Table of Contents Title Page Dedication Acknowledgements PART I - An Introduction to Sleep ONE - Sleep Deprived No More Common Sleep Issues Faced by Pregnant Women and New Moms How Much Sleep Do You Need? How Much Sleep Are Pregnant and New Moms Actually Getting? Why Sleep Matters What You’ll Learn in This Book Reminders TWO - How We Sleep: The Basics What Is Sleep? Sleep Stages Why Do We Sleep? “Why Do I Feel So Tired During the Day?” Do You Have a Sleep Problem? Reminders THREE - Tips for Improving Your Sleep Put Yourself on a “Sleep Hygiene” Routine A Sleep-Friendly Lifestyle Make Your Bedroom a Sleep Haven Juggling Sleep with Shift Work Reminders PART II - Sleep and Pregnancy: Trimester by Trimester FOUR - The First Trimester Common Causes of Sleep Problems During the First Trimester Common Early-Pregnancy Sleep Disorders Sleepy, Fatigued and Just Plain Tired Pregnancy the Second, Third, or Fourth Time Around Cope with Life’s Demands Solve Sleep Problems in Older Children Now Reminders FIVE - The Second Trimester The Good News And Now for the Bad News Causes of Sleep Problems During the Second Trimester Common Mid-Pregnancy Sleep Disorders Reminders SIX - The Third Trimester Looking at the Numbers Causes of Sleep Problems During the Third Trimester Common End-of-Pregnancy Sleep Disorders Bed Rest Looking Ahead Reminders PART III - Solving Common Sleep Problems SEVEN - Insomnia Symptoms of Insomnia What Causes Insomnia? Are Anxious Thoughts Keeping You Up at Night? Getting Sleep: What You Can Do Behavioral Strategies Medication Talk to Your Health Care Provider Reminders EIGHT - Restless Legs Syndrome and Periodic Limb Movement Disorder Restless Legs Syndrome (RLS) Periodic Limb Movement Disorder RLS, PLMA, or Both? How Common Are RLS and PLMD During Pregnancy? What Causes These Conditions? Making the Diagnosis What Else Could It Be? What You Can Do What to Avoid Talk to Your Health Care Provider Reminders NINE - Snoring and Sleep Apnea Snoring Sleep Apnea Are You at Risk for Developing Snoring and Sleep Apnea? Impact of Snoring and Sleep Apnea During Pregnancy Making the Diagnosis What You Can Do Medical Treatments Talk to Your Health Care Provider Reminders PART IV - After the Baby Is Born TEN - The First Six Weeks Surviving (and Enjoying) the First Six Weeks So How Do You Get Some Sleep? Be Good to Yourself Breast-feeding and Sleep Bottle-Feeding and Sleep Sharing Nighttime Duty Postpartum Depression Reminders ELEVEN - Six Weeks to Six Months Moms and Sleep by the Numbers How to Get More Sleep and Feel Less Sleep Deprived Going Back to Work Don’t Forget Your Marriage Reminders TWELVE - Helping Your Baby Sleep Through the Night Be Realistic Sleep Safety Co-sleeping Coping with Day/Night Reversal Sleep and Breast-feeding Manage Feedings to Maximize Sleep Establish Good Sleep Habits Early Make Sleep Transitions by Months And One Final Piece of Advice—Savor the Moments Reminders Appendix A: - Your Sleep Diary Appendix B Index Copyright Page JODI A MINDELL, PHD, is the author of Take Charge of Your Child’s Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens and Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night’s Sleep She is the associate director of the Sleep Center at the Children’s Hospital of Philadelphia and professor of psychology at Saint Joseph’s University flu antibodies fluids (water, juice) focal feedings folic acid, low levels of food See diet Food and Drug Administration medication classifications footed blanket sleeper foot massage friends asking for help from for help with worry scheduling visits of sleeping vs returning calls to G genetics ginger for nausea guided imagery guilt, dealing with feelings of H healthy food suggestions heartburn from bed rest cause of overview prevention of heart disease and sleep deprivation hogging the covers “honeymoon” period See second trimester hormones firsttrimester postpartum prolactin and RLS or PLMD second trimester See also estrogen; progesterone hospitalization for bed rest for delivery house cleaner, hiring a I immune system and sleep deprivation improving your sleep See sleep hygiene infants See entries beginning with “babies” inner clock insomnia causes of incidence of medication for noise issues and overview quiz on in second trimester seven rules for beating insomnia from sleep apnea sleep strategies for symptoms of in third trimester tuning out the world See also behavioral strategies for overcoming insomnia Internet for bed rest support for overcoming worry iron deficiency blood tests for healthy diet vs multiple fetuses and and RLS or PLMD itchy skin J journaling K kidneys and pregnancy L labor, sleep quality and length of labor and delivery, sleep issues from leg cramps legs, pain and discomfort in See also periodic limb movement disorder; restless legs syndrome life satisfaction vs sleep deprivation light and lights dimmer switches effect of room-darkening shades for sleeping shift worker management of lip balm lists adding sleep to big projects into manageable pieces too demanding or complex worry list liver and pregnancy Lunestra (eszopiclone) M malls, walking the massage for insomnia for leg cramps for new mom’s self-care prenatal for RLS or PLMD medical problems and sleep deprivation medical tests blood tests for iron deficiency and ferritin level polysomnogram for sleep apnea medication classifications (FDA) medications antidepressants for