How To Manage Sleep Apnea During Pregnancy

Sleeping during pregnancy, especially in later trimesters, can be challenging. Many factors contribute to difficulties falling and staying asleep. Later in your pregnancy, snoring and sleep apnea may inhibit your ability to get the type of rest you need to feel energized and rested each morning.

Key takeaways:
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    Sleep apnea is common during pregnancy, affecting up to 26% of women.
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    There are two types of sleep apnea: central and obstructive sleep apnea (OSA).
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    Many symptoms of OSA are similar to pregnancy side effects making diagnosis difficult.
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    OSA is statistically more common later in pregnancy.
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    Obesity, high blood pressure, and gestational diabetes increase the risk of OSA during pregnancy.

Studies suggest up to 26% of women experience sleep apnea during pregnancy.

What is sleep apnea?

Sleep apnea is a medical condition that involves difficulty breathing during sleep. When someone has sleep apnea, their breathing stops and then restarts several times throughout their sleep. Depending on the severity of one's sleep apnea, these cycles can inhibit the body's ability to get enough oxygen leading to fatigue during the day and other symptoms of poor sleep.

There are two types of sleep apnea. Central sleep apnea occurs when the brain does not correctly trigger the respiratory system and related nerves to breathe. Obstructive sleep apnea involves an obstruction of the upper airway during sleep leading to partial or complete airflow obstruction. Obstructive sleep apnea (OSA) is the most commonly diagnosed type.

Symptoms of OSA during pregnancy

OSA during pregnancy is linked to hormonal changes. Both estrogen and progesterone affect your respiratory system and the muscles in your airway. Weight gain associated with pregnancy and a growing uterus putting pressure on your lungs also affects your ability to breathe at night, especially when lying on your back. The signs of OSA during pregnancy are generally similar to OSA of someone who is not pregnant.

For example:

  • Excessive fatigue.
  • Loud snoring.
  • Waking up gasping for air.
  • Morning headaches.
  • Problems with concentration.
  • Dry mouth upon waking.

The risk of sleep apnea during pregnancy and menopause increases due to hormonal changes. Although many women experience OSA during pregnancy, it is not considered a pregnancy side effect. If you suspect you have OSA, it is essential to reach out to your medical provider to discuss your symptoms. OSA in pregnancy often goes undiagnosed and untreated as many common symptoms of OSA, such as morning nausea, headaches, heartburn, and frequently waking during the night, are also “normal” pregnancy side effects.

Because the symptoms of OSA and the side effects of pregnancy overlap, it can be difficult to get an accurate diagnosis in some cases. For some women, the symptoms of OSA become more noticeable as their pregnancy progresses. Data from one study indicated approximately 10.5% of women during their first trimester had OSA compared to 26.7% in their third trimester. Although the symptoms of OSA are similar across all the trimesters, women in the third trimester are at a greater risk of developing OSA and experiencing symptoms of greater severity.

OSA during pregnancy - learn the causes

Pregnancy leads to many changes in a woman's body, some of which may increase your risk of developing OSA during pregnancy.

Hormonal changes

During pregnancy, hormone levels, specifically estrogen and progesterone, increase. Higher levels of estrogen can lead to swollen mucous membranes in the nose. When these membranes swell, it causes feelings of congestion which lead to snoring and sleep apnea. Progesterone, another hormone that increases during pregnancy, relaxes the muscles in your airway. As these muscles relax, it can also cause sleep apnea.

Weight gain

Weight gain is an expected and healthy part of pregnancy. The weight gain associated with a developing pregnancy can put additional pressure on your airway, making breathing during sleep challenging.

Increased uterine size

Another change that occurs during pregnancy involves uterine growth. As the uterus grows to accommodate a developing baby, it puts pressure on the lungs, reducing air volume and changing your breathing.

Who is at risk?

Anyone can develop OSA during pregnancy; however, some underlying medical conditions may increase one’s risk.

Obesity

Obese pregnant women are 15%-20% more likely to have OSA, and their risk may increase throughout pregnancy due to natural weight gain.

Gestational diabetes

Studies suggest OSA is prevalent in women with gestational diabetes. Data from one study indicated women with gestational diabetes are up to 7 times more likely to develop OSA than pregnant women without gestational diabetes.

High blood pressure

Several studies have investigated the connection between high blood pressure and gestational OSA. High blood pressure can cause OSA regardless of pregnancy. Studies suggest that for pregnant women, the risk of developing OSA due to high blood pressure increases with each trimester.

Sleep apnea during pregnancy complications

If left untreated, OSA during pregnancy can impact the overall health of both mom and baby. OSA affects breathing, heart rate, and oxygen levels in the blood. OSA can lead to several health conditions (even in those who are not pregnant), such as:

  • Diabetes.
  • Heart disease.
  • Stroke.
  • High blood pressure.
  • Acid reflux.
  • Asthma.
  • Depression.
  • Reduced immune response.

How to treat OSA during pregnancy?

Treatment for OSA during pregnancy varies based on the severity of one’s symptoms. When treating a medical condition during pregnancy, your doctor will likely start with the least invasive treatment option first. In the case of OSA treatment, this may include breathing strips, saline sprays and rinses, and humidifiers.

Sometimes, your provider may recommend sleep apnea patches, mouth appliances that control jaw position, or a continuous positive airway pressure (CPAP) machine. A CPAP machine provides a gentle and constant flow of air that helps keep your airways open, reducing breathing disruption during the night.

Tips to manage OSA at home

In addition to medical interventions, your provider will likely recommend some at-home tips as well. Often, they will suggest these before suggesting a CPAP machine. Examples of at-home OSA management tips may include:

  • Changing your sleep position (attempting to sleep on your left side).
  • Dietary changes to help manage weight gain during pregnancy.
  • Using a pregnancy pillow to elevate your head and upper body to reduce fluid retention around the upper airway.

Does sleep apnea go away after pregnancy?

In some cases, OSA symptoms may resolve within a few weeks to months of delivery, but this is not the case for all. For these women, it is not uncommon for an underlying case of OSA to have been present before pregnancy.

Treating sleep apnea after pregnancy

For women who continue to experience OSA symptoms, ongoing CPAP treatment and at-home remedies may provide relief.

OSA may develop during pregnancy for various reasons associated with a healthy pregnancy, including natural weight gain and hormonal changes. Although OSA can lead to medical complications, there are several treatments you can try to improve your sleep and your physical and emotional well-being during your pregnancy.

Can sleep apnea during pregnancy cause harm to the baby?

During pregnancy, OSA can increase the risk of gestational diabetes and gestational hypertension (high blood pressure). Studies also show OSA can lead to preeclampsia, prolonged labor, and unplanned cesarian births. Currently, there is little evidence to suggest OSA can lead to fetal death or miscarriage; however, research is ongoing.

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