our body's attempt to promote it, many of the normal physiologic and psychological changes accompanying pregnancy make restful sleep all but impossible.

2 – 4 The message is clear : good sleep is important for a healthy pregnancy. 1 Meanwhile, there is growing evidence linking sleep disturbances with adverse pregnancy outcomes. The high levels of human chorionic gonadotropin and progesterone that are required to maintain pregnancy are also soporific and thermogenic, promoting daytime sleepiness and early sleep onset. Most epidemiologic studies suggest there is an increased need for sleep during pregnancy. Pregnancy is a very special and joyous time in a woman's life, but it is also a time of serious sleep disturbances.

Insomnia in late pregnancy sign of labor