heartburn for insomnia for nausea over-the-counter for postpartum depression for RLS or PLMD RLS or PLMD from for sleep apnea medications, over-the-counter melatonin memory impairment mental health issues and sleep deprivation metabolism Mirapex (pramipexole) mommy mode monitors mood postpartum changes in and sleep apnea and sleep deprivation See also emotions; enjoying the moment; postpartum depression morning sickness motherhood accepting chaos baby blues bed rest and children’s concerns connecting with father/partner coping with change developing a schedule expecting the unexpected fatigue getting some sleep going back to work labor and delivery sleep issues making sleep a priority pampering yourself sharing nighttime duty statistics on new mom’s sleep suggestions for dealing with See also babies; babies sleeping through the night; postpartum depression movies multiple births N nannies naps for pregnant or new moms overview scheduling in second trimester shift work and for sleepiness taking while baby sleeps in third trimester at work naptime routine for babies nasal congestion, pregnancy-related See also allergies or asthma National Sleep Foundation Sleep in America Poll 2004 National Sleep Foundation Sleep in America Poll 2007 on new moms on pets in bed and sleep quality on pregnant women and new moms on second trimester sleep problems on third trimester sleep problems nausea and morning sickness neck size and snoring or sleep apnea negative thoughts, dealing with negotiation See communication neurotransmitters nicotine and RLS or PLMD nighttime feedings non-REM sleep nursing See breast-feeding nursing bras and pads O obesity See also weight obstructive sleep apnea (OSA) See sleep apnea organization, value of outdoor activities, benefits from overheating babies, dangers of P pacifiers pajamas paralysis-like feeling partners See fathers/partners pedometers pee, urge to See bathroom breaks performance and sleep deprivation pergolide (Permax) periodic limb movement disorder (PLMD) causes of overview with RLS suggestions for dealing with in third trimester periodic limb movement index Permax (pergolide) pets and sleep physical aspects of sleep body’s activity circadian clock and dreaming and insomnia overview sleep architecture sleep cycles sleep stages snoring pillows for comfort for elevating your head evaluating your hypoallergenic pregnancy pillows See also comfortable sleeping position Pittsburg Sleep Quality Index scale PLMD See periodic limb movement disorder PMR (progressive muscle relaxation) polysomnogram postpartum depression (PPD) causes of Edinburgh Postnatal Depression Scale father/partner’s help with fatigue leading to overview planning for risk factors and sleep patterns suggestions for dealing with symptoms of postpartum psychosis postpartum RLS and/or PLMD potty time See bathroom breaks PPD See postpartum depression pramipexole (Mirapex) preeclampsia pregnancy and body temperature first vs second (or more) sleep architecture changes sleep patterns before and after See also first trimester; second trimester; third trimester pregnancy pillows See also comfortable sleeping position; pillows premature labor prevention See bed rest private chefs progesterone post-delivery decrease in second trimester decrease in sleepiness from and urge to pee progressive muscle relaxation (PMR) projects, small steps for prolactin psychotherapy for insomnia pumping milk Q quiet sleep in newborns (non-REM) quiet time for older children quizzes/screening questionnaires Are you getting enough sleep? Do You Have Insomnia? Edinburgh Postnatal Depression Scale Epworth Sleepiness Scale Pittsburg Sleep Quality Index scale Screening Questionnaire for Restless Legs Syndrome R racing mind syndrome ramelteon (Rozerem) rapid eye movement See REM sleep recliner, sleeping in a reflux disease See also heartburn relaxation and bed rest in bedtime routine behavioral strategies for protecting days off for round ligament pain warm bath or shower with aromatherapy See also enjoying the moment; massage REM sleep (rapid eye movement) Requip (ropinirole) restless legs syndrome (RLS) causes of diagnosing incidence of overview with PLMA screening questionnaire suggestions for dealing with symptoms of in third trimester restorative effects of sleep RLS See restless legs syndrome ropinirole (Requip) rotating shifts round ligament pain routines for adults for babies and circadian clock for households shift work vs Rozerem (ramelteon) S schedule during bed rest See also sleep schedule for adults screening questionnaires See quizzes/ screening questionnaires second trimester back pain insomnia itchy skin leg cramps nasal congestion overview positive aspects of round ligament pain sleeping position issues sleep schedule self-care during baby’s first six weeks for back pain comfortable sleeping attire for congestion doing something to get sleep as for heartburn if baby has colic for insomnia, behavioral strategies for insomnia, general sleep strategies for itchy skin for leg cramps for managing sleepiness for managing worry for nausea overview with postpartum depression to prevent baby from associating sleep with breast-feeding for restless legs syndrome and returning to work for sleep apnea small steps for big projects for urge to pee See also comfortable sleeping position; massage; relaxation; sleep hygiene seven rules for beating insomnia sharing a bed sharing nighttime duty shift work showers or baths, warm sidecar sleepers (bassinets) SIDS (sudden infant death syndrome) Sinemet (carbidopa/levodopa) skin, itchiness of sleep apnea consulting your doctor diagnosing impact of incidence of, in pregnant women medical treatments overview physical causes of poor quality sleep from suggestions for dealing with symptoms in third trimester sleep architecture sleep basics control of sleep defining sleep overview reasons for sleeping sleep structure sleep structure in babies See also sleep hygiene; sleep problems sleep clock sleep deprivation consequences of difficulty sleeping due to incidence of individual tolerance to making up for overview and postpartum depression sleep diary sleep disorders See also insomnia; periodic limb movement disorder; restless legs syndrome; sleep apnea; snoring sleep drive sleep-friendly bedroom See bedroom as sleep haven sleep-friendly lifestyle sleep-friendly time zone sleep habits, establishing your baby’s sleep hygiene bedtime routine aspect of bras for sleeping negotiations for sharing a bed overview and shift work sleep-friendly lifestyle See also bed for adults; bedroom as sleep haven; sleep schedule for adults Sleep in America Poll 2007 See National Sleep Foundation Sleep in America Poll 2007 sleepiness See daytime sleepiness sleeping attire sleeping environment sleeping on your left side sleeping pills sleeping position for babies sleeping position for pregnant moms See comfortable sleeping position Sleeping Through the Night (Mindell) sleep loss See sleep deprivation sleep need sleep patterns sleep problems from caring for infant categories of in first trimester overview in second trimester self-diagnosing Sleep in America Poll 2004 on in third trimester See also bathroom breaks; National Sleep Foundation Sleep in America Poll 2007; sleep disorders sleep quality sleep restriction sleep safety for babies sleep schedule for adults bed partners’ differences bedtime routines for insomniacs overview during pregnancy sleep schedule for babies bedtime routines and breast-feeding establishing feed-play-sleep schedule managing feeding to maximize overview reversing day/night reversal for twins (or more) in womb vs born sleep stages sleep start sleep strategies sleep structure sleep training smoking and smokers snoring consulting your doctor impact of incidence of overview physical causes of poor quality sleep from seriousness of and sharing a bed in third trimester society sodas with caffeine Sonata (zaleplon) stages of sleep stimulus control sudden infant death syndrome (SIDS) support groups for new moms swaddling your newborn T Take Charge of Your Child’s Sleep (Mindell) tea with caffeine telecommuting television for older children temperature of bed third trimester baby’s movements back pain bathroom breaks comfortable position heartburn insomnia leg cramps overview preparing for infant’s sleep habits RLS and PLMD sleep quality and post-birth experience sleep schedule snoring and sleep apnea See also bed rest time, perspective on time management timing cycles of sleep stages tiredness See fatigue/tiredness trimesters See first trimester; second trimester; third trimester tuning out the world twins (or more) “2-hour rule,” U uterus expansion and bladder and diaphragm heartburn from round ligament pain from V video monitors W weight and bed rest obesity and sleep apnea and sleep deprivation and snoring weight, baby’s white-noise machines or fans work, returning to worrying See anxiety and worrying worry time, setting aside a Z zaleplon (Sonata) zolpidem (Ambien) SLEEP DEPRIVED NO MORE: From Pregnancy to Early Motherhood— Helping You and Your Baby Sleep Through the Night Copyright © 2007 by Jodi A Mindell, PhD Published by Marlowe & Company An Imprint of Avalon Publishing Group, Incorporated 11 Cambridge Center Cambridge, MA 02142 All rights reserved No part of this book may be reproduced in whole or in part without written permission from the publisher, except by reviewers who may quote brief excerpts in connection with a review in a newspaper, magazine, or electronic publication; nor may any part of this book be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or other, without written permission from the publisher The information in this book is intended to help readers make informed decisions about their health and the health of their loved ones It is not intended to be a substitute for treatment by or the advice and care of a professional health care provider While the author and publisher have endeavored to ensure that the information presented is accurate and up to date, they are not responsible for adverse effects or consequences sustained by any person using this book Cataloging-in-Publication Data is available from the Library of Congress eISBN : 978-0-738-21504-4 ... Dedication Acknowledgements PART I - An Introduction to Sleep ONE - Sleep Deprived No More Common Sleep Issues Faced by Pregnant Women and New Moms How Much Sleep Do You Need? How Much Sleep Are... night’s sleep after a period of being sleep deprived People who are sleep deprived will also have more stages three and four sleep on nights they are catching up on their sleep Sleep, however, is not... REM sleep and non-REM sleep are as different from one another as the difference between “awake” and “asleep.” Sleep itself is comprised of several sleep stages, which experts refer to as “sleep